A network meta-analysis of desmopressin, alarm, and combination of both in the treatment of monosymptomatic nocturnal enuresis in children / 临床儿科杂志

Objective To systematically explore the efficacy of four intervention regiments including desmopressin, alarm, desmopressin combined with alarm, and desmopressin combined with anticholinergic drugs in the treatment of monosymptomatic nocturnal enuresis in children by network meta-analysis. Methods The databases of PubMed, Cochrance Library, EMBase and Web of Science were systematically searched and retrieved upto August 1, 2017. Included were the randomized controlled trials (RCTs) which had any two or more of four intervention regiments (desmopressin, alarm, desmopressin combined with alarm, and desmopressin combined with anticholinergic drugs) for treatment of monosymptomatic nocturnal enuresis in children. The literature was screened according to the established inclusion and exclusion criteria, and the data extraction and quality evaluation were performed for the final inclusion of RCT. Software R 3.3.2 and STATA 14.0 were used for data analysis. Results Fifteen RCTs were included with a total of 1505 children. Network meta-analysis showed that the complete response rate and success rate of desmopressin combined with anticholinergic drugs were higher than those of desmopressin (complete reaction rate: OR=2.8, 95％ CI :1.5～5.4; success rate: OR=3.5, 95％ CI :1.7～7.5) and alarm (complete response rate: OR=2.7, 95％ CI :1.1～6.6; success rate: OR=3.8, 95％ CI: 1.6～9.0. The success rate of desmopressin combined with alarm was higher than that of alarm (OR=1.9, 95％CI: 1.1～3.4) . The recurrence rate of alarm after treatment was significantly lower than that of desmopressin (OR=0.15, 95％CI: 0.03～0.53) . The ranking results showed that the complete response rate and success rate of desmopressin combined with anticholinergic drugs were the best. The desmopressin combined with alarm can minimize the number of bed-wetting episodes per week and the recurrence rate of alarm was the lowest among the four regiments. Conclusion The effect of desmopressin combined with anticholinergic drugs is significantly better than that of alarm or desmopressin alone. The combination of desmopressin and alarm has a slight advantage or similar effect to that of single alarm or desmopressin treatment. The effect of desmopressin is similar to that of alarm. Alarm treatment has the lowest recurrence rate.

<b>Effect of Hachimijiogan for Male Lower Urinary Tract Symptoms</b> / 日本東洋医学雑誌

We evaluated the effect of hachimijiogan in 30 cases of anticholinergic agent and α-blocker resistant LUTS. International Prostate Symptom Scores (IPSS), QOL scores, Benign Prostatic Hyperplasia Impact Index (BII) scores and urinary 8-OHdG of the patients were statistically much improved. This study demonstrated improvement in urinary symptoms, urinary QOL and oxidative stress, in LUTS resistant to anticholinergic agents and α-blockers. Further long-term studies will be needed not only in urinary symptoms, but also in effect as an anti-aging medicine.

<b>Effect of Hachimijiogan and its Additional Prescription for Anticholinergic Agent-resistant Overactive Bladder </b> / 日本東洋医学雑誌

We evaluated the effects of Hachimijiougan and its additional prescription in 11 cases of anticholinergic agent-resistant overactive bladder. The improvements in IPSS, QOL score, BII score and urinary 8-OHdG for the patients were statistically much improved. This study showed improvements of urinary symptoms and QOL in anticholinergic agent-resistant overactive bladder. Further long-term studies will be needed not only in urinary symptoms but also on effects as an anti-aging medicine.

Concomitant Use of Anticholinergic Agents with Atypical Antipsychotics in Schizophrenic Patients: A Preliminary Report / 대한정신약물학회지

OBJECTIVE: It is well known that antipsychotic drugs induce extrapyramidal symptoms such as dystonia, akathisia and parkinsonian symptoms even early in the treatment. With the advent of atypical antipsychotic drugs, the incidence of extrapyramidal symptoms has decreased, but danger still exists. Hence, anticholinergic agents are often indicated in treatment of schizophrenia with antipsychotics. METHODS: In this observational retrospective study, we examined the use of anticholinergic agents among schizophrenic patients who were initiated on risperidone, olanzapine, or quetiapine, the three most widely prescribed atypical antipsychotics. We reviewed medical records of schizophrenic patients who were initiated on risperidone, olanzapine or quetiapine from January 2004 through December 2004 and continuously treated with the antipsychotics for 6 months. The data were analysed using one way ANOVA, Mann-Whitney U test, chi-square test or Fisher's exact tests. RESULTS: The study yields two major findings. Firstly, compared with risperidone initiators, there were significantly fewer olanzapine initiators who used anticholinergic agent concomitantly. Secondly, there were significantly fewer olanzapine or quetiapine initiators than risperidone initiators who prescribed anticholinergic agent on the same day when antipsychotics was initiated. CONCLUSION: As the use of anticholinergic agent is a proxy for the presence of extrapyramidal symptom, these findings suggest that risperidone may be more associated with extrapyramidal symptoms than olanzapine or quetiapine. Controlled studies comparing them to one another should be of particular interest.

Hemodynamic Responses of Systemic and Pulmonary Vessels to Head-down Tilt (-6 degrees) and Effect of Anticholinergic Agent

Head-down tilt (HDT) has been commonly used as the simulation of a microgravity to evaluate the hemodynamic and the hormonal responses to the central blood shift observed during the spaceflight. But there were some differences in the systemic responses according to species or angle of tilt, and there are few reports in the hemodynamic response and the regulation on polmonary vascular bed during the early stage of HDT. This study was attempted to clarify the regulatory mechanism on the systemic and pulmonary vascular responses through the low pressure receptor, and the hormonal changes to the -6 degrees HDT, and to investigate the effect of anticholinergic agent, glycopyrrolate, on the hemodynamic and the hormonal responses. In 28 anesthetized dogs(8~14 kg), 15 dogs(TILT group) were tilted from the supine position to the -6 degrees head-down position(HDP ) for 30 minutes, then back to the supine recovery position for the next 30 minutes, and the same tilt procedure was taken at 20 minutes after the intra venous administration of 0.2g glycopyrrolate. The rest 13 dogs were kept in the supine position without tilt as the control group(CONT group ) for the same time course of the TILT group. Cardiac output(Q), heart rate(HR), stroke volume(SV), index of contractility(IC) and thoracic fluid volume(TFV) were deterkuned by the impedance cardiograph. Systemic arterial pressure (SAP) and pulmonary arterial pressure(PAP) were measured at the brachial and pulmonary arteries respectively, and central venous pressure(CVP) also at the right atrium. And systemic and pulmonary vascular resistances (SVR and PVR) were calculated. The concentration of plusma ANP and ADH in the arterial blood were measured by the radioimmunoassay in 8 dogs in each group at 5 minutes before, and 25 and 55 minutes after begining of the tilt. During the HDP, Q, SV and TFV increased to 9%,10.6% and 12.6ml respectively in the TILT group, where as they decreased by 10%, 13.8% and 7.5ml respectively in the CONT group. SAP, PAP and HR did not change significantly in the TILT group, but SAP and HR increased in the CONT group. At the same time, SVR and PVR reduced significantly by 4.5% and 8.9% respectively at 15 minutes of HDP in the TILT group, where as they elevated gradually to 21.8% and 13.4% respectively at the first 30 runutes In the CONT group. There were no significant differences in the changes of HR, PAP and CVP between the TILT and the CONT group. And the plasma ANP and ADH did not change significantly in the both groups. After the administration of glycopyrrolate, SAP and SVR Increased to 3.7mmHg and 5.1% respectively, and PAP, PVR, Q, HR, and SV did not change significantly during the HDP in the TILT group. There was no significant difference in the change of each hemodynamic parameter between the TILT and the CONT group, except in TFV, which showed the same change as that before the administration of glycopyrrolate in the both groups. The plsma ANP showed nonslgnificant increased trend at the HDP in the TILT group but did not change In the CONT group, and the plasma ADH showed nonsignificant decreased trend in the both groups. In summary, the cardiopulmonary baroreceptors induced the vasodilations of both systemic and pulmonary vessels by the expansion of thoracic fluid volume at the head-down tilt, and the anticholinergic agent(glycopyrrolate) tended to attenuate the hemodynamic responses to the tilt. The concentration of the plasma ANP and ADH did not show significant changes in this study. It is suggested that the regulatory mechanism inducing the systeruc and pulmonary vats odilation during the early phase of the head-down tilt is mediated by the cholinergic vasodilator fiber in the dog.