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Objective To systematically examine the randomized controlled trial ( RCT) evidence regarding efficacy and tolerability of topiramate cotreatment with antipsychotics in schizophrenia-spectrum disorders. Methods Random-effects meta-analysis of RCTs of topiramate cotreatment with antipsychotics vs. placebo/ongoing antipsychotic treatment in schizophrenia-spectrum disorders. Standardized or weighted mean difference ( SMD/ WMD), risk ratio ( RR) ±95% confidence intervals ( CIs), and number needed to harm ( NNH) were calculated. Results Across 16 RCTs ( n = 934, duration = 11.8 ± 5.6 weeks), topiramate outperformed the comparator regarding change/endpoint of total ( SMD: −0.58, 95% CI: −0.82, −0.35, P < 0.00001), positive ( SMD: −0.37, 95% CI: −0.61, −0.14, P = 0.002), negative ( SMD: −0.58, 95% CI: −0.87, −0.29, P < 0.0001), and general symptoms ( SMD: −0.68, 95% CI: −0.95, −0.40, P < 0.00001). Furthermore, topiramate was superior regarding body weight ( WMD: -2.75 kg, 95% CI: −4.03, −1.47, P < 0.0001), body mass index ( BMI) ( WMD: -1.77, 95% CI: −2.38, −1.15, P < 0.00001), triglycerides ( P = 0.006), and insulin levels ( P < 0.00001). Superiority regarding psychopathology and body weight/ BMI was consistent across Chinese/Asian and Western RCTs, double-blind and open designs, clozapine and non-clozapine cotreatment, augmentation and co-initiation RCTs, and higher and lower quality RCTs. In meta-regression analyses, topiramate's efficacy for total symptoms was moderated by shorter illness duration ( P = 0.047), while weight loss was greater in prevention/co-initiation vs. intervention/augmentation RCTs (−4.11 kg, 95% CI: −6.70, −1.52 vs. −1.41 kg, 95% CI: −2.23, −0.59, P < 0.001). All-cause discontinuation was similar between topiramate and comparators (RR: 1.28, 95% CI: 0.91, 1.81, P = 0.16). While topiramate led to more concentration/attention difficulties ( P = 0.03, NNH = 8, 95% CI=4-25), psychomotor slowing ( P = 0.02, NNH = 7, 95% CI = 4-25), and paresthesia ( P = 0.05, NNH = 2, 95% CI = 4-33), it led to less ≥7% weight gain ( P = 0.0001, NNH = 2, 95% CI = 2-3) and constipation ( P = 0.04, NNH = 9, 95% CI = 5-100) than the comparator. Conclusions These results indicate that adjunctive topiramate to antipsychotics is an effective and safe treatment choice for symptomatic improvement and weight reduction in patients with schizophrenia-spectrum disorders. [ABSTRACT FROM AUTHOR]

Objective: Free radicals may be involved in the pathogenesis of tardive dyskinesia (TD). We conducted this meta-analysis to systematically examine the efficacy of extract of Ginkgo biloba (EGb), a potent antioxidant possessing free radical- scavenging properties, as a treatment for TD in schizophrenia using randomized controlled trial (RCT) data. Method: Drawn from English and Chinese databases, 3 RCTs of EGb augmentation of antipsychotics (APs) vs. AP plus placebo or AP monotherapy were identified. 2 evaluators extracted data. The primary outcome measure was the severity of TD symptoms assessed by the Abnormal Involuntary Movement Scale (AIMS). Weighted mean difference (WMD) and risk ratio (RR) ± 95% confidence intervals (CI) were calculated. Statistical analyses were performed using Review Manager (version 5.1.7.0) and STATA (version 12.0). Results: The 3 RCTs (n = 299) from China, of 12 weeks duration, involved schizophrenia patients with TD of 55.9 ± 13.4 years old. EGb (240 mg/ day) outperformed the control group in reducing the severity of TD and clinical symptoms as measured by the AIMS (trials = 3, n = 299, WMD: -2.30 (95%CI: − 3.04, − 1.55), P < 0.00001) and the adverse drug reactions as assessed by the Treatment Emergent Symptom Scale (TESS) (trials = 2, n = 142, WMD: − 2.38 (95%CI: -4.01, -0.74), P = 0.004). Both the Positive and Negative Syndrome Scale (PANSS) total score (trials = 2, n = 239, P = 0.87) and all-cause discontinuation (trials = 3, n = 299, P = 0.21) were similar between the EGb and control group. Conclusion: This meta-analysis suggests that adjunctive EGb appeared to be an effective and safe option for improving TD in the treatment of schizophrenia patients. However, better RCTs are needed to demonstrate its efficacy and safety especially on cognitive function in TD. [ABSTRACT FROM AUTHOR]

Background and Objective Diallyl sulfide ( DAS), a flavor compound from garlic, has varied potential therapeutic activities. Periodontitis is a disease that develops because of host-mediated inflammation to periodontal pathogens. In this study, the effects of DAS on the common proinflammatory cytokines and nuclear factor-kappa B ( NF-κ B) in human gingival fibroblasts ( HGFs) being stimulated with lipopolysaccharide from Porphyromonas gingivalis, a potent periodontal pathogen, were evaluated. Material and Methods Cytotoxicities of DAS and lipopolysaccharide on HGFs were measured with MTS assay. The m RNA and protein expressions of proinflammatory cytokines, including interleukin ( IL)-1β, IL-6 and tumor necrosis factor ( TNF)-α, from the HGFs treated with lipopolysaccharide with and without DAS were examined with reverse transcription-polymerase chain reaction and immunocytochemistry, respectively. In addition, the activation and nuclear translocation of NF-κ B with and without DAS were compared. Results DAS and lipopolysaccharide treatments within 3 m m and 10 μg/mL, respectively, did not affect the survival rate of HGFs. Lipopolysaccharide (1 μg/mL) significantly increased the m RNA expressions of IL-1β, IL-6 and TNF-α; however, DAS (1 m m) inhibited these expressions. The protein expressions of TNF-α, IL-1β, as well as the NF-κ B nuclear translocation were increased after lipopolysaccharide treatment, but decreased when there was a DAS pretreatment. Conclusion DAS diminished P. gingivalis lipopolysaccharide-stimulated cytokine expression and NF-κ B activation in HGFs; we therefore suggest DAS may be beneficial on periodontal inflammation. [ABSTRACT FROM AUTHOR]

Background Ustekinumab, an interleukin-12/23 inhibitor, is effective in the treatment of psoriasis. A recent Italian study showed more favourable response to ustekinumab in patients with positive human leucocyte antigen ( HLA)-Cw6. Nonetheless, there are differences in genetic susceptibility to psoriasis between races, and no studies have specifically assessed the candidate genetic markers in predicting therapy outcome in Chinese patients with psoriasis treated with ustekinumab. Objectives To determine whether HLA gene polymorphisms can predict the response to ustekinumab in Chinese patients with psoriasis. Methods Sixty-six patients with psoriasis treated with ustekinumab were included in the study, and the effectiveness of ustekinumab therapy was evaluated at weeks 0, 16 and 28 by Psoriasis Area and Severity Index ( PASI). Results More HLA-Cw6-positive patients achieved a PASI 75 response at week 4 compared with HLA-Cw6-negative patients (38% vs. 9%, P = 0·019). Similarly, at week 16, patients carrying the HLA-Cw6 allele showed a higher likelihood of achieving PASI 50, 75 and 90 than Cw6-negative patients, although this was not statistically significant. At week 28, a significantly higher percentage of HLA-Cw6-positive patients maintained PASI 90 response compared with Cw6-negative patients (63% vs. 26%, P = 0·035). Further analysis of other HLA allele polymorphisms did not show significant associations with therapeutic response to ustekinumab. Conclusions This pharmacogenetic study provides preliminary data indicating that positive HLA-Cw6 is associated with a good response to ustekinumab treatment in Chinese patients with psoriasis. [ABSTRACT FROM AUTHOR]

Background Ustekinumab, an interleukin ( IL)-12 and IL-23 blocker, has emerged as a new therapeutic option for patients with psoriasis. It is generally well tolerated but safety data on the use of ustekinumab in patients with viral hepatitis are limited. Objective To assess the safety profile of ustekinumab in the treatment of patients with psoriasis who have concomitant hepatitis B or hepatitis C. Methods This study included 18 patients with concurrent psoriasis and hepatitis B virus ( HBV) infection (14 patients) or hepatitis C virus ( HCV) infection (four patients) who were treated with at least two ustekinumab injections. Viral loads were measured at baseline and each time before the administration of ustekinumab. Relevant clinical data were recorded. Results Among 11 patients positive for hepatitis B surface antigen ( HBsAg), two out of the seven (29%) patients who did not receive antiviral prophylaxis exhibited HBV reactivation during ustekinumab treatment. No viral reactivation was observed in the three occult HBV-infected patients ( HBsAg-negative/hepatitis B core antibody-positive patients). One patient with HCV, liver cirrhosis and treated hepatocellular carcinoma ( HCC) experienced HCV reactivation and recurrent HCC during the ustekinumab treatment. No significant increase in aminotransferase levels was observed in any patient. Conclusions Antiviral prophylaxis appears to minimize the risk of viral reactivation in patients with concurrent psoriasis and HBV infection. Without effective anti-viral prophylaxis, the risk/benefit of ustekinumab treatment should be carefully assessed in patients with psoriasis and HBV or HCV infection and/or HCC. Close monitoring for HBV and HCV viral load is recommended, particularly for patients with high-risk factors. Serum aminotransferase determination may not be useful for early detection of viral reactivation. [ABSTRACT FROM AUTHOR]

BackgroundTo date, there has been no large-scale survey of geriatric depression (GD) involving both rural and urban areas in China using standardized assessment tools and diagnostic criteria. This study aimed to determine the 12-month and lifetime prevalence rates of GD and sociodemographic correlates in urban and rural regions of Beijing, China.MethodA total of 1601 elderly patients (aged ?60 years) were randomly selected and interviewed in Beijing using the Composite International Diagnostic Interview (CIDI 1.0). Basic sociodemographic and clinical data were also collected during the interviews.ResultsThe overall 12-month prevalence of GD was 4.33%, and the 12-month prevalence rates for men and women were 2.65% and 5.83% respectively. The overall lifetime prevalence of GD was 7.83%, and lifetime prevalence rates for men and women were 4.65% and 10.66% respectively. Female sex, lower educational level, monthly income, rural abode, and the presence of one or more major medical conditions were associated with increased risk of GD. Of the GD subjects interviewed, 25.2% were receiving some type of treatment, with only 4.7% preferring to seek treatment from mental health professionals.ConclusionsAlthough still relatively low by international standards, there is an increasing trend in the prevalence of GD in China. The low percentage of subjects treated for GD is a major public health concern that should be addressed urgently. [ABSTRACT FROM AUTHOR]

Objective – To evaluate the clinical course of patients with myasthenia gravis (MG) up to 3 months after double filtration plasmapheresis (DFP). Material and methods – We recorded the MG score and measured the level of acetylcholine receptor antibody (AchRAb) at baseline and day 1 (D1), week 1 (W1), 1 month (M1), 2 (M2) and 3 months (M3) after DFP in 16 MG patients. Based on the difference in score during follow-up, we divided our patients into clinical improvement (CI) and clinical worsening (CW) groups. Results – The MG score decreased in all courses from a mean of 8.1 at baseline to 5.6 at D1, and to 4.7, 4.0, 3.8, and 3.7 at W1, M1, M2, and M3, respectively. In the CW group, AchRAb levels were significantly higher at M1 (P = 0.022). The AchRAb level at W1 correlated significantly with the MG score at M3 (P = 0.027) and the changes of MG score from W1 to M1 (P = 0.029). The ratio of AchRAb levels of M1 to W1 correlated well with MG score at W1 (P = 0.032), at M3 (P = 0.001), and the changes of MG score from W1 to M1 (P = 0.004). Conclusion – Excessive rebounds of AchRAb level at W1 may suggest clinical worsening and further increases in AchRAb level at M1 predict poorer outcome after DFP. [ABSTRACT FROM AUTHOR]

Rational pharmacotherapy helping chronic psychiatric patients in the difficult process of reintegration into the community is an important prerequisite of successful rehabilitation. Results of a survey conducted at the opening of a rehabilitation facility in Hong Kong revealed a number of illogicalities in prescription patterns. Frequently encountered faulty treatment decisions incompatible with the recommendations of modern literature included polypharmacy, higher than necessary doses of anticholinergic antiparkinsonian agents and giving psychotropic drugs in inconveniently divided doses. With the newly emerging subspecialty of rehabilitation-community psychiatry in Hong Kong, it is expected that large numbers of chronically hospitalized patients will enter rehabilitation programmes. The present survey indicated that it is imperative to pay continued attention to their medication status. [ABSTRACT FROM AUTHOR]

A letter to the editor discussing the use of finasteride in the treatment of androgenetic alopecia is presented.

Studies the relationship between clinical responses and plasma concentrations of imipramine and its active metabolites in depressed patients in China. Degree of response and plasma levels of imipramine and/or its metabolites; Drug dosage and administration.

Schizophrenia is a complex illness with unknown aetiology and pathogenesis. Currently, a considerable number of patients with schizophrenia do not receive standardised and systematic treatment in China. In the past years, many controlled trials have been conducted in chronic schizophrenia. In contrast, research on first-episode schizophrenia is lacking. This paper describes the background and design of the Chinese First-Episode Schizophrenia Trial project — a multicentre, randomised, open-label clinical trial. A total of 600 first-episode schizophrenia patients were randomly divided into 3 groups and treated with risperidone, aripiprazole, and olanzapine for 1 year. During the study period, only 1 medication change of the 3 antipsychotic medications was allowed. [ABSTRACT FROM AUTHOR]