The methodologic quality of these trials was considerably poor. The median sample size of each comparison group was 45, and the median trial duration was 21 days. The frequency of acupuncture treatment was once-daily, with a median of 16 sessions in each trial. Acupuncture for chemotherapy-induced leukopenia is an intriguing clinical question.

However, the inferior quality and publication bias present in these studies may lead to a false-positive estimation. Meta-analysis based on these published trials should be treated in an exploratory nature only. In a review on the safety and effectivenes of various interventions for the treatment of neck pain, Binder stated that compared with sham treatment, inactive treatment, or waiting list control, acupuncture may be more effective than some types of sham treatment not further defined or inactive treatment not further defined at improving pain relief at the end of treatment or in the short-term less than 3 months , but not in the intermediate-term not defined or in the long-term not defined in people with chronic mechanical disorders.

The author also noted that acupuncture may be more effective than sham TENS at improving pain at 1 week after treatment, and at 6 months, in people with chronic neck pain. Needle acupuncture may be more effective than no acupuncture at improving a composite outcome of neck pain and disability not further defined at 3 months in people with chronic neck pain very low-quality evidence. Furthermore, compared with sham treatment, inactive treatment, or waiting list control, needle acupuncture may be more effective than no acupuncture at improving quality of life measured by SF at 3 months in people with chronic neck pain very low-quality evidence.

There is no evidence of benefit of acupuncture for dyspnea palliation in cancer patients. Ben-Aharon and associates conducted a systematic review of RCTs assessing all pharmacological and non-pharmacological interventions for dyspnea palliation in cancer patients. Two reviewers independently appraised the quality of trials and extracted data.

The administration of subcutaneous morphine resulted in a significant reduction in dyspnea visual analog scale VAS compared with placebo.

No difference was observed in dyspnea VAS score when nebulized morphine was compared with subcutaneous morphine, although patients preferred the nebulized route. The addition of benzodiazepines to morphine was significantly more effective than morphine alone, without additional adverse effects.

Oxygen was not superior to air for alleviating dyspnea, except for patients with hypoxemia. Nursing-led interventions improved breathlessness. Acupuncture was not beneficial. The authors concluded that their review supports the use of opioids for dyspnea relief in cancer patients. The use of supplemental oxygen to alleviate dyspnea can be recommended only in patients with hypoxemia. Nursing-led non-pharmacological interventions seem valuable.

Only a few studies addressing this question were performed. Thus, the investigators concluded, further studies evaluating interventions for alleviating dyspnea are warranted. A systematic evidence review by Bausewein et al reached similar conclusions about the lack of adequate evidence to support the use of acupuncture for cancer-associated dyspnea.

There is a lack of reliable evidence for acpuncture treatment of Parkinson's disease. Lam and co-workers evaluated the safety and effectiveness of acupuncture therapy monotherapy or adjuvant therapy , compared with placebo, conventional interventions, or no treatment in treating patients with idiopathic Parkinson's disease IPD.

All RCTs of any duration comparing monotherapy and adjuvant acupuncture therapy with placebo or no intervention were included. Data were abstracted independently by 2 investigators onto standardized forms, and disagreements were resolved by discussion.

A total of 10 trials were included, each using a different set of acupoints and manipulation of needles. None of them reported the concealment of allocation. Only 2 studies mentioned the number of dropouts; 2 used a non-blind method while others did not mention their blinding methods. Nine studies claimed a statistically significant positive effect from acupuncture as compared with their control; only 1 indicated that there were no statistically significant differences for all variables measured.

Only 2 studies described details about adverse events. The authors concluded that there is evidence indicating the potential effectiveness of acupuncture for treating IPD. However, results were limited by the methodological flaws, unknowns in concealment of allocation, number of dropouts, and blinding methods in the studies.

They stated that large, well-designed, placebo-controlled RCTs with rigorous methods of randomization and adequately concealed allocation, as well as intention-to-treat data analysis are needed to ascertain the clinical value of acupuncture in the treatment of IPD. There is insufficient evidence for the use of acupuncture in polycystic ovary syndrome.

Stener-Victorin and colleagues described the etiology and pathogenesis of polycystic ovary syndrome PCOS and evaluated the use of acupuncture to prevent and reduce symptoms related with PCOS. This syndrome is the most common female endocrine disorder and it is strongly associated with hyper-androgenism, ovulatory dysfunction and obesity.

It increases the risk for metabolic disturbances such as hyper-insulinemia and insulin resistance, which can lead to type 2 diabetes, hypertension and an increased likelihood of developing cardiovascular risk factors and impaired mental health later in life.

Despite extensive research, little is known about the etiology of PCOS. The syndrome is associated with peripheral and central factors that influence sympathetic nerve activity. Therefore, the sympathetic nervous system may be an important factor in the development and maintenance of PCOS.

Many women with PCOS require prolonged treatment. Current pharmacological approaches are effective but have adverse effects. Thus, non-pharmacological treatment strategies need to be evaluated.

Acupuncture may affect PCOS via modulation of endogenous regulatory systems, including the sympathetic nervous system, the endocrine and the neuroendocrine system. Experimental observations in rat models of steroid-induced polycystic ovaries and clinical data from studies in women with PCOS suggested that acupuncture exert long-lasting beneficial effects on metabolic and endocrine systems and ovulation.

Direct recordings of multi-unit efferent post-ganglionic muscle sympathetic nerve activity MSNA in a muscle fascicle of the peroneal nerve before and following 16 wks of treatment were carried out. Biometric, hemodynamic, endocrine, and metabolic parameters were measured. No correlation was found for body mass index and MSNA in the exercise group. There were no differences between the groups in hemodynamic, endocrine, and metabolic variables.

For the first time, these researchers showed that low-frequency EA and physical exercise lowers high sympathetic nerve activity in women with PCOS. Thus, treatment with low-frequency EA or physical exercise with the aim to reduce MSNA may be of importance for women with PCOS. There is insufficient evidence of the effectiveness of acupuncture for toxic neuropathy. Zhou et al noted that thalidomide and bortezomib are effective in the treatment of multiple myeloma.

Unfortunately, their use can cause sensory neuropathy that frequently limits dose and duration of treatment. Although the relationship between peripheral neuropathy and therapeutic dose is controversial, many researchers have demonstrated a positive correlation between neuropathy and cumulative dose, dose intensity, and length of therapy. Peripheral neuropathic pain is the most troublesome symptom of neuropathy.

Spontaneous pain, allodynia, hyperalgesia, and hyperpathia are often associated with decreased physical activity, increased fatigue, mood, and sleep problems. Symptoms are often difficult to manage, and available treatment options rarely provide total relief. Moreover, the adverse effects of these treatments often limit their use.

Several studies have reported the efficacy of acupuncture, with fewer adverse effects than analgesic drugs, in the treatment of painful diabetic and human immunodeficiency virus-related neuropathy. However, the effectiveness of acupuncture in treating toxic neuropathy has not been assessed. Although its putative mechanisms remain elusive, acupuncture has strong potential as an adjunctive therapy in thalidomide- or bortezomib-induced painful neuropathy, and a better understanding might guide its use in the management of chemotherapy-induced neuropathic pain.

The authors concluded that well-designed clinical trials with adequate sample size and power are warranted. There is no reliable evidence for the use of acupuncture as a treatment for erectile dysfunction. Lee and colleagues evaluated the current evidence for the use of acupuncture to treat erectile dysfunction ED. Systematic searches were conducted in 15 electronic databases, with no language restrictions.

Hand-searches included conference proceedings and our files. All clinical studies of acupuncture as a treatment for ED were considered for inclusion, and their methodological quality was assessed using the Jadad score.

Of the 4 studies included, 1 randomized controlled trial RCT showed beneficial effects of acupuncture compared with sham acupuncture in terms of response rate, while another RCT found no effects of acupuncture. The remaining 2 studies were uncontrolled clinical trials.

Collectively these data showed that RCTs of acupuncture for ED are feasible but scarce. Most investigations had methodological flaws e. The authors concluded that the evidence is insufficient to suggest that acupuncture is an effective intervention for treating ED. They stated that further research is needed to investigate if there are specific benefits of acupuncture for men with ED.

A Cochrane review found insufficient evidence of the effectiveness of acupuncture in Bell's palsy. Chen et al examined the effectiveness of acupuncture in hastening recovery and reducing long-term morbidity from Bell's palsy. These investigators updated the searches of the Cochrane Neuromuscular Disease Group Trials Specialized Register May 24, , the Cochrane Central Register of Controlled Trials CENTRAL issue 2, , MEDLINE January to May , EMBASE January to May , AMED January to May , LILACS from January to May and the Chinese Biomedical Retrieval System January to May for RCTs using "Bell's palsy" and its synonyms, "idiopathic facial paralysis" or "facial palsy" as well as search terms including "acupuncture".

Chinese journals in which the researchers thought they might find RCTs relevant to their study were hand-searched. These investigators reviewed the bibliographies of the randomized trials and contacted the authors and known experts in the field to identify additional published or unpublished data. They included all RCTs involving acupuncture by needle insertion in the treatment of Bell's palsy irrespective of any language restrictions. Two review authors identified potential articles from the literature search, extracted data and assessed quality of each trial independently.

All disagreements were resolved by discussion between the review authors. The literature search and hand-searching identified 49 potentially relevant articles. Of these, 6 RCTs were included involving participants with Bell's palsy. Two more possible trials were identified in the update than the previous version of this systematic review, but both were excluded because they were not real RCTs.

Of the 6 included trials, 5 used acupuncture while the other 1 used acupuncture combined with drugs. No trial reported on the outcomes specified for this review. Harmful side effects were not reported in any of the trials.

Poor quality caused by flaws in study design or reporting including uncertain method of randomization, allocation concealment and blinding and clinical differences between trials prevented reliable conclusions about the effectiveness of acupuncture. The authors concluded that the quality of the included trials was inadequate to allow any conclusion about the effectiveness of acupuncture. They stated that more research with high quality trials is needed.

There is insufficient evidence of the effectiveness of acupuncture for respiratory symptoms. Gibson and colleagues noted that anecdotal evidence from both clinicians and patients suggests there may be some beneficial effect of acupuncture in the treatment of respiratory symptoms, such as bronchospasm, breathlessness and hyper-ventilation syndromes.

Some respiratory clinicians are introducing acupuncture as a treatment modality for the management of respiratory symptoms, despite the lack of available objective evidence to support this practice.

The authors reviewed the available evidence on the use of acupuncture in respiratory disorders and discussed the methodological issues that are evident within this literature. In addition, they highlighted reasons for the lack of objective evidence to support acupuncture for respiratory conditions and the difficulties faced by acupuncture researchers when designing randomized, placebo-controlled trials.

The authors concluded that presently, there is insufficient evidence to support a recommendation on the use of acupuncture in respiratory disorders. There is insufficient evidence of the effectiveness of acupuncture for treatment of uterine fibroids.

Zhang et al evaluated the benefits and harms of acupuncture in women with uterine fibroids. All RCTs comparing acupuncture management with placebo acupuncture, no management, Chinese medication, Western medication or other managements of uterine fibroids were considered for inclusion.

Acupuncture management included either traditional acupuncture or contemporary acupuncture, regardless of the source of stimulation e. Acupuncture management without needling was excluded.

Two review authors assessed trial risk of bias according to their a priori criteria. No trials were included in this version of the review, therefore no data was collected. No randomized double-blind controlled trials met the inclusion criteria. The authors concluded that the effectiveness of acupuncture for the management of uterine fibroids remains uncertain.

They stated that more evidence is needed to establish the safety and effectiveness of acupuncture for uterine fibroids. There is a continued need for well-designed RCTs with long-term follow-up.

In a randomized, patient-assessor blinded, sham-acupuncture, controlled trial, Shin et al assessed the safety and effectiveness of acupuncture for ocular symptoms, tear film stability and tear secretion in dry eye patients. A total of 42 subjects with defined moderate to severe dry eye underwent acupuncture treatment 3 times a week for 3 weeks. Seventeen standard points GV23; bilateral BL2, GB14, TE23, Ex1, ST1 and GB20; and unilateral SP3, LU9, LU10 and HT8 on the left for men and right for women with "de qi" manipulation for the verum acupuncture group and seventeen sham points of shallow penetration without other manipulation for the sham group were applied during the acupuncture treatment.

Differences were measured using the ocular surface disease index OSDI , the VAS of ocular discomfort, the tear film break-up time TFBUT and the Schimer I test with anesthesia. In addition, adverse events were recorded. There were no statistically significant differences between results on the OSDI, VAS, TFBUT or Schimer I tests from baseline between the verum and sham acupuncture groups.

However, results from the within-group analysis showed that the OSDI and VAS in both groups and the TFBUT in the verum acupuncture group were significantly improved after 3 weeks of treatment.

No adverse events were reported during this trial. The authors concluded that both types of acupuncture improved signs and symptoms in dry-eye patients after a 4-week treatment.

However, verum acupuncture did not result in better outcomes than sham acupuncture. Lee and colleagues evaluated the effectiveness of acupuncture as a treatment option for treating the condition of dry eye. These investigators searched the literature using 14 databases from their inceptions to December 3, , without language restrictions. They included RCTs comparing acupuncture with conventional treatment.

Their risk of bias was assessed using Cochrane criteria. A total of 6 RCTs met all the inclusion criteria. Three RCTs compared the effects of acupuncture with artificial tears in patients with xerophthalmia or Sjögren syndrome. The other 3 RCTs compared the effects of acupuncture plus artificial tears with artificial tears alone — 2 of these studies failed to show significant effects of acupuncture, while 1 reported significant effects.

For Schirmer test scores and frequency of artificial tear usage, 2 RCTs reported superior effects of acupuncture plus artificial tears, while 1 RCT failed to do so. The authors concluded that these findings provide limited evidence for the effectiveness of acupuncture for treating dry eye. However, the total number of RCTs, the total sample size and the methodological quality were too low to draw firm conclusions.

In a prospective, randomized, controlled, cross-over trial, Lam et al evaluated the safety and adjunctive effect of acupuncture added to refractive correction for anisometropic amblyopia in younger children.

Main outcome measures were BCVA in the amblyopic eye at 15, 30, and 60 weeks. The mean baseline BCVA in the amblyopic eye was 0. After 15 weeks of treatment, the BCVA had improved by a mean of 2. The mean difference in BCVA between groups was 0. BCVA of less than or equal to 0. After the regimens were crossed-over at 30 weeks, group 1 had a mean of 1.

The proportions of responders, resolution, and participants achieving a BCVA of less than or equal to 0. After completion of acupuncture, only 1 participant had greater than 1 line of VA decrease to 60 weeks.

Acupuncture was well-tolerated by all children, and no severe adverse effect was encountered. The authors concluded that acupuncture is a potentially useful complementary treatment modality that may provide sustainable adjunctive effect to refractive correction for anisometropic amblyopia in young children.

They stated that acupuncture has good potential to become a complimentary therapeutic modality for amblyopia, and further large-scale studies seem warranted. In a Cochrane review, Cheuk et al examined the effectiveness of acupuncture for people with autism spectrum disorders ASD in improving core autistic features, as well as communication, cognition, overall functioning and quality of life, and established if it has any adverse effects.

These investigators searched the following databases on September 30, CENTRAL The Cochrane Library, , Issue 3 , MEDLINE to September Week 2 , EMBASE to Week 38 , PsycINFO, CINAHL, China Journal Full-text Database, China Master Theses Full-text Database, China Doctor Dissertation Full-text Database, China Proceedings of Conference Database, Index to Taiwan Periodical Literature System, metaRegister of Controlled Trials and the Chinese Clinical Trials Registry.

They also searched AMED February 26, and Dissertation Abstracts International March 3, , but these were no longer available to the authors or editorial base at the date of the most recent search. TCMLARS Traditional Chinese Medical Literature Analysis and Retrieval System was last searched on March 3, These researchers included RCTs and quasi-RCTs. They included studies comparing an acupuncture group with at least one control group that used no treatment, placebo or sham acupuncture treatment in people with ASD.

They excluded trials that compared different forms of acupuncture or compared acupuncture with another treatment. Two review authors independently extracted trial data and assessed the risk of bias in the trials.

They used relative risk RR for dichotomous data and mean difference MD for continuous data. The authors included 10 trials that involved children with ASD. The age range was 3 to 18 years and the treatment duration ranged from 4 weeks to 9 months. The studies were carried out in Hong Kong, mainland China and Egypt. Two trials compared needle acupuncture with sham acupuncture and found no difference in the primary outcome of core autistic features RFRLRS total score: MD 0.

Six trials compared needle acupuncture plus conventional treatment with conventional treatment alone. The trials used different primary outcome measures and most could not demonstrate effectiveness of acupuncture in improving core autistic features in general, though 1 trial reported patients in the acupuncture group were more likely to have improvement on the Autism Behavior Checklist RR 1.

There was no evidence that acupuncture was effective for the secondary outcome of communication and linguistic ability, though there seemed to be some benefit for the secondary outcomes of cognitive function and global functioning. Two trials compared acupressure plus conventional treatment with conventional treatment alone and did not report on the primary outcome.

Individual study results suggested there may be some benefit from acupressure for certain aspects of the secondary outcomes of communication and linguistic ability, cognitive function and global functioning. Four trials reported some adverse effects, though there was little quantitative information, and at times both intervention and control groups experienced them.

Adverse effects included bleeding, crying due to fear or pain, irritability, sleep disturbance and increased hyperactivity. None of the trials reported on quality of life. There are a number of problems with the evidence base: the trials were few in number and included only children; 6 of the trials were at high-risk of bias; they were heterogeneous in terms of participants and intervention; they were of short duration and follow-up; they reported inconsistent and imprecise results, and, due to carrying out large numbers of analyses, they were at risk of false positivity.

The authors concluded that current evidence does not support the use of acupuncture for treatment of ASD. There is no conclusive evidence that acupuncture is effective for treatment of ASD in children and no RCTs have been carried out with adults. They stated that further high quality trials of larger size and longer follow-up are needed. In a Cochrane review, Wei et al evaluated the safety and effectiveness of acupuncture in slowing the progression of myopia in children and adolescents.

These investigators searched CENTRAL which contains the Cochrane Eyes and Vision Group Trials Register The Cochrane Library , Issue 7 , MEDLINE January to July , EMBASE January to July , the Allied and Complementary Medicine Database AMED January to July , Latin American and Caribbean Health Sciences Literature Database LILACS January to July , the metaRegister of Controlled Trials mRCT , ClinicalTrials.

gov, the National Center for Complementary and Alternative Medicine NCCAM The first issue to August , the Chinese Biological Medicine Database CBM to April , China National Knowledge Infrastructure CNKI to April and VIP to April There were no date or language restrictions in the electronic searches for trials. CENTRAL, MEDLINE, EMBASE, AMED, LILACS, mRCT and ClinicalTrials.

gov were last searched on 9 July NCCAM was searched up to August and CBM, CNKI, and VIP were last searched on April 6, These researchers included RCTs that included any type of acupuncture treatment for myopia in children and adolescents. Two authors independently evaluated the search results according to the inclusion and exclusion criteria. Two authors extracted and assessed data independently.

They contacted the study investigator for missing data. The authors included 2 RCTs conducted in Taiwan with a total of participants. They did not perform a meta-analysis as the trials were assessing different outcomes. Neither trial met the pre-defined primary outcome criteria of myopia progression defined as 1 diopter mean change. Only 1 trial reported the changes of axial length without non-significant difference among groups and both trials reported that several children experienced mild pain during acupuncture stimulation.

Two trials were included in this review but no conclusions can be drawn for the benefit of co-acupressure for slowing progress of myopia in children. The authors concluded that further evidence in the form of RCTs are needed before any recommendations can be made for the use of acupuncture treatment in clinical use. These trials should compare acupuncture to placebo and have large sample sizes.

Other types of acupuncture such as auricular acupuncture should be explored further as well as compliance with treatment for at least 6 months or longer. Axial length elongation of the eye should be investigated for at least 1 year. Refractory dyspnea is a common and difficult symptom to treat in patients with advanced COPD. There are many questions concerning optimal management and, specifically, whether various therapies are effective in this setting.

These investigators addressed these important clinical issues using an evidence-based systematic review process led by a representative inter-professional panel of experts. The evidence supported the benefits of oral opioids, neuromuscular electrical stimulation, chest wall vibration, walking aids and pursed-lip breathing in the management of dyspnea in the individual patient with advanced COPD.

Oxygen is recommended for COPD patients with resting hypoxemia, but its use for the targeted management of dyspnea in this setting should be reserved for patients who receive symptomatic benefit. There is insufficient evidence to support the routine use of anxiolytic medications, nebulized opioids, acupuncture, acupressure, distractive auditory stimuli music , relaxation, hand-held fans, counseling programs or psychotherapy.

There is also no evidence to support the use of supplemental oxygen to reduce dyspnea in non-hypoxemic patients with advanced COPD. Williams et al stated that acne is a chronic inflammatory disease of the pilo-sebaceous unit resulting from androgen-induced increased sebum production, altered keratinization, inflammation, and bacterial colonization of hair follicles on the face, neck, chest, and back by Propionibacterium acnes. Although early colonization with P acnes and family history might have important roles in the disease, exactly what triggers acne and how treatment affects the course of the disease remain unclear.

Other factors such as diet have been implicated, but not proven. Acne can persist into adulthood, with detrimental effects on self-esteem.

There is no ideal treatment for acne, although a suitable regimen for reducing lesions can be found for most patients. Good quality evidence on comparative effectiveness of common topical and systemic acne therapies is scarce. Topical therapies including benzoyl peroxide, retinoids, and antibiotics when used in combination usually improve control of mild to moderate acne. Treatment with combined oral contraceptives can help women with acne. Patients with more severe inflammatory acne usually need oral antibiotics combined with topical benzoyl peroxide to decrease antibiotic-resistant organisms.

Oral isotretinoin is the most effective therapy and is used early in severe disease, although its use is limited by teratogenicity and other side-effects. Availability, adverse effects, and cost, limit the use of photodynamic therapy. New research is needed into the therapeutic comparative effectiveness and safety of the many products available, and to better understand the natural history, subtypes, and triggers of acne.

Moreover, the authors stated that complementary and alternative medicine including acupuncture can not be recommended for the treatment of acne because it is not supported by good evidence. Yan et al noted that burning mouth syndrome BMS is a common chronic pain condition that lacks a satisfactory treatment approach.

These researchers examined the effects of acupuncture or acupoint injection on the management of BMS and evaluated the evidence supporting the use of acupuncture therapy for BMS in clinical practice. The following databases were searched for relevant articles: Cochrane Oral Health Group Trials Register July , Cochrane Central Register of Controlled Trials issue 7, , MEDLINE to June , and electronic medical database from the China-National Knowledge Infrastructure to June Articles were screened, and the quality of the included trials was assessed independently by 2 reviewers.

After screening, 9 studies with randomized patients were included in this review. All 9 articles were published in Chinese and were clinical trial studies with a Jadad score of less than 3.

The authors concluded that in light of the positive outcomes reported, the use of acupuncture therapy for BMS patients warrants further research. Bo and colleagues evaluated the reports' qualities which are about RCTs of acupuncture treatment on diabetic peripheral neuropathy DPN.

A total of 8 databases including The Cochrane Library to Sept. Hand-search for further references was conducted. Language was limited to Chinese and English. These investigators identified 75 RCTs that used acupuncture as an intervention and assessed the quality of these reports with the Consolidated Standards for Reporting of Trials statement CONSORT and Standards for Reporting Interventions Controlled Trials of Acupuncture STRICTA No article gave the description of the mechanism of allocation concealment, no experiment applied the method of blinding.

Only 1 article 1. No article mentioned the number of cases lost or eliminated. During 1 exp eriment, acupuncture syncope led to temporal interruption of the therapy. Two articles 2. None of articles reported the base of calculation of sample size, or has any analysis about the metaphase of an experiment or an explanation of its interruption. One 1. The authors concluded that the quality of the reports on RCTs of acupuncture for diabetic peripheral neuropathy is moderate to low.

They stated that the CONSORT and STRICTA should be used to standardize the reporting of RCTs of acupuncture in future. The research team reviewed a total of 13 studies involving 1, participants with facial spasm. Researchers in China had conducted all studies, and most studies were poor in methodological quality. All studies reported that acupuncture was superior to other treatments, including carbamazepine, mecobalamin, and massage, and the meta-analysis on these low-quality studies yielded similar results.

The authors concluded that present trials evaluating the effectiveness of acupuncture in treatment of facial spasm are mostly poor in methodological quality. These studies showed that acupuncture was superior to other treatments for facial spasm; however, in its meta-analysis, the research team could not draw an affirmative conclusion as to the benefits of acupuncture due to the poor methodological quality and localized population of the included trials. The authors concluded that the field needs large international, well-conducted RCTs.

In a Cochrane review, He and colleagues evaluated the safety and effectiveness of acupuncture for children with mumps. These investigators searched CENTRAL , Issue 4 , MEDLINE to April week 4, , EMBASE to May , CINAHL to May , AMED to May , the Chinese BioMedicine Database CBM to May , China National Knowledge Infrastructure CNKI to May , Chinese Technology Periodical Database CTPD to May and WANFANG database to May They also hand-searched a number of journals from first issue to current issue.

These researchers included RCTs comparing acupuncture with placebo acupuncture, no management, Chinese medication, Western medication or other treatments for mumps. Acupuncture included either traditional acupuncture or contemporary acupuncture, regardless of the source of stimulation body, electro, scalp, fire, hand, fine needle, moxibustion. Two review authors independently extracted data and assessed the quality of included studies.

Only 1 study with participants met the inclusion criteria. There were a total of participants in the acupuncture group, of which recovered, with their temperature returning back to normal and no swelling or pain of the parotid gland; the condition of 14 participants improved, with a drop in temperature and alleviation of swelling or pain of the parotid gland. There were participants in the Western medicine group, of which 56 recovered and the condition of 63 improved.

Have you hit the peak for that or can you sustain that growth? We're not done building yet, and I don't know when we ever will be.

We continue to both release new services because customers need them and they ask us for them and, at the same time, we've put tremendous effort into adding new capabilities inside of the existing services that we've already built. We don't just build a service and move on. Inside of each of our services — you can pick any example — we're just adding new capabilities all the time. One of our focuses now is to make sure that we're really helping customers to connect and integrate between our different services.

So those kinds of capabilities — both building new services, deepening our feature set within existing services, and integrating across our services — are all really important areas that we'll continue to invest in.

Do customers still want those fundamental building blocks and to piece them together themselves, or do they just want AWS to take care of all that? There's no one-size-fits-all solution to what customers want. It is interesting, and I will say somewhat surprising to me, how much basic capabilities, such as price performance of compute, are still absolutely vital to our customers.

But it's absolutely vital. Part of that is because of the size of datasets and because of the machine learning capabilities which are now being created. They require vast amounts of compute, but nobody will be able to do that compute unless we keep dramatically improving the price performance. We also absolutely have more and more customers who want to interact with AWS at a higher level of abstraction…more at the application layer or broader solutions, and we're putting a lot of energy, a lot of resources, into a number of higher-level solutions.

One of the biggest of those … is Amazon Connect, which is our contact center solution. In minutes or hours or days, you can be up and running with a contact center in the cloud. At the beginning of the pandemic, Barclays … sent all their agents home. In something like 10 days, they got 6, agents up and running on Amazon Connect so they could continue servicing their end customers with customer service.

We've built a lot of sophisticated capabilities that are machine learning-based inside of Connect. We can do call transcription, so that supervisors can help with training agents and services that extract meaning and themes out of those calls.

We don't talk about the primitive capabilities that power that, we just talk about the capabilities to transcribe calls and to extract meaning from the calls.

It's really important that we provide solutions for customers at all levels of the stack. Given the economic challenges that customers are facing, how is AWS ensuring that enterprises are getting better returns on their cloud investments? Now's the time to lean into the cloud more than ever, precisely because of the uncertainty. We saw it during the pandemic in early , and we're seeing it again now, which is, the benefits of the cloud only magnify in times of uncertainty.

For example, the one thing which many companies do in challenging economic times is to cut capital expense. For most companies, the cloud represents operating expense, not capital expense. You're not buying servers, you're basically paying per unit of time or unit of storage. That provides tremendous flexibility for many companies who just don't have the CapEx in their budgets to still be able to get important, innovation-driving projects done. Another huge benefit of the cloud is the flexibility that it provides — the elasticity, the ability to dramatically raise or dramatically shrink the amount of resources that are consumed.

You can only imagine if a company was in their own data centers, how hard that would have been to grow that quickly. The ability to dramatically grow or dramatically shrink your IT spend essentially is a unique feature of the cloud. These kinds of challenging times are exactly when you want to prepare yourself to be the innovators … to reinvigorate and reinvest and drive growth forward again.

We've seen so many customers who have prepared themselves, are using AWS, and then when a challenge hits, are actually able to accelerate because they've got competitors who are not as prepared, or there's a new opportunity that they spot. We see a lot of customers actually leaning into their cloud journeys during these uncertain economic times.

Do you still push multi-year contracts, and when there's times like this, do customers have the ability to renegotiate?

Many are rapidly accelerating their journey to the cloud. Some customers are doing some belt-tightening. What we see a lot of is folks just being really focused on optimizing their resources, making sure that they're shutting down resources which they're not consuming. You do see some discretionary projects which are being not canceled, but pushed out.

Every customer is free to make that choice. But of course, many of our larger customers want to make longer-term commitments, want to have a deeper relationship with us, want the economics that come with that commitment.

We're signing more long-term commitments than ever these days. We provide incredible value for our customers, which is what they care about. That kind of analysis would not be feasible, you wouldn't even be able to do that for most companies, on their own premises. So some of these workloads just become better, become very powerful cost-savings mechanisms, really only possible with advanced analytics that you can run in the cloud. In other cases, just the fact that we have things like our Graviton processors and … run such large capabilities across multiple customers, our use of resources is so much more efficient than others.

We are of significant enough scale that we, of course, have good purchasing economics of things like bandwidth and energy and so forth. So, in general, there's significant cost savings by running on AWS, and that's what our customers are focused on. The margins of our business are going to … fluctuate up and down quarter to quarter. It will depend on what capital projects we've spent on that quarter.

Obviously, energy prices are high at the moment, and so there are some quarters that are puts, other quarters there are takes.

The important thing for our customers is the value we provide them compared to what they're used to. And those benefits have been dramatic for years, as evidenced by the customers' adoption of AWS and the fact that we're still growing at the rate we are given the size business that we are. That adoption speaks louder than any other voice. Do you anticipate a higher percentage of customer workloads moving back on premises than you maybe would have three years ago?

Absolutely not. We're a big enough business, if you asked me have you ever seen X, I could probably find one of anything, but the absolute dominant trend is customers dramatically accelerating their move to the cloud. Moving internal enterprise IT workloads like SAP to the cloud, that's a big trend. Creating new analytics capabilities that many times didn't even exist before and running those in the cloud.

More startups than ever are building innovative new businesses in AWS. Our public-sector business continues to grow, serving both federal as well as state and local and educational institutions around the world.

It really is still day one. The opportunity is still very much in front of us, very much in front of our customers, and they continue to see that opportunity and to move rapidly to the cloud. In general, when we look across our worldwide customer base, we see time after time that the most innovation and the most efficient cost structure happens when customers choose one provider, when they're running predominantly on AWS.

A lot of benefits of scale for our customers, including the expertise that they develop on learning one stack and really getting expert, rather than dividing up their expertise and having to go back to basics on the next parallel stack. That being said, many customers are in a hybrid state, where they run IT in different environments. In some cases, that's by choice; in other cases, it's due to acquisitions, like buying companies and inherited technology.

We understand and embrace the fact that it's a messy world in IT, and that many of our customers for years are going to have some of their resources on premises, some on AWS.

Some may have resources that run in other clouds. We want to make that entire hybrid environment as easy and as powerful for customers as possible, so we've actually invested and continue to invest very heavily in these hybrid capabilities.

A lot of customers are using containerized workloads now, and one of the big container technologies is Kubernetes. We have a managed Kubernetes service, Elastic Kubernetes Service, and we have a … distribution of Kubernetes Amazon EKS Distro that customers can take and run on their own premises and even use to boot up resources in another public cloud and have all that be done in a consistent fashion and be able to observe and manage across all those environments.

So we're very committed to providing hybrid capabilities, including running on premises, including running in other clouds, and making the world as easy and as cost-efficient as possible for customers. Can you talk about why you brought Dilip Kumar, who was Amazon's vice president of physical retail and tech, into AWS as vice president applications and how that will play out?

He's a longtime, tenured Amazonian with many, many different roles — important roles — in the company over a many-year period. Dilip has come over to AWS to report directly to me, running an applications group. We do have more and more customers who want to interact with the cloud at a higher level — higher up the stack or more on the application layer. We talked about Connect, our contact center solution, and we've also built services specifically for the healthcare industry like a data lake for healthcare records called Amazon HealthLake.

We've built a lot of industrial services like IoT services for industrial settings, for example, to monitor industrial equipment to understand when it needs preventive maintenance. We have a lot of capabilities we're building that are either for … horizontal use cases like Amazon Connect or industry verticals like automotive, healthcare, financial services.

We see more and more demand for those, and Dilip has come in to really coalesce a lot of teams' capabilities, who will be focusing on those areas. You can expect to see us invest significantly in those areas and to come out with some really exciting innovations. Would that include going into CRM or ERP or other higher-level, run-your-business applications? I don't think we have immediate plans in those particular areas, but as we've always said, we're going to be completely guided by our customers, and we'll go where our customers tell us it's most important to go next.

It's always been our north star. Correction: This story was updated Nov. Bennett Richardson bennettrich is the president of Protocol. Prior to joining Protocol in , Bennett was executive director of global strategic partnerships at POLITICO, where he led strategic growth efforts including POLITICO's European expansion in Brussels and POLITICO's creative agency POLITICO Focus during his six years with the company.

Prior to POLITICO, Bennett was co-founder and CMO of Hinge, the mobile dating company recently acquired by Match Group. Bennett began his career in digital and social brand marketing working with major brands across tech, energy, and health care at leading marketing and communications agencies including Edelman and GMMB.

Bennett is originally from Portland, Maine, and received his bachelor's degree from Colgate University. Prior to joining Protocol in , he worked on the business desk at The New York Times, where he edited the DealBook newsletter and wrote Bits, the weekly tech newsletter. He has previously worked at MIT Technology Review, Gizmodo, and New Scientist, and has held lectureships at the University of Oxford and Imperial College London.

He also holds a doctorate in engineering from the University of Oxford. We launched Protocol in February to cover the evolving power center of tech. It is with deep sadness that just under three years later, we are winding down the publication. As of today, we will not publish any more stories. All of our newsletters, apart from our flagship, Source Code, will no longer be sent. Source Code will be published and sent for the next few weeks, but it will also close down in December.

Building this publication has not been easy; as with any small startup organization, it has often been chaotic. But it has also been hugely fulfilling for those involved. We could not be prouder of, or more grateful to, the team we have assembled here over the last three years to build the publication. They are an inspirational group of people who have gone above and beyond, week after week.

Today, we thank them deeply for all the work they have done. We also thank you, our readers, for subscribing to our newsletters and reading our stories. We hope you have enjoyed our work.

As companies expand their use of AI beyond running just a few machine learning models, and as larger enterprises go from deploying hundreds of models to thousands and even millions of models, ML practitioners say that they have yet to find what they need from prepackaged MLops systems. As companies expand their use of AI beyond running just a few machine learning models, ML practitioners say that they have yet to find what they need from prepackaged MLops systems.

Kate Kaye is an award-winning multimedia reporter digging deep and telling print, digital and audio stories. She covers AI and data for Protocol. Her reporting on AI and tech ethics issues has been published in OneZero, Fast Company, MIT Technology Review, CityLab, Ad Age and Digiday and heard on NPR.

Kate is the creator of RedTailMedia. org and is the author of "Campaign ' A Turning Point for Digital Media," a book about how the presidential campaigns used digital media and data. On any given day, Lily AI runs hundreds of machine learning models using computer vision and natural language processing that are customized for its retail and ecommerce clients to make website product recommendations, forecast demand, and plan merchandising.

And he said that while some MLops systems can manage a larger number of models, they might not have desired features such as robust data visualization capabilities or the ability to work on premises rather than in cloud environments. As companies expand their use of AI beyond running just a few ML models, and as larger enterprises go from deploying hundreds of models to thousands and even millions of models, many machine learning practitioners Protocol interviewed for this story say that they have yet to find what they need from prepackaged MLops systems.

Companies hawking MLops platforms for building and managing machine learning models include tech giants like Amazon, Google, Microsoft, and IBM and lesser-known vendors such as Comet, Cloudera, DataRobot, and Domino Data Lab. It's actually a complex problem. Intuit also has constructed its own systems for building and monitoring the immense number of ML models it has in production, including models that are customized for each of its QuickBooks software customers.

The model must recognize those distinctions. For instance, Hollman said the company built an ML feature management platform from the ground up. For companies that have been forced to go DIY, building these platforms themselves does not always require forging parts from raw materials. Москва, Россия Курсы валют от EUR ЦБ — 69,10 руб. Медицина и здоровье на Doctor. ru: Артрозы Рак крови и беременность: Как работает фонд борьбы с лейкемией Новогодние опасности для детей. Ссылки: на главную почта знакомства одноклассники фото открытки тесты чат.

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Commercial CPB Medicare CPB. As defined in Aetna commercial policies, health care services are not medically necessary when they are more costly than alternative services that are at least as likely to produce equivalent therapeutic or diagnostic results. Myobloc rimabotulinumtoxinB brand is more costly to Aetna than other botulinum toxin agents for certain indications. There is a lack of reliable evidence that Myobloc rimabotulinumtoxinB is superior to the lower cost botulinum toxin agents: Botox onabotulinumtoxinA , Dysport abobotulinumtoxinA , and Xeomin incobotulinumtoxinA for the medically necessary indications listed below.

Therefore, Aetna considers Myobloc rimabotulinumtoxinB to be medically necessary only for members who have a contraindication, intolerance or ineffective response to the available equivalent alternative botulinum toxin agents: Botox onabotulinumtoxinA , Dysport abobotulinumtoxinA , and Xeomin incobotulinumtoxinA for the following medically necessary indications:. Precertification of botulinum toxin Botox [onabotulinumtoxinA]; Dysport [abobotulinumtoxinA]; Myobloc [rimabotulinumtoxinB]; and Xeomin [incobotulinumtoxinA] is required of all Aetna participating providers and members in applicable plan designs.

For precertification of botulinum toxin Botox [onabotulinumtoxinA]; Dysport [abobotulinumtoxinA]; Myobloc [rimabotulinumtoxinB]; and Xeomin [incobotulinumtoxinA] , call Commercial , Medicare , or fax Aetna considers onabotulinumtoxinA Botox medically necessary for any of the following indications:.

Treatment of achalasia when the member has tried and failed or is a poor candidate for conventional therapy such as pneumatic dilation and surgical myotomy;.

Treatment of chronic anal fissures when the member has not responded to first line therapy such as topical calcium channel blockers or topical nitrates;. Treatment of blepharospasm, including blepharospasm associated with dystonia and benign essential blepharospasm;. Treatment of adults with cervical dystonia e. Treatment of excessive salivation chronic sialorrhea or ptyalism when the member has been refractory to pharmacotherapy e.

Treatment of first bite syndrome when the member has failed relief from analgesics, antidepressants or anticonvulsants;. Member has signs and symptoms consistent with chronic migraine diagnostic criteria as defined by the International Headache Society IHS ;.

Treatment of myofascial pain syndrome when the member has tried and failed all of the following:. Treatment of orofacial tardive dyskinesia when conventional therapies have been tried and failed e.

Treatment of overactive bladder with urinary incontinence, urgency, and frequency when all of the following criteria are met:. Treatment of painful bruxism when the member has had an inadequate response to a night guard and has had an inadequate response to pharmacologic therapy such as diazepam;. Treatment of palatal myoclonus when the member has disabling symptoms e. Treatment of strabismus when interference with normal visual system development is likely to occur and spontaneous recovery is unlikely;.

Note : Strabismus repair is considered cosmetic in adults with uncorrected congenital strabismus and no binocular fusion. Treatment of upper or lower limb spasticity either as a primary diagnosis or as a symptom of a condition causing limb spasticity;. Treatment of urinary incontinence associated with a neurologic condition e. Aetna considers all other indications as experimental and investigational for additional information, see Experimental and Investigational and Background sections.

Aetna considers rimabotuninumtoxinB Myobloc medically necessary for the treatment of any of the following indications:. Treatment of excessive salivation chronic sialorrhea when the member has been refractory to pharmacotherapy e. Treatment of primary axillary or palmer hyperhidrosis when all of the following criteria are met:. Treatment of upper limb spasticity either as a primary diagnosis or as a symptom of a condition causing limb spasticity.

Aetna considers continuation of rimabotuninumtoxinB Myobloc therapy medically necessary for all members who meet all initial authorization criteria.

Aetna considers abobotulinumtoxin A Dysport medically necessary for the treatment of any of the following indications:. Ttreatment of blepharospasm, including blepharospasm associated with dystonia and benign essential blepharospasm;. Treatment of chronic anal fissures when the member has not responded to first-line therapy such as topical calcium channel blockers or topical nitrates;.

Treatment of upper or lower limb spasticity either as a primary diagnosis or as a symptom of a condition causing limb spasticity. Aetna considers incobotulinumtoxinA Xeomin medically necessary for the treatment of any of the following indications:. anticholinergics ;. Aetna considers continuation of incobotulinumtoxinA Xeomin therapy medically necessary for all members who meet all initial authorization criteria.

Reconstitution instructions are specific for the Unit and Unit vials. Reconstituted DYSPORT is intended for intramuscular injection only. After reconstitution, DYSPORT should be used for only one injection session and for only one patient. Please consult the Full Prescribing Information for complete details for recommended dose adjustments. Sources: Allergan, ; Ipsen Biopharmaceuticals, Inc. Aetna considers testing for neutralizing antibodies to botulinum toxin experimental and investigational.

Aetna considers botulinum toxin [Botox onabotulinumtoxinA ; Dysport abobotulinumtoxinA ; Myobloc rimabotulinumtoxinB ; and Xeomin incobotulinumtoxinA ] experimental and investigational for all other indications, including any of the following conditions not all-inclusive list :.

Aetna considers electrical stimulation to augment the effects of botulinum toxin injection for the treatment of spasticity as experimental and investigational. Aetna considers intra-operative pyloric botulinum toxin injection during gastroesophagectomy for the prevention of delayed gastric emptying as experimental and investigational.

Aetna considers ultrasound guidance during botulinum toxin injection for the treatment of migraine as experimental and investigational. Local injections of onabotulinumtoxinA Botox have been approved by the U. Food and Drug Administration FDA for the treatment of strabismus, essential blepharospasm, and hemifacial spasm. In patients with congenital strabismus who have compromised or absent binocular vision, treatment is cosmetic as ocular realignment is not capable of restoring binocular vision.

Strabismus is the condition of misalignment of the eyes. Most strabismus is the result of an abnormality of the neuromuscular control of eye movement. Strabismus can be horizontal, vertical, or torsional. Common types of strabismus are esotropia, exotropia, and hypertropia. Esotropia is in-turning of one or both eyes. It may be intermittent or constant and may occur with near fixation, distance fixation, or both. The crossing may occur predominantly with one eye or may alternate between eyes.

Esotropia may occur at any age and is the opposite of exotropia outward eye turn. The terms hypertropia and hypotropia are used to describe vertical misalignment. Hypertropia is an abnormal eye higher than the normal eye. Hypotropia is when the abnormal eye is lower than the normal eye.

The terms can generally be interchanged depending upon which eye is being described American Association for Pediatric Ophthalmology and Strabismus, Blepharospasm is a focal dystonia involving the orbicularis oculi muscles and other periocular muscles, including the procerus and corrugator muscles. Clinical manifestations include increased blinking and spasms of involuntary eye closure.

Symptoms are usually bilateral, synchronous, and symmetric, but may be asymmetric. Involuntary eye closure caused by forcible dystonic spasms of the orbicularis oculi should be distinguished from the more curtain-like "apraxia" of eyelid opening due to failure of levator palpebrae contraction. In some patients, the two conditions can coexist Comella Hemifacial spasm is characterized by involuntary synchronous spasms of one side of the face, usually beginning around the eye.

They are typically brief, irregular clonic movements but are occasionally tonic. The disorder almost always presents unilaterally, although bilateral involvement may occur in severe cases less than 5 percent overall. Brief clonic movements are first noted in the orbicularis oculi and spread over months to years to involve other facial muscles.

It never involves muscles other than those innervated by the facial nerve. Patients cannot suppress the movements. Unlike other movement disorders, this can continue during sleep. Onset is most commonly in midlife. Complete remission is rare. Neurovascular compression of the ipsilateral facial nerve is evident in 88 to 93 percent of magnetic resonance imaging studies.

Botulinum toxin injections are the most effective treatment Nguyen Clinical studies indicate that Botox can also provide symptomatic relief in a variety of other conditions characterized by involuntary spasm of certain muscle groups, notably in cervical dystonia also known as spasmodic torticollis the most common isolated focal dystonia, affecting the muscles of the neck and shoulders. Cervical dystonia may appear as horizontal turning of the head torticollis , lateral tilt of the neck laterocollis , flexion of the head anterocollis , or extension of the head retrocollis.

Botox can also provide symptomatic relief in spasmodic dysphonia i. Delays of several years before diagnosis are common, and symptoms are often confused with muscle tension dysphonia.. Ninety percent of spasmodic torticollis patients show some improvement of pain relief, head position, and disability, and botulinum toxin is now the treatment of choice for this condition.

Botox has been shown to result in normal or near normal voice in patients with adductor type strained or strangled voice laryngeal dystonia and to be of considerable benefit in patients with abductor type breathy, whispery voice laryngeal dystonia. Persaud et al noted that botulinum toxin Botox works by blocking the release of acetylcholine from the cholinergic nerve end plates leading to inactivity of the muscles or glands innervated. Botox is best known for its beneficial role in facial aesthetics but recent literature has highlighted its usage in multiple non-cosmetic medical and surgical conditions.

These investigators reviewed the current evidence pertaining to Botox use in the head and neck. A literature review was conducted using the Cochrane Controlled Trials Register, Medline and Embase databases limited to English Language articles published from to The findings suggested that there is level-1 evidence supporting the efficacy of Botox in the treatment of spasmodic dysphonia, essential voice tremor, headache, cervical dystonia, masticatory myalgia, sialorrhea, temporo-mandibular joint disorders, bruxism, blepharospasm, hemi-facial spasm and rhinitis.

For chronic neck pain there is level-1 evidence to show that Botox is ineffective. Level-2 evidence exists for vocal tics, trigeminal neuralgia, dysphagia and post-laryngectomy esophageal speech. Thus, the literature high-lighted a therapeutic role for Botox in a wide range of non-cosmetic conditions pertaining to the head and neck mainly level-1 evidence.

With ongoing research, the spectrum of clinical applications and number of people receiving Botox will no doubt increase. Botulinum toxin is currently used in those entities characterized by excessive muscle contraction, including dystonia and spasticity.

In addition, BT has been used to control pain associated with increased muscle contraction in dystonia and spasticity, but also is useful to control chronic pain not associated with muscle contraction, such as chronic daily headache. Finally, BT is useful in sialorrhea and bruxism.

Unit dosing of onabotulinumtoxinA Botox , abobotulinumtoxinA Dysport , and rimabotulinumtoxinB Myobloc or other botulinum toxin serotypes are not interchangeable. According to the FDA, "[u]nits of biologic activity of Botox cannot be compared to nor converted into Units of any other botulinum toxin or any toxin assessed with any other assay method. If concomitant neuromuscular disorders, such as myasthenia gravis and certain myopathies exist, Botox may be harmful.

Thus, non-pharmacological treatment strategies need to be evaluated. Three hundred one patients were randomly assigned to active or sham TMS in a 6-week, controlled trial. A total of 24 studies were identified that involved acupuncture for endometriosis; however only 1 trial, enrolling 67 participants, met all the inclusion criteria. A fact is a thought that is true. However, the acupuncture group had a longer time to cure than the control group.

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