BackgroundDifferent types of medications are currently used in vestibular migraine (VM) prophylaxis, although recommendations for use are generally based on expert opinion rather than on solid data from randomized trials. We evaluated the efficacy and safety of venlafaxine, flunarizine, and valproic acid in a randomized comparison trial for VM prophylaxis.MethodsSubjects were randomly allocated to one of three groups (venlafaxine group, flunarizine group, and valproic acid group). To assess the efficacy of treatment on vertigo symptoms, the following parameters were assessed at baseline and 3 months after treatment: Dizziness Handicap Inventory (DHI) scores, number of vertiginous attacks in the previous month, and Vertigo Severity Score (VSS). Adverse events also were evaluated.ResultsA decrease in DHI total scores was shown following treatment with all three medications, with no obvious differences between the groups. Treatment effects differed, however, in the DHI physical, functional, and emotional domains with only venlafaxine showing a decreased effect in all of three domains. Flunarizine and valproic acid showed an effect in only one DHI domain. Venlafaxine and flunarizine showed decreased VSS scores (p = 0 and p = 0.03, respectively). Although valproic acid had no obvious effect on VSS (p = 0.27), decreased vertigo attack frequency was observed in this group (p = 0). Venlafaxine also had an effect on vertigo attack frequency (p = 0), but flunarizine had no obvious effect (p = 0.06). No serious adverse events were reported in the three groups.ConclusionOur data confirm the efficacy and safety of venlafaxine, flunarizine, and valproic acid in the prophylaxis of VM, venlafaxine had an advantage in terms of emotional domains. Venlafaxine and valproic acid also were shown to be preferable to flunarizine in decreasing the number of vertiginous attacks, but valproic acid was shown to be less effective than venlafaxine and flunarizine to decrease vertigo severity.Trial registrationChiCTR-OPC-17011266 ().

BackgroundIncreasing recent evidence has implicated osteoporosis as a risk factor for benign paroxysmal positional vertigo (BPPV). We conducted a systematic review to examine the association between osteoporosis and BPPV.MethodsFour electronic databases (PubMed, EMBASE, Cochrane Library, and the China Network Knowledge Infrastructure) were searched to identify all papers, published in either English or Chinese, examining the association between osteoporosis (osteopenia) and BPPV.ResultsSeven studies were eligible for analysis, though these studies included some weaknesses. Most of the studies demonstrated a correlation between osteoporosis (osteopenia) and the occurrence and recurrence of BPPV, especially in older women. Patients with osteoporosis may require more canalith-repositioning procedures.ConclusionsThis systematic review provides insight into currently available evidence and elucidates the possible existence of an association between BPPV and osteoporosis (osteopenia). However, the evidence supporting that conclusion is not strong, and further studies are needed to clarify the association between these conditions.

This study aimed at a systematic review and meta-analysis of all available randomized controlled trials (RCTs) using acupuncture to treat tinnitus. Five electronic databases, in both English and Chinese, were searched. All studies in our review and meta-analysis included parallel RCTs of tinnitus patients which compared subjects receiving acupuncture (or its other forms, such as electroacupuncture) to subjects receiving no treatment, sham treatment, drugs or basic medical therapy. Data from the articles were validated and extracted using a predefined data extraction form. Nearly all of Chinese studies reported positive results, while most of English studies reported negative results. Analysis of the combined data found that the acupuncture treatments seemed to provide some advantages over conventional therapies for tinnitus. It had difference in acupuncture points and sessions between Chinese studies and English studies. Methodological flaws were also found in many of the RCTs, especially in Chinese studies. The results of this review suggest that acupuncture therapy may offer subjective benefit to some tinnitus patients. Acupuncture points and sessions used in Chinese studies may be more appropriate, whereas these studies have many methodological flaws and risk bias, which prevents us making a definitive conclusion.

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The purpose of this study was to test our hypothesis that p38 mitogen-activated protein kinase (p38 MAPK) inhibitor SB203580 may favorably affect tumor necrosis factor alpha (TNFalpha) secretion and left ventricular (LV) remodeling after myocardial ischemia (MI). The left anterior descending coronary artery (LAD) was ligated to produce anterior MI in 40 rats that were randomly divided into two groups: p38i group (n = 24) and MIR group (MI rat models, n = 24). A sham operation group without LAD ligation (Sham, n = 16) was also studied. SB203580 (2 mg/kg) and saline was injected i.p. once every 3 days in the first two groups, respectively. One and six weeks after MI, cardiac function, myocardial fibrosis, the cardiac expressions of phosphorylated p38 MAPK (p-p38 MAPK), TNFalpha, alpha smooth muscle actin (alphaSMA) and collagen I, the ultramicrostructure of the myocardium were examined by echocardiography, histological staining, western blot, immunohistochemical staining, transmission electron microscope (TEM), respectively. Treatments with SB203580 suppressed myocardial fibrosis and LV remodeling, as well as attenuated the expressions of p-p38-MAPK, TNFalpha, alphaSMA and collagen I as compared with the MIR. In conclusion, SB203850 has an effect of inhibiting inflammation-induced fibrosis, which leads to attenuation of LV remodeling.

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