Impaired glucose tolerance (IGT) is a pre-diabetic state of hyperglycemia that is associated with insulin resistance, increased risk of type II diabetes, and cardiovascular pathology. Recently, investigators hypothesized that decreased vagus nerve activity may be the underlying mechanism of metabolic syndrome including obesity, elevated glucose levels, and high blood pressure.

Background: Shiatsu, similar to acupressure, uses finger pressure, manipulations and stretches, along Traditional Chinese Medicine meridians. Shiatsu is popular in Europe, but lacks reviews on its evidence-base.Methods: Acupressure and Shiatsu clinical trials were identified using the MeSH term 'acupressure' in: EBM reviews; AMED; BNI; CINAHL; EMBASE; MEDLINE; PsycARTICLES; Science Direct; Blackwell Synergy; Ingenta Select; Wiley Interscience; Index to Theses and ZETOC. References of articles were checked. Inclusion criteria were Shiatsu or acupressure administered manually/bodily, published after January 1990. Two reviewers performed independent study selection and evaluation of study design and reporting, using standardised checklists (CONSORT, TREND, CASP and STRICTA).Results: Searches identified 1714 publications. Final inclusions were 9 Shiatsu and 71 acupressure studies. A quarter were graded A (highest quality). Shiatsu studies comprised 1 RCT, three controlled non-randomised, one within-subjects, one observational and 3 uncontrolled studies investigating mental and physical health issues. Evidence was of insufficient quantity and quality. Acupressure studies included 2 meta-analyses, 6 systematic reviews and 39 RCTs. Strongest evidence was for pain (particularly dysmenorrhoea, lower back and labour), post-operative nausea and vomiting. Additionally quality evidence found improvements in sleep in institutionalised elderly. Variable/poor quality evidence existed for renal disease symptoms, dementia, stress, anxiety and respiratory conditions. Appraisal tools may be inappropriate for some study designs. Potential biases included focus on UK/USA databases, limited grey literature, and exclusion of qualitative and pre-1989 studies.Conclusions: Evidence is improving in quantity, quality and reporting, but more research is needed, particularly for Shiatsu, where evidence is poor. Acupressure may be beneficial for pain, nausea and vomiting and sleep.

Background: Probiotics seems to play a beneficial role in stressed populations; thus, a systematic review and meta‐analysis to assess the effects of probiotics on stress in healthy subjects were conducted.Methods: Randomized controlled trials on the effects of probiotics on stress in healthy subjects were retrieved from five databases. The effects of probiotics on subjective stress level, stress‐related subthreshold anxiety/depression level, cortisol level, and adverse reactions were analyzed. Separate subgroup analyses were conducted on single‐strain probiotics versus multi‐strain probiotics, and short‐term administration versus long‐term administration.Results: Seven studies were included, involving a total of 1,146 subjects. All the studies were rated as low or moderate risk of bias. Our research found that probiotic administration can generally reduce the subjective stress level of healthy volunteers and may improve their stress‐related subthreshold anxiety/depression level, but no significant effect was observed in the subgroup analysis. The effect of probiotics on cortisol level was not significant. Adverse reactions were reported in only one of seven studies, but left undescribed.Conclusion: Current evidence suggests that probiotics can reduce subjective stress level in healthy volunteers and may alleviate stress‐related subthreshold anxiety/depression level, without significant effect on cortisol level, and there is not enough support to draw conclusions about adverse effects; thus, more reliable evidence from clinical trials is needed.

Shenmai injection (SM), as a traditional Chinese medicine injection, is widely used for chronic cor pulmonale heart failure in mainland China. It is essential to systematically assess the efficacy and safety of SM as an adjuvant treatment for chronic cor pulmonale heart failure. Eight English and Chinese electronic databases were searched, from inception to December 2014, to identify randomized controlled trials (RCTs) of SM for chronic cor pulmonale heart failure. The Cochrane Risk of Bias tool was used to evaluate the methodological quality of eligible studies. Meta-analysis was performed by Review Manager 5.2. Twenty-seven RCTs with 2045 participants were identified. The methodological quality of the included studies was generally low. Only one trial reported data on death. None of the included trials reported quality of life. The meta-analysis indicated that compared to conventional treatment, the combination of SM and conventional treatment was more effective in terms of the New York Heart Association classification (RR, 1.26; 95 % CI, 1.20–1.32; P < 0.00001), Left Ventricular Ejection Fraction (MD, 11.33; 95 % CI, 8.59–14.07; p < 0.00001), partial pressure of oxygen (MD, 1.00; 95 % CI, 0.64–1.36; P < 0.00001) and partial pressure of carbon dioxide (MD, 0.83; 95 % CI, 0.58–1.08; p < 0.00001). In addition, two trials reported that SM plus conventional treatment was superior to the conventional treatment alone to reduce B-type natriuretic peptide. No serious adverse drug events or reactions were reported. SM plus conventional treatment appeared to be effective and relatively safe for chronic cor pulmonale heart failure. However, due to the generally low methodological quality and small sample size, this review didn’t find evidence to support routine use of SM as an adjuvant treatment for chronic cor pulmonale heart failure.

Objectives: Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in childhood, which may be related to adverse childhood experiences (ACEs). Our study aims to explore the association between ACEs and subsequent ADHD, and analyze the potential moderators.Methods: Literature search was conducted by a combined computer‐assisted and manual method. Studies were included if they had reported the association between ACEs and subsequent ADHD. Overall estimates of odds ratios (ORs) were obtained using random‐effects meta‐analyses, meta‐regressions and further stratified analyses were conducted to examine potential moderator variables.Results: Totals of 70 studies involving nearly 4 million participants from among 6,452 unique articles were included. In the primary analyses, ACEs were found to be associated with subsequent ADHD (OR = 1.68, 95% CI: 1.54–1.83), and the negative effects of different forms of ACEs for ADHD were nonequivalent. Such as lived in the stepfamily, been adopted or fostered, and experienced sexual abuse were more deleterious than others. It was found that individuals who had experienced multiple ACEs or who are female were more vulnerable to ADHD.Conclusions: The findings provide critical evidence for understanding the association between ACEs and ADHD. ACEs could increase the susceptibility of ADHD, especially for individuals who ever experienced multiple ACEs and females.

Acute bronchitis (AB) is one of the common diseases. Tanreqing injection (TRQ) was widely used to treat patients with acute bronchitis, and many randomized controlled trials have been conducted to investigate its efficacy. The purpose of this systematic review is to evaluate the efficacy and safety of TRQ for AB. Eight English and Chinese electronic databases, up to October 2014, were searched to identify randomized controlled trials on TRQ for AB. Two reviewers independently extracted data and assessed the quality of each trial by using Cochrane handbook. Meta-analysis was carried out by using Review Manager software. A total of 49 trials with 5131 participants were collected. Data of three main outcomes were pooled and analyzed as following: (1) effective rates: TRQ versus antibiotics (RR 1.12; 95% CI 1.05, 1.18; P=0.0002); TRQ plus antiviral drugs versus antiviral drugs (RR: 5.12; 95% CI 3.03, 8.66; P<0.00001); TRQ plus antibiotics versus antibiotics (RR 3.46; 95% CI 2.59, 4.62; P<0.00001); TRQ versus antibiotics plus antiviral drugs (RR 2.03; 95% CI 1.10, 3.74; P=0.02); TRQ plus conventional therapy versus conventional therapy alone (RR 1.21; 95% CI 1.15, 1.27; P<0.00001). (2) Time for fever resolution: TRQ plus antiviral drugs versus antiviral drugs (MD: -1.08; 95% CI -1.59, -0.57; P<0.00001); TRQ plus antibiotics versus antibiotics (MD -1.33; 95% CI -1.81, -0.86; P<0.00001); TRQ versus antibiotics plus antiviral drugs (MD -0.88; 95% CI -1.25, -0.51; P<0.00001); TRQ plus conventional therapy versus conventional therapy alone (MD -1.06; 95% CI -1.13, -0.98; P<0.00001). (3) Resolution of cough: TRQ plus antiviral drugs versus antiviral drugs (MD: -2.09; 95% CI -3.11, -1.43; P<0.00001); TRQ plus antibiotics versus antibiotics (MD: -2.65; 95% CI -2.88, -2.42; P<0.00001); TRQ plus conventional therapy versus conventional therapy alone (MD -1.84; 95% CI -2.85, -0.83; P=0.0003). Four trials described the adverse drug reactions of TRQ, while no severe adverse drug reactions reported. As a therapy for AB, TRQ has potentially beneficial effect in improving effective rates, reducing the time to resolution of fever, cough, crackles and absorption of shadows on X-ray. However, due to the limitations of methodological quality of the included trials, it is difficult to make a conclusive recommendation about TRQ treating patients with AB. Further rigorous clinical trials are warranted to evaluate the efficacy and safety of TRQ.