Comparative Efficacy of Antidepressants for Symptoms Remission of Gastroesophageal Reflux: A Bayesian Network Meta-analysis of Randomized Controlled Trials.

BACKGROUND: The present study aimed to compare and evaluate the efficacy of antidepressants in remission of esophageal reflux symptoms. METHODS: A comprehensive literature review was performed including sources published on MEDLINE, EMBASE, the Cochrane Central Registry of Controlled Trials (Cochrane), Web of Science, China National Knowledge Infrastructure Database (CNKI), Chinese VIP Information Databases (VIP), Chinese Biology Medicine disc (CBM), and Wan-Fang databases for randomized controlled trials, published up to and including March 31, 2020. We analyzed relevant randomized, placebo-controlled trials reporting the effect of antidepressant therapy in relieving esophageal reflux symptoms ADDIS 1.16.8 was used to perform the network meta-analysis. Furthermore, we performed a split analysis to test inconsistency, and rank probability was complemented for comparison among antidepressants. RESULTS: A total of 10 randomized controlled trials (RCTs) examining the effects of antidepressants, selective 5-HT reabsorption inhibitor (SSRI), 5-HT 1A receptor agonist (5-HT1AA), tricyclic antidepressants (TCAs), and the complex of flupentixol-melitracen (FM) were included. Flupentixol-melitracen and SSRIs exhibited a significantly higher rate of remission than placebo. However, there was no statistically significant difference among different antidepressants compared. Rank probability showed that FM exhibited the highest probability of rank 1 compared with other antidepressants and placebo. CONCLUSION: This network meta-analysis of RCTs supported the use of FM and SSRIs as a potentially effective regimen for symptom remission of gastroesophageal reflux. Furthermore, according to our analysis, FM represents the most efficient antidepressant with highest probability of symptom remission.

Gastric Juice-Based Genotypic Methods for Diagnosis of Helicobacter pylori Infection and Antibiotic Resistance Testing: A Systematic Review and Meta-analysis.

OBJECTIVE: To evaluate the diagnostic efficacy of gastric juice-based genotypic methods for Helicobacter pylori detection and antibiotic resistance testing. METHODS: We used electronic databases including Medline, Embase, Web of Science and the Cochrane Central Register of Controlled Trial for literature survey using keywords such as "gastric juice", "Helicobacter pylori" and their synonyms. The quality of the studies was assessed using QUADAS-2. Summary performance measures (sensitivity, specificity, positive predictive values, negative predictive values, diagnostic odds ratio, and area under the summary receiver operating characteristic curve) and HSROC curves were produced. In addition, fagan plots were applied to illustrate the relationship among the prior test probability, PLR/NLR, and posterior test probability. RESULTS: Our study cohort comprised eight studies with 1235 participants (617 participants of H. pylori infection and 618 participants of non-H. pylori infection). Pooled sensitivity and specificity with a corresponding 95% confidence interval (CI) of gastric juice-based genotypic methods reflected values of 94% (95%CI, 86% - 98%) and 98% (95%CI, 85% - 100%), respectively. The global sensitivity and specificity of clarithromycin resistance were 92% (95%CI, 85% - 96%) and 90% (95%CI, 80% - 95%), respectively. CONCLUSION: Gastric juice-based genotypic methods can be used for diagnostic prediction of H. pylori infection as well as clarithromycin resistance testing.

Allicin as add-on therapy for Helicobacter pylori infection: A systematic review and meta-analysis.

BACKGROUND: Allicin (2-propene-1-sulfinothioic acid S-2-propenyl ester, diallyl thiosulfinate) extracted from garlic, has proven activity against Helicobacter pylori (H. Pylori) infection. In recent years, clinical trials have explored its utility as an add-on therapy with variable outcomes reported. AIM: To perform a systemic review of allicin as an add-on treatment for H. Pylori infection and assess its efficacy in randomized controlled trials (RCTs). METHODS: Electronic databases including MEDLINE, EMBASE, the Web of Science, the Cochrane Database, the China National Knowledge Infrastructure Database, Chinese VIP Information Databases, Chinese Medical Databases, and the Wan-Fang Database were searched for keywords including "allicin", "Helicobacter pylori", "randomized clinical trials", and their synonyms. A meta-analysis was performed using the fixed-effects model for low heterogeneity and the random-effects model for high heterogeneity with sensitivity analysis. Bias was evaluated using Egger's tests. Trial sequential analysis (TSA) was used to evaluate information size and treatment benefits. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to assess the level of quality, and studies were classed as "high quality", "moderate quality", "low quality", and "very low quality". RESULTS: A total of eight RCTs consisting of 867 participants (435 from the allicin group and 432 from the control group) were included. Eradication rate in the allicin group (93.33%, 406/435) was significantly higher than that of the control group (83.56%, 361/432) [I 2 = 0%, odds ratio (OR) = 2.75, 95% confidence interval (CI): 1.74-4.35, P < 0.001]. The healing rate of ulcers following H. pylori therapy in the allicin group (86.17%, 349/405) was significantly higher than that of the control group (75.87%, 305/402) [I 2 = 0%, OR = 2.05, 95%CI: 1.39-3.03, P < 0.001]. The total remission rate of peptic ulcers across all allicin groups was 97.16%, which was significantly higher than that of controls [96.05% (389/405) vs 86.55% (360/402), I 2 = 0, OR = 3.04, 95%CI: 1.51-6.12, P = 0.015]. No significant differences in side effects were observed. TSA suggested that the trials were of sufficient standard to draw reliable conclusions. The quality of outcomes including eradication rates and side effects was graded as "very low" due to downgrades for "risk of bias" and "indirectness". Other outcomes such as ulcer healing rates and total ulcer remission rates were graded as "low" due to downgrades for "risk of bias". CONCLUSION: Allicin as an add-on therapy improves H. pylori eradication, healing of ulcers, and remission of symptoms. These results are suggested to be treated with caution due to limited quality.

Muscle edema of the lower limb determined by MRI in Asian hypokalaemic periodic paralysis patients.

OBJECTIVE: To determine the pattern of muscle edema occurring in the lower limb muscles of Asian hypokalaemic periodic paralysis (hypoPP) patients using magnetic resonance imaging (MRI). Specifically, the relationship between muscle edema and muscle activity during daily use was examined by comparing the lower limb muscle MRI of healthy subjects following exercise and hypoPP patients. METHODS: Twenty Asian patients (mean age: 29·3±7·53 years) clinically diagnosed with hypoPP were enrolled in the present study. Ten healthy subjects were also enrolled. Direct automated DNA sequencing of the S4 regions of CACNA1S and SCN4A in all hypoPP patients was performed. The upper and lower legs of all hypoPP patients during the time interval between attacks and healthy subjects pre- and post-exercise were examined on a 3 T system with T2-weighted fat saturation sequence. Images were evaluated by means of a region of interest analysis. A scoring from 0 to 3 was used to compare the degree of muscle edema among individual muscles. RESULTS: Three hypoPP patients were identified with mutations in the screened genes: R1239H and R900S of CACNA1S and R672H of SCN4A. The lower leg muscles of both hypoPP patients and healthy subjects after exercise displayed significantly higher MRI signal intensities compared to healthy subjects before exercise (P < 0·0001 and P < 0·0001, respectively). In contrast, there was no significant change in the upper leg muscle signal intensities of hypoPP patients and healthy subjects following exercise compared to pre-exercise healthy subjects (P  =  0·7598 and P  =  0·9651, respectively). In the hypoPP patient group, high signal intensity in the upper leg muscles was seen only in the patient with the R1239H mutation. In the lower legs, muscle edema was most frequently seen in the gastrocnemius lateralis, soleus, and gastrocnemius medialis in the hypoPP patient group. Furthermore, the degree of muscle edema was the greatest in these muscles. This similar pattern of muscle edema was also seen in healthy subjects after exercise. CONCLUSIONS: In Asian hypoPP patients, muscle edema as well as the underlying abnormal ion distributions across the muscle membrane is present even during the time interval between attacks of muscle weakness. The muscles of the lower leg are more likely to be edematous than muscles of the upper leg since these muscles are more actively used in daily life. Thus, muscles subjected to high activity are more likely to be edematous and sodium-overloaded.

Statin therapy does not improve lung function in asthma: a meta-analysis of randomized controlled trials.

OBJECTIVE: To assess the efficacy of statins in the treatment of asthma. METHODS: Electronic databases were searched to identify randomized controlled trials that measured the efficacy of statins in the treatment of asthma, and a meta-analysis of the pooled data was performed. RESULTS: Five trials were identified; four met the inclusion criteria (total number of patients 200). Compared with controls, patients in the statin groups had higher forced expiratory volume in 1 s (FEV1) values before inhaled corticosteroids (0.09 l, 95% confidence interval [CI] -0.06, 0.23), higher FEV1 values after inhaled corticosteroids (0.06 l, 95% CI -0.09, 0.22), and higher morning peak expiratory flow rates (9.87 l, 95% CI -15.66, 35.40). These results were not statistically significant and, furthermore, publication bias was detected. CONCLUSION: In conclusion, there is currently insufficient evidence to show that statins improve lung function in patients with asthma.