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22 | 26,739,716 | Several factors were found to be associated with disability at follow-up for at least two different pain symptoms .
However , owing to insufficient studies , no generic risk factors for sick leave were identified .
Conclusions Multiple site pain , high pain severity , older age , baseline disability and longer pain duration were identified as potential prognostic factors for disability across pain sites .
There was limited evidence that anxiety and depression were associated with disability in patients with subacute pain , indicating that these factors may not play as large a role as expected in developing disability due to a pain condition . | Objective This systematic review aims to identify generic prognostic factors for disability and sick leave in subacute pain patients . | 400 | 18,427,840 | Independent evaluation of a clinical prediction rule for spinal manipulative therapy: a randomised controlled trial | A clinical prediction rule to identify patients most likely to respond to spinal manipulation has been published and widely cited but requires further testing for external validity . We performed a pre-planned secondary analysis of a r and omised controlled trial investigating the efficacy of spinal manipulative therapy in 239 patients presenting to general practice clinics for acute , non-specific , low back pain . Patients were r and omised to receive spinal manipulative therapy or placebo 2 to 3 times per week for up to 4 weeks . All patients received general practitioner care ( advice and paracetamol ) . Outcomes were pain and disability measured at 1 , 2 , 4 and 12 weeks . Status on the clinical prediction rule was measured at baseline . The clinical prediction rule performed no better than chance in identifying patients with acute , non-specific low back pain most likely to respond to spinal manipulative therapy ( pain P = 0.805 , disability P = 0.600 ) . At 1-week follow-up , the mean difference in effect of spinal manipulative therapy compared to placebo in patients who were rule positive rather than rule negative was 0.3 points less on a 10-point pain scale ( 95 % CI −0.8 to 1.4 ) . The clinical prediction rule proposed by Childs et al. did not generalise to patients presenting to primary care with acute low back pain who received a course of spinal manipulative therapy | 22 | Several factors were found to be associated with disability at follow-up for at least two different pain symptoms .
However , owing to insufficient studies , no generic risk factors for sick leave were identified .
Conclusions Multiple site pain , high pain severity , older age , baseline disability and longer pain duration were identified as potential prognostic factors for disability across pain sites .
There was limited evidence that anxiety and depression were associated with disability in patients with subacute pain , indicating that these factors may not play as large a role as expected in developing disability due to a pain condition . | Objective This systematic review aims to identify generic prognostic factors for disability and sick leave in subacute pain patients . |
22 | 26,739,716 | Several factors were found to be associated with disability at follow-up for at least two different pain symptoms .
However , owing to insufficient studies , no generic risk factors for sick leave were identified .
Conclusions Multiple site pain , high pain severity , older age , baseline disability and longer pain duration were identified as potential prognostic factors for disability across pain sites .
There was limited evidence that anxiety and depression were associated with disability in patients with subacute pain , indicating that these factors may not play as large a role as expected in developing disability due to a pain condition . | Objective This systematic review aims to identify generic prognostic factors for disability and sick leave in subacute pain patients . | 401 | 23,699,833 | Point-of-care prognosis for common musculoskeletal pain in older adults. | IMPORTANCE Many site-specific , multivariable risk models for predicting the outcome of musculoskeletal pain problems have been published . The overlapping content in these models suggests a common set of generic indicators suitable for use in primary care . OBJECTIVE To investigate whether a brief set of generic prognostic indicators can predict the outcome of musculoskeletal pain in older patients presenting to general practitioners . DESIGN , SETTING , AND PARTICIPANTS A prospect i ve observational cohort study conducted from September 1 , 2006 , through March 31 , 2007 , of consecutive patients 50 years or older presenting with noninflammatory musculoskeletal pain to 1 of the 5 participating general practice s in the United Kingdom . MAIN OUTCOME MEASURES During consultation , the treating physician assessed and recorded 5 brief generic items ( duration of present pain episode , current pain intensity , pain interference with daily activities , presence of multiple-site pain , and ultrashort depression screen ) and recorded their overall prognostic judgment . The primary outcome was patient-rated improvement , which was measured 6 months after consultation and cross-vali date d with repeated measures up to 3 years . RESULTS A total of 194 ( 48.1 % ) of 403 participants were classified as having an unfavorable outcome at 6 months . Inclusion of 3 generic prognostic indicators ( duration of present pain episode , pain interference with daily activities , and presence of multiple-site pain ) in the prognostic model improved on reliance on physicians ' prognostic judgment alone ( C statistic = 0.72 vs 0.62 ; net reclassification index = 0.136 ; proportion correctly classified = 69 % ) . The improvement in prognostic accuracy was attributable to correcting physicians ' tendency toward overoptimistic expectations of outcome . CONCLUSIONS AND RELEVANCE Three easy-to-obtain pieces of information followed by systematic recording of the general practitioners ' prognostic judgment provide a simple generic assessment of prognosis at point of care in older persons presenting with musculoskeletal problems to primary care practice s in the United Kingdom . Such an assessment offers a common foundation for investigating the usefulness of prognostic stratification for guiding management in the consultation across a range of common painful conditions | 22 | Several factors were found to be associated with disability at follow-up for at least two different pain symptoms .
However , owing to insufficient studies , no generic risk factors for sick leave were identified .
Conclusions Multiple site pain , high pain severity , older age , baseline disability and longer pain duration were identified as potential prognostic factors for disability across pain sites .
There was limited evidence that anxiety and depression were associated with disability in patients with subacute pain , indicating that these factors may not play as large a role as expected in developing disability due to a pain condition . | Objective This systematic review aims to identify generic prognostic factors for disability and sick leave in subacute pain patients . |
22 | 26,739,716 | Several factors were found to be associated with disability at follow-up for at least two different pain symptoms .
However , owing to insufficient studies , no generic risk factors for sick leave were identified .
Conclusions Multiple site pain , high pain severity , older age , baseline disability and longer pain duration were identified as potential prognostic factors for disability across pain sites .
There was limited evidence that anxiety and depression were associated with disability in patients with subacute pain , indicating that these factors may not play as large a role as expected in developing disability due to a pain condition . | Objective This systematic review aims to identify generic prognostic factors for disability and sick leave in subacute pain patients . | 402 | 20,932,646 | Are prognostic indicators for poor outcome different for acute and chronic low back pain consulters in primary care? | & NA ; Few studies have investigated whether prognostic indicators , which contribute to the transition from acute to chronic low back pain ( LBP ) , are also those which contribute to continuing persistence of chronic LBP . We compared the contribution of physical , psychological and social indicators to predicting disability after one year between consulters with LBP of less than 3 months duration and more than 3 months duration . Data from two large prospect i ve cohort studies of consecutive patients consulting with LBP in general practice s were merged , providing complete data for 258 cases with acute/subacute LBP and 668 cases with chronic LBP at 12 months follow‐up . There were significant differences between the two LBP groups in baseline characteristics and clinical course of disability , assessed by Rol and Morris Disability Question naire , during the year of follow‐up . Adjusted associations between potential prognostic indicators and disability at 12 months were carried out in the two LBP subgroups . The final multivariable regression models showed that being non‐employed , having widespread pain , a high level of Chronic Pain Grade , and catastrophising were the strongest prognostic indicators for disability at 12 months in both LBP groups . Fear of pain was significantly associated with disability in chronic LBP . Importantly , beyond baseline disability , the effect size of the other prognostic indicators for poor outcome was rather low . These findings must continue to challenge research ers to identify useful early predictors of outcome in persons with disabling back pain , as screening and targeted treatment approaches are dependent upon prognostic indicators with clinical significance | 22 | Several factors were found to be associated with disability at follow-up for at least two different pain symptoms .
However , owing to insufficient studies , no generic risk factors for sick leave were identified .
Conclusions Multiple site pain , high pain severity , older age , baseline disability and longer pain duration were identified as potential prognostic factors for disability across pain sites .
There was limited evidence that anxiety and depression were associated with disability in patients with subacute pain , indicating that these factors may not play as large a role as expected in developing disability due to a pain condition . | Objective This systematic review aims to identify generic prognostic factors for disability and sick leave in subacute pain patients . |
22 | 26,739,716 | Several factors were found to be associated with disability at follow-up for at least two different pain symptoms .
However , owing to insufficient studies , no generic risk factors for sick leave were identified .
Conclusions Multiple site pain , high pain severity , older age , baseline disability and longer pain duration were identified as potential prognostic factors for disability across pain sites .
There was limited evidence that anxiety and depression were associated with disability in patients with subacute pain , indicating that these factors may not play as large a role as expected in developing disability due to a pain condition . | Objective This systematic review aims to identify generic prognostic factors for disability and sick leave in subacute pain patients . | 403 | 3,626,659 | Does a patient’s physical activity predict recovery from an episode of acute low back pain? A prospective cohort study | Background Advice to remain active and normalisation of activity are commonly prescribed in the management of low back pain ( LBP ) . However , no research has assessed whether objective measurements of physical activity predict outcome and recovery in acute low back pain . Method The aims of this study were to assess the predictive relationship between activity and disability at 3 months in a sub-acute LBP population . This prospect i ve cohort study recruited 101 consenting patients with sub-acute LBP ( < 6 weeks ) who completed the Rol and Morris Disability Question naire ( RMDQ ) , the Visual Analogue Scale , and resumption of full ‘ normal ’ activity question ( Y/N ) , at baseline and 3 months . Physical activity was measured for 7 days at both baseline and at 3 months with an RT3 accelerometer and a recall question naire . Results Observed and self-reported measures of physical activity at baseline and change in activity from baseline to 3 months were not independent predictors of RMDQ ( p > 0.05 ) or RMDQ change ( p > 0.05 ) over 3 months . A self-report of a return to full ‘ normal ’ activities was significantly associated with greater RMDQ change score at 3 months ( p < 0.001 ) . Paired t-tests found no significant change in activity levels measured with the RT3 ( p = 0.57 ) or the recall question naire ( p = 0.38 ) from baseline to 3 months . Conclusions These results question the predictive role of physical activity in LBP recovery , and the assumption that activity levels change as LBP symptoms resolve . The importance of a patient ’s perception of activity limitation in recovery from acute LBP was also highlighted . Trial registration Clinical Trial Registration Number , | 22 | Several factors were found to be associated with disability at follow-up for at least two different pain symptoms .
However , owing to insufficient studies , no generic risk factors for sick leave were identified .
Conclusions Multiple site pain , high pain severity , older age , baseline disability and longer pain duration were identified as potential prognostic factors for disability across pain sites .
There was limited evidence that anxiety and depression were associated with disability in patients with subacute pain , indicating that these factors may not play as large a role as expected in developing disability due to a pain condition . | Objective This systematic review aims to identify generic prognostic factors for disability and sick leave in subacute pain patients . |
22 | 26,739,716 | Several factors were found to be associated with disability at follow-up for at least two different pain symptoms .
However , owing to insufficient studies , no generic risk factors for sick leave were identified .
Conclusions Multiple site pain , high pain severity , older age , baseline disability and longer pain duration were identified as potential prognostic factors for disability across pain sites .
There was limited evidence that anxiety and depression were associated with disability in patients with subacute pain , indicating that these factors may not play as large a role as expected in developing disability due to a pain condition . | Objective This systematic review aims to identify generic prognostic factors for disability and sick leave in subacute pain patients . | 404 | 17,334,295 | Psychosocial Variables in Patients With (Sub)Acute Low Back Pain: An Inception Cohort in Primary Care Physical Therapy in the Netherlands | Study Design . A prospect i ve cohort study of patients with episodes of acute or subacute low back pain , seeking physical therapy in primary care , with follow-up at weeks 2 , 4 , 8 , and 12 . Objectives . To evaluate the association between psychosocial factors and the transition from acute or subacute low back pain to chronicity . Summary of Background Data . Psychosocial factors have long been thought to be associated with chronic pain only . Recent prospect i ve studies , however , suggest that these factors may also be important in acute or subacute low back pain . Methods . Demographic , psychosocial , and psychological baseline data were collected and analyzed from a sample of 66 acute or subacute patients with low back pain in order to predict the 3-month outcome . Results . After 3 months , response rate was 85 % ( 56 patients ) . Forty-five percent rated their current status as “ not recovered . ” Twelve percent reported work absenteeism . Using multiple regression analyses , baseline scores on the Acute Low Back Pain Screening Question naire , Pain Coping Inventory , Fear-Avoidance Beliefs Question naire , and Tampa Scale for Kinesiophobia were not significantly associated with nonrecovery at 3 months . The only significant predictor at baseline was the subscale pain of the ALBPSQ , correctly classifying 80 % of the patients . The relative risk for not being recovered was 3.72 ( 95 % confidence interval , 1.63–8.52 ) for the subjects with high scores on the subscale for pain . Pain scores and scores on psychosocial variables at 12 weeks were not associated . Conclusions . The study strongly revealed pain-related items to be essential factors in the development of chronicity and long-term disability in primary care physical therapy . Health status at 8 weeks seems crucial in developing chronicity | 22 | Several factors were found to be associated with disability at follow-up for at least two different pain symptoms .
However , owing to insufficient studies , no generic risk factors for sick leave were identified .
Conclusions Multiple site pain , high pain severity , older age , baseline disability and longer pain duration were identified as potential prognostic factors for disability across pain sites .
There was limited evidence that anxiety and depression were associated with disability in patients with subacute pain , indicating that these factors may not play as large a role as expected in developing disability due to a pain condition . | Objective This systematic review aims to identify generic prognostic factors for disability and sick leave in subacute pain patients . |
22 | 26,739,716 | Several factors were found to be associated with disability at follow-up for at least two different pain symptoms .
However , owing to insufficient studies , no generic risk factors for sick leave were identified .
Conclusions Multiple site pain , high pain severity , older age , baseline disability and longer pain duration were identified as potential prognostic factors for disability across pain sites .
There was limited evidence that anxiety and depression were associated with disability in patients with subacute pain , indicating that these factors may not play as large a role as expected in developing disability due to a pain condition . | Objective This systematic review aims to identify generic prognostic factors for disability and sick leave in subacute pain patients . | 405 | 16,099,095 | A longitudinal study on the predictive validity of the fear–avoidance model in low back pain | & NA ; Recently , fear – avoidance models have been quite influential in underst and ing the transition from acute to chronic low back pain ( LBP ) . Not only has pain‐related fear been found to be associated with disability and increased pain severity , but also treatment focused at reducing pain‐related fear has shown to successfully reduce disability levels . In spite of these developments , there is still a lack in well‐ design ed prospect i ve studies examining the role of pain‐related fear in acute back pain . The aim of the current study was to prospect ively test the assumption that pain‐related fear in acute stages successfully predicts future disability . Subjects were primary care acute LBP patients consulting because of a new episode of LBP ( ≤3 weeks ) . They completed question naires on background variables , fear – avoidance model variables and LBP outcome ( Grade d Chronic Pain Scale , GCPS ) at baseline , 3 , 6 , and 12 months follow‐up and at the end of the study . Two‐hundred and twenty‐two acute LBP patients were included , of whom 174 provided full follow‐up information ( 78.4 % ) . A backward ordinal regression analysis showed previous LBP history and pain intensity to be the most important predictors of end of study GCPS . Of the fear – avoidance model variables , only negative affect added to this model . Our results do not really support the longitudinal validity of the fear – avoidance model , but they do feed the discussion on the role of pain‐related fear in early stages of LBP | 22 | Several factors were found to be associated with disability at follow-up for at least two different pain symptoms .
However , owing to insufficient studies , no generic risk factors for sick leave were identified .
Conclusions Multiple site pain , high pain severity , older age , baseline disability and longer pain duration were identified as potential prognostic factors for disability across pain sites .
There was limited evidence that anxiety and depression were associated with disability in patients with subacute pain , indicating that these factors may not play as large a role as expected in developing disability due to a pain condition . | Objective This systematic review aims to identify generic prognostic factors for disability and sick leave in subacute pain patients . |
22 | 26,739,716 | Several factors were found to be associated with disability at follow-up for at least two different pain symptoms .
However , owing to insufficient studies , no generic risk factors for sick leave were identified .
Conclusions Multiple site pain , high pain severity , older age , baseline disability and longer pain duration were identified as potential prognostic factors for disability across pain sites .
There was limited evidence that anxiety and depression were associated with disability in patients with subacute pain , indicating that these factors may not play as large a role as expected in developing disability due to a pain condition . | Objective This systematic review aims to identify generic prognostic factors for disability and sick leave in subacute pain patients . | 406 | 16,540,870 | Fear of Movement/(Re)Injury Predicting Chronic Disabling Low Back Pain: A Prospective Inception Cohort Study | Study Design . Prospect i ve inception cohort study . Objective . To investigate prospect ively whether pain-related fear predicts future perceived disability and participation in patients with acute low back pain ( LBP ) . Summary of Background Data . There are indications that fear of movement/(re)injury , as measured by the Tampa Scale for Kinesiophobia , is present early in an episode of LBP , and that it might be a predictor of future perceived disability and participation . Methods . A cohort of 555 patients with acute LBP included by general practitioners and physical therapists in primary care setting s was followed for 6 months . Results . Results indicate that baseline fear of movement/(re)injury was predictive of future perceived disability and , to a lesser extent ( and together with duration and radiation ) , of participation . Conclusions . The results suggest that interventions aim ed at reducing pain-related fear in the acute stage of LBP might prevent restrictions of activity and participation because of pain , and might be a way of preventing the transition from acute to chronic LBP | 22 | Several factors were found to be associated with disability at follow-up for at least two different pain symptoms .
However , owing to insufficient studies , no generic risk factors for sick leave were identified .
Conclusions Multiple site pain , high pain severity , older age , baseline disability and longer pain duration were identified as potential prognostic factors for disability across pain sites .
There was limited evidence that anxiety and depression were associated with disability in patients with subacute pain , indicating that these factors may not play as large a role as expected in developing disability due to a pain condition . | Objective This systematic review aims to identify generic prognostic factors for disability and sick leave in subacute pain patients . |
22 | 26,739,716 | Several factors were found to be associated with disability at follow-up for at least two different pain symptoms .
However , owing to insufficient studies , no generic risk factors for sick leave were identified .
Conclusions Multiple site pain , high pain severity , older age , baseline disability and longer pain duration were identified as potential prognostic factors for disability across pain sites .
There was limited evidence that anxiety and depression were associated with disability in patients with subacute pain , indicating that these factors may not play as large a role as expected in developing disability due to a pain condition . | Objective This systematic review aims to identify generic prognostic factors for disability and sick leave in subacute pain patients . | 407 | 18,565,009 | Clinical course and prognostic factors in acute neck pain: an inception cohort study in general practice. | OBJECTIVE To describe the natural course of patients with acute neck pain presenting in general practice and to identify prognostic factors for recovery and sick leave . DESIGN We conducted a prospect i ve cohort study with a 1-year follow-up in general practice . Question naires were collected at baseline and after 6 , 12 , 26 , and 52 weeks . Days of sick leave were dichotomized into two groups : below and above 7 days of sick leave . Logistic regression was used to identify prognostic factors for recovery and sick leave . PATIENTS Consecutive patients with nonspecific neck pain lasting no longer than 6 weeks were invited to participate . RESULTS One hundred eighty-seven patients were included and 138 ( 74 % ) provided follow-up data . After 1 year , 76 % of the patients stated to be fully recovered or much improved , although 47 % reported to have ongoing neck pain . Almost half of the patients on sick leave at baseline returned to work within 7 days . Multivariate analysis showed that the highest association with recovery was the advice of the general practitioner ( GP ) " to wait and see " ( odds ratio [ OR ] 6.7 , 95 % confidence interval [ CI ] 1.6 - 31.8 ) . For sick leave , referral by the GP , for physical therapy or to a medical specialist , showed the highest association ( OR 2.8 , 95 % CI 1.0 - 8.4 ) . CONCLUSION Acute neck pain had a good prognosis for the majority of patients , but still a relatively high proportion of patients reported neck pain after 1-year follow-up . The advice given by the GP " to wait and see " was associated with recovery , and " referral " was associated with prolonged sick leave | 22 | Several factors were found to be associated with disability at follow-up for at least two different pain symptoms .
However , owing to insufficient studies , no generic risk factors for sick leave were identified .
Conclusions Multiple site pain , high pain severity , older age , baseline disability and longer pain duration were identified as potential prognostic factors for disability across pain sites .
There was limited evidence that anxiety and depression were associated with disability in patients with subacute pain , indicating that these factors may not play as large a role as expected in developing disability due to a pain condition . | Objective This systematic review aims to identify generic prognostic factors for disability and sick leave in subacute pain patients . |
22 | 26,739,716 | Several factors were found to be associated with disability at follow-up for at least two different pain symptoms .
However , owing to insufficient studies , no generic risk factors for sick leave were identified .
Conclusions Multiple site pain , high pain severity , older age , baseline disability and longer pain duration were identified as potential prognostic factors for disability across pain sites .
There was limited evidence that anxiety and depression were associated with disability in patients with subacute pain , indicating that these factors may not play as large a role as expected in developing disability due to a pain condition . | Objective This systematic review aims to identify generic prognostic factors for disability and sick leave in subacute pain patients . | 408 | 20,801,246 | A randomized controlled trial comparing manipulation with mobilization for recent onset neck pain. | UNLABELLED A r and omized controlled trial comparing manipulation with mobilization for recent onset neck pain . OBJECTIVE To determine whether neck manipulation is more effective for neck pain than mobilization . DESIGN R and omized controlled trial with blind assessment of outcome . SETTING Primary care physiotherapy , chiropractic , and osteopathy clinics in Sydney , Australia . PARTICIPANTS Patients ( N=182 ) with nonspecific neck pain less than 3 months in duration and deemed suitable for treatment with manipulation by the treating practitioner . INTERVENTIONS Participants were r and omly assigned to receive treatment with neck manipulation ( n=91 ) or mobilization ( n=91 ) . Patients in both groups received 4 treatments over 2 weeks . MAIN OUTCOME MEASURE The number of days taken to recover from the episode of neck pain . RESULTS The median number of days to recovery of pain was 47 in the manipulation group and 43 in the mobilization group . Participants treated with neck manipulation did not experience more rapid recovery than those treated with neck mobilization ( hazard ratio=.98 ; 95 % confidence interval , .66 - 1.46 ) . CONCLUSIONS Neck manipulation is not appreciably more effective than mobilization . The use of neck manipulation therefore can not be justified on the basis of superior effectiveness | 22 | Several factors were found to be associated with disability at follow-up for at least two different pain symptoms .
However , owing to insufficient studies , no generic risk factors for sick leave were identified .
Conclusions Multiple site pain , high pain severity , older age , baseline disability and longer pain duration were identified as potential prognostic factors for disability across pain sites .
There was limited evidence that anxiety and depression were associated with disability in patients with subacute pain , indicating that these factors may not play as large a role as expected in developing disability due to a pain condition . | Objective This systematic review aims to identify generic prognostic factors for disability and sick leave in subacute pain patients . |
22 | 26,739,716 | Several factors were found to be associated with disability at follow-up for at least two different pain symptoms .
However , owing to insufficient studies , no generic risk factors for sick leave were identified .
Conclusions Multiple site pain , high pain severity , older age , baseline disability and longer pain duration were identified as potential prognostic factors for disability across pain sites .
There was limited evidence that anxiety and depression were associated with disability in patients with subacute pain , indicating that these factors may not play as large a role as expected in developing disability due to a pain condition . | Objective This systematic review aims to identify generic prognostic factors for disability and sick leave in subacute pain patients . | 409 | 23,419,913 | People seeking treatment for a new episode of neck pain typically have rapid improvement in symptoms: an observational study. | QUESTION What is the clinical course of a new episode of non-specific neck pain in people who are treated with multimodal physical therapies in a primary care setting ? DESIGN Observational study with 3-month follow-up , run in conjunction with a r and omised trial . PARTICIPANTS 181 adults who consulted a physiotherapist or chiropractor for a new episode of nonspecific neck pain . OUTCOME MEASURES Time to recover from the episode of neck pain , time to recover normal activity , and pain and neck-related disability at three months . Clinical and demographic characteristics were investigated as potential predictors of recovery . RESULTS Within 3 months , 53 % of participants reported complete recovery from the episode of neck pain . On a scale from 0 ( none ) to 10 ( worst ) , pain improved from 6.1 ( SD 2.0 ) at baseline to 2.5 ( SD 2.1 ) at 2 weeks and to 1.5 ( SD 1.8 ) at 3 months . On a scale from 0 ( none ) to 50 ( worst ) , disability improved from 15.5 ( SD 7.4 ) at baseline to 5.4 ( SD 6.4 ) at 3 months . Faster recovery was independently associated with better self-rated general health , shorter duration of symptoms , being a smoker , and absence of concomitant upper back pain or headache . Higher disability at 3 months was independently associated with higher disability at baseline , concomitant upper or lower back pain , older age , and previous sick leave for neck pain . CONCLUSION People who seek physical treatments for a new episode of neck pain in this primary care setting typically have high pain scores that improve rapidly after commencing treatment . Although almost half of those who seek treatment do not recover completely within three months , residual pain and disability in this group is relatively low . Physiotherapists should reassure people with a new episode of neck pain that rapid improvement in symptoms is common , modifying this advice where applicable based on risk factors | 22 | Several factors were found to be associated with disability at follow-up for at least two different pain symptoms .
However , owing to insufficient studies , no generic risk factors for sick leave were identified .
Conclusions Multiple site pain , high pain severity , older age , baseline disability and longer pain duration were identified as potential prognostic factors for disability across pain sites .
There was limited evidence that anxiety and depression were associated with disability in patients with subacute pain , indicating that these factors may not play as large a role as expected in developing disability due to a pain condition . | Objective This systematic review aims to identify generic prognostic factors for disability and sick leave in subacute pain patients . |
22 | 26,739,716 | Several factors were found to be associated with disability at follow-up for at least two different pain symptoms .
However , owing to insufficient studies , no generic risk factors for sick leave were identified .
Conclusions Multiple site pain , high pain severity , older age , baseline disability and longer pain duration were identified as potential prognostic factors for disability across pain sites .
There was limited evidence that anxiety and depression were associated with disability in patients with subacute pain , indicating that these factors may not play as large a role as expected in developing disability due to a pain condition . | Objective This systematic review aims to identify generic prognostic factors for disability and sick leave in subacute pain patients . | 410 | 11,576,740 | The role of fear-avoidance beliefs in acute low back pain: relationships with current and future disability and work status | & NA ; Fear‐avoidance beliefs have been identified as an important psychosocial variable in patients with chronic disability doe to low back pain . The importance of fear‐avoidance beliefs for individuals with acute low back pain has not been explored . Seventy‐eight subjects with work‐related low back pain of less than 3 weeks ' duration were studied . Measurements of pain intensity , physical impairment , disability , nonorganic signs and symptoms , and depression were taken at the initial evaluation . Fear‐avoidance beliefs were measured with the work and physical activity subscales of the Fear‐avoidance Beliefs Question naire . Disability and work status were re‐assessed after 4 weeks of physical therapy . Patterns of correlation between fear‐avoidance beliefs and other concurrently‐measured variables were similar to those reported in patients with chronic low back pain . Fear‐avoidance beliefs did not explain a significant amount of the variability in initial disability levels after controlling for pain intensity and physical impairment . Fear‐avoidance beliefs about work were significant predictors of 4‐week disability and work status even after controlling for initial levels of pain intensity , physical impairment , and disability , and the type of therapy received . Fear‐avoidance beliefs are present in patients with acute low back pain , and may be an important factor in explaining the transition from acute to chronic conditions . Screening for fear‐avoidance beliefs may be useful for identifying patients at risk of prolonged disability and work absence | 22 | Several factors were found to be associated with disability at follow-up for at least two different pain symptoms .
However , owing to insufficient studies , no generic risk factors for sick leave were identified .
Conclusions Multiple site pain , high pain severity , older age , baseline disability and longer pain duration were identified as potential prognostic factors for disability across pain sites .
There was limited evidence that anxiety and depression were associated with disability in patients with subacute pain , indicating that these factors may not play as large a role as expected in developing disability due to a pain condition . | Objective This systematic review aims to identify generic prognostic factors for disability and sick leave in subacute pain patients . |
22 | 26,739,716 | Several factors were found to be associated with disability at follow-up for at least two different pain symptoms .
However , owing to insufficient studies , no generic risk factors for sick leave were identified .
Conclusions Multiple site pain , high pain severity , older age , baseline disability and longer pain duration were identified as potential prognostic factors for disability across pain sites .
There was limited evidence that anxiety and depression were associated with disability in patients with subacute pain , indicating that these factors may not play as large a role as expected in developing disability due to a pain condition . | Objective This systematic review aims to identify generic prognostic factors for disability and sick leave in subacute pain patients . | 411 | 22,434,236 | Prognostic occupational factors for persistent low back pain in primary care | Purpose To reduce the socio-economic burden of persistent low back pain ( LBP ) , factors influencing the progression of acute/subacute LBP to the persistent state must be identified at an early stage . Methods Prospect i ve inception cohort study of patients attending a health practitioner for their first episode of acute/subacute or recurrent LBP . Patients were assessed at baseline addressing occupational , psychological , biomedical and demographic/lifestyle factors and followed up over 6 months . Multivariate logistic regression analysis was performed separately for the variables groups of the four different domains , controlling for age , gender and body mass index . The overall predictive value was calculated for the full regression models of the different domains . Finally , all significant variables from the different domains were combined into a final predictor model . Results The final four-predictor model predicted 51 % of variance of persistent LBP and included ‘ resigned attitude towards the job ’ ( OR 1.73 ; 95 % CI 1.16–2.59 ) , ‘ social support at work ’ ( OR 0.54 ; 95 % CI 0.32–0.90 ) , ‘ functional limitation ’ ( OR 1.05 ; 95 % CI 1.01–1.10 ) and ‘ duration of LBP ’ ( OR 1.04 ; 95 % CI 1.02–1.06 ) . The accuracy of the model was 83 % , with 92 % of non-persistent and 67 % of persistent LBP patients correctly identified . Conclusions In this study of patients with acute/subacute LBP , ‘ resigned attitude towards the job ’ increased the likelihood of persistent LBP at 6 month . Addressing this factor with workplace interventions has the potential to modify the outcome . In patients experiencing ‘ social support at work ’ , the development of persistent LBP was less likely and might therefore be considered as potential re source for prevention of persistent LBP | 22 | Several factors were found to be associated with disability at follow-up for at least two different pain symptoms .
However , owing to insufficient studies , no generic risk factors for sick leave were identified .
Conclusions Multiple site pain , high pain severity , older age , baseline disability and longer pain duration were identified as potential prognostic factors for disability across pain sites .
There was limited evidence that anxiety and depression were associated with disability in patients with subacute pain , indicating that these factors may not play as large a role as expected in developing disability due to a pain condition . | Objective This systematic review aims to identify generic prognostic factors for disability and sick leave in subacute pain patients . |
22 | 26,739,716 | Several factors were found to be associated with disability at follow-up for at least two different pain symptoms .
However , owing to insufficient studies , no generic risk factors for sick leave were identified .
Conclusions Multiple site pain , high pain severity , older age , baseline disability and longer pain duration were identified as potential prognostic factors for disability across pain sites .
There was limited evidence that anxiety and depression were associated with disability in patients with subacute pain , indicating that these factors may not play as large a role as expected in developing disability due to a pain condition . | Objective This systematic review aims to identify generic prognostic factors for disability and sick leave in subacute pain patients . | 412 | 16,919,058 | The Natural History of Headache: Predictors of Onset and Recovery | The objective of this study was to determine predictors of onset of new headache episodes and recovery from headache over one year . A population -based cohort study was conducted , comprising a baseline postal survey to a r and om sample of adults aged ≥18 years , with follow-up survey after 1 year . Risk factor data at baseline were compared with headache status at follow-up in two groups : ( i ) those free of recent headache at baseline and ( ii ) those with a recent headache at baseline . In respondents free of recent headache at baseline , previous headache [ risk ratio ( RR ) 4.15 ] , the presence of other pain at baseline ( RR 1.43 ) , severe sleep problems ( RR 1.67 ) and drinking caffeine ( RR 1.99 ) increased the risk of a new headache episode during the follow-up year . In respondents with recent headache at baseline , less severe headaches at baseline predicted recovery during the follow-up year , as did the absence of anxiety [ recovery ratio ( ReR ) 2.84 ] and of sleep problems ( ReR 2.77 ) . Risks for increased headache-related disability reflected those for onset of a new episode and these risks increased in strength for large increases in disability . Sleep problems and caffeine consumption increase the risk of developing headache and thus provide targets for prevention . Low levels of anxiety , sleep problems and the absence of other pain improve the likelihood of recovering and remaining free from headache | 22 | Several factors were found to be associated with disability at follow-up for at least two different pain symptoms .
However , owing to insufficient studies , no generic risk factors for sick leave were identified .
Conclusions Multiple site pain , high pain severity , older age , baseline disability and longer pain duration were identified as potential prognostic factors for disability across pain sites .
There was limited evidence that anxiety and depression were associated with disability in patients with subacute pain , indicating that these factors may not play as large a role as expected in developing disability due to a pain condition . | Objective This systematic review aims to identify generic prognostic factors for disability and sick leave in subacute pain patients . |
22 | 26,739,716 | Several factors were found to be associated with disability at follow-up for at least two different pain symptoms .
However , owing to insufficient studies , no generic risk factors for sick leave were identified .
Conclusions Multiple site pain , high pain severity , older age , baseline disability and longer pain duration were identified as potential prognostic factors for disability across pain sites .
There was limited evidence that anxiety and depression were associated with disability in patients with subacute pain , indicating that these factors may not play as large a role as expected in developing disability due to a pain condition . | Objective This systematic review aims to identify generic prognostic factors for disability and sick leave in subacute pain patients . | 413 | 16,287,668 | Predictors of return to work in patients sick listed for sub-acute low back pain: a 12-month follow-up study. | OBJECTIVE To investigate whether personal and work-related factors , physical performance and back-specific question naires predict return to work . A prospect i ve study identifying prognostic factors for return to work . SUBJECTS Ninety-three patients sick-listed for 8 - 12 weeks for non-specific sub-acute low back pain included in a r and omized controlled trial . METHODS Patients were examined with regard to demographic variables , a battery of back-specific question naires and physical tests before entering a r and omized controlled trial . A stepwise backward Cox regression model was established to identify the most powerful predictors . RESULTS During follow-up 78.5 % of the patients have returned to full-time work . Fear-avoidance beliefs for work ( relative risk ( RR ) for 1 SD change 0.49 ; 95 % confidence interval ( CI ) 0.38 - 0.64 ) , disability ( RR 1.39 , 95 % CI 1.02 - 1.88 ) and cardiovascular fitness ( RR 1.42 , 95 % CI 1.12 - 1.79 ) were identified as the best predictors for return to work . The prevalence of correct predictions was 69.3 % . CONCLUSION The predictors identified in the present study may reflect personal risk factors in a patient who gets acute low back pain . On the other h and , they may support that fear of pain and injury may be more disabling than pain itself , and that deconditioning is a result of altered behaviour reflecting attitudes towards low back pain in society , and information and advice given in primary healthcare | 22 | Several factors were found to be associated with disability at follow-up for at least two different pain symptoms .
However , owing to insufficient studies , no generic risk factors for sick leave were identified .
Conclusions Multiple site pain , high pain severity , older age , baseline disability and longer pain duration were identified as potential prognostic factors for disability across pain sites .
There was limited evidence that anxiety and depression were associated with disability in patients with subacute pain , indicating that these factors may not play as large a role as expected in developing disability due to a pain condition . | Objective This systematic review aims to identify generic prognostic factors for disability and sick leave in subacute pain patients . |
22 | 26,739,716 | Several factors were found to be associated with disability at follow-up for at least two different pain symptoms .
However , owing to insufficient studies , no generic risk factors for sick leave were identified .
Conclusions Multiple site pain , high pain severity , older age , baseline disability and longer pain duration were identified as potential prognostic factors for disability across pain sites .
There was limited evidence that anxiety and depression were associated with disability in patients with subacute pain , indicating that these factors may not play as large a role as expected in developing disability due to a pain condition . | Objective This systematic review aims to identify generic prognostic factors for disability and sick leave in subacute pain patients . | 414 | 14,652,481 | Outcome Determinants of Subacute Low Back Pain | Study Design . Descriptive prognostic study . Objectives . To identify outcome determinants of subacute low back pain . Summary of Background Data . The factors predicting recovery from prolonged back pain among working adults are largely unknown . Material s and Methods . One hundred sixty-four employed patients with subacute ( duration of pain 4–12 weeks ) daily low back pain were recruited from primary health care to a r and omized study . Data on potential predictive factors were collected before r and omization . In multiple regressions using repeated measures analysis , the treatment received was adjusted when determining the impact of the predictive factors . Dependent outcome variables used were pain , perceived functional disability , generic health-related quality of life , satisfaction with care , days on sick leave , use of health care , and costs of health care consumption measured , at 3- , 6- , and 12-month follow-ups . Results . Age and intensity of pain at baseline predicted most of the outcomes . The perceived risk of not recovering was a stronger determinant of outcome than gender , education , or self-rated health status ( which did not have any predictive value ) or body mass index , expectations of treatment effect , satisfaction with work , or the presence of radicular symptoms below the knee ( only slight predictive value ) . The only factors predicting the duration of sick leave were the duration of sick leave at baseline and the type of occupation . Conclusion . Age and intensity of pain are the strongest predictors of outcome . Accumulation of days on sick leave is predicted by the duration of sick leave at entry and the type of work , but not by pain , perceived disability , or satisfaction with work | 22 | Several factors were found to be associated with disability at follow-up for at least two different pain symptoms .
However , owing to insufficient studies , no generic risk factors for sick leave were identified .
Conclusions Multiple site pain , high pain severity , older age , baseline disability and longer pain duration were identified as potential prognostic factors for disability across pain sites .
There was limited evidence that anxiety and depression were associated with disability in patients with subacute pain , indicating that these factors may not play as large a role as expected in developing disability due to a pain condition . | Objective This systematic review aims to identify generic prognostic factors for disability and sick leave in subacute pain patients . |
22 | 26,739,716 | Several factors were found to be associated with disability at follow-up for at least two different pain symptoms .
However , owing to insufficient studies , no generic risk factors for sick leave were identified .
Conclusions Multiple site pain , high pain severity , older age , baseline disability and longer pain duration were identified as potential prognostic factors for disability across pain sites .
There was limited evidence that anxiety and depression were associated with disability in patients with subacute pain , indicating that these factors may not play as large a role as expected in developing disability due to a pain condition . | Objective This systematic review aims to identify generic prognostic factors for disability and sick leave in subacute pain patients . | 415 | 15,611,489 | A Clinical Prediction Rule To Identify Patients with Low Back Pain Most Likely To Benefit from Spinal Manipulation: A Validation Study | Context In this r and omized , controlled trial , spinal manipulation plus exercise produced outcomes for low back pain similar to those produced by exercise alone . Yet , some patients did respond to spinal manipulation , and it would be helpful for doctors to be able to identify such patients . Contribution Patients were most likely to benefit from spinal manipulation if they met 4 of 5 of the following criteria : symptom duration less than 16 days , no symptoms distal to knee , score less than 19 on a fear-avoidance measure , at least 1 hypomobile lumbar segment , and at least 1 hip with more than 35 degrees of internal rotation . Implication s Clinicians may be able to use these criteria to identify patients with low back pain who are good c and i date s for spinal manipulation . The Editors Next to the common cold , low back pain is the most common reason that individuals visit a physician 's office ( 1 ) . Billions of dollars in medical expenditures and lost labor costs for this condition are incurred each year ( 2 , 3 ) . Attempts to identify effective interventions for individuals with low back pain have been largely unsuccessful ( 4 ) . In particular , conflicting evidence exists about the effectiveness of spinal manipulation ; some r and omized trials have shown a benefit , while other trials have not ( 5 - 7 ) . These conflicting conclusions are reflected in the various recommendations in national clinical practice guidelines , with some recommending manipulation and others not ( 8) . The variety of conclusions in trials of manipulation may be attributable to the failure of research ers to adequately consider the importance of classification . Using broad inclusion criteria results in a heterogeneous sample that may include many patients for whom no benefit is expected , thus masking the intervention 's true value ( 9 , 10 ) . Consequently , developing methods for matching patients with low back pain to treatments that are most likely to benefit them has become an important research priority ( 11 ) . Clinical prediction rules are tools design ed to assist clinicians in decision making when caring for patients ( 12 ) . Several clinical prediction rules have been developed and vali date d to improve clinical decision making for the use of imaging in patients with ankle , knee , cervical spine , or minor head injuries ( 13 - 16 ) . Few studies have attempted to develop rules that establish prognosis on the basis of outcome from a specific intervention , such as spinal manipulation . Recently , Flynn and colleagues ( 17 ) developed a clinical prediction rule for identifying patients with low back pain who are likely to benefit from manipulation . They examined a series of patients with low back pain who received a manipulation intervention . Five factors formed the most parsimonious set of predictors for identifying patients who achieved at least 50 % improvement in disability within 1 week with a maximum of 2 manipulation interventions ( Table 1 ) ( 17 ) . The positive likelihood ratio among patients who met at least 4 of 5 of the criteria was 24.4 ( 95 % CI , 4.6 to 139.4 ) . Table 1 . Five Criteria in the Spinal Manipulation Clinical Prediction Rule Clinical prediction rules must be vali date d in separate population s before being recommended for widespread implementation ( 18 ) . A clinical prediction rule for identifying which patients with low back pain are most likely to respond to manipulation could improve clinical efficiency and re source utilization . Thus , we aim ed to vali date the spinal manipulation clinical prediction rule in a multicenter trial . Methods We considered consecutive patients with a primary symptom of low back pain who were referred to physical therapy for participation . We used 14 physical therapists at 8 clinics in various U.S. regions and setting s ( 2 academic medical centers and smaller outpatient practice setting s ) . Most participating sites were health care facilities within the U.S. Air Force . Each site 's institutional review board approved the study before we began recruitment and data collection . Inclusion criteria were age 18 to 60 years ; a primary symptom of low back pain , with or without referral into the lower extremity ; and an Oswestry Disability Question naire ( ODQ ) score of at least 30 % . We excluded patients who had red flags for a serious spinal condition ( for example , tumor , compression fracture , or infection ) , those who had signs consistent with nerve root compression ( that is , positive straight-leg increase < 45 degrees or diminished reflexes , sensation , or lower-extremity strength ) , those who were pregnant , or those who had previous surgery to the lumbar spine or buttock . These criteria are consistent with those used in Flynn and colleagues ' study ( 17 ) and were design ed to include patients without a contraindication to manipulation . Once patients were admitted to the study , we used intention-to-treat principles , and no patient was removed for nonadherence . History and Physical Examination Before r and omization , patients completed several self-report measures and then received a st and ardized history and physical examination . We collected demographic information , including age and sex ; medical history ; and location and nature of symptoms . Self-report measures included a body diagram to assess the symptom distribution ( 19 ) . We used an 11-point pain-rating scale ranging from 0 ( no pain ) to 10 ( worst imaginable pain ) to assess current pain intensity and the best and worst level of pain during the last 24 hours ( 20 ) . We used the average of the 3 ratings . We used the Fear-Avoidance Beliefs Question naire ( FABQ ) to quantify the patient 's fear of pain and beliefs about avoiding activity ( 21 ) . Previous studies have found a high level of testretest reliability for both the FABQ physical activity and work subscales ( 22 ) . Fearavoidance beliefs have been associated with current and future disability and work loss in patients with acute ( 23 ) and chronic ( 24 ) low back pain . The modified ODQ is a region-specific disability scale for patients with low back pain ( 25 ) that has high levels of reliability , validity , and responsiveness ( 26 ) . Physical examination measures included lumbar active range of motion ( 27 ) and various tests purported to identify dysfunction in the lumbopelvic region ( 28 ) . Complete details of the physical examination are described elsewhere ( 26 ) . Specific components pertinent to validation of the rule were assessment s of segmental mobility and hip internal rotation range of motion , the performance of which is described in Appendix 1 and Appendix 3 video . Each physical therapist received a detailed manual that operationally defined each examination and treatment procedure and was trained in the study procedures by an investigator before data collection began . Supplement . Appendix 3 video : A Clinical Prediction Rule To Identify Patients with Low Back Pain Most Likely To Benefit from Spinal Manipulation Determining Status on the Clinical Prediction Rule A physical therapist who was blinded to the patients ' treatment group assignment assessed the 5 criteria in the rule ( Table 1 , Appendix 1 , and Appendix 3 video ) . To further minimize bias , examiners were not instructed in the rule 's criteria and were unaware of the patient 's status on the rule . After completion of the study , an examiner who was blinded to the patient 's treatment assignment determined the patient 's status on the rule by using the results of the baseline examination . As was done in the initial study ( 17 ) , we classified patients as positive if they met at least 4 of 5 criteria and were therefore likely to respond to manipulation . We classified patients with 3 or fewer criteria as negative . An examiner who was blinded to the patient 's status on the rule repeated the history and physical examination 1 and 4 weeks after r and omization . Patients also completed a 6-month follow-up postal question naire to assess disability , work status , and health care utilization . Treatment Groups We used a r and om-number generator to generate a r and omization list before the study began . We prepared individual , sequentially numbered index cards with the r and omization assignments . We folded the cards and placed them in sealed envelopes . After the baseline examination , the physical therapist who conducted the examination opened the next envelope , indicating the treatment group assignment . We r and omly assigned patients to 1 of 2 groups : 1 ) spinal manipulation plus an exercise program ( manipulation group ) or 2 ) an exervideocise program alone ( exercise group ) . Patients in both groups attended physical therapy twice during the first week and then once a week for the next 3 weeks , for a total of 5 sessions . We initiated treatment immediately after completion of the baseline examination , unless prohibited by time constraints ; in that case the first treatment session took place 24 to 48 hours after the baseline examination . All patients received an exercise instruction booklet that outlined the proper performance and frequency of each exercise and were instructed to perform their assigned exercise program once daily on the days that they did not attend therapy . On the basis of the benefits associated with remaining active ( 29 ) , patients in both groups were given advice to maintain usual activity within the limits of pain . Manipulation Group The treatment received by the manipulation group differed from that of the exercise group during the first 2 physical therapy sessions . During these 2 sessions , patients received high-velocity thrust spinal manipulation and a range-of-motion exercise only . First , the physical therapist performed the manipulation by using the same technique used by Flynn and colleagues ( 17 ) . Appendix 2 describes and Figure 1 and Appendix 3 video illustrate the procedures used to perform the manipulation technique . Figure 1 . Manipulative intervention used in developing and validating the spinal manipulation clinical prediction rule . Exercise Group We treated patients in the exercise group with a low-stress | 22 | Several factors were found to be associated with disability at follow-up for at least two different pain symptoms .
However , owing to insufficient studies , no generic risk factors for sick leave were identified .
Conclusions Multiple site pain , high pain severity , older age , baseline disability and longer pain duration were identified as potential prognostic factors for disability across pain sites .
There was limited evidence that anxiety and depression were associated with disability in patients with subacute pain , indicating that these factors may not play as large a role as expected in developing disability due to a pain condition . | Objective This systematic review aims to identify generic prognostic factors for disability and sick leave in subacute pain patients . |
22 | 26,739,716 | Several factors were found to be associated with disability at follow-up for at least two different pain symptoms .
However , owing to insufficient studies , no generic risk factors for sick leave were identified .
Conclusions Multiple site pain , high pain severity , older age , baseline disability and longer pain duration were identified as potential prognostic factors for disability across pain sites .
There was limited evidence that anxiety and depression were associated with disability in patients with subacute pain , indicating that these factors may not play as large a role as expected in developing disability due to a pain condition . | Objective This systematic review aims to identify generic prognostic factors for disability and sick leave in subacute pain patients . | 416 | 15,599,130 | Screening to Identify Patients at Risk: Profiles of Psychological Risk Factors for Early Intervention | There is a serious need to provide effective early interventions that prevent the development of persistent pain and disability . Identifying patients at risk for this development is an important step . Our aim was to explore whether distinct subgroups of individuals with similar response patterns on a screening question naire exist . Moreover , the objective was to then relate these groups to future outcomes , for example , sick leave as an impetus for developing tailored interventions that might better prevent chronic problems . A total of 363 patients seeking primary care for acute or subacute spinal pain completed the Örebro Musculoskeletal Pain Screening Question naire and were then followed to determine outcome . Cluster analysis was used to identify subgroups . Validity was tested using 3 methods including the split-half technique . The subgroups were compared prospect ively on outcome measures obtained 1 year later . Using pain intensity , fear-avoidance beliefs , function , and mood , we found 4 distinct profiles : Fear-Avoidant , Distressed Fear-Avoidant , Low Risk , and Low Risk-Depressed Mood . These 4 subgroups were also robust in all 3 of the validity procedures . The 4 subgroups were clearly related to outcome . Although the low risk profiles had virtually no one developing long-term sick leave , the Fear-Avoidant profile had 35 % and the Distressed Fear-Avoidant profile 62 % developing long-term sick leave . Our results suggest that fear-avoidance and distress are important factors in the development of pain-related disability and may serve as a key for early identification . Providing interventions specific to the factors isolated in the profiles should enhance the prevention of persistent pain and disability | 22 | Several factors were found to be associated with disability at follow-up for at least two different pain symptoms .
However , owing to insufficient studies , no generic risk factors for sick leave were identified .
Conclusions Multiple site pain , high pain severity , older age , baseline disability and longer pain duration were identified as potential prognostic factors for disability across pain sites .
There was limited evidence that anxiety and depression were associated with disability in patients with subacute pain , indicating that these factors may not play as large a role as expected in developing disability due to a pain condition . | Objective This systematic review aims to identify generic prognostic factors for disability and sick leave in subacute pain patients . |
23 | 29,318,741 | CONCLUSIONS Based on a limited number of studies , the use of ergonomic saddle seats and dental loupes leads to improved working postures .
The use of loupes appears to relieve shoulder , arm and h and pain .
However , their effect on neck pain is scarce .
None of the studies reported on the effect of the saddle seats on musculoskeletal pain . | OBJECTIVES Musculoskeletal disorders affect a high percentage of dentists , dental hygienists and therapists .
Static and awkward working postures are considered as major risk factors .
Proper seat selection and use of magnification loupes are promoted for their ergonomic benefits .
The aim of this review was to evaluate the existing empirical evidence on the effect of the above interventions on ( i ) correction of poor posture and ( ii ) reduction in musculoskeletal pain . | 417 | 18,172,233 | Effect of magnification loupes on dental hygiene student posture. | The chair-side work posture of dental hygienists has long been a concern because of health-related problems potentially caused or exacerbated by poor posture . The purpose of this study was to investigate if using magnification loupes improved dental hygiene students ' posture during provision of treatment . The treatment chosen was h and -scaling , and the effect of the timing of introduction of the loupes to students was also examined . Thirty-five novice dental hygiene students took part in the study . Each student was assessed providing dental hygiene care with and without loupes , thus controlling for innate differences in natural posture . Students were r and omized into two groups . Group one used loupes in the first session and did not use them for the second session . Group two reversed this sequence . At the end of each session , all students were videotaped while performing scaling procedures . Their posture was assessed using an adapted version of Branson et al. 's Posture Assessment Instrument ( PAI ) . Four raters assessed students at three time periods for nine posture components on the PAI . A paired t-test compared scores with and without loupes for each student . Scores showed a significant improvement in posture when using loupes ( p<0.0001 ) , and these improvements were significantly more pronounced for students starting loupes immediately on entering the program compared with students who delayed until the second session ( p<0.1 ) . These results suggest a significant postural benefit is realized by requiring students to master the use of magnification loupes as early as possible within the curriculum | 23 | CONCLUSIONS Based on a limited number of studies , the use of ergonomic saddle seats and dental loupes leads to improved working postures .
The use of loupes appears to relieve shoulder , arm and h and pain .
However , their effect on neck pain is scarce .
None of the studies reported on the effect of the saddle seats on musculoskeletal pain . | OBJECTIVES Musculoskeletal disorders affect a high percentage of dentists , dental hygienists and therapists .
Static and awkward working postures are considered as major risk factors .
Proper seat selection and use of magnification loupes are promoted for their ergonomic benefits .
The aim of this review was to evaluate the existing empirical evidence on the effect of the above interventions on ( i ) correction of poor posture and ( ii ) reduction in musculoskeletal pain . |
23 | 29,318,741 | CONCLUSIONS Based on a limited number of studies , the use of ergonomic saddle seats and dental loupes leads to improved working postures .
The use of loupes appears to relieve shoulder , arm and h and pain .
However , their effect on neck pain is scarce .
None of the studies reported on the effect of the saddle seats on musculoskeletal pain . | OBJECTIVES Musculoskeletal disorders affect a high percentage of dentists , dental hygienists and therapists .
Static and awkward working postures are considered as major risk factors .
Proper seat selection and use of magnification loupes are promoted for their ergonomic benefits .
The aim of this review was to evaluate the existing empirical evidence on the effect of the above interventions on ( i ) correction of poor posture and ( ii ) reduction in musculoskeletal pain . | 418 | 5,139,140 | Rayyan—a web and mobile app for systematic reviews | Background Synthesis of multiple r and omized controlled trials ( RCTs ) in a systematic review can summarize the effects of individual outcomes and provide numerical answers about the effectiveness of interventions . Filtering of search es is time consuming , and no single method fulfills the principal requirements of speed with accuracy . Automation of systematic review s is driven by a necessity to expedite the availability of current best evidence for policy and clinical decision-making . We developed Rayyan ( http://rayyan.qcri.org ) , a free web and mobile app , that helps expedite the initial screening of abstract s and titles using a process of semi-automation while incorporating a high level of usability . For the beta testing phase , we used two published Cochrane review s in which included studies had been selected manually . Their search es , with 1030 records and 273 records , were uploaded to Rayyan . Different features of Rayyan were tested using these two review s. We also conducted a survey of Rayyan ’s users and collected feedback through a built-in feature . Results Pilot testing of Rayyan focused on usability , accuracy against manual methods , and the added value of the prediction feature . The “ taster ” review ( 273 records ) allowed a quick overview of Rayyan for early comments on usability . The second review ( 1030 records ) required several iterations to identify the previously identified 11 trials . The “ suggestions ” and “ hints , ” based on the “ prediction model , ” appeared as testing progressed beyond five included studies . Post rollout user experiences and a reflexive response by the developers enabled real-time modifications and improvements . The survey respondents reported 40 % average time savings when using Rayyan compared to others tools , with 34 % of the respondents reporting more than 50 % time savings . In addition , around 75 % of the respondents mentioned that screening and labeling studies as well as collaborating on review s to be the two most important features of Rayyan . As of November 2016 , Rayyan users exceed 2000 from over 60 countries conducting hundreds of review s totaling more than 1.6 M citations . Feedback from users , obtained mostly through the app web site and a recent survey , has highlighted the ease in exploration of search es , the time saved , and simplicity in sharing and comparing include-exclude decisions . The strongest features of the app , identified and reported in user feedback , were its ability to help in screening and collaboration as well as the time savings it affords to users . Conclusions Rayyan is responsive and intuitive in use with significant potential to lighten the load of review ers | 23 | CONCLUSIONS Based on a limited number of studies , the use of ergonomic saddle seats and dental loupes leads to improved working postures .
The use of loupes appears to relieve shoulder , arm and h and pain .
However , their effect on neck pain is scarce .
None of the studies reported on the effect of the saddle seats on musculoskeletal pain . | OBJECTIVES Musculoskeletal disorders affect a high percentage of dentists , dental hygienists and therapists .
Static and awkward working postures are considered as major risk factors .
Proper seat selection and use of magnification loupes are promoted for their ergonomic benefits .
The aim of this review was to evaluate the existing empirical evidence on the effect of the above interventions on ( i ) correction of poor posture and ( ii ) reduction in musculoskeletal pain . |
23 | 29,318,741 | CONCLUSIONS Based on a limited number of studies , the use of ergonomic saddle seats and dental loupes leads to improved working postures .
The use of loupes appears to relieve shoulder , arm and h and pain .
However , their effect on neck pain is scarce .
None of the studies reported on the effect of the saddle seats on musculoskeletal pain . | OBJECTIVES Musculoskeletal disorders affect a high percentage of dentists , dental hygienists and therapists .
Static and awkward working postures are considered as major risk factors .
Proper seat selection and use of magnification loupes are promoted for their ergonomic benefits .
The aim of this review was to evaluate the existing empirical evidence on the effect of the above interventions on ( i ) correction of poor posture and ( ii ) reduction in musculoskeletal pain . | 419 | 4,554,244 | Evaluation of ergonomic factors and postures that cause muscle pains in dentistry students’ bodies | Background Work-related musculoskeletal disorders commonly experienced by dental professionals are one of the main occupational health problem affecting their health and well-being . This study was conducted to evaluate ergonomic factors and profession-related postures and also investigate relationship between demographic factors and work condition with pain in dental students . Material and Methods 60 freshman and sophomore dentistry students were r and omly chosen as the subjects of control group , and 60 of 5th and 6th-year students were selected as the members of exposure group . Data related to the subjects such as sex , doing exercise , severity of musculoskeletal pain were obtained through question naire . Students ’ postures were directly observed while treating patients and they were scored by REBA method . Data were analyzed by SPSS software using Man-Whitney , Kruskal-Wallis , Spearman and Kendall correlation tests . Results 80.8 % of the subjects were not aware of the correct ergonomic postures for dental procedures . Severity of musculoskeletal pain in the exposure group ( 15.9± 4.2 ) was significantly higher than the control group ( 10.5 ±3.2 ) , ( p < 0.001 ) . Risk of the most subjects ( 84 % ) was at the medium level . Students who were more involved in clinical activities experienced more muscular pains . Conclusions The musculoskeletal disorders are probable prolonged in working hours in static positions , incorrect work postures , implying more force and even tools and instruments . Therefore , students who are aware of ergonomic principals of their own profession would be able to maintain their health through activities and lifelong . Key words : Posture , dentistry , students , musculoskeletal pain | 23 | CONCLUSIONS Based on a limited number of studies , the use of ergonomic saddle seats and dental loupes leads to improved working postures .
The use of loupes appears to relieve shoulder , arm and h and pain .
However , their effect on neck pain is scarce .
None of the studies reported on the effect of the saddle seats on musculoskeletal pain . | OBJECTIVES Musculoskeletal disorders affect a high percentage of dentists , dental hygienists and therapists .
Static and awkward working postures are considered as major risk factors .
Proper seat selection and use of magnification loupes are promoted for their ergonomic benefits .
The aim of this review was to evaluate the existing empirical evidence on the effect of the above interventions on ( i ) correction of poor posture and ( ii ) reduction in musculoskeletal pain . |
23 | 29,318,741 | CONCLUSIONS Based on a limited number of studies , the use of ergonomic saddle seats and dental loupes leads to improved working postures .
The use of loupes appears to relieve shoulder , arm and h and pain .
However , their effect on neck pain is scarce .
None of the studies reported on the effect of the saddle seats on musculoskeletal pain . | OBJECTIVES Musculoskeletal disorders affect a high percentage of dentists , dental hygienists and therapists .
Static and awkward working postures are considered as major risk factors .
Proper seat selection and use of magnification loupes are promoted for their ergonomic benefits .
The aim of this review was to evaluate the existing empirical evidence on the effect of the above interventions on ( i ) correction of poor posture and ( ii ) reduction in musculoskeletal pain . | 420 | 11,171,934 | Are neck flexion, neck rotation, and sitting at work risk factors for neck pain? Results of a prospective cohort study | OBJECTIVE To study the relation between neck pain and work related neck flexion , neck rotation , and sitting . METHODS A prospect i ve cohort study was performed with a follow up of 3 years among 1334 workers from 34 companies . Work related physical load was assessed by analysing objective ly measured exposure data ( video recordings ) of neck flexion , neck rotation , and sitting posture . Neck pain was assessed by a question naire . Adjustments were made for various physical factors that were related or not related to work , psychosocial factors , and individual characteristics . RESULTS A significant positive relation was found between the percentage of the working time in a sitting position and neck pain , implying an increased risk of neck pain for workers who were sitting for more than 95 % of the working time ( crude relative risk ( RR ) 2.01 , 95 % confidence interval ( 95 % CI ) 1.04 to 3.88 ; adjusted RR 2.34 , 95 % CI 1.05 to 5.21 ) . A trend for a positive relation between neck flexion and neck pain was found , suggesting an increased risk of neck pain for people working with the neck at a minimum of 20 ° of flexion for more than 70 % of the working time ( crude RR 2.01 , 95 % CI 0.98 to 4.11 ; adjusted RR 1.63 , 95 % CI 0.70 to 3.82 ) . No clear relation was found between neck rotation and neck pain . CONCLUSION Sitting at work for more than 95 % of the working time seems to be a risk factor for neck pain and there is a trend for a positive relation between neck flexion and neck pain . No clear relation was found between neck rotation and neck pain | 23 | CONCLUSIONS Based on a limited number of studies , the use of ergonomic saddle seats and dental loupes leads to improved working postures .
The use of loupes appears to relieve shoulder , arm and h and pain .
However , their effect on neck pain is scarce .
None of the studies reported on the effect of the saddle seats on musculoskeletal pain . | OBJECTIVES Musculoskeletal disorders affect a high percentage of dentists , dental hygienists and therapists .
Static and awkward working postures are considered as major risk factors .
Proper seat selection and use of magnification loupes are promoted for their ergonomic benefits .
The aim of this review was to evaluate the existing empirical evidence on the effect of the above interventions on ( i ) correction of poor posture and ( ii ) reduction in musculoskeletal pain . |
23 | 29,318,741 | CONCLUSIONS Based on a limited number of studies , the use of ergonomic saddle seats and dental loupes leads to improved working postures .
The use of loupes appears to relieve shoulder , arm and h and pain .
However , their effect on neck pain is scarce .
None of the studies reported on the effect of the saddle seats on musculoskeletal pain . | OBJECTIVES Musculoskeletal disorders affect a high percentage of dentists , dental hygienists and therapists .
Static and awkward working postures are considered as major risk factors .
Proper seat selection and use of magnification loupes are promoted for their ergonomic benefits .
The aim of this review was to evaluate the existing empirical evidence on the effect of the above interventions on ( i ) correction of poor posture and ( ii ) reduction in musculoskeletal pain . | 421 | 15,816,703 | Working postures of dentists and dental hygienists. | A joint study was conducted by a manufacturer of dental stools in the Midwest of the United States and Marquette University to measure the occupational postures of dentists and dental hygienists . The postures of 10 dentists and 10 dental hygienists were assessed using work sampling and video techniques . Postural data of the neck , shoulders and lower back were recorded from video and categorized into 30-degree intervals : o ( neutral posture of respective joint ) , 30 , 60 and 90 degrees . Each subject 's postures were observed while they were treating patients during a four-hour period , during which 100 observations of postures were recorded at r and om times . Compared to st and ing , dentists and dental hygienists were seated 78 percent and 66 percent of the time , respectively . Dentists and dental hygienists flexed their trunk at least 30 degrees more than 50 percent of the time . They flexed their neck at least 30 degrees 85 percent of the time during the four-hour duration , and their shoulders were elevated to the side of their trunk ( abducted ) at least 30 degrees more half of the time . The postures of the trunk , shoulders , and neck were primarily static . This data base of postures can be used by dental professionals and ergonomists to assess the risk dentists and dental hygienists are exposed to musculoskeletal disorders , such as low back pain or shoulder tenosynovitis , from deviated joint postures . They could use these data to select dental furniture or dental devices that promote good body posture , i.e. , reduce the magnitude and duration of deviated joint postures , which , in theory , would decrease the risk of musculoskeletal disorders | 23 | CONCLUSIONS Based on a limited number of studies , the use of ergonomic saddle seats and dental loupes leads to improved working postures .
The use of loupes appears to relieve shoulder , arm and h and pain .
However , their effect on neck pain is scarce .
None of the studies reported on the effect of the saddle seats on musculoskeletal pain . | OBJECTIVES Musculoskeletal disorders affect a high percentage of dentists , dental hygienists and therapists .
Static and awkward working postures are considered as major risk factors .
Proper seat selection and use of magnification loupes are promoted for their ergonomic benefits .
The aim of this review was to evaluate the existing empirical evidence on the effect of the above interventions on ( i ) correction of poor posture and ( ii ) reduction in musculoskeletal pain . |
23 | 29,318,741 | CONCLUSIONS Based on a limited number of studies , the use of ergonomic saddle seats and dental loupes leads to improved working postures .
The use of loupes appears to relieve shoulder , arm and h and pain .
However , their effect on neck pain is scarce .
None of the studies reported on the effect of the saddle seats on musculoskeletal pain . | OBJECTIVES Musculoskeletal disorders affect a high percentage of dentists , dental hygienists and therapists .
Static and awkward working postures are considered as major risk factors .
Proper seat selection and use of magnification loupes are promoted for their ergonomic benefits .
The aim of this review was to evaluate the existing empirical evidence on the effect of the above interventions on ( i ) correction of poor posture and ( ii ) reduction in musculoskeletal pain . | 422 | 21,206,933 | The effect of magnification loupes on the performance of preclinical dental students. | OBJECTIVE optical magnifying devices such as magnification loupes are increasingly used in clinical practice and educational setting s. However , scientific evidence to vali date their benefits is limited . This study assessed the effect of dental magnification loupes on psychomotor skill acquisition during a pre clinical operative dentistry course . METHOD AND MATERIAL S the performance of first-year dental students was assessed during an Advanced Simulation Course ( AS ) using virtual reality-based technology ( VRBT ) training . The test group consisted of 116 dental students using magnification loupes ( + MAG ) , while students not using them ( -MAG , n = 116 ) served as the control . The following parameters were evaluated : number of successfully passing preparation procedures per course rotation , amount of time per tooth preparation , number of times students needed computer assistance and evaluation , and amount of time spent in the computer assistance and evaluation mode per procedure . Data were collected on each student through VRBT during the preparation procedure and stored on a closed network server computer . Unpaired t tests were used to analyze mean differences between the groups . In addition , student acceptance of magnification loupes was measured and evaluated through survey interpretation . RESULTS + MAG students completed more preparations , worked faster per procedure , and used the computer-assisted evaluation less frequently and for shorter periods , therefore displaying greater overall performance . The survey revealed a high degree of student acceptance of using magnification . CONCLUSION dental magnification loupes significantly enhanced student performance during pre clinical dental education and were considered an effective adjunct by the students who used them | 23 | CONCLUSIONS Based on a limited number of studies , the use of ergonomic saddle seats and dental loupes leads to improved working postures .
The use of loupes appears to relieve shoulder , arm and h and pain .
However , their effect on neck pain is scarce .
None of the studies reported on the effect of the saddle seats on musculoskeletal pain . | OBJECTIVES Musculoskeletal disorders affect a high percentage of dentists , dental hygienists and therapists .
Static and awkward working postures are considered as major risk factors .
Proper seat selection and use of magnification loupes are promoted for their ergonomic benefits .
The aim of this review was to evaluate the existing empirical evidence on the effect of the above interventions on ( i ) correction of poor posture and ( ii ) reduction in musculoskeletal pain . |
23 | 29,318,741 | CONCLUSIONS Based on a limited number of studies , the use of ergonomic saddle seats and dental loupes leads to improved working postures .
The use of loupes appears to relieve shoulder , arm and h and pain .
However , their effect on neck pain is scarce .
None of the studies reported on the effect of the saddle seats on musculoskeletal pain . | OBJECTIVES Musculoskeletal disorders affect a high percentage of dentists , dental hygienists and therapists .
Static and awkward working postures are considered as major risk factors .
Proper seat selection and use of magnification loupes are promoted for their ergonomic benefits .
The aim of this review was to evaluate the existing empirical evidence on the effect of the above interventions on ( i ) correction of poor posture and ( ii ) reduction in musculoskeletal pain . | 423 | 18,037,853 | Assessment of dental student posture in two seating conditions using RULA methodology – a pilot study | Objectives To assess dental students ' posture on two different seats in order to determine if one seat predisposes to a difference in working posture . Design A between-subject experimental design was selected . Setting The study was undertaken at the University of Birmingham School of Dentistry in 2006 . Subjects ( material s ) and methods Sixty second year dental students at the University of Birmingham who were attending their fi rst classes in the phantom head laboratory were r and omly selected and allocated to two different seats ( 30 Bambach Saddle Seats and 30 conventional seats ) . Students were trained in the use of the seats . After ten weeks , the students were observed , photographs were taken by the research er and these were assessed using Rapid Upper Limb Assessment ( RULA ) . Main outcome measures The posture of the students was assessed using the RULA . Each student was given a risk score . A Mann Whitney test was used for statistical analysis . Results The results indicated that the students using the conventional seat recorded signifi cantly higher risk scores ( p < 0.05 ) when compared with the students using Bambach Saddle Seat , suggesting an improvement in posture when using the Bambach Saddle Seat . Conclusion RULA has identifi ed that dental students using a Bambach Saddle Seat were able to maintain an acceptable working posture during simulated dental treatment and this seating may reduce the development of work-related musculoskeletal disorders | 23 | CONCLUSIONS Based on a limited number of studies , the use of ergonomic saddle seats and dental loupes leads to improved working postures .
The use of loupes appears to relieve shoulder , arm and h and pain .
However , their effect on neck pain is scarce .
None of the studies reported on the effect of the saddle seats on musculoskeletal pain . | OBJECTIVES Musculoskeletal disorders affect a high percentage of dentists , dental hygienists and therapists .
Static and awkward working postures are considered as major risk factors .
Proper seat selection and use of magnification loupes are promoted for their ergonomic benefits .
The aim of this review was to evaluate the existing empirical evidence on the effect of the above interventions on ( i ) correction of poor posture and ( ii ) reduction in musculoskeletal pain . |
23 | 29,318,741 | CONCLUSIONS Based on a limited number of studies , the use of ergonomic saddle seats and dental loupes leads to improved working postures .
The use of loupes appears to relieve shoulder , arm and h and pain .
However , their effect on neck pain is scarce .
None of the studies reported on the effect of the saddle seats on musculoskeletal pain . | OBJECTIVES Musculoskeletal disorders affect a high percentage of dentists , dental hygienists and therapists .
Static and awkward working postures are considered as major risk factors .
Proper seat selection and use of magnification loupes are promoted for their ergonomic benefits .
The aim of this review was to evaluate the existing empirical evidence on the effect of the above interventions on ( i ) correction of poor posture and ( ii ) reduction in musculoskeletal pain . | 424 | 20,698,919 | Assessment of study quality for systematic reviews: a comparison of the Cochrane Collaboration Risk of Bias Tool and the Effective Public Health Practice Project Quality Assessment Tool: methodological research. | BACKGROUND The Cochrane Collaboration is strongly encouraging the use of a newly developed tool , the Cochrane Collaboration Risk of Bias Tool ( CCRBT ) , for all review groups . However , the psychometric properties of this tool to date have yet to be described . Thus , the objective of this study was to add information about psychometric properties of the CCRBT including inter-rater reliability and concurrent validity , in comparison with the Effective Public Health Practice Project Quality Assessment Tool ( EPHPP ) . METHODS Both tools were used to assess the method ological quality of 20 r and omized controlled trials included in our systematic review of the effectiveness of knowledge translation interventions to improve the management of cancer pain . Each study assessment was completed independently by two review ers using each tool . We analysed the inter-rater reliability of each tool 's individual domains , as well as final grade assigned to each study . RESULTS The EPHPP had fair inter-rater agreement for individual domains and excellent agreement for the final grade . In contrast , the CCRBT had slight inter-rater agreement for individual domains and fair inter-rater agreement for final grade . Of interest , no agreement between the two tools was evident in their final grade assigned to each study . Although both tools were developed to assess ' quality of the evidence ' , they appear to measure different constructs . CONCLUSIONS Both tools performed quite differently when evaluating the risk of bias or method ological quality of studies in knowledge translation interventions for cancer pain . The newly introduced CCRBT assigned these studies a higher risk of bias . Its psychometric properties need to be more thoroughly vali date d , in a range of research fields , to underst and fully how to interpret results from its application | 23 | CONCLUSIONS Based on a limited number of studies , the use of ergonomic saddle seats and dental loupes leads to improved working postures .
The use of loupes appears to relieve shoulder , arm and h and pain .
However , their effect on neck pain is scarce .
None of the studies reported on the effect of the saddle seats on musculoskeletal pain . | OBJECTIVES Musculoskeletal disorders affect a high percentage of dentists , dental hygienists and therapists .
Static and awkward working postures are considered as major risk factors .
Proper seat selection and use of magnification loupes are promoted for their ergonomic benefits .
The aim of this review was to evaluate the existing empirical evidence on the effect of the above interventions on ( i ) correction of poor posture and ( ii ) reduction in musculoskeletal pain . |
23 | 29,318,741 | CONCLUSIONS Based on a limited number of studies , the use of ergonomic saddle seats and dental loupes leads to improved working postures .
The use of loupes appears to relieve shoulder , arm and h and pain .
However , their effect on neck pain is scarce .
None of the studies reported on the effect of the saddle seats on musculoskeletal pain . | OBJECTIVES Musculoskeletal disorders affect a high percentage of dentists , dental hygienists and therapists .
Static and awkward working postures are considered as major risk factors .
Proper seat selection and use of magnification loupes are promoted for their ergonomic benefits .
The aim of this review was to evaluate the existing empirical evidence on the effect of the above interventions on ( i ) correction of poor posture and ( ii ) reduction in musculoskeletal pain . | 425 | 15,038,640 | Effect of magnification lenses on student operator posture. | A distinct body of literature supports the association between clinical postures of the dental practitioner and work-related musculoskeletal disorders ( WRMD ) . Several aids or devices have been tested to improve clinical posture in the interest of decreasing WRMD . The use of magnification lenses while performing dental procedures may increase the quality of work and decrease the likelihood of musculoskeletal problems . To date , only anecdotal and personal opinions had existed regarding the benefits of using magnification lenses , and no empirical evidence had authenticated the contention that use of magnification lenses exerts a positive change in operator posture . The objective of this study was to assess the effect magnification lenses had on the posture of dental hygiene students . Using a r and omized crossover design , research ers videotaped nineteen senior dental hygiene students performing an intra-oral procedure with and without the use of magnification lenses . The tapes were then evaluated by a panel of five dental hygiene educators calibrated in the use of Branson 's Posture Assessment Instrument ( PAI ) . Results of a paired t-test indicate that the posture of the students while wearing magnification lenses was more acceptable ( p=.019 ) than when wearing traditional safety glasses . Results of this study indicate a quantifiable change in acceptability of posture for clinicians wearing magnification lenses and suggest that the use of such lenses in dental education may be warranted | 23 | CONCLUSIONS Based on a limited number of studies , the use of ergonomic saddle seats and dental loupes leads to improved working postures .
The use of loupes appears to relieve shoulder , arm and h and pain .
However , their effect on neck pain is scarce .
None of the studies reported on the effect of the saddle seats on musculoskeletal pain . | OBJECTIVES Musculoskeletal disorders affect a high percentage of dentists , dental hygienists and therapists .
Static and awkward working postures are considered as major risk factors .
Proper seat selection and use of magnification loupes are promoted for their ergonomic benefits .
The aim of this review was to evaluate the existing empirical evidence on the effect of the above interventions on ( i ) correction of poor posture and ( ii ) reduction in musculoskeletal pain . |
23 | 29,318,741 | CONCLUSIONS Based on a limited number of studies , the use of ergonomic saddle seats and dental loupes leads to improved working postures .
The use of loupes appears to relieve shoulder , arm and h and pain .
However , their effect on neck pain is scarce .
None of the studies reported on the effect of the saddle seats on musculoskeletal pain . | OBJECTIVES Musculoskeletal disorders affect a high percentage of dentists , dental hygienists and therapists .
Static and awkward working postures are considered as major risk factors .
Proper seat selection and use of magnification loupes are promoted for their ergonomic benefits .
The aim of this review was to evaluate the existing empirical evidence on the effect of the above interventions on ( i ) correction of poor posture and ( ii ) reduction in musculoskeletal pain . | 426 | 19,433,537 | Work-related musculoskeletal disorders among Brazilian dental students. | The aim of this analytical cross-sectional study was to evaluate the presence of work-related musculoskeletal disorders ( WMSD ) among dental students in two Brazilian dental schools . The sample included 227 r and omized subjects from fifth to ninth semesters who were developing clinical activities . Each student signed an informed consent form . A self-reporting question naire was used to obtain data on the practice of physical exercise , the presence of pain during or soon after treating patients , and the adoption of preventive measures related to clinical activities . Results were analyzed using the Statistical Package for Social Sciences 13.0 . The chi(2 ) test was used to identify associations between variables . The presence of pain during or after clinical work was reported by 173 participants ( 76.2 percent ) . Statistically significant differences were found between gender and the occurrence of pain . Pain was present during clinical activities ( p=0.006 ) and imposed limitations on the work routine ( p=0.011 ) . Among those who practice d physical exercise , eighty-eight ( 74.6 percent ) reported pain . The high percentage of pain reported by dental students suggests the value of review ing work conditions in dental practice s in order to minimize the exposure of all workers to WMSD | 23 | CONCLUSIONS Based on a limited number of studies , the use of ergonomic saddle seats and dental loupes leads to improved working postures .
The use of loupes appears to relieve shoulder , arm and h and pain .
However , their effect on neck pain is scarce .
None of the studies reported on the effect of the saddle seats on musculoskeletal pain . | OBJECTIVES Musculoskeletal disorders affect a high percentage of dentists , dental hygienists and therapists .
Static and awkward working postures are considered as major risk factors .
Proper seat selection and use of magnification loupes are promoted for their ergonomic benefits .
The aim of this review was to evaluate the existing empirical evidence on the effect of the above interventions on ( i ) correction of poor posture and ( ii ) reduction in musculoskeletal pain . |
24 | 23,236,190 | CONCLUSION Mud pack therapy is considered an alternative and effective therapy in the clinical management of knee OA . | OBJECTIVE The main objective of this study was to systematic ally review all the scientific studies that analyse the effectiveness of mud pack therapy on patients diagnosed with knee OA . | 427 | 12,182,234 | Both serum receptors of tumor necrosis factor are influenced by mud pack treatment in osteoarthrotic patients. | Several authors have demonstrated the pivotal role of proinflammatory cytokines in inducing progressive cartilage degradation and secondary inflammation of the synovial membrane in osteoarthritis ( OA ) . It has recently been established that tumor necrosis factor (TNF)-alpha plays a well-defined role in the pathophysiology of inflammatory joint diseases and that binding to circulating soluble TNF-alpha receptors can inactivate it . We investigated the influence of mud pack treatment , which is able to diminish TNF-alpha serum values , on specific TNF receptor ( sTNF-R ) levels . Thirty-six patients with OA were enrolled and r and omized into two groups . Group A underwent mud pack treatment and group B underwent thermal bath treatment . A group of 20 healthy untreated subjects was used as a control . Blood sample s were collected at baseline and after treatment , and assays of sTNF-R55 and sTNF-R75 were performed in both groups . We found small changes in sTNF-Rs serum values but these were not statistically significant . sTNF-R55 serum values decreased by 0.4 % after the therapy in group A , while in group B the decrease was -17.7 % . sTNF-R75 was reduced by -21.17 % in group A and by -10.6 % in group B. In conclusion , through its thermic and ant/inflammatory activity mud pack treatment shows complex interaction with the most common factors of inflammatory and cartilage degradation . Our results suggest that the thermic component of this natural treatment is mainly involved in modulating inflammatory reaction and cartilage damage through binding of the circulating TNF , which controls the activation of the cells responsible for the production of proinflammatory cytokines | 24 | CONCLUSION Mud pack therapy is considered an alternative and effective therapy in the clinical management of knee OA . | OBJECTIVE The main objective of this study was to systematic ally review all the scientific studies that analyse the effectiveness of mud pack therapy on patients diagnosed with knee OA . |
24 | 23,236,190 | CONCLUSION Mud pack therapy is considered an alternative and effective therapy in the clinical management of knee OA . | OBJECTIVE The main objective of this study was to systematic ally review all the scientific studies that analyse the effectiveness of mud pack therapy on patients diagnosed with knee OA . | 428 | 15,589,440 | Comparison of a generic and a disease specific quality of life scale to assess a comprehensive spa therapy program for knee osteoarthritis. | OBJECTIVES To compare the differences or correlation between the results obtained from a generic and a disease-specific instrument for the study group and to assess the short-term effects of spa therapy on quality of life of patients with knee osteoarthritis . PATIENTS AND METHODS Fifty patients with knee osteoarthritis were r and omly recruited . They underwent a comprehensive spa therapy program for 21 days . Forty-six patients completed the study . The results were evaluated with Medical Outcomes Study 36-Item Short Form-36 ( SF-36 ) and Arthritis Impact Measurement Scale 2 ( AIMS 2 ) . RESULTS Statistically significant improvement was observed in all subscales of SF-36 . All subscales of AIMS 2 improved too , but only half of them were significant . Correlation between matching subscales of each test was also significant , except physical activity . CONCLUSION Comprehensive spa therapy seems to increase the quality of life of patients with knee osteoarthritis for short term | 24 | CONCLUSION Mud pack therapy is considered an alternative and effective therapy in the clinical management of knee OA . | OBJECTIVE The main objective of this study was to systematic ally review all the scientific studies that analyse the effectiveness of mud pack therapy on patients diagnosed with knee OA . |
24 | 23,236,190 | CONCLUSION Mud pack therapy is considered an alternative and effective therapy in the clinical management of knee OA . | OBJECTIVE The main objective of this study was to systematic ally review all the scientific studies that analyse the effectiveness of mud pack therapy on patients diagnosed with knee OA . | 429 | 20,390,281 | A study on the efficacy of treatment with mud packs and baths with Sillene mineral water (Chianciano Spa Italy) in patients suffering from knee osteoarthritis | Mud-bath therapy plays a primary role in the treatment and prevention of osteoarthritis that has been recognised since antiquity . Numerous studies have demonstrated its clinical benefits and its effects on inflammatory mediators ( interleukins ) , the immune system , cenesthesic factors ( endorphins ) , and the diencephalic – pituitary – adrenal axis . This study was conducted to assess the efficacy of mud-bath therapy with mineral water from the Sillene Spring at Italy ’s Chianciano Spa in patients with osteoarthritis of the knee . Patients ( n = 61 ) were divided into two groups . Group A underwent three cycles of mud-based spa therapy over a year ’s time , whereas group B did not . Clinical conditions , visual analogue scale pain ratings , and Lequesne indexes of the two groups were compared . We also compared these same parameters in the patients of the two groups that were following the therapy with drugs and in the patients of the group A before and after spa treatment . The percentage of patients with no symptoms or mild symptoms was higher in group A than in group B. Within group A , this percentage was higher after treatment than before spa therapy . Even in the comparison between the patients of the two groups that were following the therapy with drug , the results was that in group A the percentage of patients with no symptoms or mild symptoms was higher than in group B. Statistical analyses based on various tests revealed that almost all these differences were highly significant . No adverse effects were observed in any of the patients in group A. In conclusion , the mud-bath therapy performed at Chianciano Spa with Sillene Spring water remarkably improved the clinical conditions of patients with knee arthritis and significantly reduces the frequency and severity of symptoms and the disability they cause | 24 | CONCLUSION Mud pack therapy is considered an alternative and effective therapy in the clinical management of knee OA . | OBJECTIVE The main objective of this study was to systematic ally review all the scientific studies that analyse the effectiveness of mud pack therapy on patients diagnosed with knee OA . |
24 | 23,236,190 | CONCLUSION Mud pack therapy is considered an alternative and effective therapy in the clinical management of knee OA . | OBJECTIVE The main objective of this study was to systematic ally review all the scientific studies that analyse the effectiveness of mud pack therapy on patients diagnosed with knee OA . | 430 | 17,041,359 | Therapy With Mud Compresses for Knee Osteoarthritis: Comparison of Natural Mud Preparations With Mineral-Depleted Mud | Mud pack therapy is an alternative mode of treatment for rheumatic diseases . It is based on the application of heated mud packs to the entire body or to specific areas , such as over joints . The aim of the current study was to evaluate the efficacy of treatment with mud compresses at patients ’ homes for osteoarthritis of the knee . Fifty-eight patients with osteoarthritis of the knee were enrolled in a prospect i ve , double-blinded , controlled study . Forty patients were treated with natural mineral-rich mud compresses and 18 patients were treated with mineral-depleted mud compresses . Mud compresses were applied 5 times each week during 3 weeks for a total of 15 treatments . Patients were assessed at baseline , at completion of the 3-week treatment period , and twice after the conclusion of the treatment period — after 1 month and after 3 months . The main outcome measures were the Lequesne Index of severity of knee osteoarthritis , patient self- assessment of pain , and severity of knee pain on a visual analog scale . A reduction of 20 % or more in the pain scores was considered clinical ly significant . In the group treated with natural mud compresses , a significant reduction in knee pain was observed at all assessment s. Similarly , improvement in the Lequesne Index was seen at the end of therapy and a month after treatment . In the control group , given mineral-depleted mud compresses , no significant change in knee pain was seen at any assessment . Improvement in the Lequesne Index was seen 1 and 3 months after completion of the therapy , but not at the end of therapy . Seventy-two percent of the patients in the treatment group had an improvement of > 20 % in self- assessment of knee pain , compared with 33 % in the control group ( p = 0.005).The data suggest that treatment with mud compresses , but only in their natural form , temporarily relieves pain in patients with osteoarthritis of the knees . We believe that treatment with mud compresses might augment conventional medical therapy in these patients | 24 | CONCLUSION Mud pack therapy is considered an alternative and effective therapy in the clinical management of knee OA . | OBJECTIVE The main objective of this study was to systematic ally review all the scientific studies that analyse the effectiveness of mud pack therapy on patients diagnosed with knee OA . |
24 | 23,236,190 | CONCLUSION Mud pack therapy is considered an alternative and effective therapy in the clinical management of knee OA . | OBJECTIVE The main objective of this study was to systematic ally review all the scientific studies that analyse the effectiveness of mud pack therapy on patients diagnosed with knee OA . | 431 | 2,927,613 | Spa therapy in the treatment of knee osteoarthritis: a large randomised multicentre trial | Objective To determine whether spa therapy , plus home exercises and usual medical treatment provides any benefit over exercises and usual treatment , in the management of knee osteoarthritis . Methods Large multicentre r and omised prospect i ve clinical trial of patients with knee osteoarthritis according to the American College of Rheumatology criteria , attending French spa resorts as out patients between June 2006 and April 2007 . Zelen r and omisation was used so patients were ignorant of the other group and spa personnel were not told which patients were participating . The main endpoint criteria were patient self-assessed . All patients continued usual treatments and performed daily st and ardised home exercises . The spa therapy group also received 18 days of spa therapy ( massages , showers , mud and pool sessions ) . Main Endpoint The number of patients achieving minimal clinical ly important improvement ( MCII ) at 6 months , defined as ≥19.9 mm on the visual analogue pain scale and /or ≥9.1 points in a normalised Western Ontario and McMaster Universities osteoarthritis index function score and no knee surgery . Results The intention to treat analysis included 187 controls and 195 spa therapy patients . At 6 months , 99/195 ( 50.8 % ) spa group patients had MCII and 68/187 ( 36.4 % ) controls ( χ2=8.05 ; df=1 ; p=0.005 ) . However , no improvement in quality of life ( Short Form 36 ) or patient acceptable symptom state was observed at 6 months . Conclusion For patients with knee osteoarthritis a 3-week course of spa therapy together with home exercises and usual pharmacological treatments offers benefit after 6 months compared with exercises and usual treatment alone , and is well tolerated . Trial registration number NCT00348777 | 24 | CONCLUSION Mud pack therapy is considered an alternative and effective therapy in the clinical management of knee OA . | OBJECTIVE The main objective of this study was to systematic ally review all the scientific studies that analyse the effectiveness of mud pack therapy on patients diagnosed with knee OA . |
24 | 23,236,190 | CONCLUSION Mud pack therapy is considered an alternative and effective therapy in the clinical management of knee OA . | OBJECTIVE The main objective of this study was to systematic ally review all the scientific studies that analyse the effectiveness of mud pack therapy on patients diagnosed with knee OA . | 432 | 21,573,819 | Efficacy of balneotherapy on pain, function and quality of life in patients with osteoarthritis of the knee | The aims of this study were to evaluate whether balneotherapy with mineral sulphate – bicarbonate – calcium water could determine substantial symptomatic improvement , and to detect any changes in the quality of life ( QoL ) of patients with symptomatic knee osteoarthritis ( OA ) . This was a prospect i ve r and omized , single blind controlled trial . Sixty out patients with primary bilateral knee OA , according to ACR criteria , were included in the study and r and omized to one of two groups : group I ( 30 patients ) was treated with a daily sulphate – bicarbonate – calcium mineral water bath ; group II ( 30 patients ) , the control group , continued their regular outpatient care routine . At baseline , after 15 days and after 12 weeks , patients were evaluated by Visual Analogue Scale ( VAS ) for spontaneous pain , Lequesne and Womac Index for gonarthrosis , SF-36 , Arthritis Impact Measurement Scale ( AIMS ) and symptomatic drugs consumption . We observed a significant improvement of all parameters at the end of the cycle of balneotherapy which persisted throughout the follow-up period , whereas in the control group no significant differences were noted . This symptomatic effect was confirmed by the significant reduction of symptomatic drugs consumption . The differences between the two groups were significant for all considered parameters already from the 15th day and persisted during follow-up . Tolerability of balneotherapy seemed to be good , with light and transitory side effects . Our results confirm that the beneficial effects of balneotherapy in patients with knee OA last over time , with positive effects on the painful symptomatology , a significant improvement on functional capacities and QoL. Balneotherapy can represent a useful backup to pharmacological treatment of knee OA or a valid alternative for patients who do not tolerate pharmacological treatments | 24 | CONCLUSION Mud pack therapy is considered an alternative and effective therapy in the clinical management of knee OA . | OBJECTIVE The main objective of this study was to systematic ally review all the scientific studies that analyse the effectiveness of mud pack therapy on patients diagnosed with knee OA . |
24 | 23,236,190 | CONCLUSION Mud pack therapy is considered an alternative and effective therapy in the clinical management of knee OA . | OBJECTIVE The main objective of this study was to systematic ally review all the scientific studies that analyse the effectiveness of mud pack therapy on patients diagnosed with knee OA . | 433 | 11,314,241 | Mud bath therapy influences nitric oxide, myeloperoxidase and glutathione peroxidase serum levels in arthritic patients. | Nitric oxide ( NO ) has recently been proposed as an important mediator in inflammatory phases and in loss of cartilage . In inflammatory arthritis NO levels are correlated with disease activity and articular cartilage is able to produce large amounts of NO with the appropriate inducing factors such as cytokines and /or endotoxin . Neutrophils also play an important role in inflammatory reactions and the level of myeloperoxidase , a constituent of neutrophil granules , is related to the intensity of the inflammation . Because there is evidence that suggests that mud packs influence the main cytokines involved in cartilage damage , we tried to determine whether NO and myeloperoxidase are involved in the mechanisms of action of mud bath treatment . We enrolled 37 subjects and r and omly assigned them to two groups : 19 patients underwent mud bath treatment ( group A ) while 18 patients underwent bath treatment alone . Blood sample s were obtained before and after the treatment cycles to assay serum levels of NO , myeloperoxidase ( MPO ) and glutathione (GSH)-peroxidase . The results showed a statistically significant decrease in NO and myeloperoxidase serum values in groups A and B , while GSH-peroxidase was not significantly increase in either of the groups ; no correlation was found between NO , myeloperoxidase and GSH-peroxidase serum values . Mud bath treatment can exert beneficial effects on cartilage homeostasis and inflammatory reactions , influencing NO and decreasing myeloperoxidase serum values . The increase in GSH-peroxidase was not correlated with the reduction of other biochemical markers , suggesting that mud bath treatment has different mechanisms of action | 24 | CONCLUSION Mud pack therapy is considered an alternative and effective therapy in the clinical management of knee OA . | OBJECTIVE The main objective of this study was to systematic ally review all the scientific studies that analyse the effectiveness of mud pack therapy on patients diagnosed with knee OA . |
24 | 23,236,190 | CONCLUSION Mud pack therapy is considered an alternative and effective therapy in the clinical management of knee OA . | OBJECTIVE The main objective of this study was to systematic ally review all the scientific studies that analyse the effectiveness of mud pack therapy on patients diagnosed with knee OA . | 434 | 17,106,661 | Therapeutic effect of spa therapy and short wave therapy in knee osteoarthritis: a randomized, single blind, controlled trial | Spa therapy and short wave therapy are two of the most commonly used non-pharmacological approaches for osteoarthritis . The aim of this study was to assess their efficacy in comparison to conventional therapy in patients with osteoarthritis of the knee in a single blind , r and omized , controlled trial . Seventy-four out patients were enrolled ; 30 patients were treated with a combination of daily local mud packs and arsenical ferruginous mineral bath water from the thermal resort of Levico Terme ( Trento , Italy ) for 3 weeks ; 24 patients were treated with short wave therapy for the same period and 20 patients continued regular , routine ambulatory care . Patients were assessed at baseline , upon completion of the 3-week treatment period , and 12 weeks later . Spa therapy and short wave therapy both demonstrated effective symptomatic treatment in osteoarthritis of the knee at the end of the treatment , but only the spa therapy was shown to have efficacy persistent over time . Our study demonstrated the superiority of arsenical ferruginous spa therapy compared to short wave therapy in the treatment of osteoarthritis of the knee , probably in relationship to the specific effects of the minerals in this water | 24 | CONCLUSION Mud pack therapy is considered an alternative and effective therapy in the clinical management of knee OA . | OBJECTIVE The main objective of this study was to systematic ally review all the scientific studies that analyse the effectiveness of mud pack therapy on patients diagnosed with knee OA . |
24 | 23,236,190 | CONCLUSION Mud pack therapy is considered an alternative and effective therapy in the clinical management of knee OA . | OBJECTIVE The main objective of this study was to systematic ally review all the scientific studies that analyse the effectiveness of mud pack therapy on patients diagnosed with knee OA . | 435 | 15,517,930 | [Therapeutic efficacy of peloid plasters in the treatment of osteoarthritis of the peripheral joints and spondylosis]. | The objective of the study was to investigate the efficacy and tolerability of the peloid plasters in the group of 20 patients with osteoarthritis of peripheral joints ( 10 patients with gonarthrosis and 10 with omarthrosis ) and 20 patients with spondylosis . This form of the pelotherapy decreased pain in joints after 10 days of the treatment . No allergic or other side effects were observed . Peloid plasters through the analgesic action improve the comfort of life and reduce the use of oral analgesic drugs | 24 | CONCLUSION Mud pack therapy is considered an alternative and effective therapy in the clinical management of knee OA . | OBJECTIVE The main objective of this study was to systematic ally review all the scientific studies that analyse the effectiveness of mud pack therapy on patients diagnosed with knee OA . |
24 | 23,236,190 | CONCLUSION Mud pack therapy is considered an alternative and effective therapy in the clinical management of knee OA . | OBJECTIVE The main objective of this study was to systematic ally review all the scientific studies that analyse the effectiveness of mud pack therapy on patients diagnosed with knee OA . | 436 | 9,495,574 | Mud pack therapy in osteoarthrosis. Changes in serum levels of chondrocyte markers. | We have previously shown that thermal mud therapy is able to influence chondrocyte activity of osteoarthrosic patients by modulating the production of serum cytokines , such as interleukin 1 , and this was related to the presence of an anti-inflammatory principle in mature thermal mud . Mud therapy influences many biochemical processes of the body , independently of the thermic stimulation alone and the present paper documents specific increases of insulin growth factor 1 and decreases of tumor necrosis factor alpha in serum of osteoarthrosic patients after 12 days of mud pack application | 24 | CONCLUSION Mud pack therapy is considered an alternative and effective therapy in the clinical management of knee OA . | OBJECTIVE The main objective of this study was to systematic ally review all the scientific studies that analyse the effectiveness of mud pack therapy on patients diagnosed with knee OA . |
24 | 23,236,190 | CONCLUSION Mud pack therapy is considered an alternative and effective therapy in the clinical management of knee OA . | OBJECTIVE The main objective of this study was to systematic ally review all the scientific studies that analyse the effectiveness of mud pack therapy on patients diagnosed with knee OA . | 437 | 17,223,602 | The efficacy of balneotherapy and mud-pack therapy in patients with knee osteoarthritis. | OBJECTIVES Knee osteoarthritis ( OA ) is a common chronic degenerative disorder . There are various treatment modalities . This study was planned to investigate the efficacy of balneotherapy , mud-pack therapy in patients with knee OA . METHODS A total of 80 patients with knee OA were included . Their ages ranged between 39 - 78 . The patients were separated in to three groups . Group I ( n=25 ) received balneotherapy , group II ( n=29 ) received mud-pack therapy and group III ( n=26 ) was hot-pack therapy group . The therapies were applied for 20 min duration , once a day , five times per week and a total of 10 session . Patients were assessed according to pain , functional capacity and quality of life parameters . Pain was assessed by using Visual Analogue Scale ( VAS ) and Western Ontario McMaster Osteoarthritis Index ( WOMAC ) pain scale ( 0 - 4 likert scale ) . Functional capacity was assessed by using WOMAC functional capacity and WOMAC global index . Quality of life was evaluated by Nottingham Health Profile ( NHP ) self-administered question naire . Also physician 's global assessment and the maximum distance that patient can walk without pain , were evaluated . The assessment parameters were evaluated before and after three months . RESULTS There were statistically significant improvement in VAS and WOMAC pain scores in group I ( p<0.001 ) , group II and III ( p<0.05 ) . The WOMAC functional and global index also decreased in group I ( p<0.05 ) , group II ( p<0.001 ) and hot-pack group ( p<0.05 ) . Quality of life results were significantly improved in balneotherapy and mud-pack therapy groups ( p<0.05 ) . No difference was observed in hot-pack therapy group ( p>0.05 ) . The maximum distance was improved both in group I and II ( p<0.05 ) but not in group III . Also physician 's global assessment was found to be improved in all groups ( p<0.05 ) . CONCLUSIONS Balneotherapy and mud-pack therapy were effective in treating patients with knee OA | 24 | CONCLUSION Mud pack therapy is considered an alternative and effective therapy in the clinical management of knee OA . | OBJECTIVE The main objective of this study was to systematic ally review all the scientific studies that analyse the effectiveness of mud pack therapy on patients diagnosed with knee OA . |
24 | 23,236,190 | CONCLUSION Mud pack therapy is considered an alternative and effective therapy in the clinical management of knee OA . | OBJECTIVE The main objective of this study was to systematic ally review all the scientific studies that analyse the effectiveness of mud pack therapy on patients diagnosed with knee OA . | 438 | 9,526,176 | Cytokine levels in osteoarthrosis patients undergoing mud bath therapy. | Osteoarthritis is an important rheumatic condition characterized by the progressive destruction of cartilage . The pathophysiologic phenomena leading to the pathologic changes in the joint appear to result from biomechanical factors and activation of final common pathways of tissue damage influencing chondrocyte homeostasis and a functional program . Several cytokines and growth factors are reported to be responsible for inflammation and cartilage degradation . Among these , IL-1 and TNF alpha have been suggested as important in promoting cartilage inflammation and tissue destruction , while IGF I has a protective influence on cartilage structure . Chondrocytes and their metabolism have gained interest as targets of drug intervention ; the results of this study confirm that mud bath therapy is also able to influence chondrocyte activities . Our data suggest that mud bath therapy influences cytokines related to osteoarthrosis pathomechanism and maintenance , and encourage further investigations to evaluate possible synergism between pharmacological treatment and mud bath therapy | 24 | CONCLUSION Mud pack therapy is considered an alternative and effective therapy in the clinical management of knee OA . | OBJECTIVE The main objective of this study was to systematic ally review all the scientific studies that analyse the effectiveness of mud pack therapy on patients diagnosed with knee OA . |
24 | 23,236,190 | CONCLUSION Mud pack therapy is considered an alternative and effective therapy in the clinical management of knee OA . | OBJECTIVE The main objective of this study was to systematic ally review all the scientific studies that analyse the effectiveness of mud pack therapy on patients diagnosed with knee OA . | 439 | 19,884,812 | Short- and Long-Term Effects of Spa Therapy in Knee Osteoarthritis | Fioravanti A , Iacoponi F , Bellisai B , Cantarini L , Galeazzi M : Short- and long-term effects of spa therapy in knee osteoarthritis . Objective : To assess both the short- and long-term effectiveness of spa therapy in patients with primary knee osteoarthritis in a prospect i ve , r and omized , single-blinded , controlled trial . Design : Eighty out patients were enrolled in this study ; 40 patients were treated with a combination of daily local mud packs and bicarbonate-sulfate mineral bath water from the spa center of Rapolano Terme ( Siena , Italy ) for 2 wks , and 40 patients continued regular , routine ambulatory care . Patients were assessed at baseline time ; after 2 wks ; after 3 , 6 , and 9 mos after the beginning of the study and were evaluated by Visual Analog Scale for spontaneous pain , Lequesne index , Western Ontario and McMaster Universities Index for gonarthrosis , Arthritis Impact Measurement Scale-1 , and symptomatic drug consumption . Results : We observed a significant improvement of all evaluated parameters at the end of the cycle of spa therapy , which persisted throughout the whole of the follow-up period , whereas in the control group no significant differences were noted . This symptomatic effect was confirmed by the significant reduction of symptomatic drug consumption . Tolerability of spa therapy seemed to be good , with light and transitory side effects . Conclusions : The results from our study confirm that the beneficial effects of spa therapy in patients with knee osteoarthritis lasts over time , with positive effects on the painful symptomatology and a significant improvement on functional capacities . Spa therapy can represent a useful backup to pharmacologic treatment of knee osteoarthritis or a valid alternative for patients who do not tolerate pharmacologic treatments | 24 | CONCLUSION Mud pack therapy is considered an alternative and effective therapy in the clinical management of knee OA . | OBJECTIVE The main objective of this study was to systematic ally review all the scientific studies that analyse the effectiveness of mud pack therapy on patients diagnosed with knee OA . |
25 | 22,575,611 | Findings were inconclusive for lamotrigine and carbamazepine although overall lamotrigine may have a beneficial but modest effect .
Negative results were found for levetiracetam and gabapentin but the evidence base on these agents is scant .
All anticonvulsants were generally well tolerated .
No double-blind RCTs were found for the use of other anticonvulsants such as oxcarbazepine , licarbazepine , zonisamide , retigabine , pregabalin , tiagabine , felbamate and vigabatrine in the acute treatment of bipolar depression .
To sum up , taking into consideration the efficacy and tolerability profiles of anticonvulsants , current evidence supports the use of divalproex and lamotrigine in the treatment of acute bipolar depression . | Despite the high morbidity and mortality associated with bipolar depression , the optimal treatment for this phase is still a matter of debate .
The aim of the current review was to provide up date d evidence about the efficacy and tolerability of anticonvulsants in the treatment of acute bipolar depression . | 440 | 11,106,131 | A placebo-controlled study of lamotrigine and gabapentin monotherapy in refractory mood disorders. | There is a pressing need for additional treatment options for refractory mood disorders . This controlled comparative study evaluated the efficacy of lamotrigine ( LTG ) and gabapentin ( GBP ) monotherapy versus placebo ( PLC ) . Thirty-one patients with refractory bipolar and unipolar mood disorders participated in a double-blind , r and omized , crossover series of three 6-week monotherapy evaluations including LTG , GBP , and PLC . There was a st and ardized blinded titration to assess clinical efficacy or to determine the maximum tolerated daily dose ( LTG 500 mg or GBP 4,800 mg ) . The primary outcome measure was the Clinical Global Impressions Scale ( CGI ) for Bipolar Illness as supplemented by other st and ard rating instruments . The mean doses at week 6 were 274 + /- 128 mg for LTG and 3,987 + /- 856 mg for GBP . Response rates ( CGI ratings of much or very much improved ) were the following : LTG , 52 % ( 16/31 ) ; GBP , 26 % ( 8/31 ) ; and PLC , 23 % ( 7/31 ) ( Cochran 's Q = 6.952 , df = 2 , N = 31 , p = 0.031 ) . Post hoc Q differences ( df = 1 , N = 31 ) were the following : LTG versus GBP ( Qdiff = 5.33 , p = 0.011 ) ; LTG versus PLC ( Qdiff = 4.76 , p = 0.022 ) ; and GBP versus PLC ( Qdiff = 0.08 , p = 0.70 ) . With respect to anticonvulsant dose and gender , there was no difference between the responders and the nonresponders . The agents were generally well tolerated . This controlled investigation preliminarily suggests the efficacy of LTG in treatment-refractory affectively ill patients . Further definition of responsive subtypes and the role of these medications in the treatment of mood disorders requires additional study | 25 | Findings were inconclusive for lamotrigine and carbamazepine although overall lamotrigine may have a beneficial but modest effect .
Negative results were found for levetiracetam and gabapentin but the evidence base on these agents is scant .
All anticonvulsants were generally well tolerated .
No double-blind RCTs were found for the use of other anticonvulsants such as oxcarbazepine , licarbazepine , zonisamide , retigabine , pregabalin , tiagabine , felbamate and vigabatrine in the acute treatment of bipolar depression .
To sum up , taking into consideration the efficacy and tolerability profiles of anticonvulsants , current evidence supports the use of divalproex and lamotrigine in the treatment of acute bipolar depression . | Despite the high morbidity and mortality associated with bipolar depression , the optimal treatment for this phase is still a matter of debate .
The aim of the current review was to provide up date d evidence about the efficacy and tolerability of anticonvulsants in the treatment of acute bipolar depression . |
25 | 22,575,611 | Findings were inconclusive for lamotrigine and carbamazepine although overall lamotrigine may have a beneficial but modest effect .
Negative results were found for levetiracetam and gabapentin but the evidence base on these agents is scant .
All anticonvulsants were generally well tolerated .
No double-blind RCTs were found for the use of other anticonvulsants such as oxcarbazepine , licarbazepine , zonisamide , retigabine , pregabalin , tiagabine , felbamate and vigabatrine in the acute treatment of bipolar depression .
To sum up , taking into consideration the efficacy and tolerability profiles of anticonvulsants , current evidence supports the use of divalproex and lamotrigine in the treatment of acute bipolar depression . | Despite the high morbidity and mortality associated with bipolar depression , the optimal treatment for this phase is still a matter of debate .
The aim of the current review was to provide up date d evidence about the efficacy and tolerability of anticonvulsants in the treatment of acute bipolar depression . | 441 | 18,162,014 | Divalproex in the treatment of acute bipolar depression: a preliminary double-blind, randomized, placebo-controlled pilot study. | OBJECTIVE To determine the efficacy of divalproex ( extended release ) in the treatment of acute nonrefractory bipolar depression . METHOD In a stratified , double-blind , r and omized , placebo-controlled trial , 18 acutely depressed bipolar out patients ( DSM-IV criteria ) received either divalproex monotherapy ( target dose level , 70 - 90 ng/dL ) ( N = 9 ) or placebo ( N = 9 ) for 6 weeks . Patients were recruited between January 2004 and May 2005 . Clinical assessment on the Montgomery-Asberg Depression Rating Scale ( MADRS ) determined primary efficacy . RESULTS The divalproex treatment group showed significantly greater reduction in MADRS scores compared to placebo ( group x time interaction , p = .0078 ) . Absolute effect size of estimated MADRS total score reduction over time was 13.6 points with divalproex versus 1.4 points with placebo ( p = .003 , linear growth curve model ) . St and ardized effect size was large ( Cohen d = 0.81 ) . MADRS item analyses demonstrated improvement in core mood symptoms more than in anxiety or insomnia symptoms . There was also a modest but significant association between MADRS and Mania Rating Scale scores in the divalproex group ( r = 0.29 , df = 51 , p = .03 ) , but not in the placebo group ( r = -0.15 , df = 35 , p = .36 ) . CONCLUSIONS Divalproex appeared to be an effective treatment for acute nonrefractory bipolar depression , which is consistent with previous small r and omized studies . Some evidence of benefit in the depressive mixed state was observed . Confirmation or refutation with larger r and omized clinical trials is warranted . CLINICAL TRIAL REGISTRATION Clinical Trials.gov identifier NCT00226343 | 25 | Findings were inconclusive for lamotrigine and carbamazepine although overall lamotrigine may have a beneficial but modest effect .
Negative results were found for levetiracetam and gabapentin but the evidence base on these agents is scant .
All anticonvulsants were generally well tolerated .
No double-blind RCTs were found for the use of other anticonvulsants such as oxcarbazepine , licarbazepine , zonisamide , retigabine , pregabalin , tiagabine , felbamate and vigabatrine in the acute treatment of bipolar depression .
To sum up , taking into consideration the efficacy and tolerability profiles of anticonvulsants , current evidence supports the use of divalproex and lamotrigine in the treatment of acute bipolar depression . | Despite the high morbidity and mortality associated with bipolar depression , the optimal treatment for this phase is still a matter of debate .
The aim of the current review was to provide up date d evidence about the efficacy and tolerability of anticonvulsants in the treatment of acute bipolar depression . |
25 | 22,575,611 | Findings were inconclusive for lamotrigine and carbamazepine although overall lamotrigine may have a beneficial but modest effect .
Negative results were found for levetiracetam and gabapentin but the evidence base on these agents is scant .
All anticonvulsants were generally well tolerated .
No double-blind RCTs were found for the use of other anticonvulsants such as oxcarbazepine , licarbazepine , zonisamide , retigabine , pregabalin , tiagabine , felbamate and vigabatrine in the acute treatment of bipolar depression .
To sum up , taking into consideration the efficacy and tolerability profiles of anticonvulsants , current evidence supports the use of divalproex and lamotrigine in the treatment of acute bipolar depression . | Despite the high morbidity and mortality associated with bipolar depression , the optimal treatment for this phase is still a matter of debate .
The aim of the current review was to provide up date d evidence about the efficacy and tolerability of anticonvulsants in the treatment of acute bipolar depression . | 442 | 12,044,195 | The long-term natural history of the weekly symptomatic status of bipolar I disorder. | BACKGROUND To our knowledge , this is the first prospect i ve natural history study of weekly symptomatic status of patients with bipolar I disorder ( BP-I ) during long-term follow-up . METHODS Analyses are based on ongoing prospect i ve follow-up of 146 patients with Research Diagnostic Criteria BP-I , who entered the National Institute of Mental Health ( Bethesda , Md ) Collaborative Depression Study from 1978 through 1981 . Weekly affective symptom status ratings were analyzed by polarity and severity , ranging from asymptomatic , to subthreshold levels , to full-blown major depression and mania . Percentages of follow-up weeks at each level as well as number of shifts in symptom status and polarity during the entire follow-up period were examined . Finally , 2 new measures of chronicity were evaluated in relation to previously identified predictors of chronicity for BP-I. RESULTS Patients with BP-I were symptomatically ill 47.3 % of weeks throughout a mean of 12.8 years of follow-up . Depressive symptoms ( 31.9 % of total follow-up weeks ) predominated over manic/hypomanic symptoms ( 8.9 % of weeks ) or cycling/mixed symptoms ( 5.9 % of weeks ) . Subsyndromal , minor depressive , and hypomanic symptoms combined were nearly 3 times more frequent than syndromal-level major depressive and manic symptoms ( 29.9 % vs 11.2 % of weeks , respectively ) . Patients with BP-I changed symptom status an average of 6 times per year and polarity more than 3 times per year . Longer intake episodes and those with depression-only or cycling polarity predicted greater chronicity during long-term follow-up , as did comorbid drug-use disorder . CONCLUSIONS The longitudinal weekly symptomatic course of BP-I is chronic . Overall , the symptomatic structure is primarily depressive rather than manic , and subsyndromal and minor affective symptoms predominate . Symptom severity levels fluctuate , often within the same patient over time . Bipolar I disorder is expressed as a dimensional illness featuring the full range ( spectrum ) of affective symptom severity and polarity | 25 | Findings were inconclusive for lamotrigine and carbamazepine although overall lamotrigine may have a beneficial but modest effect .
Negative results were found for levetiracetam and gabapentin but the evidence base on these agents is scant .
All anticonvulsants were generally well tolerated .
No double-blind RCTs were found for the use of other anticonvulsants such as oxcarbazepine , licarbazepine , zonisamide , retigabine , pregabalin , tiagabine , felbamate and vigabatrine in the acute treatment of bipolar depression .
To sum up , taking into consideration the efficacy and tolerability profiles of anticonvulsants , current evidence supports the use of divalproex and lamotrigine in the treatment of acute bipolar depression . | Despite the high morbidity and mortality associated with bipolar depression , the optimal treatment for this phase is still a matter of debate .
The aim of the current review was to provide up date d evidence about the efficacy and tolerability of anticonvulsants in the treatment of acute bipolar depression . |
25 | 22,575,611 | Findings were inconclusive for lamotrigine and carbamazepine although overall lamotrigine may have a beneficial but modest effect .
Negative results were found for levetiracetam and gabapentin but the evidence base on these agents is scant .
All anticonvulsants were generally well tolerated .
No double-blind RCTs were found for the use of other anticonvulsants such as oxcarbazepine , licarbazepine , zonisamide , retigabine , pregabalin , tiagabine , felbamate and vigabatrine in the acute treatment of bipolar depression .
To sum up , taking into consideration the efficacy and tolerability profiles of anticonvulsants , current evidence supports the use of divalproex and lamotrigine in the treatment of acute bipolar depression . | Despite the high morbidity and mortality associated with bipolar depression , the optimal treatment for this phase is still a matter of debate .
The aim of the current review was to provide up date d evidence about the efficacy and tolerability of anticonvulsants in the treatment of acute bipolar depression . | 443 | 12,695,317 | A placebo-controlled 18-month trial of lamotrigine and lithium maintenance treatment in recently manic or hypomanic patients with bipolar I disorder. | BACKGROUND Lamotrigine has been shown to be an effective treatment for bipolar depression and rapid cycling in placebo-controlled clinical trials . This double-blind , placebo-controlled study was conducted to assess the efficacy and tolerability of lamotrigine and lithium compared with placebo for the prevention of relapse or recurrence of mood episodes in recently manic or hypomanic patients with bipolar I disorder . METHODS After an 8- to 16-week open-label phase during which treatment with lamotrigine was initiated and other psychotropic drug regimens were discontinued , patients were r and omized to lamotrigine ( 100 - 400 mg daily ) , lithium ( 0.8 - 1.1 mEq/L ) , or placebo as double-blind maintenance treatment for as long as 18 months . RESULTS Of 349 patients who met screening criteria and entered the open-label phase , 175 met stabilization criteria and were r and omized to double-blind maintenance treatment ( lamotrigine , 59 patients ; lithium , 46 patients ; and placebo , 70 patients ) . Both lamotrigine and lithium were superior to placebo at prolonging the time to intervention for any mood episode ( lamotrigine vs placebo , P = .02 ; lithium vs placebo , P = .006 ) . Lamotrigine was superior to placebo at prolonging the time to a depressive episode ( P = .02 ) . Lithium was superior to placebo at prolonging the time to a manic , hypomanic , or mixed episode ( P = .006 ) . The most common adverse event reported for lamotrigine was headache . CONCLUSIONS Both lamotrigine and lithium were superior to placebo for the prevention of relapse or recurrence of mood episodes in patients with bipolar I disorder who had recently experienced a manic or hypomanic episode . The results indicate that lamotrigine is an effective , well-tolerated maintenance treatment for bipolar disorder , particularly for prophylaxis of depression | 25 | Findings were inconclusive for lamotrigine and carbamazepine although overall lamotrigine may have a beneficial but modest effect .
Negative results were found for levetiracetam and gabapentin but the evidence base on these agents is scant .
All anticonvulsants were generally well tolerated .
No double-blind RCTs were found for the use of other anticonvulsants such as oxcarbazepine , licarbazepine , zonisamide , retigabine , pregabalin , tiagabine , felbamate and vigabatrine in the acute treatment of bipolar depression .
To sum up , taking into consideration the efficacy and tolerability profiles of anticonvulsants , current evidence supports the use of divalproex and lamotrigine in the treatment of acute bipolar depression . | Despite the high morbidity and mortality associated with bipolar depression , the optimal treatment for this phase is still a matter of debate .
The aim of the current review was to provide up date d evidence about the efficacy and tolerability of anticonvulsants in the treatment of acute bipolar depression . |
25 | 22,575,611 | Findings were inconclusive for lamotrigine and carbamazepine although overall lamotrigine may have a beneficial but modest effect .
Negative results were found for levetiracetam and gabapentin but the evidence base on these agents is scant .
All anticonvulsants were generally well tolerated .
No double-blind RCTs were found for the use of other anticonvulsants such as oxcarbazepine , licarbazepine , zonisamide , retigabine , pregabalin , tiagabine , felbamate and vigabatrine in the acute treatment of bipolar depression .
To sum up , taking into consideration the efficacy and tolerability profiles of anticonvulsants , current evidence supports the use of divalproex and lamotrigine in the treatment of acute bipolar depression . | Despite the high morbidity and mortality associated with bipolar depression , the optimal treatment for this phase is still a matter of debate .
The aim of the current review was to provide up date d evidence about the efficacy and tolerability of anticonvulsants in the treatment of acute bipolar depression . | 444 | 16,449,473 | Treatment-resistant bipolar depression: a STEP-BD equipoise randomized effectiveness trial of antidepressant augmentation with lamotrigine, inositol, or risperidone. | OBJECTIVE Clinicians have few evidence -based options for the management of treatment-resistant bipolar depression . This study represents the first r and omized trial of competing options for treatment-resistant bipolar depression and assesses the effectiveness and safety of antidepressant augmentation with lamotrigine , inositol , and risperidone . METHOD Participants ( N=66 ) were patients with bipolar I or bipolar II disorder enrolled in the NIMH Systematic Treatment Enhancement Program for Bipolar Disorder ( STEP-BD ) . All patients were in a current major depressive episode that was nonresponsive to a combination of adequate doses of established mood stabilizers plus at least one antidepressant . Patients were r and omly assigned to open-label adjunctive treatment with lamotrigine , inositol , or risperidone for up to 16 weeks . The primary outcome measure was the rate of recovery , defined as no more than two symptoms meeting DSM-IV threshold criteria for a mood episode and no significant symptoms present for 8 weeks . RESULTS No significant between-group differences were seen when any pair of treatments were compared on the primary outcome measure . However , the recovery rate with lamotrigine was 23.8 % , whereas the recovery rates with inositol and risperidone were 17.4 % and 4.6 % , respectively . Patients receiving lamotrigine had lower depression ratings and Clinical Global Impression severity scores as well as greater Global Assessment of Functioning scores compared with those receiving inositol and risperidone . CONCLUSIONS No differences were found in primary pairwise comparison analyses of open-label augmentation with lamotrigine , inositol , or risperidone . Post hoc secondary analyses suggest that lamotrigine may be superior to inositol and risperidone in improving treatment-resistant bipolar depression | 25 | Findings were inconclusive for lamotrigine and carbamazepine although overall lamotrigine may have a beneficial but modest effect .
Negative results were found for levetiracetam and gabapentin but the evidence base on these agents is scant .
All anticonvulsants were generally well tolerated .
No double-blind RCTs were found for the use of other anticonvulsants such as oxcarbazepine , licarbazepine , zonisamide , retigabine , pregabalin , tiagabine , felbamate and vigabatrine in the acute treatment of bipolar depression .
To sum up , taking into consideration the efficacy and tolerability profiles of anticonvulsants , current evidence supports the use of divalproex and lamotrigine in the treatment of acute bipolar depression . | Despite the high morbidity and mortality associated with bipolar depression , the optimal treatment for this phase is still a matter of debate .
The aim of the current review was to provide up date d evidence about the efficacy and tolerability of anticonvulsants in the treatment of acute bipolar depression . |
25 | 22,575,611 | Findings were inconclusive for lamotrigine and carbamazepine although overall lamotrigine may have a beneficial but modest effect .
Negative results were found for levetiracetam and gabapentin but the evidence base on these agents is scant .
All anticonvulsants were generally well tolerated .
No double-blind RCTs were found for the use of other anticonvulsants such as oxcarbazepine , licarbazepine , zonisamide , retigabine , pregabalin , tiagabine , felbamate and vigabatrine in the acute treatment of bipolar depression .
To sum up , taking into consideration the efficacy and tolerability profiles of anticonvulsants , current evidence supports the use of divalproex and lamotrigine in the treatment of acute bipolar depression . | Despite the high morbidity and mortality associated with bipolar depression , the optimal treatment for this phase is still a matter of debate .
The aim of the current review was to provide up date d evidence about the efficacy and tolerability of anticonvulsants in the treatment of acute bipolar depression . | 445 | 17,139,035 | Influence of sub-syndromal symptoms after remission from manic or mixed episodes. | BACKGROUND Sub-syndromal symptoms in bipolar disorder impair functioning and diminish quality of life . AIMS To examine factors associated with time spent with sub-syndromal symptoms and to characterise how these symptoms influence outcomes . METHOD In a double-blind r and omised maintenance trial , patients received either olanzapine or lithium monotherapy for 1 year . Stepwise logistic regression models were used to identify factors that were significant predictors of percentage time spent with sub-syndromal symptoms . The presence of sub-syndromal symptoms during the first 8 weeks was examined as a predictor of subsequent relapse . RESULTS Presence of sub-syndromal depressive symptoms during the first 8 weeks significantly increased the likelihood of depressive relapse ( relative risk 4.67 , P<0.001 ) . Patients with psychotic features and those with a greater number of previous depressive episodes were more likely to experience sub-syndromal depressive symptoms ( RR=2.51 , P<0.001 and RR=2.35 , P=0.03 respectively ) . CONCLUSIONS These findings help to identify patients at increased risk of affective relapse and suggest that appropriate therapeutic interventions should be considered even when syndromal-level symptoms are absent | 25 | Findings were inconclusive for lamotrigine and carbamazepine although overall lamotrigine may have a beneficial but modest effect .
Negative results were found for levetiracetam and gabapentin but the evidence base on these agents is scant .
All anticonvulsants were generally well tolerated .
No double-blind RCTs were found for the use of other anticonvulsants such as oxcarbazepine , licarbazepine , zonisamide , retigabine , pregabalin , tiagabine , felbamate and vigabatrine in the acute treatment of bipolar depression .
To sum up , taking into consideration the efficacy and tolerability profiles of anticonvulsants , current evidence supports the use of divalproex and lamotrigine in the treatment of acute bipolar depression . | Despite the high morbidity and mortality associated with bipolar depression , the optimal treatment for this phase is still a matter of debate .
The aim of the current review was to provide up date d evidence about the efficacy and tolerability of anticonvulsants in the treatment of acute bipolar depression . |
25 | 22,575,611 | Findings were inconclusive for lamotrigine and carbamazepine although overall lamotrigine may have a beneficial but modest effect .
Negative results were found for levetiracetam and gabapentin but the evidence base on these agents is scant .
All anticonvulsants were generally well tolerated .
No double-blind RCTs were found for the use of other anticonvulsants such as oxcarbazepine , licarbazepine , zonisamide , retigabine , pregabalin , tiagabine , felbamate and vigabatrine in the acute treatment of bipolar depression .
To sum up , taking into consideration the efficacy and tolerability profiles of anticonvulsants , current evidence supports the use of divalproex and lamotrigine in the treatment of acute bipolar depression . | Despite the high morbidity and mortality associated with bipolar depression , the optimal treatment for this phase is still a matter of debate .
The aim of the current review was to provide up date d evidence about the efficacy and tolerability of anticonvulsants in the treatment of acute bipolar depression . | 446 | 7,386,656 | Carbamazepine in manic-depressive illness: a new treatment. | The authors evaluated carbamazepine ( Tegretol ) , a drug of choice for treatment of temporal lobe epilepsy , in a double-blind placebo-controlled trial in patients with manic-depressive illness . Seven of 9 manic patients had a partial to marked response ; several also showed relapses when placebo was substituted and improvement when carbamazepine was reinstituted . Five of 13 depressed patients showed significant improvement in depression ratings ; 3 additional patients experienced partial relapse when placebo was substituted . Carbamazepine might also have prophylactic as well as acute efficacy in patients with both phases of manic-depressive illness , including some patients who do not respond to lithium . Therapeutic effects were achieved with 600 - 1600 mg/day at blood levels of 8 - 12 microgram/ml with relatively few side effects . Carbamazepine may prove to be a useful additional treatment for affective illness | 25 | Findings were inconclusive for lamotrigine and carbamazepine although overall lamotrigine may have a beneficial but modest effect .
Negative results were found for levetiracetam and gabapentin but the evidence base on these agents is scant .
All anticonvulsants were generally well tolerated .
No double-blind RCTs were found for the use of other anticonvulsants such as oxcarbazepine , licarbazepine , zonisamide , retigabine , pregabalin , tiagabine , felbamate and vigabatrine in the acute treatment of bipolar depression .
To sum up , taking into consideration the efficacy and tolerability profiles of anticonvulsants , current evidence supports the use of divalproex and lamotrigine in the treatment of acute bipolar depression . | Despite the high morbidity and mortality associated with bipolar depression , the optimal treatment for this phase is still a matter of debate .
The aim of the current review was to provide up date d evidence about the efficacy and tolerability of anticonvulsants in the treatment of acute bipolar depression . |
25 | 22,575,611 | Findings were inconclusive for lamotrigine and carbamazepine although overall lamotrigine may have a beneficial but modest effect .
Negative results were found for levetiracetam and gabapentin but the evidence base on these agents is scant .
All anticonvulsants were generally well tolerated .
No double-blind RCTs were found for the use of other anticonvulsants such as oxcarbazepine , licarbazepine , zonisamide , retigabine , pregabalin , tiagabine , felbamate and vigabatrine in the acute treatment of bipolar depression .
To sum up , taking into consideration the efficacy and tolerability profiles of anticonvulsants , current evidence supports the use of divalproex and lamotrigine in the treatment of acute bipolar depression . | Despite the high morbidity and mortality associated with bipolar depression , the optimal treatment for this phase is still a matter of debate .
The aim of the current review was to provide up date d evidence about the efficacy and tolerability of anticonvulsants in the treatment of acute bipolar depression . | 447 | 16,889,444 | A 7-week, randomized, double-blind trial of olanzapine/fluoxetine combination versus lamotrigine in the treatment of bipolar I depression. | OBJECTIVE Determine the efficacy and tolerability of olanzapine/fluoxetine combination ( OFC ) for treatment of acute bipolar I depression compared with lamotrigine . METHOD The 7-week , acute phase of a r and omized , double-blind study compared OFC ( 6/25 , 6/50 , 12/25 , or 12/50 mg/day ; N = 205 ) with lamotrigine ( [ LMG ] titrated to 200 mg/day ; N = 205 ) in patients with DSM-IV-diagnosed bipolar I disorder , depressed . The study was conducted from November 2003 to August 2004 . RESULTS Completion rates were similar between treatments ( OFC , 66.8 % vs. LMG , 65.4 % ; p = .835 ) . OFC-treated patients had significantly greater improvement than lamotrigine-treated patients in change from baseline across the 7-week treatment period on the Clinical Global Impressions-Severity of Illness scale ( primary outcome ) ( p = .002 , effect size = 0.26 ) , Montgomery-Asberg Depression Rating Scale ( MADRS ) ( p = .002 , effect size = 0.24 ) , and Young Mania Rating Scale total scores ( p = .001 , effect size = 0.24 ) . Response rates did not significantly differ between groups when defined as > or = 50 % reduction in MADRS score ( OFC , 68.8 % vs. LMG , 59.7 % ; p = .073 ) . Time to response was significantly shorter for OFC-treated patients ( median days [ 95 % CI ] = OFC , 17 [ 14 to 22 ] vs. LMG , 23 [ 21 to 34 ] ; p = .010 ) . There was a significant difference in incidence of " suicidal and self-injurious behavior " adverse events ( OFC , 0.5 % vs. LMG , 3.4 % ; p = .037 ) . Somnolence , increased appetite , dry mouth , sedation , weight gain , and tremor occurred more frequently ( p < .05 ) in OFC-treated patients than lamotrigine-treated patients . Weight , total cholesterol , and triglyceride levels were significantly elevated in OFC-treated patients compared with lamotrigine-treated patients ( all p < or = .001 ) . CONCLUSIONS Patients with acute bipolar I depression had statistically significantly greater improvement in depressive and manic symptoms , more treatment-emergent adverse events , greater weight gain , and some elevated metabolic factors with OFC than lamotrigine . Treatment differences were of modest size | 25 | Findings were inconclusive for lamotrigine and carbamazepine although overall lamotrigine may have a beneficial but modest effect .
Negative results were found for levetiracetam and gabapentin but the evidence base on these agents is scant .
All anticonvulsants were generally well tolerated .
No double-blind RCTs were found for the use of other anticonvulsants such as oxcarbazepine , licarbazepine , zonisamide , retigabine , pregabalin , tiagabine , felbamate and vigabatrine in the acute treatment of bipolar depression .
To sum up , taking into consideration the efficacy and tolerability profiles of anticonvulsants , current evidence supports the use of divalproex and lamotrigine in the treatment of acute bipolar depression . | Despite the high morbidity and mortality associated with bipolar depression , the optimal treatment for this phase is still a matter of debate .
The aim of the current review was to provide up date d evidence about the efficacy and tolerability of anticonvulsants in the treatment of acute bipolar depression . |
25 | 22,575,611 | Findings were inconclusive for lamotrigine and carbamazepine although overall lamotrigine may have a beneficial but modest effect .
Negative results were found for levetiracetam and gabapentin but the evidence base on these agents is scant .
All anticonvulsants were generally well tolerated .
No double-blind RCTs were found for the use of other anticonvulsants such as oxcarbazepine , licarbazepine , zonisamide , retigabine , pregabalin , tiagabine , felbamate and vigabatrine in the acute treatment of bipolar depression .
To sum up , taking into consideration the efficacy and tolerability profiles of anticonvulsants , current evidence supports the use of divalproex and lamotrigine in the treatment of acute bipolar depression . | Despite the high morbidity and mortality associated with bipolar depression , the optimal treatment for this phase is still a matter of debate .
The aim of the current review was to provide up date d evidence about the efficacy and tolerability of anticonvulsants in the treatment of acute bipolar depression . | 448 | 12,180,276 | Topiramate versus bupropion SR when added to mood stabilizer therapy for the depressive phase of bipolar disorder: a preliminary single-blind study. | OBJECTIVE Antiepileptic drugs ( AEDs ) are commonly employed in the treatment of bipolar disorder . The efficacy and tolerability of topiramate , a novel anticonvulsant , and bupropion SR when added to mood stabilizer therapy were compared under single-blind conditions ( rater-blinded ) in patients meeting DSM-IV criteria for bipolar I/II depression . METHODS A total of 36 out- patients with Hamilton Depression Rating Scale ( HDRS-17 ) scores > or = 16 were r and omized to receive escalating doses of either topiramate ( 50 - 300 mg/day ) or bupropion SR ( 100 - 400 mg/day ) for 8 weeks . Data were analyzed on an intent-to-treat basis using the last observation carried forward method . RESULTS The percentage of patients meeting a priori response criteria ( > or = 50 % decrease from baseline in mean HDRS-17 total score ) was significant for both topiramate ( 56 % ) and bupropion SR ( 59 % ) [ t(17 ) = 2.542 , p = 0.04 and t(17 ) = 2.661 , p = 0.03 , respectively ] . Baseline demographic and clinical parameters were comparable between the two treatment groups . The mean doses of study medication were 176 mg/day ( SD = 102 mg/day ) for the topiramate-treated group and 250 mg/day ( SD = 133 mg/day ) for the bupropion SR-treated group . A significant and comparable reduction in depressive symptoms was observed from baseline to endpoint following topiramate and bupropion SR treatment , according to a > or = 50 % reduction in the HDRS-17 . Total mean HDRS-17 scores significantly decreased from baseline to endpoint in both groups ( p = 0.001 ) , however , differences between the topiramate-treated group and the bupropion SR-treated group were not significant [ t(36 ) = 1.754 , p = 0.097 ] . Both topiramate and bupropion SR were generally well tolerated . Thirteen patients discontinued the study : 2 because of lack of efficacy , 1 due to withdrawal of consent and 10 following side-effects ( six in the topiramate and four in the bupropion SR-treated group ) . There were no cases of affective switch in either arm . Weight loss was experienced by patients in both groups ( mean weight loss at endpoint was 1.2 kg in bupropion SR and 5.8 kg in topiramate ) [ t(17 ) = 2.325 , p = 0.061 and t(17 ) = 2.481 , p = 0.043 , respectively ] . CONCLUSIONS These preliminary data suggest that adjunctive topiramate may reduce depressive symptom severity in acute bipolar depression . The antidepressant efficacy of this compound requires confirmation via double-blind placebo controlled investigation | 25 | Findings were inconclusive for lamotrigine and carbamazepine although overall lamotrigine may have a beneficial but modest effect .
Negative results were found for levetiracetam and gabapentin but the evidence base on these agents is scant .
All anticonvulsants were generally well tolerated .
No double-blind RCTs were found for the use of other anticonvulsants such as oxcarbazepine , licarbazepine , zonisamide , retigabine , pregabalin , tiagabine , felbamate and vigabatrine in the acute treatment of bipolar depression .
To sum up , taking into consideration the efficacy and tolerability profiles of anticonvulsants , current evidence supports the use of divalproex and lamotrigine in the treatment of acute bipolar depression . | Despite the high morbidity and mortality associated with bipolar depression , the optimal treatment for this phase is still a matter of debate .
The aim of the current review was to provide up date d evidence about the efficacy and tolerability of anticonvulsants in the treatment of acute bipolar depression . |
25 | 22,575,611 | Findings were inconclusive for lamotrigine and carbamazepine although overall lamotrigine may have a beneficial but modest effect .
Negative results were found for levetiracetam and gabapentin but the evidence base on these agents is scant .
All anticonvulsants were generally well tolerated .
No double-blind RCTs were found for the use of other anticonvulsants such as oxcarbazepine , licarbazepine , zonisamide , retigabine , pregabalin , tiagabine , felbamate and vigabatrine in the acute treatment of bipolar depression .
To sum up , taking into consideration the efficacy and tolerability profiles of anticonvulsants , current evidence supports the use of divalproex and lamotrigine in the treatment of acute bipolar depression . | Despite the high morbidity and mortality associated with bipolar depression , the optimal treatment for this phase is still a matter of debate .
The aim of the current review was to provide up date d evidence about the efficacy and tolerability of anticonvulsants in the treatment of acute bipolar depression . | 449 | 16,081,106 | Adjunctive herbal medicine with carbamazepine for bipolar disorders: A double-blind, randomized, placebo-controlled study. | Chinese herbal medicines possess the therapeutic potential for mood disorders . This double-blind , r and omized , placebo-controlled study was design ed to evaluate the efficacy and side effects of the herbal medicine called Free and Easy W and erer Plus ( FEWP ) as an adjunct to carbamazepine ( CBZ ) in patients with bipolar disorders . One hundred and twenty-four bipolar depressed and 111 manic patients were r and omized to treatment with CBZ alone , CBZ plus FEWP , or equivalent placebo for 12 weeks . CBZ was initiated at 300mg/day and FEWP was given at a fixed dose of 36g/day . Efficacy measures included the Hamilton Rating Scale for Depression , Montgomery-Asberg Depression Rating Scale , Young Mania Rating Scale , Bech-Rafaelsen Mania Scale , and Clinical Global Impression-Severity ( CGI-S ) . CBZ monotherapy produced significantly greater improvement on manic measures at week 2 through endpoint and CGI-S of depression at endpoint compared to placebo . CBZ monotherapy also yielded significantly higher clinical response rates than placebo on bipolar depression ( 63.8 % vs. 34.8 % , p=0.044 ) and mania ( 87.8 % vs. 57.1 % , p=0.012 ) . Compared to CBZ monotherapy , adjunctive FEWP with CBZ result ed in significantly better outcomes on the three measures of depression at week 4 and week 8 and significantly greater clinical response rate in depressed subjects ( 84.8 % vs. 63.8 % , p=0.032 ) , but failed to produce significantly greater improvement on manic measures and the response rate in manic subjects . There was a lesser incidence of dizziness and fatigue in the combination therapy compared to CBZ monotherapy . These results suggest that adjunctive FEWP has additive beneficial effects in bipolar patients , particularly for those in depressive phase | 25 | Findings were inconclusive for lamotrigine and carbamazepine although overall lamotrigine may have a beneficial but modest effect .
Negative results were found for levetiracetam and gabapentin but the evidence base on these agents is scant .
All anticonvulsants were generally well tolerated .
No double-blind RCTs were found for the use of other anticonvulsants such as oxcarbazepine , licarbazepine , zonisamide , retigabine , pregabalin , tiagabine , felbamate and vigabatrine in the acute treatment of bipolar depression .
To sum up , taking into consideration the efficacy and tolerability profiles of anticonvulsants , current evidence supports the use of divalproex and lamotrigine in the treatment of acute bipolar depression . | Despite the high morbidity and mortality associated with bipolar depression , the optimal treatment for this phase is still a matter of debate .
The aim of the current review was to provide up date d evidence about the efficacy and tolerability of anticonvulsants in the treatment of acute bipolar depression . |
25 | 22,575,611 | Findings were inconclusive for lamotrigine and carbamazepine although overall lamotrigine may have a beneficial but modest effect .
Negative results were found for levetiracetam and gabapentin but the evidence base on these agents is scant .
All anticonvulsants were generally well tolerated .
No double-blind RCTs were found for the use of other anticonvulsants such as oxcarbazepine , licarbazepine , zonisamide , retigabine , pregabalin , tiagabine , felbamate and vigabatrine in the acute treatment of bipolar depression .
To sum up , taking into consideration the efficacy and tolerability profiles of anticonvulsants , current evidence supports the use of divalproex and lamotrigine in the treatment of acute bipolar depression . | Despite the high morbidity and mortality associated with bipolar depression , the optimal treatment for this phase is still a matter of debate .
The aim of the current review was to provide up date d evidence about the efficacy and tolerability of anticonvulsants in the treatment of acute bipolar depression . | 450 | 12,622,659 | A prospective investigation of the natural history of the long-term weekly symptomatic status of bipolar II disorder. | BACKGROUND This is the first prospect i ve longitudinal study , to our knowledge , of the natural history of the weekly symptomatic status of bipolar II disorder ( BP-II ) . METHODS Weekly affective symptom status ratings for 86 patients with BP-II were based on interviews conducted at 6- or 12-month intervals during a mean of 13.4 years of prospect i ve follow-up . Percentage of weeks at each symptom severity level and the number of shifts in symptom status and polarity were examined . Predictors of chronicity for BP-II were evaluated using new chronicity measures . Chronicity was also analyzed in relation to the percentage of follow-up weeks with different types of somatic treatment . RESULTS Patients with BP-II were symptomatic 53.9 % of all follow-up weeks : depressive symptoms ( 50.3 % of weeks ) dominated the course over hypomanic ( 1.3 % of weeks ) and cycling/mixed ( 2.3 % of weeks ) symptoms . Subsyndromal , minor depressive , and hypomanic symptoms combined were 3 times more common than major depressive symptoms . Longer intake episodes , a family history of affective disorders , and poor previous social functioning predicted greater chronicity . Prescribed somatic treatment did not correlate significantly with symptom chronicity . Patients with BP-II of brief ( 2 - 6 days ) vs longer ( > or = 7 days ) hypomanias were not significantly different on any measure . CONCLUSIONS The longitudinal symptomatic course of BP-II is chronic and is dominated by depressive rather than hypomanic or cycling/mixed symptoms . Symptom severity fluctuates frequently within the same patient over time , involving primarily symptoms of minor and subsyndromal severity . Longitudinally , BP-II is expressed as a dimensional illness involving the full severity range of depressive and hypomanic symptoms . Hypomania of long or short duration in BP-II seems to be part of the same disease process | 25 | Findings were inconclusive for lamotrigine and carbamazepine although overall lamotrigine may have a beneficial but modest effect .
Negative results were found for levetiracetam and gabapentin but the evidence base on these agents is scant .
All anticonvulsants were generally well tolerated .
No double-blind RCTs were found for the use of other anticonvulsants such as oxcarbazepine , licarbazepine , zonisamide , retigabine , pregabalin , tiagabine , felbamate and vigabatrine in the acute treatment of bipolar depression .
To sum up , taking into consideration the efficacy and tolerability profiles of anticonvulsants , current evidence supports the use of divalproex and lamotrigine in the treatment of acute bipolar depression . | Despite the high morbidity and mortality associated with bipolar depression , the optimal treatment for this phase is still a matter of debate .
The aim of the current review was to provide up date d evidence about the efficacy and tolerability of anticonvulsants in the treatment of acute bipolar depression . |
25 | 22,575,611 | Findings were inconclusive for lamotrigine and carbamazepine although overall lamotrigine may have a beneficial but modest effect .
Negative results were found for levetiracetam and gabapentin but the evidence base on these agents is scant .
All anticonvulsants were generally well tolerated .
No double-blind RCTs were found for the use of other anticonvulsants such as oxcarbazepine , licarbazepine , zonisamide , retigabine , pregabalin , tiagabine , felbamate and vigabatrine in the acute treatment of bipolar depression .
To sum up , taking into consideration the efficacy and tolerability profiles of anticonvulsants , current evidence supports the use of divalproex and lamotrigine in the treatment of acute bipolar depression . | Despite the high morbidity and mortality associated with bipolar depression , the optimal treatment for this phase is still a matter of debate .
The aim of the current review was to provide up date d evidence about the efficacy and tolerability of anticonvulsants in the treatment of acute bipolar depression . | 451 | 10,807,488 | A randomized, placebo-controlled 12-month trial of divalproex and lithium in treatment of outpatients with bipolar I disorder. Divalproex Maintenance Study Group. | BACKGROUND Long-term outcomes are often poor in patients with bipolar disorder despite treatment ; more effective treatments are needed to reduce recurrences and morbidity . This study compared the efficacy of divalproex , lithium , and placebo as prophylactic therapy . METHODS A r and omized , double-blind , parallel-group multicenter study of treatment outcomes was conducted over a 52-week maintenance period . Patients who met the recovery criteria within 3 months of the onset of an index manic episode ( n = 372 ) were r and omized to maintenance treatment with divalproex , lithium , or placebo in a 2:1:1 ratio . Psychotropic medications were discontinued before r and omization , except for open-label divalproex or lithium , which were gradually tapered over the first 2 weeks of maintenance treatment . The primary outcome measure was time to recurrence of any mood episode . Secondary measures were time to a manic episode , time to a depressive episode , average change from baseline in Schedule for Affective Disorders and Schizophrenia-Change Version subscale scores for depression and mania , and Global Assessment of Function scores . RESULTS The divalproex group did not differ significantly from the placebo group in time to any mood episode . Divalproex was superior to placebo in terms of lower rates of discontinuation for either a recurrent mood episode or depressive episode . Divalproex was superior to lithium in longer duration of successful prophylaxis in the study and less deterioration in depressive symptoms and Global Assessment Scale scores . CONCLUSIONS The treatments did not differ significantly on time to recurrence of any mood episode during maintenance therapy . Patients treated with divalproex had better outcomes than those treated with placebo or lithium on several secondary outcome measures | 25 | Findings were inconclusive for lamotrigine and carbamazepine although overall lamotrigine may have a beneficial but modest effect .
Negative results were found for levetiracetam and gabapentin but the evidence base on these agents is scant .
All anticonvulsants were generally well tolerated .
No double-blind RCTs were found for the use of other anticonvulsants such as oxcarbazepine , licarbazepine , zonisamide , retigabine , pregabalin , tiagabine , felbamate and vigabatrine in the acute treatment of bipolar depression .
To sum up , taking into consideration the efficacy and tolerability profiles of anticonvulsants , current evidence supports the use of divalproex and lamotrigine in the treatment of acute bipolar depression . | Despite the high morbidity and mortality associated with bipolar depression , the optimal treatment for this phase is still a matter of debate .
The aim of the current review was to provide up date d evidence about the efficacy and tolerability of anticonvulsants in the treatment of acute bipolar depression . |
25 | 22,575,611 | Findings were inconclusive for lamotrigine and carbamazepine although overall lamotrigine may have a beneficial but modest effect .
Negative results were found for levetiracetam and gabapentin but the evidence base on these agents is scant .
All anticonvulsants were generally well tolerated .
No double-blind RCTs were found for the use of other anticonvulsants such as oxcarbazepine , licarbazepine , zonisamide , retigabine , pregabalin , tiagabine , felbamate and vigabatrine in the acute treatment of bipolar depression .
To sum up , taking into consideration the efficacy and tolerability profiles of anticonvulsants , current evidence supports the use of divalproex and lamotrigine in the treatment of acute bipolar depression . | Despite the high morbidity and mortality associated with bipolar depression , the optimal treatment for this phase is still a matter of debate .
The aim of the current review was to provide up date d evidence about the efficacy and tolerability of anticonvulsants in the treatment of acute bipolar depression . | 452 | 21,034,692 | Levetiracetam in the management of bipolar depression: a randomized, double-blind, placebo-controlled trial. | OBJECTIVE To study the efficacy of adjunctive levetiracetam therapy compared with placebo in the treatment of subjects with depression with bipolar disorder . METHOD This double-blind , placebo-controlled clinical trial r and omly assigned out patients with bipolar disorder type I and type II who were experiencing a major depressive episode ( Structured Clinical Interview for DSM-IV Axis I Disorders-Clinician Version criteria ) to treatment with either placebo or adjunctive levetiracetam ( up to 2,500 mg/d flexibly dosed ) for 6 weeks . The subjects were recruited from October 2005 to June 2008 . The primary efficacy measure was mean change from baseline to week 6 in the Hamilton Depression Rating Scale ( 21-item ) . Secondary efficacy assessment s included the Montgomery-Åsberg Depression Rating Scale , the Beck Depression Inventory , the Clinical Global Impressions-Bipolar Version scale , the Hamilton Anxiety Rating Scale , and the Young Mania Rating Scale . RESULTS Of 42 subjects r and omly assigned to placebo or drug , 32 received at least 1 postbaseline assessment and thus were included in the analysis . The mean ( SD ) levetiracetam daily dose at endpoint evaluation was 1,132 ( 425 ) mg/d . There was no significant difference in the mean change from baseline to week 6 in the Hamilton Depression Rating Scale scores for levetiracetam compared with placebo . There were no significant differences in any of the secondary outcome measures . CONCLUSIONS Levetiracetam adjunctive therapy was not superior to placebo in the short-term treatment of subjects with depression with bipolar disorder in the population studied . TRIAL REGISTRATION Clinical trials.gov Identifier : NCT00566150 | 25 | Findings were inconclusive for lamotrigine and carbamazepine although overall lamotrigine may have a beneficial but modest effect .
Negative results were found for levetiracetam and gabapentin but the evidence base on these agents is scant .
All anticonvulsants were generally well tolerated .
No double-blind RCTs were found for the use of other anticonvulsants such as oxcarbazepine , licarbazepine , zonisamide , retigabine , pregabalin , tiagabine , felbamate and vigabatrine in the acute treatment of bipolar depression .
To sum up , taking into consideration the efficacy and tolerability profiles of anticonvulsants , current evidence supports the use of divalproex and lamotrigine in the treatment of acute bipolar depression . | Despite the high morbidity and mortality associated with bipolar depression , the optimal treatment for this phase is still a matter of debate .
The aim of the current review was to provide up date d evidence about the efficacy and tolerability of anticonvulsants in the treatment of acute bipolar depression . |
25 | 22,575,611 | Findings were inconclusive for lamotrigine and carbamazepine although overall lamotrigine may have a beneficial but modest effect .
Negative results were found for levetiracetam and gabapentin but the evidence base on these agents is scant .
All anticonvulsants were generally well tolerated .
No double-blind RCTs were found for the use of other anticonvulsants such as oxcarbazepine , licarbazepine , zonisamide , retigabine , pregabalin , tiagabine , felbamate and vigabatrine in the acute treatment of bipolar depression .
To sum up , taking into consideration the efficacy and tolerability profiles of anticonvulsants , current evidence supports the use of divalproex and lamotrigine in the treatment of acute bipolar depression . | Despite the high morbidity and mortality associated with bipolar depression , the optimal treatment for this phase is still a matter of debate .
The aim of the current review was to provide up date d evidence about the efficacy and tolerability of anticonvulsants in the treatment of acute bipolar depression . | 453 | 21,052,983 | Number needed to treat analyses of drugs used for maintenance treatment of bipolar disorder | Rationale Due to the episodic and chronic nature of bipolar disorder ( BD ) , maintenance therapy represents a critical part of treatment ; however , there is a paucity of studies comparing effectiveness of available long-term treatments . Objective The aim of this study is to determine and compare the efficacy of pharmacological treatments for maintenance treatment of BD by means of the number needed to treat ( NNT ) . Methods The efficacy of drugs used for maintenance treatment of BD , as emerging from the results of r and omized controlled trials , was assessed using the size effect measure of NNT . PubMed search es were conducted on English- language articles published until May 2010 using the search terms “ bipolar disorder , ” “ mania , ” “ mixed episode , ” or “ bipolar depression , ” cross-referenced with trial characteristic search phrases and generic names of medications . The search was supplemented by manually review ing reference lists from identified publications . Results In 15 studies , aripiprazole , olanzapine , quetiapine , risperidone long-acting injection , lithium , lamotrigine , and divalproex proved effectiveness in terms of NNTs ( ≥10 % advantage over placebo ) for prevention of relapse into any mood episode . Quetiapine , lithium , risperidone long-acting injection , aripiprazole , and olanzapine are effective in manic recurrence prevention . Lamotrigine , quetiapine , and lithium present significant NNTs for prevention of depressive relapses . Conclusions All of the pharmacological agents assessed were effective in the prevention of any kind of mood episode ; however , different efficacy profiles were found for prevention of manic and /or depressive relapses . The comparison of NNT values of the available agents may represent a useful tool in clinical setting s , in order to facilitate implementation of long-term pharmacological interventions in patients with BD | 25 | Findings were inconclusive for lamotrigine and carbamazepine although overall lamotrigine may have a beneficial but modest effect .
Negative results were found for levetiracetam and gabapentin but the evidence base on these agents is scant .
All anticonvulsants were generally well tolerated .
No double-blind RCTs were found for the use of other anticonvulsants such as oxcarbazepine , licarbazepine , zonisamide , retigabine , pregabalin , tiagabine , felbamate and vigabatrine in the acute treatment of bipolar depression .
To sum up , taking into consideration the efficacy and tolerability profiles of anticonvulsants , current evidence supports the use of divalproex and lamotrigine in the treatment of acute bipolar depression . | Despite the high morbidity and mortality associated with bipolar depression , the optimal treatment for this phase is still a matter of debate .
The aim of the current review was to provide up date d evidence about the efficacy and tolerability of anticonvulsants in the treatment of acute bipolar depression . |
25 | 22,575,611 | Findings were inconclusive for lamotrigine and carbamazepine although overall lamotrigine may have a beneficial but modest effect .
Negative results were found for levetiracetam and gabapentin but the evidence base on these agents is scant .
All anticonvulsants were generally well tolerated .
No double-blind RCTs were found for the use of other anticonvulsants such as oxcarbazepine , licarbazepine , zonisamide , retigabine , pregabalin , tiagabine , felbamate and vigabatrine in the acute treatment of bipolar depression .
To sum up , taking into consideration the efficacy and tolerability profiles of anticonvulsants , current evidence supports the use of divalproex and lamotrigine in the treatment of acute bipolar depression . | Despite the high morbidity and mortality associated with bipolar depression , the optimal treatment for this phase is still a matter of debate .
The aim of the current review was to provide up date d evidence about the efficacy and tolerability of anticonvulsants in the treatment of acute bipolar depression . | 454 | 16,449,474 | Predictors of recurrence in bipolar disorder: primary outcomes from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). | OBJECTIVE Little is known about clinical features associated with the risk of recurrence in patients with bipolar disorder receiving treatment according to contemporary practice guidelines . The authors looked for the features associated with risk of recurrence . METHOD The authors examined prospect i ve data from a cohort of patients with bipolar disorder participating in the multicenter Systematic Treatment Enhancement Program for Bipolar Disorder ( STEP-BD ) study for up to 24 months . For those who were symptomatic at study entry but subsequently achieved recovery , time to recurrence of mania , hypomania , mixed state , or a depressive episode was examined with Cox regression . RESULTS Of 1,469 participants symptomatic at study entry , 858 ( 58.4 % ) subsequently achieved recovery . During up to 2 years of follow-up , 416 ( 48.5 % ) of these individuals experienced recurrences , with more than twice as many developing depressive episodes ( 298 , 34.7 % ) as those who developed manic , hypomanic , or mixed episodes ( 118 , 13.8 % ) . The time until 25 % of the individuals experienced a depressive episode was 21.4 weeks and until 25 % experienced a manic/hypomanic/mixed episode was 85.0 weeks . Residual depressive or manic symptoms at recovery and proportion of days depressed or anxious in the preceding year were significantly associated with shorter time to depressive recurrence . Residual manic symptoms at recovery and proportion of days of elevated mood in the preceding year were significantly associated with shorter time to manic , hypomanic , or mixed episode recurrence . CONCLUSIONS Recurrence was frequent and associated with the presence of residual mood symptoms at initial recovery . Targeting residual symptoms in maintenance treatment may represent an opportunity to reduce risk of recurrence | 25 | Findings were inconclusive for lamotrigine and carbamazepine although overall lamotrigine may have a beneficial but modest effect .
Negative results were found for levetiracetam and gabapentin but the evidence base on these agents is scant .
All anticonvulsants were generally well tolerated .
No double-blind RCTs were found for the use of other anticonvulsants such as oxcarbazepine , licarbazepine , zonisamide , retigabine , pregabalin , tiagabine , felbamate and vigabatrine in the acute treatment of bipolar depression .
To sum up , taking into consideration the efficacy and tolerability profiles of anticonvulsants , current evidence supports the use of divalproex and lamotrigine in the treatment of acute bipolar depression . | Despite the high morbidity and mortality associated with bipolar depression , the optimal treatment for this phase is still a matter of debate .
The aim of the current review was to provide up date d evidence about the efficacy and tolerability of anticonvulsants in the treatment of acute bipolar depression . |
25 | 22,575,611 | Findings were inconclusive for lamotrigine and carbamazepine although overall lamotrigine may have a beneficial but modest effect .
Negative results were found for levetiracetam and gabapentin but the evidence base on these agents is scant .
All anticonvulsants were generally well tolerated .
No double-blind RCTs were found for the use of other anticonvulsants such as oxcarbazepine , licarbazepine , zonisamide , retigabine , pregabalin , tiagabine , felbamate and vigabatrine in the acute treatment of bipolar depression .
To sum up , taking into consideration the efficacy and tolerability profiles of anticonvulsants , current evidence supports the use of divalproex and lamotrigine in the treatment of acute bipolar depression . | Despite the high morbidity and mortality associated with bipolar depression , the optimal treatment for this phase is still a matter of debate .
The aim of the current review was to provide up date d evidence about the efficacy and tolerability of anticonvulsants in the treatment of acute bipolar depression . | 455 | 12,784,116 | Maintenance Efficacy of Divalproex in the Prevention of Bipolar Depression | Breakthrough depression is a common problem in the treatment of bipolar disorder . Only one , recently published , double-blind , placebo-controlled trial has examined the efficacy of divalproex in the prevention of depressive episodes in bipolar patients . This report describes , in further detail , the findings from that trial of the effect of divalproex on multiple dimensions of depressive morbidity in bipolar disorder . A r and omized , double-blind , parallel-group , multicenter study was conducted over a 52-week maintenance period . Bipolar I patients , who may have been treated with open-label lithium or divalproex and who met recovery criteria within 3 months of onset of an index manic episode , were r and omized to maintenance treatment with divalproex , lithium , or placebo in a 2 : 1 : 1 ratio . Adjunctive paroxetine or sertraline for breakthrough depression was allowed in maintenance phase . Outcome measures were the rate of early discontinuation for depression , time to depressive relapse , proportion of patients with depressive relapse , mean change in Depressive Syndrome Scale score , proportion of patients receiving antidepressants , and time in the study . Among patients taking an antidepressant , a higher percentage of patients on placebo than divalproex discontinued early for depression . Patients who were previously hospitalized for affective episodes or took divalproex in the open period relapsed later on divalproex than on lithium during the maintenance period . Divalproex-treated patients had less worsening of depressive symptoms than lithium-treated patients during maintenance . Indices of severity of pre study illness course predicted worse outcome in all treatment groups . Divalproex improved several dimensions of depressive morbidity and reduced the probability of depressive relapse in bipolar disorder , particularly in patients who had responded to divalproex when manic , and among patients with a more severe course of illness | 25 | Findings were inconclusive for lamotrigine and carbamazepine although overall lamotrigine may have a beneficial but modest effect .
Negative results were found for levetiracetam and gabapentin but the evidence base on these agents is scant .
All anticonvulsants were generally well tolerated .
No double-blind RCTs were found for the use of other anticonvulsants such as oxcarbazepine , licarbazepine , zonisamide , retigabine , pregabalin , tiagabine , felbamate and vigabatrine in the acute treatment of bipolar depression .
To sum up , taking into consideration the efficacy and tolerability profiles of anticonvulsants , current evidence supports the use of divalproex and lamotrigine in the treatment of acute bipolar depression . | Despite the high morbidity and mortality associated with bipolar depression , the optimal treatment for this phase is still a matter of debate .
The aim of the current review was to provide up date d evidence about the efficacy and tolerability of anticonvulsants in the treatment of acute bipolar depression . |
25 | 22,575,611 | Findings were inconclusive for lamotrigine and carbamazepine although overall lamotrigine may have a beneficial but modest effect .
Negative results were found for levetiracetam and gabapentin but the evidence base on these agents is scant .
All anticonvulsants were generally well tolerated .
No double-blind RCTs were found for the use of other anticonvulsants such as oxcarbazepine , licarbazepine , zonisamide , retigabine , pregabalin , tiagabine , felbamate and vigabatrine in the acute treatment of bipolar depression .
To sum up , taking into consideration the efficacy and tolerability profiles of anticonvulsants , current evidence supports the use of divalproex and lamotrigine in the treatment of acute bipolar depression . | Despite the high morbidity and mortality associated with bipolar depression , the optimal treatment for this phase is still a matter of debate .
The aim of the current review was to provide up date d evidence about the efficacy and tolerability of anticonvulsants in the treatment of acute bipolar depression . | 456 | 3,510,572 | Antidepressant effects of carbamazepine. | Thirty-five depressed patients diagnosed by DSM-III criteria participated in a double-blind study of the acute antidepressant effects of the anticonvulsant carbamazepine , at average doses of 971 mg/day , achieving mean + /- SD blood levels of 9.3 + /- 1.9 micrograms/ml ( range , 3 - 12.5 micrograms/ml ) . Twenty patients ( 57 % ) showed at least mild improvement , and 12 showed more substantial improvement . Possible clinical predictors of antidepressant response to carbamazepine are discussed . These preliminary data suggest that carbamazepine has some acute antidepressant efficacy in addition to the growing evidence that it has acute antimanic and longer-term prophylactic efficacy in both phases of manic-depressive illness | 25 | Findings were inconclusive for lamotrigine and carbamazepine although overall lamotrigine may have a beneficial but modest effect .
Negative results were found for levetiracetam and gabapentin but the evidence base on these agents is scant .
All anticonvulsants were generally well tolerated .
No double-blind RCTs were found for the use of other anticonvulsants such as oxcarbazepine , licarbazepine , zonisamide , retigabine , pregabalin , tiagabine , felbamate and vigabatrine in the acute treatment of bipolar depression .
To sum up , taking into consideration the efficacy and tolerability profiles of anticonvulsants , current evidence supports the use of divalproex and lamotrigine in the treatment of acute bipolar depression . | Despite the high morbidity and mortality associated with bipolar depression , the optimal treatment for this phase is still a matter of debate .
The aim of the current review was to provide up date d evidence about the efficacy and tolerability of anticonvulsants in the treatment of acute bipolar depression . |
25 | 22,575,611 | Findings were inconclusive for lamotrigine and carbamazepine although overall lamotrigine may have a beneficial but modest effect .
Negative results were found for levetiracetam and gabapentin but the evidence base on these agents is scant .
All anticonvulsants were generally well tolerated .
No double-blind RCTs were found for the use of other anticonvulsants such as oxcarbazepine , licarbazepine , zonisamide , retigabine , pregabalin , tiagabine , felbamate and vigabatrine in the acute treatment of bipolar depression .
To sum up , taking into consideration the efficacy and tolerability profiles of anticonvulsants , current evidence supports the use of divalproex and lamotrigine in the treatment of acute bipolar depression . | Despite the high morbidity and mortality associated with bipolar depression , the optimal treatment for this phase is still a matter of debate .
The aim of the current review was to provide up date d evidence about the efficacy and tolerability of anticonvulsants in the treatment of acute bipolar depression . | 457 | 20,816,041 | Acute efficacy of divalproex sodium versus placebo in mood stabilizer-naive bipolar I or II depression: a double-blind, randomized, placebo-controlled trial. | OBJECTIVE To conduct an exploratory evaluation of the acute efficacy of extended-release divalproex sodium compared to placebo in patients with bipolar I or II depression . METHOD Out patients aged 18 - 70 years with mood stabilizer-naive bipolar I or II disorder experiencing a major depressive episode ( DSM-IV ) were r and omly assigned to 6 weeks of divalproex sodium monotherapy or placebo . The primary outcome measure was mean change from baseline to week 6 on the Montgomery-Åsberg Depression Rating Scale ( MADRS ) total score . Secondary outcomes included rates of response and remission , changes in the Clinical Global Impressions-Bipolar ( CGI-BP ) Severity of Illness scores , and changes in anxiety symptoms as measured by the Hamilton Anxiety Rating Scale . The study was conducted between 2003 and 2007 . RESULTS Fifty-four subjects with bipolar I ( n = 20 ) or bipolar II ( n = 34 ) disorder were r and omly assigned to divalproex or placebo ; 67 % ( 36 of 54 ) met DSM-IV criteria for rapid cycling . Divalproex treatment produced statistically significant improvement in MADRS scores compared with placebo from week 3 onward . The proportions of patients meeting response criteria were 38.5 % ( 10 of 26 ) in the divalproex group versus 10.7 % ( 3 of 28 ) for the placebo group ( P = .017 ) . The proportions of patients meeting remission criteria were 23.1 % ( 6 of 26 ) for divalproex versus 10.7 % ( 3 of 28 ) for placebo ( P = .208 ) . Subgroup analysis revealed no separation between divalproex and placebo for those with bipolar II diagnoses . Nausea , increased appetite , diarrhea , dry mouth , and cramps were the most common side effects . CONCLUSIONS These data suggest that divalproex sodium is efficacious and reasonably well tolerated in the acute treatment of mood stabilizer-naive patients with bipolar depression , particularly for those with rapid-cycling type I presentations , and that confirmatory large-scale studies are indicated . TRIAL REGISTRATION Clinical trials.gov Identifier : NCT00194116 | 25 | Findings were inconclusive for lamotrigine and carbamazepine although overall lamotrigine may have a beneficial but modest effect .
Negative results were found for levetiracetam and gabapentin but the evidence base on these agents is scant .
All anticonvulsants were generally well tolerated .
No double-blind RCTs were found for the use of other anticonvulsants such as oxcarbazepine , licarbazepine , zonisamide , retigabine , pregabalin , tiagabine , felbamate and vigabatrine in the acute treatment of bipolar depression .
To sum up , taking into consideration the efficacy and tolerability profiles of anticonvulsants , current evidence supports the use of divalproex and lamotrigine in the treatment of acute bipolar depression . | Despite the high morbidity and mortality associated with bipolar depression , the optimal treatment for this phase is still a matter of debate .
The aim of the current review was to provide up date d evidence about the efficacy and tolerability of anticonvulsants in the treatment of acute bipolar depression . |
25 | 22,575,611 | Findings were inconclusive for lamotrigine and carbamazepine although overall lamotrigine may have a beneficial but modest effect .
Negative results were found for levetiracetam and gabapentin but the evidence base on these agents is scant .
All anticonvulsants were generally well tolerated .
No double-blind RCTs were found for the use of other anticonvulsants such as oxcarbazepine , licarbazepine , zonisamide , retigabine , pregabalin , tiagabine , felbamate and vigabatrine in the acute treatment of bipolar depression .
To sum up , taking into consideration the efficacy and tolerability profiles of anticonvulsants , current evidence supports the use of divalproex and lamotrigine in the treatment of acute bipolar depression . | Despite the high morbidity and mortality associated with bipolar depression , the optimal treatment for this phase is still a matter of debate .
The aim of the current review was to provide up date d evidence about the efficacy and tolerability of anticonvulsants in the treatment of acute bipolar depression . | 458 | 15,780,695 | Divalproex in the treatment of bipolar depression: a placebo-controlled study. | BACKGROUND The treatment of bipolar disorder in the depressed phase is complicated by a tendency for conventional antidepressant drugs to worsen the course of the illness by precipitating a manic episode or increasing cycle frequency . Thus , the potential antidepressant efficacy of mood stabilizers , such as divalproex , which is an effective treatment for the manic phase of bipolar disorder , is of considerable interest . METHODS The clinical efficacy of divalproex ( valproate , Depakote ) was tested in an 8-week , double-blind , placebo-controlled , r and omized clinical trial in 25 out patients with bipolar I depression . The primary outcome measure was the 17-item Hamilton Rating Scale for Depression , and secondary measures included the Hamilton Rating Scale for Anxiety , the Clinician Administered Rating Scale for Mania , and the Clinical Global Impression scale . RESULTS Using repeated measures ANOVA with last observation carried forward , divalproex was more effective than placebo in improving symptoms of depression ( p = 0.0002 ) and symptoms of anxiety ( p = 0.0001 ) than placebo . LIMITATIONS The sample size was small , and most patients were male . CONCLUSIONS These pilot results indicate that divalproex is effective in reducing the symptoms of depression and anxiety in bipolar I , depressed phase . These positive results support the need to perform a larger , multisite study of divalproex treatment for bipolar depression | 25 | Findings were inconclusive for lamotrigine and carbamazepine although overall lamotrigine may have a beneficial but modest effect .
Negative results were found for levetiracetam and gabapentin but the evidence base on these agents is scant .
All anticonvulsants were generally well tolerated .
No double-blind RCTs were found for the use of other anticonvulsants such as oxcarbazepine , licarbazepine , zonisamide , retigabine , pregabalin , tiagabine , felbamate and vigabatrine in the acute treatment of bipolar depression .
To sum up , taking into consideration the efficacy and tolerability profiles of anticonvulsants , current evidence supports the use of divalproex and lamotrigine in the treatment of acute bipolar depression . | Despite the high morbidity and mortality associated with bipolar depression , the optimal treatment for this phase is still a matter of debate .
The aim of the current review was to provide up date d evidence about the efficacy and tolerability of anticonvulsants in the treatment of acute bipolar depression . |
25 | 22,575,611 | Findings were inconclusive for lamotrigine and carbamazepine although overall lamotrigine may have a beneficial but modest effect .
Negative results were found for levetiracetam and gabapentin but the evidence base on these agents is scant .
All anticonvulsants were generally well tolerated .
No double-blind RCTs were found for the use of other anticonvulsants such as oxcarbazepine , licarbazepine , zonisamide , retigabine , pregabalin , tiagabine , felbamate and vigabatrine in the acute treatment of bipolar depression .
To sum up , taking into consideration the efficacy and tolerability profiles of anticonvulsants , current evidence supports the use of divalproex and lamotrigine in the treatment of acute bipolar depression . | Despite the high morbidity and mortality associated with bipolar depression , the optimal treatment for this phase is still a matter of debate .
The aim of the current review was to provide up date d evidence about the efficacy and tolerability of anticonvulsants in the treatment of acute bipolar depression . | 459 | 10,084,633 | A double-blind placebo-controlled study of lamotrigine monotherapy in outpatients with bipolar I depression. Lamictal 602 Study Group. | BACKGROUND More treatment options for bipolar depression are needed . Currently available antidepressants may increase the risk of mania and rapid cycling , and mood stabilizers appear to be less effective in treating depression than mania . Preliminary data suggest that lamotrigine , an established antiepileptic drug , may be effective for both the depression and mania associated with bipolar disorder . This is the first controlled multicenter study evaluating lamotrigine monotherapy in the treatment of bipolar I depression . METHODS Out patients with bipolar I disorder experiencing a major depressive episode ( DSM-IV , N = 195 ) received lamotrigine ( 50 or 200 mg/day ) or placebo as monotherapy for 7 weeks . Psychiatric evaluations , including the Hamilton Rating Scale for Depression ( HAM-D ) , the Montgomery-Asberg Depression Rating Scale ( MADRS ) , Mania Rating Scale , and the Clinical Global Impressions scale for Severity ( CGI-S ) and Improvement ( CGI-I ) were completed at each weekly visit . RESULTS Lamotrigine 200 mg/day demonstrated significant antidepressant efficacy on the 17-item HAM-D , HAM-D Item 1 , MADRS , CGI-S , and CGI-I compared with placebo . Improvements were seen as early as week 3 . Lamotrigine 50 mg/day also demonstrated efficacy compared with placebo on several measures . The proportions of patients exhibiting a response on CGI-I were 51 % , 41 % , and 26 % for lamotrigine 200 mg/day , lamotrigine 50 mg/day , and placebo groups , respectively . Adverse events and other safety results were similar across treatment groups , except for a higher rate of headache in the lamotrigine groups . CONCLUSION Lamotrigine monotherapy is an effective and well-tolerated treatment for bipolar depression | 25 | Findings were inconclusive for lamotrigine and carbamazepine although overall lamotrigine may have a beneficial but modest effect .
Negative results were found for levetiracetam and gabapentin but the evidence base on these agents is scant .
All anticonvulsants were generally well tolerated .
No double-blind RCTs were found for the use of other anticonvulsants such as oxcarbazepine , licarbazepine , zonisamide , retigabine , pregabalin , tiagabine , felbamate and vigabatrine in the acute treatment of bipolar depression .
To sum up , taking into consideration the efficacy and tolerability profiles of anticonvulsants , current evidence supports the use of divalproex and lamotrigine in the treatment of acute bipolar depression . | Despite the high morbidity and mortality associated with bipolar depression , the optimal treatment for this phase is still a matter of debate .
The aim of the current review was to provide up date d evidence about the efficacy and tolerability of anticonvulsants in the treatment of acute bipolar depression . |
25 | 22,575,611 | Findings were inconclusive for lamotrigine and carbamazepine although overall lamotrigine may have a beneficial but modest effect .
Negative results were found for levetiracetam and gabapentin but the evidence base on these agents is scant .
All anticonvulsants were generally well tolerated .
No double-blind RCTs were found for the use of other anticonvulsants such as oxcarbazepine , licarbazepine , zonisamide , retigabine , pregabalin , tiagabine , felbamate and vigabatrine in the acute treatment of bipolar depression .
To sum up , taking into consideration the efficacy and tolerability profiles of anticonvulsants , current evidence supports the use of divalproex and lamotrigine in the treatment of acute bipolar depression . | Despite the high morbidity and mortality associated with bipolar depression , the optimal treatment for this phase is still a matter of debate .
The aim of the current review was to provide up date d evidence about the efficacy and tolerability of anticonvulsants in the treatment of acute bipolar depression . | 460 | 21,320,258 | Long-term outcome of bipolar depressed patients receiving lamotrigine as add-on to lithium with the possibility of the addition of paroxetine in nonresponders: a randomized, placebo-controlled trial with a novel design. | OBJECTIVE In two previous manuscripts , we described the efficacy of lamotrigine versus placebo as add-on to lithium ( followed by the addition of paroxetine in nonresponders ) in the short-term treatment of bipolar depression . In this paper we describe the long-term ( 68 weeks ) outcome of that study . METHODS A total of 124 bipolar depressed patients receiving lithium were r and omized to addition of lamotrigine or placebo . After eight weeks , paroxetine was added to nonresponders for another eight weeks . Responders continued medication and were followed for up to 68 weeks or until a relapse or recurrence of a depressive or manic episode . RESULTS After eight weeks , the addition of lamotrigine to lithium was significantly more efficacious than addition of placebo , while after addition of paroxetine in nonresponders both groups further improved with no significant difference between groups at week 16 . During follow-up the efficacy of lamotrigine was maintained : time to relapse or recurrence was longer for the lamotrigine group [ median time 10.0 months ( confidence interval : 1.1 - 18.8 ) ] versus the placebo group [ 3.5 months ( confidence interval : 0.7 - 7.0 ) ] . CONCLUSION In patients with bipolar depression , despite continued use of lithium , addition of lamotrigine revealed a continued benefit compared to placebo throughout the entire study | 25 | Findings were inconclusive for lamotrigine and carbamazepine although overall lamotrigine may have a beneficial but modest effect .
Negative results were found for levetiracetam and gabapentin but the evidence base on these agents is scant .
All anticonvulsants were generally well tolerated .
No double-blind RCTs were found for the use of other anticonvulsants such as oxcarbazepine , licarbazepine , zonisamide , retigabine , pregabalin , tiagabine , felbamate and vigabatrine in the acute treatment of bipolar depression .
To sum up , taking into consideration the efficacy and tolerability profiles of anticonvulsants , current evidence supports the use of divalproex and lamotrigine in the treatment of acute bipolar depression . | Despite the high morbidity and mortality associated with bipolar depression , the optimal treatment for this phase is still a matter of debate .
The aim of the current review was to provide up date d evidence about the efficacy and tolerability of anticonvulsants in the treatment of acute bipolar depression . |
25 | 22,575,611 | Findings were inconclusive for lamotrigine and carbamazepine although overall lamotrigine may have a beneficial but modest effect .
Negative results were found for levetiracetam and gabapentin but the evidence base on these agents is scant .
All anticonvulsants were generally well tolerated .
No double-blind RCTs were found for the use of other anticonvulsants such as oxcarbazepine , licarbazepine , zonisamide , retigabine , pregabalin , tiagabine , felbamate and vigabatrine in the acute treatment of bipolar depression .
To sum up , taking into consideration the efficacy and tolerability profiles of anticonvulsants , current evidence supports the use of divalproex and lamotrigine in the treatment of acute bipolar depression . | Despite the high morbidity and mortality associated with bipolar depression , the optimal treatment for this phase is still a matter of debate .
The aim of the current review was to provide up date d evidence about the efficacy and tolerability of anticonvulsants in the treatment of acute bipolar depression . | 461 | 14,628,976 | A placebo-controlled 18-month trial of lamotrigine and lithium maintenance treatment in recently depressed patients with bipolar I disorder. | BACKGROUND The anticonvulsant lamotrigine was previously shown to be effective for bipolar depression . This study assessed the efficacy and tolerability of lamotrigine and lithium compared with placebo for the prevention of mood episodes in bipolar disorder . METHOD During an 8- to 16-week open-label phase , lamotrigine ( titrated to 200 mg/day ) was added to current therapy for currently or recently depressed DSM-IV-defined bipolar I out patients ( N = 966 ) and concomitant drugs were gradually withdrawn . Patients stabilized on open-label treatment ( N = 463 ) were then r and omly assigned to lamotrigine ( 50 , 200 , or 400 mg/day ; N = 221 ) , lithium ( 0.8 - 1.1 mEq/L ; N = 121 ) , or placebo ( N = 121 ) monotherapy for up to 18 months . The primary outcome measure was time from r and omization to intervention ( addition of pharmacotherapy ) for any mood episode ( depressive , manic , hypomanic , or mixed ) . Data were gathered from September 1997 to August 2001 . RESULTS Time to intervention for any mood episode was statistically superior ( p = .029 ) for both lamotrigine and lithium compared with placebo-median survival times were 200 , 170 , and 93 days , respectively . Intervention for depression was more frequent than for mania by a factor of nearly 3:1 . Lamotrigine was statistically superior to placebo at prolonging the time to intervention for a depressive episode ( p = .047 ) . The proportions of patients who were intervention-free for depression at 1 year were lamotrigine 57 % , lithium 46 % , and placebo 45 % . Lithium was statistically superior to placebo at prolonging the time to intervention for a manic or hypomanic episode ( p = .026 ) . The proportions of patients who were intervention-free for mania at 1 year were lamotrigine 77 % , lithium 86 % , and placebo 72 % . Headache was the most frequent adverse event for all 3 treatment groups . CONCLUSION Lamotrigine and lithium were superior to placebo for the prevention of mood episodes in bipolar I patients , with lamotrigine predominantly effective against depression and lithium predominantly effective against mania | 25 | Findings were inconclusive for lamotrigine and carbamazepine although overall lamotrigine may have a beneficial but modest effect .
Negative results were found for levetiracetam and gabapentin but the evidence base on these agents is scant .
All anticonvulsants were generally well tolerated .
No double-blind RCTs were found for the use of other anticonvulsants such as oxcarbazepine , licarbazepine , zonisamide , retigabine , pregabalin , tiagabine , felbamate and vigabatrine in the acute treatment of bipolar depression .
To sum up , taking into consideration the efficacy and tolerability profiles of anticonvulsants , current evidence supports the use of divalproex and lamotrigine in the treatment of acute bipolar depression . | Despite the high morbidity and mortality associated with bipolar depression , the optimal treatment for this phase is still a matter of debate .
The aim of the current review was to provide up date d evidence about the efficacy and tolerability of anticonvulsants in the treatment of acute bipolar depression . |
25 | 22,575,611 | Findings were inconclusive for lamotrigine and carbamazepine although overall lamotrigine may have a beneficial but modest effect .
Negative results were found for levetiracetam and gabapentin but the evidence base on these agents is scant .
All anticonvulsants were generally well tolerated .
No double-blind RCTs were found for the use of other anticonvulsants such as oxcarbazepine , licarbazepine , zonisamide , retigabine , pregabalin , tiagabine , felbamate and vigabatrine in the acute treatment of bipolar depression .
To sum up , taking into consideration the efficacy and tolerability profiles of anticonvulsants , current evidence supports the use of divalproex and lamotrigine in the treatment of acute bipolar depression . | Despite the high morbidity and mortality associated with bipolar depression , the optimal treatment for this phase is still a matter of debate .
The aim of the current review was to provide up date d evidence about the efficacy and tolerability of anticonvulsants in the treatment of acute bipolar depression . | 462 | 19,200,421 | Efficacy and safety of lamotrigine as add-on treatment to lithium in bipolar depression: a multicenter, double-blind, placebo-controlled trial. | OBJECTIVE Lamotrigine is one of the pharmacologic options for the treatment of bipolar depression but has only been studied as monotherapy . This study compared the acute effects of lamotrigine and placebo as add-on therapy to ongoing treatment with lithium in patients with bipolar depression . METHOD Out patients ( N = 124 ) aged 18 years and older with a DSM-IV bipolar I or II disorder and a major depressive episode ( Montgomery-Asberg Depression Rating Scale [ MADRS ] score > or = 18 and Clinical Global Impressions-Bipolar Version [ CGI-BP ] severity of depression score > or = 4 ) while receiving lithium treatment ( 0.6 - 1.2 mmol/L ) were r and omly assigned to 8 weeks of double-blind treatment with lamotrigine ( titrated to 200 mg/d ) or placebo . The primary outcome measure was mean change from baseline in total score on the MADRS at week 8 . Secondary outcome measures were response ( defined as a reduction of > or = 50 % on the MADRS and /or change of depression score on the CGI-BP of " much improved " or " very much improved " compared to baseline ) and switch to mania or hypomania ( defined as a CGI-BP severity of mania score of at least mildly ill at any visit ) . Patients were included in the study between August 2002 ( Spain started in October 2003 ) and May 2005 . RESULTS Endpoint mean change from baseline MADRS total score was -15.38 ( SE = 1.32 ) points for lamotrigine and -11.03 ( SE = 1.36 ) points for placebo ( t = -2.29 , df = 104 , p = .024 ) . Significantly more patients responded to lamotrigine than to placebo on the MADRS ( 51.6 % vs. 31.7 % , p = .030 ) , but not on the CGI-BP change of depression ( 64.1 % vs. 49.2 % , p = .105 ) . Switch to mania or hypomania occurred in 5 patients ( 7.8 % ) receiving lamotrigine and 2 patients ( 3.3 % ) receiving placebo ( p = .441 ) . CONCLUSION Lamotrigine was found effective and safe as add-on treatment to lithium in the acute treatment of bipolar depression . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00224510 | 25 | Findings were inconclusive for lamotrigine and carbamazepine although overall lamotrigine may have a beneficial but modest effect .
Negative results were found for levetiracetam and gabapentin but the evidence base on these agents is scant .
All anticonvulsants were generally well tolerated .
No double-blind RCTs were found for the use of other anticonvulsants such as oxcarbazepine , licarbazepine , zonisamide , retigabine , pregabalin , tiagabine , felbamate and vigabatrine in the acute treatment of bipolar depression .
To sum up , taking into consideration the efficacy and tolerability profiles of anticonvulsants , current evidence supports the use of divalproex and lamotrigine in the treatment of acute bipolar depression . | Despite the high morbidity and mortality associated with bipolar depression , the optimal treatment for this phase is still a matter of debate .
The aim of the current review was to provide up date d evidence about the efficacy and tolerability of anticonvulsants in the treatment of acute bipolar depression . |
25 | 22,575,611 | Findings were inconclusive for lamotrigine and carbamazepine although overall lamotrigine may have a beneficial but modest effect .
Negative results were found for levetiracetam and gabapentin but the evidence base on these agents is scant .
All anticonvulsants were generally well tolerated .
No double-blind RCTs were found for the use of other anticonvulsants such as oxcarbazepine , licarbazepine , zonisamide , retigabine , pregabalin , tiagabine , felbamate and vigabatrine in the acute treatment of bipolar depression .
To sum up , taking into consideration the efficacy and tolerability profiles of anticonvulsants , current evidence supports the use of divalproex and lamotrigine in the treatment of acute bipolar depression . | Despite the high morbidity and mortality associated with bipolar depression , the optimal treatment for this phase is still a matter of debate .
The aim of the current review was to provide up date d evidence about the efficacy and tolerability of anticonvulsants in the treatment of acute bipolar depression . | 463 | 16,820,213 | Randomized, double-blind pilot trial comparing lamotrigine versus citalopram for the treatment of bipolar depression. | BACKGROUND Uncertainty exists regarding the best approach for treating bipolar depression among patients already receiving a first-line mood stabilizer . The aim of this pilot study was to compare adding a second mood stabilizer or an antidepressant at this treatment decision point . METHODS Twelve-week , r and omized , double-blind pilot trial comparing the addition of lamotrigine or citalopram for bipolar depressed patients on mood stabilizer medication . Change in depressive symptoms and risk of switch were examined . RESULTS Twenty subjects were r and omized . Each treatment group experienced a significant mean reduction in total MADRS scores ( citalopram Delta - 14.2 , p=0.002 ; lamotrigine Delta - 13.3 , p= 0.001 ) , and there was no significant difference between treatment groups ( p=0.78 ) . Total response rates increased from 31.6 % at week 6 to 52.6 % at week 12 . One out of ten patients in each group experienced a switch to hypomania . LIMITATIONS Small sample size . Lack of a placebo arm . CONCLUSIONS Results of this small trial suggest that both lamotrigine and citalopram appear to be reasonable choices as add-on acute treatment for bipolar depression , with response rates continuing to rise considerably past 6 weeks of treatment | 25 | Findings were inconclusive for lamotrigine and carbamazepine although overall lamotrigine may have a beneficial but modest effect .
Negative results were found for levetiracetam and gabapentin but the evidence base on these agents is scant .
All anticonvulsants were generally well tolerated .
No double-blind RCTs were found for the use of other anticonvulsants such as oxcarbazepine , licarbazepine , zonisamide , retigabine , pregabalin , tiagabine , felbamate and vigabatrine in the acute treatment of bipolar depression .
To sum up , taking into consideration the efficacy and tolerability profiles of anticonvulsants , current evidence supports the use of divalproex and lamotrigine in the treatment of acute bipolar depression . | Despite the high morbidity and mortality associated with bipolar depression , the optimal treatment for this phase is still a matter of debate .
The aim of the current review was to provide up date d evidence about the efficacy and tolerability of anticonvulsants in the treatment of acute bipolar depression . |
25 | 22,575,611 | Findings were inconclusive for lamotrigine and carbamazepine although overall lamotrigine may have a beneficial but modest effect .
Negative results were found for levetiracetam and gabapentin but the evidence base on these agents is scant .
All anticonvulsants were generally well tolerated .
No double-blind RCTs were found for the use of other anticonvulsants such as oxcarbazepine , licarbazepine , zonisamide , retigabine , pregabalin , tiagabine , felbamate and vigabatrine in the acute treatment of bipolar depression .
To sum up , taking into consideration the efficacy and tolerability profiles of anticonvulsants , current evidence supports the use of divalproex and lamotrigine in the treatment of acute bipolar depression . | Despite the high morbidity and mortality associated with bipolar depression , the optimal treatment for this phase is still a matter of debate .
The aim of the current review was to provide up date d evidence about the efficacy and tolerability of anticonvulsants in the treatment of acute bipolar depression . | 464 | 14,609,883 | Efficacy of olanzapine and olanzapine-fluoxetine combination in the treatment of bipolar I depression. | BACKGROUND Despite the longer duration of the depressive phase in bipolar disorder and the frequent clinical use of antidepressants combined with antipsychotics or mood stabilizers , relatively few controlled studies have examined treatment strategies for bipolar depression . OBJECTIVE To examine the use of olanzapine and olanzapine-fluoxetine combination in the treatment of bipolar I depression . DESIGN Double-blind , 8-week , r and omized controlled trial . SETTING Eighty-four sites ( inpatient and outpatient ) in 13 countries . Patients A total of 833 r and omized adults with bipolar I depression with a Montgomery-Asberg Depression Rating Scale ( MADRS ) score of at least 20 . Intervention Patients were r and omly assigned to receive placebo ( n = 377 ) ; olanzapine , 5 to 20 mg/d ( n = 370 ) ; or olanzapine-fluoxetine combination , 6 and 25 , 6 and 50 , or 12 and 50 mg/d ( n = 86 ) . MAIN OUTCOME MEASURE Changes in MADRS total scores using mixed-effects model repeated- measures analyses . RESULTS During all 8 study weeks , the olanzapine and olanzapine-fluoxetine groups showed statistically significant improvement in depressive symptoms vs the placebo group ( P<.001 for all ) . The olanzapine-fluoxetine group also showed statistically greater improvement than the olanzapine group at weeks 4 through 8 . At week 8 , MADRS total scores were lower than at baseline by 11.9 , 15.0 , and 18.5 points in the placebo , olanzapine , and olanzapine-fluoxetine groups , respectively . Remission criteria were met by 24.5 % ( 87/355 ) of the placebo group , 32.8 % ( 115/351 ) of the olanzapine group , and 48.8 % ( 40/82 ) of the olanzapine-fluoxetine group . Treatment-emergent mania ( Young Mania Rating Scale score < 15 at baseline and > or = 15 subsequently ) did not differ among groups ( placebo , 6.7 % [ 23/345 ] ; olanzapine , 5.7 % [ 19/335 ] ; and olanzapine-fluoxetine , 6.4 % [ 5/78 ] ) . Adverse events for olanzapine-fluoxetine therapy were similar to those for olanzapine therapy but also included higher rates of nausea and diarrhea . CONCLUSIONS Olanzapine is more effective than placebo , and combined olanzapine-fluoxetine is more effective than olanzapine and placebo in the treatment of bipolar I depression without increased risk of developing manic symptoms | 25 | Findings were inconclusive for lamotrigine and carbamazepine although overall lamotrigine may have a beneficial but modest effect .
Negative results were found for levetiracetam and gabapentin but the evidence base on these agents is scant .
All anticonvulsants were generally well tolerated .
No double-blind RCTs were found for the use of other anticonvulsants such as oxcarbazepine , licarbazepine , zonisamide , retigabine , pregabalin , tiagabine , felbamate and vigabatrine in the acute treatment of bipolar depression .
To sum up , taking into consideration the efficacy and tolerability profiles of anticonvulsants , current evidence supports the use of divalproex and lamotrigine in the treatment of acute bipolar depression . | Despite the high morbidity and mortality associated with bipolar depression , the optimal treatment for this phase is still a matter of debate .
The aim of the current review was to provide up date d evidence about the efficacy and tolerability of anticonvulsants in the treatment of acute bipolar depression . |
25 | 22,575,611 | Findings were inconclusive for lamotrigine and carbamazepine although overall lamotrigine may have a beneficial but modest effect .
Negative results were found for levetiracetam and gabapentin but the evidence base on these agents is scant .
All anticonvulsants were generally well tolerated .
No double-blind RCTs were found for the use of other anticonvulsants such as oxcarbazepine , licarbazepine , zonisamide , retigabine , pregabalin , tiagabine , felbamate and vigabatrine in the acute treatment of bipolar depression .
To sum up , taking into consideration the efficacy and tolerability profiles of anticonvulsants , current evidence supports the use of divalproex and lamotrigine in the treatment of acute bipolar depression . | Despite the high morbidity and mortality associated with bipolar depression , the optimal treatment for this phase is still a matter of debate .
The aim of the current review was to provide up date d evidence about the efficacy and tolerability of anticonvulsants in the treatment of acute bipolar depression . | 465 | 18,271,912 | Lamotrigine in the acute treatment of bipolar depression: results of five double-blind, placebo-controlled clinical trials. | OBJECTIVES The efficacy of lamotrigine as maintenance treatment for bipolar disorder ( BD ) , particularly for delaying depressive episodes , is well established , but its efficacy in the acute treatment of bipolar depression is less clear . This paper reports the results of five r and omized , double-blind , placebo-controlled trials of lamotrigine monotherapy for the acute treatment of bipolar depression . METHODS Adult subjects with bipolar I or II disorder experiencing a depressive episode were r and omized to placebo or lamotrigine monotherapy ( after titration , at a fixed dose of 50 mg or 200 mg daily in Study 1 ; a flexible dose of 100 - 400 mg daily in Study 2 ; or a fixed dose of 200 mg daily in Studies 3 , 4 and 5 ) for 7 - 10 weeks . RESULTS Lamotrigine did not differ significantly from placebo on primary efficacy endpoints [ 17-item Hamilton Depression Rating Scale in Studies 1 and 2 ; Montgomery-Asberg Depression Rating Scale ( MADRS ) in Studies 3 , 4 and 5 ] . In Study 1 , lamotrigine significantly separated from placebo on some secondary measures of efficacy , including the MADRS , the Clinical Global Impressions-Severity ( CGI-S ) and the CGI-Improvement ( CGI-I ) , but seldom differed on secondary efficacy endpoints for the other studies . CONCLUSIONS Lamotrigine monotherapy did not demonstrate efficacy in the acute treatment of bipolar depression in four out of five placebo-controlled clinical studies . Lamotrigine was well tolerated in the acute treatment of bipolar depression | 25 | Findings were inconclusive for lamotrigine and carbamazepine although overall lamotrigine may have a beneficial but modest effect .
Negative results were found for levetiracetam and gabapentin but the evidence base on these agents is scant .
All anticonvulsants were generally well tolerated .
No double-blind RCTs were found for the use of other anticonvulsants such as oxcarbazepine , licarbazepine , zonisamide , retigabine , pregabalin , tiagabine , felbamate and vigabatrine in the acute treatment of bipolar depression .
To sum up , taking into consideration the efficacy and tolerability profiles of anticonvulsants , current evidence supports the use of divalproex and lamotrigine in the treatment of acute bipolar depression . | Despite the high morbidity and mortality associated with bipolar depression , the optimal treatment for this phase is still a matter of debate .
The aim of the current review was to provide up date d evidence about the efficacy and tolerability of anticonvulsants in the treatment of acute bipolar depression . |
26 | 30,113,661 | Conclusion This meta- analysis supports the potential use of microbial therapies in the treatment of NAFLD and sheds light on their potential mode of action . | Context Nonalcoholic fatty liver disease ( NAFLD ) is a highly prevalent and underdiagnosed comorbidity of many chronic diseases that is associated with altered intestinal bacterial communities .
This association has prompted research into alternative treatments aim ed at modulating intestinal microbiota .
Given the novelty of these treatments , scarce evidence regarding their effectiveness in clinical population s exists .
Objective This meta- analysis sought to systemically review and quantitatively synthesize evidence on prebiotic , probiotic , and synbiotic therapies for patients with NAFLD in r and omized controlled trials . | 466 | 16,176,140 | Effects of Cassia tora fiber supplement on serum lipids in Korean diabetic patients. | Cassia tora fiber supplement consisting of 2 g of soluble fiber extracted from Cassia semen ( C. tora L. ) , 200 mg of alpha-tocopherol , 500 mg of ascorbic acid , and 300 mg of maltodextrin was formulated in a pack , and given to 15 type II diabetic subjects ( seven men and eight women 57.1 + /- 2.9 years old ) with instructions to take two packs per day for 2 months . Placebo contained maltodextrin only with a little brown caramel color . Lifestyle factors and dietary intakes of the subjects were not altered during the 2-month period . Serum total cholesterol was moderately ( P < .1 ) decreased in the C. tora group compared with the age- and gender-matched placebo group , as was the ratio of apolipoprotein B to apolipoprotein A1 ( P < .1 ) . Levels of serum triglycerides and low-density lipoprotein-cholesterol tended to decrease more in the C. tora-supplemented group than in the placebo group . Serum alpha-tocopherol was increased ( P < .01 ) but lipid peroxides were not significantly lower in the C. tora group . Fasting blood glucose , hemoglobin A1c , blood urea nitrogen , creatinine , and activities of serum aspartate aminotransferase and alanine aminotransferase were not changed by the fiber supplement . We concluded that C. tora supplements can help improve serum lipid status in type II diabetic subjects without serious adverse effects | 26 | Conclusion This meta- analysis supports the potential use of microbial therapies in the treatment of NAFLD and sheds light on their potential mode of action . | Context Nonalcoholic fatty liver disease ( NAFLD ) is a highly prevalent and underdiagnosed comorbidity of many chronic diseases that is associated with altered intestinal bacterial communities .
This association has prompted research into alternative treatments aim ed at modulating intestinal microbiota .
Given the novelty of these treatments , scarce evidence regarding their effectiveness in clinical population s exists .
Objective This meta- analysis sought to systemically review and quantitatively synthesize evidence on prebiotic , probiotic , and synbiotic therapies for patients with NAFLD in r and omized controlled trials . |
26 | 30,113,661 | Conclusion This meta- analysis supports the potential use of microbial therapies in the treatment of NAFLD and sheds light on their potential mode of action . | Context Nonalcoholic fatty liver disease ( NAFLD ) is a highly prevalent and underdiagnosed comorbidity of many chronic diseases that is associated with altered intestinal bacterial communities .
This association has prompted research into alternative treatments aim ed at modulating intestinal microbiota .
Given the novelty of these treatments , scarce evidence regarding their effectiveness in clinical population s exists .
Objective This meta- analysis sought to systemically review and quantitatively synthesize evidence on prebiotic , probiotic , and synbiotic therapies for patients with NAFLD in r and omized controlled trials . | 467 | 3,775,173 | Effect of Daily Consumption of Probiotic Yoghurt on Serum Levels of Calcium, Iron and Liver Enzymes in Pregnant Women | Background : To reach fetal appropriate growth during the third trimester , the requirements for dietary calcium and iron intakes during the pregnancy increases . This study was carried out to determine the effects of daily consumption of probiotic yoghurt on serum calcium and iron levels and liver enzymes among Iranian healthy pregnant women . Methods : In this controlled clinical trial , 70 primigravida pregnant women carrying singleton pregnancy at their third trimester were participated . Participants were r and omly divided into two groups of consuming 200 g/d of conventional ( n = 33 ) or probiotic yogurts ( n = 37 ) for 9 weeks . The probiotic yogurt contained Lactobacillus acidophilus and Bifidobacterium lactis with a total of min 1 × 107 CFU . To measure serum calcium , iron , aspartate aminotransferase ( AST ) and alanine aminotransferase ( ALT ) levels , blood sample s were drawn in a fasting state at baseline and after 9 weeks intervention . Results : Consumption of probiotic yogurt result ed in maintaining serum calcium levels compared with the conventional yogurt ( P = 0.01 ) . Within-group differences in the conventional yogurt group revealed a significant reduction of serum calcium levels ( −1.7 mg/dL , P < 0.0001 ) . No significant differences were found between the two yogurts in terms of their effects on serum iron , AST and ALT levels . Conclusions : Consumption of probiotic yogurt among pregnant women result ed in maintaining serum calcium levels compared with the conventional yogurt ; however , it could not affect serum iron , ALT and AST levels | 26 | Conclusion This meta- analysis supports the potential use of microbial therapies in the treatment of NAFLD and sheds light on their potential mode of action . | Context Nonalcoholic fatty liver disease ( NAFLD ) is a highly prevalent and underdiagnosed comorbidity of many chronic diseases that is associated with altered intestinal bacterial communities .
This association has prompted research into alternative treatments aim ed at modulating intestinal microbiota .
Given the novelty of these treatments , scarce evidence regarding their effectiveness in clinical population s exists .
Objective This meta- analysis sought to systemically review and quantitatively synthesize evidence on prebiotic , probiotic , and synbiotic therapies for patients with NAFLD in r and omized controlled trials . |
26 | 30,113,661 | Conclusion This meta- analysis supports the potential use of microbial therapies in the treatment of NAFLD and sheds light on their potential mode of action . | Context Nonalcoholic fatty liver disease ( NAFLD ) is a highly prevalent and underdiagnosed comorbidity of many chronic diseases that is associated with altered intestinal bacterial communities .
This association has prompted research into alternative treatments aim ed at modulating intestinal microbiota .
Given the novelty of these treatments , scarce evidence regarding their effectiveness in clinical population s exists .
Objective This meta- analysis sought to systemically review and quantitatively synthesize evidence on prebiotic , probiotic , and synbiotic therapies for patients with NAFLD in r and omized controlled trials . | 468 | 3,246,186 | Supplementation with probiotics modifies gut flora and attenuates liver fat accumulation in rat nonalcoholic fatty liver disease model | This study aim ed to evaluate the relationship between gut probiotic flora and nonalcoholic fatty liver disease in a diet-induced rat model , and to compare the effects of two different probiotic strains on nonalcoholic fatty liver disease . Forty male Sprague-Dawley rats were r and omized into 4 groups for 12 weeks : control ( st and ard rat chow ) , model ( fat-rich diet ) , Lactobacillus ( fat-rich diet plus Lactobacillus acidophilus ) , and Bifidobacterium ( fat-rich diet plus Bifidobacterium longum ) groups . Probiotics were provided to rats in drinking water ( 1010/ml ) . Gut bifidobacteria and lactobacilli were obviously lower at weeks 8 and 10 , respectively , in the model group compared with the control group . Supplementation with Bifidobacterium significantly attenuated hepatic fat accumulation ( 0.10 ± 0.03 g/g liver tissue ) compared with the model group ( 0.16 ± 0.03 g/g liver tissue ) . However , there was no improvement in intestinal permeability in either the Lactobacillus or the Bifidobacterium group compared with the model group . In all 40 rats , the hepatic total lipid content was negatively correlated with gut Lactobacillus ( r = −0.623 , p = 0.004 ) and Bifidobacterium ( r = −0.591 , p = 0.008 ) . Oral supplementation with probiotics attenuates hepatic fat accumulation . Further , Bifidobacterium longum is superior in terms of attenuating liver fat accumulation than is Lactobacillus acidophilus | 26 | Conclusion This meta- analysis supports the potential use of microbial therapies in the treatment of NAFLD and sheds light on their potential mode of action . | Context Nonalcoholic fatty liver disease ( NAFLD ) is a highly prevalent and underdiagnosed comorbidity of many chronic diseases that is associated with altered intestinal bacterial communities .
This association has prompted research into alternative treatments aim ed at modulating intestinal microbiota .
Given the novelty of these treatments , scarce evidence regarding their effectiveness in clinical population s exists .
Objective This meta- analysis sought to systemically review and quantitatively synthesize evidence on prebiotic , probiotic , and synbiotic therapies for patients with NAFLD in r and omized controlled trials . |
26 | 30,113,661 | Conclusion This meta- analysis supports the potential use of microbial therapies in the treatment of NAFLD and sheds light on their potential mode of action . | Context Nonalcoholic fatty liver disease ( NAFLD ) is a highly prevalent and underdiagnosed comorbidity of many chronic diseases that is associated with altered intestinal bacterial communities .
This association has prompted research into alternative treatments aim ed at modulating intestinal microbiota .
Given the novelty of these treatments , scarce evidence regarding their effectiveness in clinical population s exists .
Objective This meta- analysis sought to systemically review and quantitatively synthesize evidence on prebiotic , probiotic , and synbiotic therapies for patients with NAFLD in r and omized controlled trials . | 469 | 4,676,823 | Effect of microbial cell preparation on renal profile and liver function among type 2 diabetics: a randomized controlled trial | Background The beneficial effect of probiotics on renal profile and liver function has been reported among patients with chronic kidney disease and fatty liver respectively . However , its effect on renal profile and liver function among type 2 diabetic individuals has not been fully understood . To investigate the effect of microbial cell preparation on renal profile and liver function tests among type 2 diabetic individuals . Methods A r and omized , double-blind , parallel-group , controlled clinical trial was conducted on a total of 136 type 2 diabetics age 30 - 70 years old in a teaching hospital in Kuala Lumpur , Malaysia . Subjects were r and omly assigned to receive microbial cell preparation ( N = 68 ) or a placebo ( N = 68 ) for 12 weeks . The outcomes measured at baseline , week 6 , and week 12 and included changes in renal profile ( Sodium , Potassium , Urea , Creatinine , Glomerular Filtration Rate ) , and liver function tests ( Albumin , Total Protein , Alkaline Phosphatase , Alanine Aminotransferase , Aspartate Aminotransferase ) . Intention to treat ( ITT ) analysis was performed on all the recruited subjects , while per protocol ( PP ) analysis was conducted on those who completed the trial with good compliance . Result The urea levels significantly declined in the probiotic group . Serum urea levels reduced from 4.26 mmol/L to 4.04 mmol/L in Probiotic Group while it increased in Placebo Group from 4.03 mmol/L to 4.24 mmol/L. These changes were significant between groups in ITT analysis ( p = 0.018 ) . Other parameters did not change significantly between groups . Conclusion 12 weeks supplementation with daily dosage of 6 × 1010 Colony Forming Units of multi-strain microbial cell preparation significantly improved urea levels . Trial registration ( Clinical trials : # NCT01752803 | 26 | Conclusion This meta- analysis supports the potential use of microbial therapies in the treatment of NAFLD and sheds light on their potential mode of action . | Context Nonalcoholic fatty liver disease ( NAFLD ) is a highly prevalent and underdiagnosed comorbidity of many chronic diseases that is associated with altered intestinal bacterial communities .
This association has prompted research into alternative treatments aim ed at modulating intestinal microbiota .
Given the novelty of these treatments , scarce evidence regarding their effectiveness in clinical population s exists .
Objective This meta- analysis sought to systemically review and quantitatively synthesize evidence on prebiotic , probiotic , and synbiotic therapies for patients with NAFLD in r and omized controlled trials . |
26 | 30,113,661 | Conclusion This meta- analysis supports the potential use of microbial therapies in the treatment of NAFLD and sheds light on their potential mode of action . | Context Nonalcoholic fatty liver disease ( NAFLD ) is a highly prevalent and underdiagnosed comorbidity of many chronic diseases that is associated with altered intestinal bacterial communities .
This association has prompted research into alternative treatments aim ed at modulating intestinal microbiota .
Given the novelty of these treatments , scarce evidence regarding their effectiveness in clinical population s exists .
Objective This meta- analysis sought to systemically review and quantitatively synthesize evidence on prebiotic , probiotic , and synbiotic therapies for patients with NAFLD in r and omized controlled trials . | 470 | 24,401,715 | Synbiotic supplementation in nonalcoholic fatty liver disease: a randomized, double-blind, placebo-controlled pilot study. | BACKGROUND Nonalcoholic fatty liver disease ( NAFLD ) is the most common chronic liver disease in the world . Oral administration of synbiotic has been proposed as an effective treatment of NAFLD because of its modulating effect on the gut flora , which can influence the gut-liver axis . OBJECTIVE The objective was to evaluate the effects of supplementation with synbiotic on hepatic fibrosis , liver enzymes , and inflammatory markers in patients with NAFLD . DESIGN In a r and omized , double-blind , placebo-controlled clinical trial conducted as a pilot study , 52 patients with NAFLD were supplemented twice daily for 28 wk with either a synbiotic or a placebo capsule . Both groups were advised to follow an energy-balanced diet and physical activity recommendations . RESULTS At the end of the study , the alanine aminotransferase ( ALT ) concentration decreased in both groups ; this reduction was significantly greater in the synbiotic group . At the end of the study , the following significant differences [ means ( 95 % CIs ) ] were seen between the synbiotic and placebo groups , respectively : ALT [ -25.1 ( -26.2 , -24 ) compared with -7.29 ( -9.5 , -5.1 ) IU/L ; P < 0.001 ] , aspartate aminotransferase [ -31.33 ( -32.1 , -30.5 ) compared with -7.94 ( -11.1 , -4.8 ) IU/L ; P < 0.001 ] , γ-glutamyltransferase [ -15.08 ( -15.5 , -14.7 ) compared with -5.21 ( -6.6 , -3.9 ) IU/L ; P < 0.001 ] , high-sensitivity C-reactive protein [ -2.3 ( -3 , -1.5 ) compared with -1.04 ( -1.5 , -0.6 ) mmol/L ; P < 0.05 ] , tumor necrosis factor-α [ -1.4 ( -1.7 , -1.1 ) compared with -0.59 ( -0.8 , -0.3 ) mmol/L ; P < 0.001 ] , total nuclear factor κ-B p65 [ -0.016 ( -0.022 , -0.011 ) compared with 0.001 ( -0.004 , -0.007 ) mmol/L ; P < 0.001 ] , and fibrosis score as determined by transient elastography [ - 2.98 ( -3.6 , -2.37 ) compared with -0.77 ( -1.32 , -0.22 ) kPa ; P < 0.001 ] . CONCLUSIONS Synbiotic supplementation in addition to lifestyle modification is superior to lifestyle modification alone for the treatment of NAFLD , at least partially through attenuation of inflammatory markers in the body . Whether these effects will be sustained with longer treatment duration s remains to be determined | 26 | Conclusion This meta- analysis supports the potential use of microbial therapies in the treatment of NAFLD and sheds light on their potential mode of action . | Context Nonalcoholic fatty liver disease ( NAFLD ) is a highly prevalent and underdiagnosed comorbidity of many chronic diseases that is associated with altered intestinal bacterial communities .
This association has prompted research into alternative treatments aim ed at modulating intestinal microbiota .
Given the novelty of these treatments , scarce evidence regarding their effectiveness in clinical population s exists .
Objective This meta- analysis sought to systemically review and quantitatively synthesize evidence on prebiotic , probiotic , and synbiotic therapies for patients with NAFLD in r and omized controlled trials . |
26 | 30,113,661 | Conclusion This meta- analysis supports the potential use of microbial therapies in the treatment of NAFLD and sheds light on their potential mode of action . | Context Nonalcoholic fatty liver disease ( NAFLD ) is a highly prevalent and underdiagnosed comorbidity of many chronic diseases that is associated with altered intestinal bacterial communities .
This association has prompted research into alternative treatments aim ed at modulating intestinal microbiota .
Given the novelty of these treatments , scarce evidence regarding their effectiveness in clinical population s exists .
Objective This meta- analysis sought to systemically review and quantitatively synthesize evidence on prebiotic , probiotic , and synbiotic therapies for patients with NAFLD in r and omized controlled trials . | 471 | 26,872,721 | The effect of enriched chicory inulin on liver enzymes, calcium homeostasis and hematological parameters in patients with type 2 diabetes mellitus: A randomized placebo-controlled trial. | BACKGROUND S AND AIMS Type 2 diabetic mellitus ( T2DM ) as one of the main causes of morbidity and mortality is associated with immune system disturbances and metabolic abnormalities . In the current study we aim ed to evaluate the effects of enriched chicory inulin supplementation on liver enzymes , serum calcium and phosphorous concentrations and hematological parameters in patients with T2DM . METHODS Forty-six diabetic females patients were r and omly allocated into intervention ( n=27 ) and control ( n=22 ) groups . Subjects in the intervention group received a daily dose of 10 g of chicory and subjects in control group received a placebo for two months . Anthropometric variables , glucose homeostasis , hematological parameters and metabolic indices including serum alanine aminotransfersae ( ALT ) , aspartate aminotransferase ( AST ) , alkaline phosphatase ( ALP ) , calcium and phosphorous as well as creatinine concentrations , glomerular filtration rate ( GFR ) and blood pressure were assessed at the beginning and end of the trial . RESULTS Significant reductions in fasting serum glucose ( FSG ) , Hb A1C , AST and ALP concentrations were observed in chicory-treated group . Systolic and diastolic blood pressures were also reduced in chicory-treated group . Serum calcium significantly increased after chicory supplementation but no change in placebo treated group has been occurred ( P=0.014 ) . Supplementation with enriched chicory for two months significantly reduced hematocrit and mean corpuscular volume ( MCV ) values ( P<0.05 ) . Changes in serum insulin , creatinine and GFR were not significant . CONCLUSION The present study showed beneficial effects of oligofructose-enriched chicory on the improvement of the glucose and calcium homeostasis , liver function tests , blood pressure and reduction in hematologic risk factors of diabetes in female patients with T2DM . Further studies in both genders are needed to generalize these findings to total population | 26 | Conclusion This meta- analysis supports the potential use of microbial therapies in the treatment of NAFLD and sheds light on their potential mode of action . | Context Nonalcoholic fatty liver disease ( NAFLD ) is a highly prevalent and underdiagnosed comorbidity of many chronic diseases that is associated with altered intestinal bacterial communities .
This association has prompted research into alternative treatments aim ed at modulating intestinal microbiota .
Given the novelty of these treatments , scarce evidence regarding their effectiveness in clinical population s exists .
Objective This meta- analysis sought to systemically review and quantitatively synthesize evidence on prebiotic , probiotic , and synbiotic therapies for patients with NAFLD in r and omized controlled trials . |
26 | 30,113,661 | Conclusion This meta- analysis supports the potential use of microbial therapies in the treatment of NAFLD and sheds light on their potential mode of action . | Context Nonalcoholic fatty liver disease ( NAFLD ) is a highly prevalent and underdiagnosed comorbidity of many chronic diseases that is associated with altered intestinal bacterial communities .
This association has prompted research into alternative treatments aim ed at modulating intestinal microbiota .
Given the novelty of these treatments , scarce evidence regarding their effectiveness in clinical population s exists .
Objective This meta- analysis sought to systemically review and quantitatively synthesize evidence on prebiotic , probiotic , and synbiotic therapies for patients with NAFLD in r and omized controlled trials . | 472 | 5,427,479 | Effects of symbiotic and vitamin E supplementation on blood pressure, nitric oxide and inflammatory factors in non-alcoholic fatty liver disease | Non-alcoholic fatty liver disease ( NAFLD ) has been suggested to be well correlated with altered blood pressure . This study was conducted to determine the effects of symbiotic and vitamin E supplementation on blood pressure and inflammatory indices of patients with NAFLD . This r and omized , double-blind , placebo-controlled trial was performed among 60 NAFLD patients aged 25 to 64 years old . Participants were r and omly divided into four groups to receive a 400 IU alpha-tocopherol and 2 × 108 CFU/g symbiotic supplement for 8 weeks . The anthropometric parameters , systolic blood pressure ( SBP ) and diastolic blood pressure ( DBP ) , serum malondialdehyde ( MDA ) , nitric oxide ( NO ) and tumor necrosis factor α ( TNFα ) were assessed at baseline and after 8 weeks of intervention . After 8 weeks of intervention , combined symbiotic and alpha-tocopherol , symbiotic and alpha-tocopherol alone administration , compared with the placebo , result ed in significant decreases in SBP ( -17.07±2.1 , -16.07±3.56 , -1.73±2.25 and -1.55±3.01 mmHg , P=0.01 ) , serum MDA ( -1.19±0.5 , -0.12±0.65 , 0.14 ± 0.64 and 0.16±0.34 nmol/mL , P<0.001 ) , serum TNFα ( -15.62±13.93 , -9.24±7.12 , -11.44 ± 15.47 and 3.01±1.71 pg/ml , P<0.001 ) concentrations . A significant decrease in serum AST ( -11.36±4.52 , -7.43±8.58 , -5.93±6.61 and 2.5±5.75 μmol/L , P < 0.001 ) , ALT ( -12.79±3.65 , -3.66±6.81 , -6.54±7.66 and 4.16±3.43 μmol/L , P < 0.001 ) and ALP ( -26.8±11.1 , -4.56±9.22 , -14.48±12.22 and 5.19±2.64 μmol/L , P < 0.001 ) was seen . Variations in DBP and serum NO concentration were not significant . Alpha-tocopherol and symbiotic supplementation among patients with NAFLD result ed in decreased SBP , serum MDA , TNFα levels and enzymes liver ; however , they did not affect DBP and serum NO concentration | 26 | Conclusion This meta- analysis supports the potential use of microbial therapies in the treatment of NAFLD and sheds light on their potential mode of action . | Context Nonalcoholic fatty liver disease ( NAFLD ) is a highly prevalent and underdiagnosed comorbidity of many chronic diseases that is associated with altered intestinal bacterial communities .
This association has prompted research into alternative treatments aim ed at modulating intestinal microbiota .
Given the novelty of these treatments , scarce evidence regarding their effectiveness in clinical population s exists .
Objective This meta- analysis sought to systemically review and quantitatively synthesize evidence on prebiotic , probiotic , and synbiotic therapies for patients with NAFLD in r and omized controlled trials . |
26 | 30,113,661 | Conclusion This meta- analysis supports the potential use of microbial therapies in the treatment of NAFLD and sheds light on their potential mode of action . | Context Nonalcoholic fatty liver disease ( NAFLD ) is a highly prevalent and underdiagnosed comorbidity of many chronic diseases that is associated with altered intestinal bacterial communities .
This association has prompted research into alternative treatments aim ed at modulating intestinal microbiota .
Given the novelty of these treatments , scarce evidence regarding their effectiveness in clinical population s exists .
Objective This meta- analysis sought to systemically review and quantitatively synthesize evidence on prebiotic , probiotic , and synbiotic therapies for patients with NAFLD in r and omized controlled trials . | 473 | 4,963,873 | Beneficial Effect of Synbiotic Supplementation on Hepatic Steatosis and Anthropometric Parameters, But Not on Gut Permeability in a Population with Nonalcoholic Steatohepatitis | Nonalcoholic fatty liver disease is the most prevalent chronic liver disease in Western countries ; it can progress to nonalcoholic steatohepatitis ( NASH ) , cirrhosis and hepatocarcinoma . The importance of gut-liver-adipose tissue axis has become evident and treatments targeting gut microbiota may improve inflammatory and metabolic parameters in NASH patients . In a r and omized , controlled clinical trial , involving 50 biopsy-proven NASH patients , we investigated the effects of synbiotic supplementation on metabolic parameters , hepatic steatosis , intestinal permeability , small intestinal bacterial overgrowth ( SIBO ) and lipopolysaccharide ( LPS ) serum levels . Patients were separated into two groups receiving Lactobacillus reuteri with guar gum and inulin for three months and healthy balanced nutritional counseling versus nutritional counseling alone . Before and after the intervention we assessed steatosis by magnetic resonance imaging , intestinal permeability by lactulose/mannitol urinary excretion and SIBO by glucose breath testing . NASH patients presented high gut permeability , but low prevalence of SIBO . After the intervention , only the synbiotic group presented a reduction in steatosis , lost weight , diminished BMI and waist circumference measurement . Synbiotic did not improve intestinal permeability or LPS levels . We concluded that synbiotic supplementation associated with nutritional counseling seems superior to nutritional counseling alone for NASH treatment as it attenuates steatosis and may help to achieve weight loss | 26 | Conclusion This meta- analysis supports the potential use of microbial therapies in the treatment of NAFLD and sheds light on their potential mode of action . | Context Nonalcoholic fatty liver disease ( NAFLD ) is a highly prevalent and underdiagnosed comorbidity of many chronic diseases that is associated with altered intestinal bacterial communities .
This association has prompted research into alternative treatments aim ed at modulating intestinal microbiota .
Given the novelty of these treatments , scarce evidence regarding their effectiveness in clinical population s exists .
Objective This meta- analysis sought to systemically review and quantitatively synthesize evidence on prebiotic , probiotic , and synbiotic therapies for patients with NAFLD in r and omized controlled trials . |
26 | 30,113,661 | Conclusion This meta- analysis supports the potential use of microbial therapies in the treatment of NAFLD and sheds light on their potential mode of action . | Context Nonalcoholic fatty liver disease ( NAFLD ) is a highly prevalent and underdiagnosed comorbidity of many chronic diseases that is associated with altered intestinal bacterial communities .
This association has prompted research into alternative treatments aim ed at modulating intestinal microbiota .
Given the novelty of these treatments , scarce evidence regarding their effectiveness in clinical population s exists .
Objective This meta- analysis sought to systemically review and quantitatively synthesize evidence on prebiotic , probiotic , and synbiotic therapies for patients with NAFLD in r and omized controlled trials . | 474 | 5,474,907 | Effects of Synbiotic Food Consumption on Serum Minerals, Liver Enzymes, and Blood Pressure in Patients with Type 2 Diabetes: A Double-blind Randomized Cross-over Controlled Clinical Trial | Background : This research was to examine the effects of synbiotic intake on minerals , liver enzymes , and blood pressure in patients with type 2 diabetes ( T2D ) . Methods : This r and omized , cross-over clinical trial was performed among 62 diabetic patients . Persons were r and omly assigned to intake either a synbiotic ( n = 62 ) or a control food ( n = 62 ) for 6 weeks . A 3-week washout period was applied following which persons were crossed over to the alternate intervention arm for an additional 6 weeks . The synbiotic was consisted of Lactobacillus sporogenes ( 1 × 107 CFU ) , 0.04 g inulin ( HPX ) as prebiotic . Persons were asked to consume the synbiotic and control foods 27 g a day . Blood pressure was measured , and blood sample s were taken at baseline and after 6-week intervention to assess calcium , magnesium , iron , alkaline phosphatase , aspartate aminotransferase , alanine aminotransferase , and total bilirubin . Results : The consumption of a synbiotic food , compared to the control food , result ed in a significant rise of calcium ( 0.66 vs. −0.14 mg/dL , P = 0.03 ) and iron ( 5.06 vs. −9.98 mg/dL , P = 0.03 ) . The decrease of total bilirubin ( 0.08 vs. −0.04 mg/dL ; P = 0.009 ) was also seen in the synbiotic group compared with the control group . Conclusions : Overall , synbiotic in T2D patients had beneficial effects on calcium , iron , and total bilirubin concentrations | 26 | Conclusion This meta- analysis supports the potential use of microbial therapies in the treatment of NAFLD and sheds light on their potential mode of action . | Context Nonalcoholic fatty liver disease ( NAFLD ) is a highly prevalent and underdiagnosed comorbidity of many chronic diseases that is associated with altered intestinal bacterial communities .
This association has prompted research into alternative treatments aim ed at modulating intestinal microbiota .
Given the novelty of these treatments , scarce evidence regarding their effectiveness in clinical population s exists .
Objective This meta- analysis sought to systemically review and quantitatively synthesize evidence on prebiotic , probiotic , and synbiotic therapies for patients with NAFLD in r and omized controlled trials . |
26 | 30,113,661 | Conclusion This meta- analysis supports the potential use of microbial therapies in the treatment of NAFLD and sheds light on their potential mode of action . | Context Nonalcoholic fatty liver disease ( NAFLD ) is a highly prevalent and underdiagnosed comorbidity of many chronic diseases that is associated with altered intestinal bacterial communities .
This association has prompted research into alternative treatments aim ed at modulating intestinal microbiota .
Given the novelty of these treatments , scarce evidence regarding their effectiveness in clinical population s exists .
Objective This meta- analysis sought to systemically review and quantitatively synthesize evidence on prebiotic , probiotic , and synbiotic therapies for patients with NAFLD in r and omized controlled trials . | 475 | 19,001,772 | Effects of xylooligosaccharides in type 2 diabetes mellitus. | The purpose of this study was to evaluate the effect of xylooligosaccharide ( XOS ) on the blood sugar , lipids and oxidative status in type 2 diabetes mellitus ( DM ) . A total of 26 outpatient subjects of Taichung Veterans General Hospital , Taiwan , with HbA1c levels between 7.0 and 10.0 % and triglyceride < 400 mg/dL were enrolled in the present study . Subjects were supplemented with 4 g/d XOS ( n=12 ) or a placebo ( n=14 ) for 8 wk in a r and omized double-blind clinical design . The results showed that the anthropometric values and nutrient intakes did not change during the experimental period . XOS supplementation not only reduced the glucose , HbA1c and fructosamine concentrations , but also decreased the levels of total cholesterol , low density lipoprotein ( LDL ) cholesterol , oxidized low density lipoprotein ( ox-LDL ) and apolipoprotein B. The activity of catalase of the erythrocyte sample decreased in the XOS group , but not the activities of superoxide dismutase and glutathione peroxidase . In conclusion , the dietary supplementation with XOS for 8 wk was effective in improving the blood sugar and lipids in type 2 diabetes , indicating that XOS-containing diets might be beneficial to DM subjects | 26 | Conclusion This meta- analysis supports the potential use of microbial therapies in the treatment of NAFLD and sheds light on their potential mode of action . | Context Nonalcoholic fatty liver disease ( NAFLD ) is a highly prevalent and underdiagnosed comorbidity of many chronic diseases that is associated with altered intestinal bacterial communities .
This association has prompted research into alternative treatments aim ed at modulating intestinal microbiota .
Given the novelty of these treatments , scarce evidence regarding their effectiveness in clinical population s exists .
Objective This meta- analysis sought to systemically review and quantitatively synthesize evidence on prebiotic , probiotic , and synbiotic therapies for patients with NAFLD in r and omized controlled trials . |
26 | 30,113,661 | Conclusion This meta- analysis supports the potential use of microbial therapies in the treatment of NAFLD and sheds light on their potential mode of action . | Context Nonalcoholic fatty liver disease ( NAFLD ) is a highly prevalent and underdiagnosed comorbidity of many chronic diseases that is associated with altered intestinal bacterial communities .
This association has prompted research into alternative treatments aim ed at modulating intestinal microbiota .
Given the novelty of these treatments , scarce evidence regarding their effectiveness in clinical population s exists .
Objective This meta- analysis sought to systemically review and quantitatively synthesize evidence on prebiotic , probiotic , and synbiotic therapies for patients with NAFLD in r and omized controlled trials . | 476 | 3,196,245 | The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials | Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more | 26 | Conclusion This meta- analysis supports the potential use of microbial therapies in the treatment of NAFLD and sheds light on their potential mode of action . | Context Nonalcoholic fatty liver disease ( NAFLD ) is a highly prevalent and underdiagnosed comorbidity of many chronic diseases that is associated with altered intestinal bacterial communities .
This association has prompted research into alternative treatments aim ed at modulating intestinal microbiota .
Given the novelty of these treatments , scarce evidence regarding their effectiveness in clinical population s exists .
Objective This meta- analysis sought to systemically review and quantitatively synthesize evidence on prebiotic , probiotic , and synbiotic therapies for patients with NAFLD in r and omized controlled trials . |
26 | 30,113,661 | Conclusion This meta- analysis supports the potential use of microbial therapies in the treatment of NAFLD and sheds light on their potential mode of action . | Context Nonalcoholic fatty liver disease ( NAFLD ) is a highly prevalent and underdiagnosed comorbidity of many chronic diseases that is associated with altered intestinal bacterial communities .
This association has prompted research into alternative treatments aim ed at modulating intestinal microbiota .
Given the novelty of these treatments , scarce evidence regarding their effectiveness in clinical population s exists .
Objective This meta- analysis sought to systemically review and quantitatively synthesize evidence on prebiotic , probiotic , and synbiotic therapies for patients with NAFLD in r and omized controlled trials . | 477 | 4,994,089 | Altered Fecal Microbiota Correlates with Liver Biochemistry in Nonobese Patients with Non-alcoholic Fatty Liver Disease | Increasing evidence suggests a role of intestinal dysbiosis in obesity and non-alcoholic fatty liver disease ( NAFLD ) . But it remains unknown in nonobese NAFLD . This prospect i ve , cross-sectional study sought to characterize differences in fecal microbiota between nonobese adult individuals with and without NAFLD and their potential association with metabolic markers of disease progression . A total of 126 nonobese subjects were enrolled : 43 NAFLD and 83 healthy controls ( HC ) . The microbial community was profiled by denaturing gradient gel electrophoresis and examined by 454 pyrosequencing of the 16S ribosomal RNA V3 region . Lower diversity and a phylum-level change in the fecal microbiome were found in NAFLD . Compared with HC , patients had 20 % more phylum Bacteroidetes ( p = 0.005 ) and 24 % less Firmicutes ( p = 0.002 ) . Within Firmicutes , four families and their 8 genera , which were short-chain fatty acids-producing and 7α-dehydroxylating bacteria , were significantly decreased . Moreover , Gram-negative ( G− ) bacteria were prevalent in NAFLD ( p = 0.008 ) . Furthermore , a significant correlation with metabolic markers was revealed for disturbed microbiota in NAFLD . This novel study indicated that intestinal dysbiosis was associated with nonobese NAFLD and might increase the risk of NAFLD progression | 26 | Conclusion This meta- analysis supports the potential use of microbial therapies in the treatment of NAFLD and sheds light on their potential mode of action . | Context Nonalcoholic fatty liver disease ( NAFLD ) is a highly prevalent and underdiagnosed comorbidity of many chronic diseases that is associated with altered intestinal bacterial communities .
This association has prompted research into alternative treatments aim ed at modulating intestinal microbiota .
Given the novelty of these treatments , scarce evidence regarding their effectiveness in clinical population s exists .
Objective This meta- analysis sought to systemically review and quantitatively synthesize evidence on prebiotic , probiotic , and synbiotic therapies for patients with NAFLD in r and omized controlled trials . |
26 | 30,113,661 | Conclusion This meta- analysis supports the potential use of microbial therapies in the treatment of NAFLD and sheds light on their potential mode of action . | Context Nonalcoholic fatty liver disease ( NAFLD ) is a highly prevalent and underdiagnosed comorbidity of many chronic diseases that is associated with altered intestinal bacterial communities .
This association has prompted research into alternative treatments aim ed at modulating intestinal microbiota .
Given the novelty of these treatments , scarce evidence regarding their effectiveness in clinical population s exists .
Objective This meta- analysis sought to systemically review and quantitatively synthesize evidence on prebiotic , probiotic , and synbiotic therapies for patients with NAFLD in r and omized controlled trials . | 478 | 23,396,737 | Treatment of nonalcoholic steatohepatitis with probiotics. A proof-of-concept study. | BACKGROUND Probiotics have profound effect on nonalcoholic steatohepatitis ( NASH ) in animal models . We aim ed to test the hypothesis that probiotics treatment was superior to usual care in reducing liver fat in NASH patients . MATERIAL AND METHODS Patients with histology-proven NASH were r and omized to receive probiotics ( n = 10 ) or usual care ( n = 10 ) for 6 months . The Lepicol probiotic formula contained Lactobacillus plantarum , Lactobacillus deslbrueckii , Lactobacillus acidophilus , Lactobacillus rhamnosus and Bifidobacterium bifidum . The primary endpoint was change in intrahepatic triglyceride content ( IHTG ) , as measured by proton-magnetic resonance spectroscopy , from baseline to month 6 . Secondary endpoints included changes in liver biochemistry and metabolic profile . RESULTS IHTG decreased from 22.6 ± 8.2 % to 14.9 ± 7.0 % in the probiotic group ( P = 0.034 ) but remained static in the usual care group ( 16.9 ± 6.1 % to 16.0 ± 6.6 % ; P = 0.55 ) . Six subjects in the probiotic group had IHTG reduced by more than 30 % from baseline , compared to 2 subjects in the usual care group ( P = 0.17 ) . The probiotic group also had greater reduction in serum aspartate aminotransferase level ( P = 0.008 ) . On the other h and , the use of probiotics was not associated with changes in body mass index , waist circumference , glucose and lipid levels . CONCLUSIONS Probiotics treatment may reduce liver fat and AST level in NASH patients . The therapeutic potential of probiotics in NASH should be tested in larger studies | 26 | Conclusion This meta- analysis supports the potential use of microbial therapies in the treatment of NAFLD and sheds light on their potential mode of action . | Context Nonalcoholic fatty liver disease ( NAFLD ) is a highly prevalent and underdiagnosed comorbidity of many chronic diseases that is associated with altered intestinal bacterial communities .
This association has prompted research into alternative treatments aim ed at modulating intestinal microbiota .
Given the novelty of these treatments , scarce evidence regarding their effectiveness in clinical population s exists .
Objective This meta- analysis sought to systemically review and quantitatively synthesize evidence on prebiotic , probiotic , and synbiotic therapies for patients with NAFLD in r and omized controlled trials . |
26 | 30,113,661 | Conclusion This meta- analysis supports the potential use of microbial therapies in the treatment of NAFLD and sheds light on their potential mode of action . | Context Nonalcoholic fatty liver disease ( NAFLD ) is a highly prevalent and underdiagnosed comorbidity of many chronic diseases that is associated with altered intestinal bacterial communities .
This association has prompted research into alternative treatments aim ed at modulating intestinal microbiota .
Given the novelty of these treatments , scarce evidence regarding their effectiveness in clinical population s exists .
Objective This meta- analysis sought to systemically review and quantitatively synthesize evidence on prebiotic , probiotic , and synbiotic therapies for patients with NAFLD in r and omized controlled trials . | 479 | 25,097,844 | The Effect of Chlorella vulgaris Supplementation on Liver En-zymes, Serum Glucose and Lipid Profile in Patients with Non-Alcoholic Fatty Liver Disease. | BACKGROUND Non-alcoholic fatty liver disease ( NAFLD ) is becoming a public health problem worldwide and using microalgae is a new approach on its treatment . The aim of this study was to investigate the effect of Chlorella vulgaris supplementation on liver enzymes , serum glucose and lipid profile in patients with NAFLD . METHODS This double-blind r and omized placebo-controlled clinical trial was conducted on 60 NAFLD patients from specialized clinics of Tabriz University of Medical Sciences from December 2011 to July 2012 . The subjects were r and omly allocated into 2 groups : 1 ) " intervention " ( n=30 ) received 400 mg/day vitamin E plus four 300 mg tablets of Chlorella vulgaris and , 2 ) " placebo " ( n=30 ) received 400 mg/day vitamin E and four placebo tablets per day for 8 weeks . Weight , liver enzymes and metabolic factors were assessed in fasting serum and dietary data was collected at baseline and end of the study . RESULTS Weight , liver enzymes , fasting blood sugar ( FBS ) and lipid profile decreased significantly in both groups ( P<0.05 ) . The differences in weight , ALP and FBS between the two groups were statistically significant ( P=0.01 , P=0.04 and P=0.02 , respectively ) . CONCLUSION C. vulgaris seems to improve FBS and lipid profile and therefore could be considered as an effective complementary treatment in NAFLD | 26 | Conclusion This meta- analysis supports the potential use of microbial therapies in the treatment of NAFLD and sheds light on their potential mode of action . | Context Nonalcoholic fatty liver disease ( NAFLD ) is a highly prevalent and underdiagnosed comorbidity of many chronic diseases that is associated with altered intestinal bacterial communities .
This association has prompted research into alternative treatments aim ed at modulating intestinal microbiota .
Given the novelty of these treatments , scarce evidence regarding their effectiveness in clinical population s exists .
Objective This meta- analysis sought to systemically review and quantitatively synthesize evidence on prebiotic , probiotic , and synbiotic therapies for patients with NAFLD in r and omized controlled trials . |
26 | 30,113,661 | Conclusion This meta- analysis supports the potential use of microbial therapies in the treatment of NAFLD and sheds light on their potential mode of action . | Context Nonalcoholic fatty liver disease ( NAFLD ) is a highly prevalent and underdiagnosed comorbidity of many chronic diseases that is associated with altered intestinal bacterial communities .
This association has prompted research into alternative treatments aim ed at modulating intestinal microbiota .
Given the novelty of these treatments , scarce evidence regarding their effectiveness in clinical population s exists .
Objective This meta- analysis sought to systemically review and quantitatively synthesize evidence on prebiotic , probiotic , and synbiotic therapies for patients with NAFLD in r and omized controlled trials . | 480 | 23,371,785 | Oat Prevents Obesity and Abdominal Fat Distribution, and Improves Liver Function in Humans | Obesity is associated with a great diversity of diseases including non-alcoholic fatty liver disease . Our recent report suggested that oat , rich in beta-glucan , had a metabolic-regulating and liver-protecting effect in an animal model . In this study , we performed a clinical trial to further confirm the effect of oat . Subjects with BMI ≧27 and aged 18–65 , were r and omly divided into a control ( n = 18 ) and an oat-treated ( n = 16 ) group , taking a placebo or beta glucan-containing oat cereal , respectively , for 12 weeks . Our data showed that consumption of oat reduced body weight , BMI , body fat and the waist-to-hip ratio . Profiles of hepatic function , including AST , but especially ALT , were useful re sources to help in the evaluation of the liver , since both showed decrements in patients with oat consumption . Nevertheless , anatomic changes were still not observed by ultrasonic image analysis . Ingestion of oat was well tolerated and there was no adverse effect during the trial . In conclusion , consumption of oat reduced obesity , abdominal fat , and improved lipid profiles and liver functions . Taken as a daily supplement , oat could act as an adjuvant therapy for metabolic disorders | 26 | Conclusion This meta- analysis supports the potential use of microbial therapies in the treatment of NAFLD and sheds light on their potential mode of action . | Context Nonalcoholic fatty liver disease ( NAFLD ) is a highly prevalent and underdiagnosed comorbidity of many chronic diseases that is associated with altered intestinal bacterial communities .
This association has prompted research into alternative treatments aim ed at modulating intestinal microbiota .
Given the novelty of these treatments , scarce evidence regarding their effectiveness in clinical population s exists .
Objective This meta- analysis sought to systemically review and quantitatively synthesize evidence on prebiotic , probiotic , and synbiotic therapies for patients with NAFLD in r and omized controlled trials . |
26 | 30,113,661 | Conclusion This meta- analysis supports the potential use of microbial therapies in the treatment of NAFLD and sheds light on their potential mode of action . | Context Nonalcoholic fatty liver disease ( NAFLD ) is a highly prevalent and underdiagnosed comorbidity of many chronic diseases that is associated with altered intestinal bacterial communities .
This association has prompted research into alternative treatments aim ed at modulating intestinal microbiota .
Given the novelty of these treatments , scarce evidence regarding their effectiveness in clinical population s exists .
Objective This meta- analysis sought to systemically review and quantitatively synthesize evidence on prebiotic , probiotic , and synbiotic therapies for patients with NAFLD in r and omized controlled trials . | 481 | 28,546,791 | Fecal Microbiota Transplantation: From Clostridium difficile to Inflammatory Bowel Disease. | Fecal microbiota transplantation ( FMT ) has evolved from a case report in the medical literature to the basis of major innovations in the treatment of Clostridium difficile infection ( CDI ) and , potentially , inflammatory bowel disease ( IBD ) . In the clinical setting , FMT was noted to significantly lower the risk of recurrent CDI , likely by increasing microbial diversity and altering the metabolic environment in the intestinal tract of recipients . In parallel , advances in the ability to quantify and characterize microbial communities in fecal sample s led to the association of IBD with a state of intestinal dysbiosis . Consequently , a number of case series and r and omized , controlled trials have evaluated FMT in treating active ulcerative colitis or Crohn 's disease . Unlike in CDI , the efficacy of FMT in the treatment of IBD appears to be influenced by a number of factors , including donor microbial profiles , inflammatory burden , and the microbial diversity of the recipient . The therapeutic potential of the microbiome has led to a number of biotechnology and pharmaceutical companies isolating specific strains from healthy stool for use as targeted therapies for IBD in clinical trials . Ongoing studies are likely to determine the missing link between the efficacy of FMT and its impact on microbial communities and mucosal inflammation | 26 | Conclusion This meta- analysis supports the potential use of microbial therapies in the treatment of NAFLD and sheds light on their potential mode of action . | Context Nonalcoholic fatty liver disease ( NAFLD ) is a highly prevalent and underdiagnosed comorbidity of many chronic diseases that is associated with altered intestinal bacterial communities .
This association has prompted research into alternative treatments aim ed at modulating intestinal microbiota .
Given the novelty of these treatments , scarce evidence regarding their effectiveness in clinical population s exists .
Objective This meta- analysis sought to systemically review and quantitatively synthesize evidence on prebiotic , probiotic , and synbiotic therapies for patients with NAFLD in r and omized controlled trials . |
26 | 30,113,661 | Conclusion This meta- analysis supports the potential use of microbial therapies in the treatment of NAFLD and sheds light on their potential mode of action . | Context Nonalcoholic fatty liver disease ( NAFLD ) is a highly prevalent and underdiagnosed comorbidity of many chronic diseases that is associated with altered intestinal bacterial communities .
This association has prompted research into alternative treatments aim ed at modulating intestinal microbiota .
Given the novelty of these treatments , scarce evidence regarding their effectiveness in clinical population s exists .
Objective This meta- analysis sought to systemically review and quantitatively synthesize evidence on prebiotic , probiotic , and synbiotic therapies for patients with NAFLD in r and omized controlled trials . | 482 | 19,038,698 | Probiotics restore bowel flora and improve liver enzymes in human alcohol-induced liver injury: a pilot study. | The effects of chronic alcohol consumption on the bowel flora and the potential therapeutic role of probiotics in alcohol-induced liver injury have not previously been evaluated . In this study , 66 adult Russian males admitted to a psychiatric hospital with a diagnosis of alcoholic psychosis were enrolled in a prospect i ve , r and omized , clinical trial to study the effects of alcohol and probiotics on the bowel flora and alcohol-induced liver injury . Patients were r and omized to receive 5 days of Bifidobacterium bifidum and Lactobacillus plantarum 8PA3 versus st and ard therapy alone ( abstinence plus vitamins ) . Stool cultures and liver enzymes were performed at baseline and again after therapy . Results were compared between groups and with 24 healthy , matched controls who did not consume alcohol . Compared to healthy controls , alcoholic patients had significantly reduced numbers of bifidobacteria ( 6.3 vs. 7.5 log colony-forming unit [CFU]/g ) , lactobacilli ( 3.15 vs. 4.59 log CFU/g ) , and enterococci ( 4.43 vs. 5.5 log CFU/g ) . The mean baseline alanine aminotransferase ( ALT ) , aspartate aminotransferase ( AST ) , and gamma-glutamyl transpeptidase ( GGT ) activities were significantly elevated in the alcoholic group compared to the healthy control group ( AST : 104.1 vs. 29.15 U/L ; ALT : 50.49 vs. 22.96 U/L ; GGT 161.5 vs. 51.88 U/L ) , indicating that these patients did have mild alcohol-induced liver injury . After 5 days of probiotic therapy , alcoholic patients had significantly increased numbers of both bifidobacteria ( 7.9 vs. 6.81 log CFU/g ) and lactobacilli ( 4.2 vs. 3.2 log CFU/g ) compared to the st and ard therapy arm . Despite similar values at study initiation , patients treated with probiotics had significantly lower AST and ALT activity at the end of treatment than those treated with st and ard therapy alone ( AST : 54.67 vs. 76.43 U/L ; ALT 36.69 vs. 51.26 U/L ) . In a subgroup of 26 subjects with well-characterized mild alcoholic hepatitis ( defined as AST and ALT greater than 30 U/L with AST-to-ALT ratio greater than one ) , probiotic therapy was associated with a significant end of treatment reduction in ALT , AST , GGT , lactate dehydrogenase , and total bilirubin . In this subgroup , there was a significant end of treatment mean ALT reduction in the probiotic arm versus the st and ard therapy arm . In conclusion , patients with alcohol-induced liver injury have altered bowel flora compared to healthy controls . Short-term oral supplementation with B. bifidum and L. plantarum 8PA3 was associated with restoration of the bowel flora and greater improvement in alcohol-induced liver injury than st and ard therapy alone | 26 | Conclusion This meta- analysis supports the potential use of microbial therapies in the treatment of NAFLD and sheds light on their potential mode of action . | Context Nonalcoholic fatty liver disease ( NAFLD ) is a highly prevalent and underdiagnosed comorbidity of many chronic diseases that is associated with altered intestinal bacterial communities .
This association has prompted research into alternative treatments aim ed at modulating intestinal microbiota .
Given the novelty of these treatments , scarce evidence regarding their effectiveness in clinical population s exists .
Objective This meta- analysis sought to systemically review and quantitatively synthesize evidence on prebiotic , probiotic , and synbiotic therapies for patients with NAFLD in r and omized controlled trials . |
26 | 30,113,661 | Conclusion This meta- analysis supports the potential use of microbial therapies in the treatment of NAFLD and sheds light on their potential mode of action . | Context Nonalcoholic fatty liver disease ( NAFLD ) is a highly prevalent and underdiagnosed comorbidity of many chronic diseases that is associated with altered intestinal bacterial communities .
This association has prompted research into alternative treatments aim ed at modulating intestinal microbiota .
Given the novelty of these treatments , scarce evidence regarding their effectiveness in clinical population s exists .
Objective This meta- analysis sought to systemically review and quantitatively synthesize evidence on prebiotic , probiotic , and synbiotic therapies for patients with NAFLD in r and omized controlled trials . | 483 | 22,013,734 | Effect of a probiotic on liver aminotransferases in nonalcoholic fatty liver disease patients: a double blind randomized clinical trial. | OBJECTIVE The present pilot trial was carried out to evaluate the effects of an acute treatment with a mixture containing 500 million of Lactobacillus bulgaricus and Streptococcus thermophilus per day in patients with non alcoholic fatty liver disease ( NAFLD ) . RESEARCH METHODS A sample of 30 patients with NAFLD ( diagnosed by liver biopsy ) was enrolled and 28 patients were analyzed in a double blind r and omized clinical trial . Patients were r and omized to one of the following treatments during 3 months : group I , treated with one tablet per day with 500 million of Lactobacillus bulgaricus and Streptococcus thermophilus and group II , treated with one placebo tablet ( 120 mg of starch ) . RESULTS In group I , alanine amino transferase ( ALT : 67.7 + /- 25.1 vs. 60.4 + /- 30.4 UI/L ; p < 0.05 ) , aspartate aminotransferase activity ( AST : 41.3 + /- 15.5 vs. 35.6 + /- 10.4 UI/L ; p < 0.05 ) and gammaglutamine transferase levels ( gammaGT : 118.2 + /- 63.1 vs. 107.7 + /- 60.8 UI/L ; p < 0.05 ) decreased . In group II , all liver function parameters remained unchanged ( ALT : 60.7 + /- 32.1 vs. 64.8 + /- 35.5 UI/L ; p < 0.05 ) , aspartate aminotransferase activity ( AST : 31.7 + /- 13.1 vs. 36.4 + /- 13.8 UI/L ; ns ) and gammaglutamine transferase levels ( gammaGT : 82.1 + /- 55.1 vs. 83.6 + /- 65.3 UI/L ; ns ) . Anthropometric parameters and cardiovascular risk factors remained unchanged after treatment in both groups . CONCLUSION A tablet of 500 million of Lactobacillus bulgaricus and Streptococcus thermophilus , with a r and omized clinical design , improved liver aminotransferases levels in patients with NAFLD | 26 | Conclusion This meta- analysis supports the potential use of microbial therapies in the treatment of NAFLD and sheds light on their potential mode of action . | Context Nonalcoholic fatty liver disease ( NAFLD ) is a highly prevalent and underdiagnosed comorbidity of many chronic diseases that is associated with altered intestinal bacterial communities .
This association has prompted research into alternative treatments aim ed at modulating intestinal microbiota .
Given the novelty of these treatments , scarce evidence regarding their effectiveness in clinical population s exists .
Objective This meta- analysis sought to systemically review and quantitatively synthesize evidence on prebiotic , probiotic , and synbiotic therapies for patients with NAFLD in r and omized controlled trials . |
26 | 30,113,661 | Conclusion This meta- analysis supports the potential use of microbial therapies in the treatment of NAFLD and sheds light on their potential mode of action . | Context Nonalcoholic fatty liver disease ( NAFLD ) is a highly prevalent and underdiagnosed comorbidity of many chronic diseases that is associated with altered intestinal bacterial communities .
This association has prompted research into alternative treatments aim ed at modulating intestinal microbiota .
Given the novelty of these treatments , scarce evidence regarding their effectiveness in clinical population s exists .
Objective This meta- analysis sought to systemically review and quantitatively synthesize evidence on prebiotic , probiotic , and synbiotic therapies for patients with NAFLD in r and omized controlled trials . | 484 | 4,809,112 | The Effect of Symbiotic Supplementation on Liver Enzymes, C-reactive Protein and Ultrasound Findings in Patients with Non-alcoholic Fatty Liver Disease: A Clinical Trial | Background : Regarding to the growing prevalence of nonalcoholic fatty liver disease ( NAFLD ) , concentrating on various strategies to its prevention and management seems necessary . The aim of this study was to determine the effects of symbiotic on C-reactive protein ( CRP ) , liver enzymes , and ultrasound findings in patients with NAFLD . Methods : Eighty NAFLD patients were enrolled in this r and omized , double-blind , placebo-controlled clinical trial . Participants received symbiotic in form of a 500 mg capsule ( containing seven species of probiotic bacteria and fructooligosaccharides ) or a placebo capsule daily for 8 weeks . Ultrasound grading , CRP , and liver enzymes were evaluated at the baseline and the end of the study . Results : In the symbiotic group , ultrasound grade decreased significantly compared to baseline ( P < 0.005 ) but symbiotic supplementation was not associated with changes in alanine aminotransferase ( ALT ) and aspartate transaminase ( AST ) levels . In the placebo group , there was no significant change in steatosis grade whereas ALT and AST levels were significantly increased ( P = 0.002 , P = 0.02 , respectively ) . CRP values remained static in either group . Conclusions : Symbiotic supplementation improved steatosis in NAFLD patients and might be useful in the management of NAFLD or protective against its progression | 26 | Conclusion This meta- analysis supports the potential use of microbial therapies in the treatment of NAFLD and sheds light on their potential mode of action . | Context Nonalcoholic fatty liver disease ( NAFLD ) is a highly prevalent and underdiagnosed comorbidity of many chronic diseases that is associated with altered intestinal bacterial communities .
This association has prompted research into alternative treatments aim ed at modulating intestinal microbiota .
Given the novelty of these treatments , scarce evidence regarding their effectiveness in clinical population s exists .
Objective This meta- analysis sought to systemically review and quantitatively synthesize evidence on prebiotic , probiotic , and synbiotic therapies for patients with NAFLD in r and omized controlled trials . |
26 | 30,113,661 | Conclusion This meta- analysis supports the potential use of microbial therapies in the treatment of NAFLD and sheds light on their potential mode of action . | Context Nonalcoholic fatty liver disease ( NAFLD ) is a highly prevalent and underdiagnosed comorbidity of many chronic diseases that is associated with altered intestinal bacterial communities .
This association has prompted research into alternative treatments aim ed at modulating intestinal microbiota .
Given the novelty of these treatments , scarce evidence regarding their effectiveness in clinical population s exists .
Objective This meta- analysis sought to systemically review and quantitatively synthesize evidence on prebiotic , probiotic , and synbiotic therapies for patients with NAFLD in r and omized controlled trials . | 485 | 18,317,656 | [Non alcoholic fatty liver disease: treatment with soluble fibres]. | The pilot study evaluated the efficiency of oral soluble fibers to treat patients with nonalcoholic fatty liver disease . Twelve patients received 10 g/day of soluble fibers during 3 months . After the treatment 100 % of patients presented reduction in body mass index , waist circumference and insulin resistance index . In 66.7 % of the patients were observed reduction of the cholesterol levels and 75 % presented normal liver enzymes ( AST , ALT , and GGT ) . The present study suggests that oral soluble fibers may be useful to control risk factors and liver enzymes in patients with nonalcoholic fatty liver disease . However , future studies with histological controls are considered necessary | 26 | Conclusion This meta- analysis supports the potential use of microbial therapies in the treatment of NAFLD and sheds light on their potential mode of action . | Context Nonalcoholic fatty liver disease ( NAFLD ) is a highly prevalent and underdiagnosed comorbidity of many chronic diseases that is associated with altered intestinal bacterial communities .
This association has prompted research into alternative treatments aim ed at modulating intestinal microbiota .
Given the novelty of these treatments , scarce evidence regarding their effectiveness in clinical population s exists .
Objective This meta- analysis sought to systemically review and quantitatively synthesize evidence on prebiotic , probiotic , and synbiotic therapies for patients with NAFLD in r and omized controlled trials . |
26 | 30,113,661 | Conclusion This meta- analysis supports the potential use of microbial therapies in the treatment of NAFLD and sheds light on their potential mode of action . | Context Nonalcoholic fatty liver disease ( NAFLD ) is a highly prevalent and underdiagnosed comorbidity of many chronic diseases that is associated with altered intestinal bacterial communities .
This association has prompted research into alternative treatments aim ed at modulating intestinal microbiota .
Given the novelty of these treatments , scarce evidence regarding their effectiveness in clinical population s exists .
Objective This meta- analysis sought to systemically review and quantitatively synthesize evidence on prebiotic , probiotic , and synbiotic therapies for patients with NAFLD in r and omized controlled trials . | 486 | 28,230,607 | Effects of Probiotics on Nonalcoholic Fatty Liver Disease in Obese Children and Adolescents | Objectives : This study aims to evaluate the effects of some probiotics on sonographic and biochemical nonalcoholic fatty liver disease ( NAFLD ) . Methods : This r and omized triple-blind trial was conducted among 64 obese children with sonographic NAFLD . They were r and omly allocated to receive probiotic capsule ( containing Lactobacillus acidophilus ATCC B3208 , 3 × 109 colony forming units [ CFU ] ; Bifidobacterium lactis DSMZ 32269 , 6 × 109 CFU ; Bifidobacterium bifidum ATCC SD6576 , 2 × 109 CFU ; Lactobacillus rhamnosus DSMZ 21690 , 2 × 109 CFU ) or placebo for 12 weeks . Results : After intervention , in the probiotic group the mean levels of alanine aminotransferase decreased from 32.8 ( 19.6 ) to 23.1 ( 9.9 ) U/L ( P = 0.02 ) and mean aspartate aminotransferase decreased from 32.2 ( 15.7 ) to 24.3 ( 7.7 ) U/L ( P = 0.02 ) . Likewise the mean cholesterol , low-density lipoprotein-C , and triglycerides as well as waist circumference decreased in the intervention group , without significant change in weight , body mass index , and body mass index z score . After the trial , normal liver sonography was reported in 17 ( 53.1 % ) and 5 ( 16.5 % ) of patients in the intervention and placebo groups , respectively . Conclusions : The present findings suggest that a course of the abovementioned probiotic compound can be effective in improving pediatric NAFLD | 26 | Conclusion This meta- analysis supports the potential use of microbial therapies in the treatment of NAFLD and sheds light on their potential mode of action . | Context Nonalcoholic fatty liver disease ( NAFLD ) is a highly prevalent and underdiagnosed comorbidity of many chronic diseases that is associated with altered intestinal bacterial communities .
This association has prompted research into alternative treatments aim ed at modulating intestinal microbiota .
Given the novelty of these treatments , scarce evidence regarding their effectiveness in clinical population s exists .
Objective This meta- analysis sought to systemically review and quantitatively synthesize evidence on prebiotic , probiotic , and synbiotic therapies for patients with NAFLD in r and omized controlled trials . |
26 | 30,113,661 | Conclusion This meta- analysis supports the potential use of microbial therapies in the treatment of NAFLD and sheds light on their potential mode of action . | Context Nonalcoholic fatty liver disease ( NAFLD ) is a highly prevalent and underdiagnosed comorbidity of many chronic diseases that is associated with altered intestinal bacterial communities .
This association has prompted research into alternative treatments aim ed at modulating intestinal microbiota .
Given the novelty of these treatments , scarce evidence regarding their effectiveness in clinical population s exists .
Objective This meta- analysis sought to systemically review and quantitatively synthesize evidence on prebiotic , probiotic , and synbiotic therapies for patients with NAFLD in r and omized controlled trials . | 487 | 24,738,701 | Randomised clinical trial: the beneficial effects of VSL#3 in obese children with non‐alcoholic steatohepatitis | Gut microbiota modifiers may have beneficial effects of non‐alcoholic fatty liver disease ( NAFLD ) but r and omised controlled trials ( RCT ) are lacking in children | 26 | Conclusion This meta- analysis supports the potential use of microbial therapies in the treatment of NAFLD and sheds light on their potential mode of action . | Context Nonalcoholic fatty liver disease ( NAFLD ) is a highly prevalent and underdiagnosed comorbidity of many chronic diseases that is associated with altered intestinal bacterial communities .
This association has prompted research into alternative treatments aim ed at modulating intestinal microbiota .
Given the novelty of these treatments , scarce evidence regarding their effectiveness in clinical population s exists .
Objective This meta- analysis sought to systemically review and quantitatively synthesize evidence on prebiotic , probiotic , and synbiotic therapies for patients with NAFLD in r and omized controlled trials . |
26 | 30,113,661 | Conclusion This meta- analysis supports the potential use of microbial therapies in the treatment of NAFLD and sheds light on their potential mode of action . | Context Nonalcoholic fatty liver disease ( NAFLD ) is a highly prevalent and underdiagnosed comorbidity of many chronic diseases that is associated with altered intestinal bacterial communities .
This association has prompted research into alternative treatments aim ed at modulating intestinal microbiota .
Given the novelty of these treatments , scarce evidence regarding their effectiveness in clinical population s exists .
Objective This meta- analysis sought to systemically review and quantitatively synthesize evidence on prebiotic , probiotic , and synbiotic therapies for patients with NAFLD in r and omized controlled trials . | 488 | 19,730,107 | Bifidobacterium combined with fructo-oligosaccharide versus lactulose in the treatment of patients with hepatic encephalopathy | Background Hepatic encephalopathy ( HE ) is a reversible neuropsychiatric syndrome in patients with liver disease . It was suggested that Bifidobacterium+fructo-oligosaccharides ( FOS ) may decrease blood and brain ammonia levels . Aim The study was conducted to compare the efficacy of Bifidobacterium+FOS and lactulose in patients with HE . Methods One hundred and twenty-five patients ( 35 hepatitis B virus infected , 70 hepatitis C virus infected and 20 cryptogenetic cirrhosis ) were enrolled in the study . Patients were r and omized either to a treatment for 60 days with Bifidobacterium and FOS ( group A ) or into-group receiving lactulose ( group B ) in double-blind . Results After 30 days of the study period , the Bifidobacterium+FOS-treated patients compared with lactulose-treated patients showed a significant decrease of Trail Making Test B ( TMT B ) ( P<0.005 ) , and a significant increase of Symbol Digit Modalities Test ( P<0.001 ) and Block Design Test ( P<0.001 ) . After 60 days of the study period , the Bifidobacterium+FOS-treated patients compared with lactulose-treated patients showed a significant decrease of NH4 fasting HE1 ( P<0.001 ) , TMT A ( P<0.05 ) , TMT B ( P<0.001 ) , and a significant increase of Symbol Digit Modalities Test ( P<0.001 ) and Block Design Test ( P<0.001 ) . Conclusion The treatment with Bifidobacterium+FOS is an alternative to the use of lactulose in patients with cirrhosis , for its usefulness in reducing blood ammonia levels and improvement of psychometric tests | 26 | Conclusion This meta- analysis supports the potential use of microbial therapies in the treatment of NAFLD and sheds light on their potential mode of action . | Context Nonalcoholic fatty liver disease ( NAFLD ) is a highly prevalent and underdiagnosed comorbidity of many chronic diseases that is associated with altered intestinal bacterial communities .
This association has prompted research into alternative treatments aim ed at modulating intestinal microbiota .
Given the novelty of these treatments , scarce evidence regarding their effectiveness in clinical population s exists .
Objective This meta- analysis sought to systemically review and quantitatively synthesize evidence on prebiotic , probiotic , and synbiotic therapies for patients with NAFLD in r and omized controlled trials . |
26 | 30,113,661 | Conclusion This meta- analysis supports the potential use of microbial therapies in the treatment of NAFLD and sheds light on their potential mode of action . | Context Nonalcoholic fatty liver disease ( NAFLD ) is a highly prevalent and underdiagnosed comorbidity of many chronic diseases that is associated with altered intestinal bacterial communities .
This association has prompted research into alternative treatments aim ed at modulating intestinal microbiota .
Given the novelty of these treatments , scarce evidence regarding their effectiveness in clinical population s exists .
Objective This meta- analysis sought to systemically review and quantitatively synthesize evidence on prebiotic , probiotic , and synbiotic therapies for patients with NAFLD in r and omized controlled trials . | 489 | 24,893,332 | Effects of traditional homemade koumiss on some hematological and biochemical characteristics in sedentary men exposed to exercise | Abstract We evaluated the effects of koumiss on some hematological and biochemical characteristics of persons who exercise . Eighteen sedentary males were assigned to three equal groups : koumiss ( K ) , koumiss + exercise ( KE ) and exercise alone ( E ) . Leukocytes ( WBC ) , differential leucocyte count , erythrocytes ( RBC ) , hemoglobin ( HGB ) , hematocrit ( HCT ) , platelet ( PLT ) , glucose , total cholesterol , triglycerides , high density lipoprotein ( HDL ) , aspartate aminotransferase ( AST ) and alanine aminotransferase ( ALT ) were assessed In blood sample s. By the end of the study , triglycerides ( TG ) and cholesterol levels tended to decrease in all groups , but the decrease was significant only at day 15 for the KE group . HDL tended to be increased in all groups at day 15 , but the increase was significant only in the KE group . We found that koumiss had beneficial effects on some hematological and biochemical characteristics | 26 | Conclusion This meta- analysis supports the potential use of microbial therapies in the treatment of NAFLD and sheds light on their potential mode of action . | Context Nonalcoholic fatty liver disease ( NAFLD ) is a highly prevalent and underdiagnosed comorbidity of many chronic diseases that is associated with altered intestinal bacterial communities .
This association has prompted research into alternative treatments aim ed at modulating intestinal microbiota .
Given the novelty of these treatments , scarce evidence regarding their effectiveness in clinical population s exists .
Objective This meta- analysis sought to systemically review and quantitatively synthesize evidence on prebiotic , probiotic , and synbiotic therapies for patients with NAFLD in r and omized controlled trials . |
26 | 30,113,661 | Conclusion This meta- analysis supports the potential use of microbial therapies in the treatment of NAFLD and sheds light on their potential mode of action . | Context Nonalcoholic fatty liver disease ( NAFLD ) is a highly prevalent and underdiagnosed comorbidity of many chronic diseases that is associated with altered intestinal bacterial communities .
This association has prompted research into alternative treatments aim ed at modulating intestinal microbiota .
Given the novelty of these treatments , scarce evidence regarding their effectiveness in clinical population s exists .
Objective This meta- analysis sought to systemically review and quantitatively synthesize evidence on prebiotic , probiotic , and synbiotic therapies for patients with NAFLD in r and omized controlled trials . | 490 | 19,321,579 | Probiotics reduce the inflammatory response induced by a high-fat diet in the liver of young rats. | Nonalcoholic fatty liver disease ( NAFLD ) is the most common form of chronic liver disease in the pediatric population . Preliminary evidence suggests a potential therapeutic utility of probiotics for this condition . Here , we tested the potential effect of the probiotic VSL#3 ( a multistrain preparation composed of Streptococcus thermophilus and several species of Lactobacillus and Bifidobacteria ) on oxidative and inflammatory damage induced by a high-fat diet in the liver of young rats . At weaning , young male Sprague-Dawley rats were r and omly divided into 3 groups ( n = 6 ) fed a st and ard , nonpurified diet ( Std ; 5.5 % of energy from fat ) or a high-fat liquid diet ( HFD ; 71 % of energy from fat ) . One of the HFD groups received by gavage VSL#3 ( 13 x 10(9 ) bacteria x kg(-1 ) x d(-1 ) ) . After 4 wk , the HFD rats had greater body weight gain , fat mass , serum aminotransferase , and liver weight than rats fed the Std diet . The HFD induced liver lipid peroxidation , tumor necrosis factor ( TNFalpha ) production , protein S-nitrosylation , inducible nitric oxide synthase ( iNOS ) , cyclooxygenase (COX)-2 expression , and metalloproteinase ( MMP ) activity . Moreover , in the HFD group , PPARalpha expression was less than in rats fed the Std diet . In rats fed the HFD diet and treated with VSL#3 , liver TNFalpha levels , MMP-2 and MMP-9 activities , and expression of iNOS and COX-2 were significantly lower than in the HFD group . In VSL#3-treated rats , PPARalpha expression was greater than in the HFD group . A modulation of the nuclear factor-kappaB pathway by VSL#3 was also demonstrated . Our data suggest that VSL#3 administration could limit oxidative and inflammatory liver damage in patients with NAFLD | 26 | Conclusion This meta- analysis supports the potential use of microbial therapies in the treatment of NAFLD and sheds light on their potential mode of action . | Context Nonalcoholic fatty liver disease ( NAFLD ) is a highly prevalent and underdiagnosed comorbidity of many chronic diseases that is associated with altered intestinal bacterial communities .
This association has prompted research into alternative treatments aim ed at modulating intestinal microbiota .
Given the novelty of these treatments , scarce evidence regarding their effectiveness in clinical population s exists .
Objective This meta- analysis sought to systemically review and quantitatively synthesize evidence on prebiotic , probiotic , and synbiotic therapies for patients with NAFLD in r and omized controlled trials . |
27 | 30,511,328 | Network meta- analysis revealed that in adolescents , intervention with 2000 mg/day metformin ranked better than other interventions ; however , 1000 mg/day metformin for 3 months may be most suitable for adolescents .
For adults , metformin at doses of 3000 and 1000 mg/day ranked the highest , other than minimeal and lifestyle interventions ; moreover , intervention with 3000 mg/day for 6 months and 1000 mg/day for 0.5 months may be suitable for adults .
Conclusion When considering the efficacy of interventions for losing weight , metformin offers clear advantages for overweight and obese population | Purpose Our aim was to assess the efficacy of metformin for weight loss in overweight and obese people through a systematic review and network meta- analysis and to identify the most suitable dosage and intervention period for using metformin in adolescents and adults . | 491 | 11,335,776 | The Effects of Metformin on Body Mass Index and Glucose Tolerance in Obese Adolescents With Fasting Hyperinsulinemia and a Family History of Type 2 Diabetes | Objectives . The prevalence of type 2 diabetes in American adolescents has increased markedly during the past generation . Although the factors that contribute to the development of type 2 diabetes are complex and not wholly eluci date d , the triad of severe obesity , hyperinsulinemia , and a family history of type 2 diabetes places a child at an increased risk for development of the disease . Current approaches to the prevention of type 2 diabetes , including dietary counseling and exercise , have had limited success . We reasoned that drugs that increase glucose tolerance in diabetic patients might prove useful in preventing the progression to glucose intolerance in high-risk patients . To that end , we conducted a double-blind , placebo-controlled study of the effects of metformin on body mass index ( BMI ) , serum leptin , glucose tolerance , and serum lipids in obese adolescents with fasting hyperinsulinemia and a family history of type 2 diabetes . Methods . The study population consisted of 29 white and black adolescents aged 12 to 19 years . All had BMI s exceeding 30 kg/m2 . Criteria for enrollment included : 1 ) a fasting insulin concentration exceeding 15 μU/mL ; and 2 ) at least 1 first- or second-degree relative with type 2 diabetes . All patients had fasting plasma glucose concentrations < 110 mg% and hemoglobin A1c concentrations ≤6.0 % . All had normal linear growth and sexual development for age , with no marked hirsutism , severe acne , or menstrual irregularities characteristic of polycystic ovary syndrome . Eight participants had acanthosis nigricans . After baseline laboratory studies including a rapidly sample d intravenous glucose tolerance test , patients were r and omized to receive metformin ( 500 mg twice daily ) or a placebo for a total of 6 months . The effects of metformin on BMI st and ard deviation score , serum leptin , glucose tolerance , and serum lipids were analyzed . The study was double-blinded and included no specific dietary restrictions . Results . Metformin caused a decline of 0.12 st and ard deviation in BMI in study participants ( −1.3 % from baseline ) , and a 5.5 % reduction in serum leptin in girls . In contrast , BMI and serum leptin rose 0.23 st and ard deviation ( 2.3 % ) and 16.2 % , respectively , in the placebo group during the treatment period . Metformin caused a progressive decline in fasting blood glucose ( from a mean of 84.9 to 75.1 mg% ) and a reduction in fasting insulin levels ( from 31.3 to 19.3 μU/mL ) . In contrast , fasting glucose levels in the placebo group rose slightly from 77.2 to 82.3 mg% , and fasting insulin levels did not change . Insulin sensitivity , as assessed by the ratio of fasting insulin to glucose concentrations and the quantitative insulin sensitivity check index ( 1/[log fasting insulin + log fasting glucose ] ) and homeostasis model assessment insulin resistance index ( fasting insulin × fasting glucose/22.5 ) indices , increased slightly in the metformin-treated participants . However , the insulin sensitivity measured using Bergman 's minimal model did not change . There were also no significant changes in glucose effectiveness , hemoglobin A1c , serum lipids , or serum lactate in the metformin or placebo groups . Metformin was tolerated well by the majority of patients . Transient abdominal discomfort or diarrhea occurred in 40 % of treated participants ; there were no episodes of vomiting or lactic acidosis . Conclusions . The treatment of obesity and insulin resistance in adults often proves ineffective because the vicious cycle leading to type 2 diabetes may have become entrenched and , to some extent , may be irreversible . Early detection and therapy of the obese adolescent with a family history of type 2 diabetes may interrupt the cycle of weight gain and insulin resistance that leads to glucose intolerance in adulthood . Through its ability to reduce fasting blood glucose and insulin concentrations and to moderate weight gain , metformin might complement the effects of dietary and exercise counseling and reduce the risk of type 2 diabetes in selected patients | 27 | Network meta- analysis revealed that in adolescents , intervention with 2000 mg/day metformin ranked better than other interventions ; however , 1000 mg/day metformin for 3 months may be most suitable for adolescents .
For adults , metformin at doses of 3000 and 1000 mg/day ranked the highest , other than minimeal and lifestyle interventions ; moreover , intervention with 3000 mg/day for 6 months and 1000 mg/day for 0.5 months may be suitable for adults .
Conclusion When considering the efficacy of interventions for losing weight , metformin offers clear advantages for overweight and obese population | Purpose Our aim was to assess the efficacy of metformin for weight loss in overweight and obese people through a systematic review and network meta- analysis and to identify the most suitable dosage and intervention period for using metformin in adolescents and adults . |
27 | 30,511,328 | Network meta- analysis revealed that in adolescents , intervention with 2000 mg/day metformin ranked better than other interventions ; however , 1000 mg/day metformin for 3 months may be most suitable for adolescents .
For adults , metformin at doses of 3000 and 1000 mg/day ranked the highest , other than minimeal and lifestyle interventions ; moreover , intervention with 3000 mg/day for 6 months and 1000 mg/day for 0.5 months may be suitable for adults .
Conclusion When considering the efficacy of interventions for losing weight , metformin offers clear advantages for overweight and obese population | Purpose Our aim was to assess the efficacy of metformin for weight loss in overweight and obese people through a systematic review and network meta- analysis and to identify the most suitable dosage and intervention period for using metformin in adolescents and adults . | 492 | 23,624,136 | Enhancing treatment of obesity by using a distracting mini-meal: a new approach to an old problem | OBJECTIVE The management of obesity , apart from exercise , mainly involves a calorie restriction regimen . A pharmaceutical treatment is often used to improve patient compliance and diet effectiveness , although several side-effects have previously been described . To improve patient compliance and diet effectiveness without incurring unpleasant side-effects , we evaluated whether a distracting mini-meal can physiologically decrease the absorption of fats and carbohydrates . DESIGN Two minutes before each of the three meals consumed daily , 32 obese patients were treated with a distracting mini-meal , 32 with metformin , and 32 with placebo . At baseline and after 1 , 3 , and 6 months of treatment , body weight , body mass index , waist circumference , fasting/post-pr and ial insulinaemia and glycaemia , homeostasis model assessment -index , triacylglycerols , and total cholesterol were evaluated . RESULTS All patients showed good compliance . With the exception of post-pr and ial glycaemia , a significant reduction in all parameters was documented in every group , albeit the greater variation was observed in patients treated with a distracting mini-meal or metformin . No one showed noteworthy side-effects . CONCLUSIONS Our study focuses on a distracting mini-meal that could become a useful tool in enhancing weight loss . The beneficial effect of a distracting meal on insulin resistance , glucose , and lipid metabolism suggest its possible use to prevent or mitigate obesity-related disorders | 27 | Network meta- analysis revealed that in adolescents , intervention with 2000 mg/day metformin ranked better than other interventions ; however , 1000 mg/day metformin for 3 months may be most suitable for adolescents .
For adults , metformin at doses of 3000 and 1000 mg/day ranked the highest , other than minimeal and lifestyle interventions ; moreover , intervention with 3000 mg/day for 6 months and 1000 mg/day for 0.5 months may be suitable for adults .
Conclusion When considering the efficacy of interventions for losing weight , metformin offers clear advantages for overweight and obese population | Purpose Our aim was to assess the efficacy of metformin for weight loss in overweight and obese people through a systematic review and network meta- analysis and to identify the most suitable dosage and intervention period for using metformin in adolescents and adults . |
27 | 30,511,328 | Network meta- analysis revealed that in adolescents , intervention with 2000 mg/day metformin ranked better than other interventions ; however , 1000 mg/day metformin for 3 months may be most suitable for adolescents .
For adults , metformin at doses of 3000 and 1000 mg/day ranked the highest , other than minimeal and lifestyle interventions ; moreover , intervention with 3000 mg/day for 6 months and 1000 mg/day for 0.5 months may be suitable for adults .
Conclusion When considering the efficacy of interventions for losing weight , metformin offers clear advantages for overweight and obese population | Purpose Our aim was to assess the efficacy of metformin for weight loss in overweight and obese people through a systematic review and network meta- analysis and to identify the most suitable dosage and intervention period for using metformin in adolescents and adults . | 493 | 22,525,206 | Metformin-based treatment for obesity-related hypertension: a randomized, double-blind, placebo-controlled trial | Objectives : Obesity and hypertension are associated with an adverse metabolic profile and systemic low- grade inflammation . Metformin reduces weight and inflammation in patients with diabetes , but it is unclear whether it has beneficial effects in patients without diabetes . The objective was to explore whether metformin-based treatment could benefit obesity-related hypertension without diabetes . Methods : A r and omized , double-blind , placebo-controlled factorial trial was conducted in 360 obese hypertensive patients without diabetes in Chongqing , China . After a 1–2-week run-in period , patients were r and omly assigned to metformin ( 500 mg once per day ) or placebo , as well as to an antihypertensive medication . Change in blood pressure , obesity measurements and metabolic profile were assessed at 24 weeks . Results : The 180 participants r and omized to metformin and 180 r and omized to placebo were similar at baseline . At 24 weeks , metformin compared with placebo did not have significant effects on blood pressure , blood glucose , high-density or low-density lipoprotein cholesterol , but it did reduce total serum cholesterol ( 0.27mmol/l , P = 0.038 ) . Metformin also significantly reduced weight ( −0.7 kg , P = 0.006 ) , BMI ( −0.2 kg/m2 , P = 0.024 ) , waist circumference ( −0.9 cm , P = 0.008 ) , and both subcutaneous ( −6.1 cm2 , P = 0.043 ) and visceral adiposity ( −5.4 cm2 , P = 0.028 ) as measured by computed tomography , and lowered serum high-sensitivity C-reactive protein levels ( −0.6 mg/dl , P < 0.001 ) . There was no significant difference in adverse events ( P = 0.785 ) . Conclusions : Metformin has no effect on blood pressure and blood glucose levels , but it does reduce total cholesterol , abdominal obesity and C-reactive protein levels in obese hypertensive patients without diabetes | 27 | Network meta- analysis revealed that in adolescents , intervention with 2000 mg/day metformin ranked better than other interventions ; however , 1000 mg/day metformin for 3 months may be most suitable for adolescents .
For adults , metformin at doses of 3000 and 1000 mg/day ranked the highest , other than minimeal and lifestyle interventions ; moreover , intervention with 3000 mg/day for 6 months and 1000 mg/day for 0.5 months may be suitable for adults .
Conclusion When considering the efficacy of interventions for losing weight , metformin offers clear advantages for overweight and obese population | Purpose Our aim was to assess the efficacy of metformin for weight loss in overweight and obese people through a systematic review and network meta- analysis and to identify the most suitable dosage and intervention period for using metformin in adolescents and adults . |
27 | 30,511,328 | Network meta- analysis revealed that in adolescents , intervention with 2000 mg/day metformin ranked better than other interventions ; however , 1000 mg/day metformin for 3 months may be most suitable for adolescents .
For adults , metformin at doses of 3000 and 1000 mg/day ranked the highest , other than minimeal and lifestyle interventions ; moreover , intervention with 3000 mg/day for 6 months and 1000 mg/day for 0.5 months may be suitable for adults .
Conclusion When considering the efficacy of interventions for losing weight , metformin offers clear advantages for overweight and obese population | Purpose Our aim was to assess the efficacy of metformin for weight loss in overweight and obese people through a systematic review and network meta- analysis and to identify the most suitable dosage and intervention period for using metformin in adolescents and adults . | 494 | 19,387,874 | Metformin in combination with structured lifestyle intervention improved body mass index in obese adolescents, but did not improve insulin resistance | This study assessed the efficacy of adding metformin to a structured lifestyle intervention in reducing BMI in obese adolescents with insulin resistance . Obese adolescents ( 25 ) aged 10–16 years with a body mass index ( BMI ) > 95th percentile and insulin resistance ( Homeostasis Model Assessment —HOMA ) > 3.0 were assessed in a community clinic . A structured lifestyle intervention comprising nutritional and exercise education and motivational support in both individual and group sessions was delivered over 6 months . Subjects were r and omized to lifestyle intervention alone or with metformin ( 1500 g daily ) . The primary outcome measures were a change in BMI and modification of metabolic risk factors , including insulin resistance , plasma lipids and adipocytokines . Eleven adolescents receiving lifestyle and metformin intervention and 14 receiving lifestyle alone completed the study . BMI decreased by 1.8 kg/m2 with lifestyle and metformin but did not change with lifestyle alone . HOMA was significantly decreased in the lifestyle intervention group , but not following metformin , while the adiponectin/leptin ratio improved significantly in both groups . Dyslipidemic profiles improved most significantly with metformin . We conclude that metformin in combination with a 6-month structured lifestyle intervention is effective in reducing BMI in obese adolescents but did not improve insulin resistance . Lifestyle intervention , with or without metformin , improved metabolic risk factors such as plasma lipids and adipocytokines | 27 | Network meta- analysis revealed that in adolescents , intervention with 2000 mg/day metformin ranked better than other interventions ; however , 1000 mg/day metformin for 3 months may be most suitable for adolescents .
For adults , metformin at doses of 3000 and 1000 mg/day ranked the highest , other than minimeal and lifestyle interventions ; moreover , intervention with 3000 mg/day for 6 months and 1000 mg/day for 0.5 months may be suitable for adults .
Conclusion When considering the efficacy of interventions for losing weight , metformin offers clear advantages for overweight and obese population | Purpose Our aim was to assess the efficacy of metformin for weight loss in overweight and obese people through a systematic review and network meta- analysis and to identify the most suitable dosage and intervention period for using metformin in adolescents and adults . |
27 | 30,511,328 | Network meta- analysis revealed that in adolescents , intervention with 2000 mg/day metformin ranked better than other interventions ; however , 1000 mg/day metformin for 3 months may be most suitable for adolescents .
For adults , metformin at doses of 3000 and 1000 mg/day ranked the highest , other than minimeal and lifestyle interventions ; moreover , intervention with 3000 mg/day for 6 months and 1000 mg/day for 0.5 months may be suitable for adults .
Conclusion When considering the efficacy of interventions for losing weight , metformin offers clear advantages for overweight and obese population | Purpose Our aim was to assess the efficacy of metformin for weight loss in overweight and obese people through a systematic review and network meta- analysis and to identify the most suitable dosage and intervention period for using metformin in adolescents and adults . | 495 | 15,831,640 | Long term cardiovascular effects of oral antidiabetic agents in non-diabetic patients with insulin resistance: double blind, prospective, randomised study | Objective : To study the long term cardiovascular effects of oral antidiabetic agents in non-diabetic patients with insulin resistance . Patients : 181 African American subjects with insulin resistance and normal glucose tolerance test were r and omised to receive glipizide 5 mg/day ( n = 25 ) , metformin 500 mg/day ( n = 59 ) , or placebo ( n = 97 ) for 24 months . Insulin sensitivity , glucose tolerance , lipid profile , left ventricular mass ( echocardiography ) , aortic distensibility ( echocardiography , blood pressure ) , aortic pulse wave velocity ( PWV , carotid to femoral artery , Doppler ) were measured at baseline and at 12 and 24 months after r and omisation . Results : A significant increase in PWV was observed in both glipizide ( mean ( SEM ) change at 24 months 2.8 ( 2.7 ) m/s , p = 0.012 ) and metformin ( 2.2 ( 0.7 ) m/s , p = 0.01 ) groups during the follow up period . In contrast , PWV remained unchanged in the placebo group . The increase in PWV in the treatment groups was significant compared with placebo ( analysis of variance p < 0.05 ) . Other cardiovascular or metabolic variables did not change significantly compared with placebo during follow up . Conclusions : The observed increase in PWV is consistent with a decrease in the elastic properties of the aorta . The use of oral antidiabetic agents for the prevention of cardiovascular complications in non-diabetic African Americans with insulin resistance needs to be critically evaluated | 27 | Network meta- analysis revealed that in adolescents , intervention with 2000 mg/day metformin ranked better than other interventions ; however , 1000 mg/day metformin for 3 months may be most suitable for adolescents .
For adults , metformin at doses of 3000 and 1000 mg/day ranked the highest , other than minimeal and lifestyle interventions ; moreover , intervention with 3000 mg/day for 6 months and 1000 mg/day for 0.5 months may be suitable for adults .
Conclusion When considering the efficacy of interventions for losing weight , metformin offers clear advantages for overweight and obese population | Purpose Our aim was to assess the efficacy of metformin for weight loss in overweight and obese people through a systematic review and network meta- analysis and to identify the most suitable dosage and intervention period for using metformin in adolescents and adults . |
27 | 30,511,328 | Network meta- analysis revealed that in adolescents , intervention with 2000 mg/day metformin ranked better than other interventions ; however , 1000 mg/day metformin for 3 months may be most suitable for adolescents .
For adults , metformin at doses of 3000 and 1000 mg/day ranked the highest , other than minimeal and lifestyle interventions ; moreover , intervention with 3000 mg/day for 6 months and 1000 mg/day for 0.5 months may be suitable for adults .
Conclusion When considering the efficacy of interventions for losing weight , metformin offers clear advantages for overweight and obese population | Purpose Our aim was to assess the efficacy of metformin for weight loss in overweight and obese people through a systematic review and network meta- analysis and to identify the most suitable dosage and intervention period for using metformin in adolescents and adults . | 496 | 10,946,879 | Effect of long-term treatment with metformin added to hypocaloric diet on body composition, fat distribution, and androgen and insulin levels in abdominally obese women with and without the polycystic ovary syndrome. | Abdominal obesity and hyperinsulinemia play a key role in the development of the polycystic ovary syndrome ( PCOS ) . Dietary-induced weight loss and the administration of insulin-lowering drugs , such as metformin , are usually followed by improved hyper and rogenism and related clinical abnormalities . This study was carried out to evaluate the effects of combined hypocaloric diet and metformin on body weight , fat distribution , the glucose-insulin system , and hormones in a group of 20 obese PCOS women [ body mass index ( BMI ) > 28 kg/m2 ] with the abdominal phenotype ( waist to hip ratio > 0.80 ) , and an appropriate control group of 20 obese women who were comparable for age and pattern of body fat distribution but without PCOS . At baseline , we measured sex hormone , sex hormone-binding globulin ( SHBG ) , and leptin blood concentrations and performed an oral glucose tolerance test and computerized tomography ( CT ) at the L4-L5 level , to measure sc adipose tissue area ( SAT ) and visceral adipose tissue area . All women were then given a low-calorie diet ( 1,200 - 1,400 kcal/day ) alone for one month , after which anthropometric parameters and CT scan were newly measured . While continuing dietary treatment , PCOS women and obese controls were subsequently placed , in a r and om order , on metformin ( 850 mg/os , twice daily ) ( 12 and 8 , respectively ) or placebo ( 8 and 12 , respectively ) , according to a double-blind design , for the following 6 months . Blood tests and the CT scan were performed in each woman at the end of the study while they were still on treatment . During the treatment period , 3 women of the control group ( all treated with placebo ) were excluded because of noncompliance ; and 2 PCOS women , both treated with metformin , were also excluded because they became pregnant . Therefore , the women cohort available for final statistical analysis included 18 PCOS ( 10 treated with metformin and 8 with placebo ) and 17 control women ( 8 treated with metformin and 9 with placebo ) . The treatment was well tolerated . In the PCOS group , metformin therapy improved hirsutism and menstrual cycles significantly more than placebo . Baseline anthropometric and CT parameters were similar in all groups . Hypocaloric dieting for 1 month similarly reduced BMI values and the waist circumference in both PCOS and control groups , without any significant effect on CT scan parameters . In both PCOS and control women , however , metformin treatment reduced body weight and BMI significantly more than placebo . Changes in the waist-to-hip ratio values were similar in PCOS women and controls , regardless of pharmacological treatment . Metformin treatment significantly decreased SAT values in both PCOS and control groups , although only in the latter group were SAT changes significantly greater than those observed during the placebo treatment . On the contrary , visceral adipose tissue area values significantly decreased during metformin treatment in both PCOS and control groups , but only in the former was the effect of metformin treatment significantly higher than that of placebo . Fasting insulin significantly decreased in both PCOS women and controls , regardless of treatment , whereas glucose-stimulated insulin significantly decreased only in PCOS women and controls treated with metformin . Neither metformin or placebo significantly modified the levels of LH , FSH , dehydroepi and rosterone sulphate , and progesterone in any group , whereas testosterone concentrations decreased only in PCOS women treated with metformin . SHBG concentrations remained unchanged in all PCOS women ; whereas in the control group , they significantly increased after both metformin and placebo . Leptin levels decreased only during metformin treatment in both PCOS and control groups . ( ABSTRACT TRUNCATED | 27 | Network meta- analysis revealed that in adolescents , intervention with 2000 mg/day metformin ranked better than other interventions ; however , 1000 mg/day metformin for 3 months may be most suitable for adolescents .
For adults , metformin at doses of 3000 and 1000 mg/day ranked the highest , other than minimeal and lifestyle interventions ; moreover , intervention with 3000 mg/day for 6 months and 1000 mg/day for 0.5 months may be suitable for adults .
Conclusion When considering the efficacy of interventions for losing weight , metformin offers clear advantages for overweight and obese population | Purpose Our aim was to assess the efficacy of metformin for weight loss in overweight and obese people through a systematic review and network meta- analysis and to identify the most suitable dosage and intervention period for using metformin in adolescents and adults . |
27 | 30,511,328 | Network meta- analysis revealed that in adolescents , intervention with 2000 mg/day metformin ranked better than other interventions ; however , 1000 mg/day metformin for 3 months may be most suitable for adolescents .
For adults , metformin at doses of 3000 and 1000 mg/day ranked the highest , other than minimeal and lifestyle interventions ; moreover , intervention with 3000 mg/day for 6 months and 1000 mg/day for 0.5 months may be suitable for adults .
Conclusion When considering the efficacy of interventions for losing weight , metformin offers clear advantages for overweight and obese population | Purpose Our aim was to assess the efficacy of metformin for weight loss in overweight and obese people through a systematic review and network meta- analysis and to identify the most suitable dosage and intervention period for using metformin in adolescents and adults . | 497 | 15,449,338 | Combination of direct and indirect evidence in mixed treatment comparisons. | Mixed treatment comparison ( MTC ) meta- analysis is a generalization of st and ard pairwise meta- analysis for A vs B trials , to data structures that include , for example , A vs B , B vs C , and A vs C trials . There are two roles for MTC : one is to strengthen inference concerning the relative efficacy of two treatments , by including both ' direct ' and ' indirect ' comparisons . The other is to facilitate simultaneous inference regarding all treatments , in order for example to select the best treatment . In this paper , we present a range of Bayesian hierarchical models using the Markov chain Monte Carlo software WinBUGS . These are multivariate r and om effects models that allow for variation in true treatment effects across trials . We consider models where the between-trials variance is homogeneous across treatment comparisons as well as heterogeneous variance models . We also compare models with fixed ( unconstrained ) baseline study effects with models with r and om baselines drawn from a common distribution . These models are applied to an illustrative data set and posterior parameter distributions are compared . We discuss model critique and model selection , illustrating the role of Bayesian deviance analysis , and node-based model criticism . The assumptions underlying the MTC models and their parameterization are also discussed | 27 | Network meta- analysis revealed that in adolescents , intervention with 2000 mg/day metformin ranked better than other interventions ; however , 1000 mg/day metformin for 3 months may be most suitable for adolescents .
For adults , metformin at doses of 3000 and 1000 mg/day ranked the highest , other than minimeal and lifestyle interventions ; moreover , intervention with 3000 mg/day for 6 months and 1000 mg/day for 0.5 months may be suitable for adults .
Conclusion When considering the efficacy of interventions for losing weight , metformin offers clear advantages for overweight and obese population | Purpose Our aim was to assess the efficacy of metformin for weight loss in overweight and obese people through a systematic review and network meta- analysis and to identify the most suitable dosage and intervention period for using metformin in adolescents and adults . |
27 | 30,511,328 | Network meta- analysis revealed that in adolescents , intervention with 2000 mg/day metformin ranked better than other interventions ; however , 1000 mg/day metformin for 3 months may be most suitable for adolescents .
For adults , metformin at doses of 3000 and 1000 mg/day ranked the highest , other than minimeal and lifestyle interventions ; moreover , intervention with 3000 mg/day for 6 months and 1000 mg/day for 0.5 months may be suitable for adults .
Conclusion When considering the efficacy of interventions for losing weight , metformin offers clear advantages for overweight and obese population | Purpose Our aim was to assess the efficacy of metformin for weight loss in overweight and obese people through a systematic review and network meta- analysis and to identify the most suitable dosage and intervention period for using metformin in adolescents and adults . | 498 | 3,028,347 | Effects of Metformin on Body Weight and Body Composition in Obese Insulin-Resistant Children | OBJECTIVE Metformin can decrease adiposity and ameliorate obesity-related comorbid conditions , including abnormalities in glucose homeostasis in adolescents , but there are few data evaluating the efficacy of metformin among younger children . Our objective was to determine whether metformin treatment causes weight loss and improves obesity-related comorbidities in obese children , who are insulin-resistant . RESEARCH DESIGN AND METHODS This study was a r and omized double-blind placebo-controlled trial consisting of 100 severely obese ( mean BMI 34.6 ± 6.6 kg/m2 ) insulin-resistant children aged 6–12 years , r and omized to 1,000 mg metformin ( n = 53 ) or placebo ( n = 47 ) twice daily for 6 months , followed by open-label metformin treatment for 6 months . All children and their parents participated in a monthly dietitian-administered weight-reduction program . RESULTS Eighty-five percent completed the 6-month r and omized phase . Children prescribed metformin had significantly greater decreases in BMI ( difference −1.09 kg/m2 , CI −1.87 to −0.31 , P = 0.006 ) , body weight ( difference −3.38 kg , CI −5.2 to −1.57 , P < 0.001 ) , BMI Z score ( difference between metformin and placebo groups −0.07 , CI −0.12 to −0.01 , P = 0.02 ) , and fat mass ( difference −1.40 kg , CI −2.74 to −0.06 , P = 0.04 ) . Fasting plasma glucose ( P = 0.007 ) and homeostasis model assessment ( HOMA ) insulin resistance index ( P = 0.006 ) also improved more in metformin-treated children than in placebo-treated children . Gastrointestinal symptoms were significantly more prevalent in metformin-treated children , which limited maximal tolerated dosage in 17 % . During the 6-month open-label phase , children treated previously with placebo decreased their BMI Z score ; those treated continuously with metformin did not significantly change BMI Z score further . CONCLUSIONS Metformin had modest but favorable effects on body weight , body composition , and glucose homeostasis in obese insulin-resistant children participating in a low-intensity weight-reduction program | 27 | Network meta- analysis revealed that in adolescents , intervention with 2000 mg/day metformin ranked better than other interventions ; however , 1000 mg/day metformin for 3 months may be most suitable for adolescents .
For adults , metformin at doses of 3000 and 1000 mg/day ranked the highest , other than minimeal and lifestyle interventions ; moreover , intervention with 3000 mg/day for 6 months and 1000 mg/day for 0.5 months may be suitable for adults .
Conclusion When considering the efficacy of interventions for losing weight , metformin offers clear advantages for overweight and obese population | Purpose Our aim was to assess the efficacy of metformin for weight loss in overweight and obese people through a systematic review and network meta- analysis and to identify the most suitable dosage and intervention period for using metformin in adolescents and adults . |
27 | 30,511,328 | Network meta- analysis revealed that in adolescents , intervention with 2000 mg/day metformin ranked better than other interventions ; however , 1000 mg/day metformin for 3 months may be most suitable for adolescents .
For adults , metformin at doses of 3000 and 1000 mg/day ranked the highest , other than minimeal and lifestyle interventions ; moreover , intervention with 3000 mg/day for 6 months and 1000 mg/day for 0.5 months may be suitable for adults .
Conclusion When considering the efficacy of interventions for losing weight , metformin offers clear advantages for overweight and obese population | Purpose Our aim was to assess the efficacy of metformin for weight loss in overweight and obese people through a systematic review and network meta- analysis and to identify the most suitable dosage and intervention period for using metformin in adolescents and adults . | 499 | 10,477,209 | Metformin treatment leads to an increase in basal, but not insulin-stimulated, glucose disposal in obese patients with impaired glucose tolerance. | AIMS This study was initiated to test the hypothesis that metformin treatment leads to enhanced glucose disposal at ambient insulin concentrations . METHODS Nineteen obese patients with impaired glucose tolerance ( IGT ) were treated with either metformin or placebo in a r and omized , double-blind , placebo-controlled , cross-over study . Insulin secretion and insulin resistance were quantified using the homeostasis model assessment ( HOMA ) and insulin-stimulated glucose disposal were measured by determining the steady-state plasma glucose ( SSPG ) . RESULTS The average benefit of metformin was 0.6 mmol/l for glucose ( 95 % confidence interval ( CI ) 0.2 - 0.9 P = 0.002 ) , 2.8 pmol/l for insulin ( 95 % CI 0.2 - 5.4 , P = 0.019 ) . Insulin resistance , as quantified by HOMA , was improved by 1.1 ( 95 % CI 0.2 - 2.0 , P = 0.004 ) , without any change in insulin secretion . Basal and insulin-stimulated glucose oxidation were comparable in the placebo and metformin-treated groups at the end of each treatment period , as was the SSPG concentration . However , both systolic and diastolic blood pressures fell significantly following metformin administration as compared to treatment with placebo . CONCLUSIONS These results indicate that metformin administration to patients with IGT is associated with enhanced glucose disposal at baseline insulin concentrations and a fall in blood pressure . In contrast , neither glucose oxidation nor glucose disposal were increased in association with metformin treatment under conditions of physiological hyperinsulinaemia | 27 | Network meta- analysis revealed that in adolescents , intervention with 2000 mg/day metformin ranked better than other interventions ; however , 1000 mg/day metformin for 3 months may be most suitable for adolescents .
For adults , metformin at doses of 3000 and 1000 mg/day ranked the highest , other than minimeal and lifestyle interventions ; moreover , intervention with 3000 mg/day for 6 months and 1000 mg/day for 0.5 months may be suitable for adults .
Conclusion When considering the efficacy of interventions for losing weight , metformin offers clear advantages for overweight and obese population | Purpose Our aim was to assess the efficacy of metformin for weight loss in overweight and obese people through a systematic review and network meta- analysis and to identify the most suitable dosage and intervention period for using metformin in adolescents and adults . |
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