Effectiveness of Acupuncture for Lateral Epicondylitis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Objective. This study aimed at assessing the clinical effectiveness of acupuncture for lateral epicondylitis (LE). Methods. The following databases were systematically searched: China National Knowledge Infrastructure, Chinese Science and Technology Periodical Database, Wan Fang database, Chinese Biomedicine Literature, PubMed, EMBASE, and Cochrane Library from inception to May 2019. Randomized controlled trials (RCTs) meeting the inclusion criteria were included. RevMan 5.3 software was used to conduct meta-analyses. The study quality was evaluated with the Cochrane risk of bias. Results. Ten RCTs involving 796 individuals were included in this meta-analysis. Three studies reported randomized methods with a specific description. For the analyses of the clinical efficacy rate, acupuncture outperformed sham acupuncture (two RCTs, n = 130, P=0.15), medicine therapy (two RCTs, n = 124, P=0.02), and blocking therapy (four RCTs, n = 427, P=0.0001). For the analyses of the visual analog scale, acupuncture outperformed sham acupuncture (two RCTs, n = 92, P=0.18), medicine therapy (two RCTs, n = 144, P<0.00001), and blocking therapy (two RCTs, n = 132, P=0.03). The subgroup analyses comparing acupuncture with sham acupuncture therapy revealed heterogeneities. The follow-up information and adverse reactions were not analyzed because of the insufficient number of studies. Conclusions. Acupuncture appears to be superior to drug or blocking therapy or sham acupuncture therapy for LE. However, considering the low quality of the available trials, further large-scale RCTs with a low risk of bias are needed in the future.

Download Full-text

Adjuvant Transarterial Chemoembolization Following Curative-Intent Hepatectomy Versus Hepatectomy Alone for Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Cancers ◽

10.3390/cancers13122984 ◽

2021 ◽

Vol 13 (12) ◽

pp. 2984

Author(s):

Stepan M. Esagian ◽

Christos D. Kakos ◽

Emmanouil Giorgakis ◽

Lyle Burdine ◽

J. Camilo Barreto ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Systematic Review ◽

Randomized Controlled Trials ◽

Transarterial Chemoembolization ◽

Meta Analysis ◽

Risk Of Bias ◽

Cochrane Library ◽

Controlled Trials ◽

Curative Intent ◽

Randomized Controlled

The role of adjuvant transarterial chemoembolization (TACE) for patients with resectable hepatocellular carcinoma (HCC) undergoing hepatectomy is currently unclear. We performed a systematic review of the literature using the MEDLINE, Embase, and Cochrane Library databases. Random-effects meta-analysis was carried out to compare the overall survival (OS) and recurrence-free survival (RFS) of patients with resectable HCC undergoing hepatectomy followed by adjuvant TACE vs. hepatectomy alone in randomized controlled trials (RCTs). The risk of bias was assessed using the Risk of Bias 2.0 tool. Meta-regression analyses were performed to explore the effect of hepatitis B viral status, microvascular invasion, type of resection (anatomic vs. parenchymal-sparing), and tumor size on the outcomes. Ten eligible RCTs, reporting on 1216 patients in total, were identified. The combination of hepatectomy and adjuvant TACE was associated with superior OS (hazard ratio (HR): 0.66, 95% confidence interval (CI): 0.52 to 0.85; p < 0.001) and RFS (HR: 0.70, 95% CI: 0.56 to 0.88; p < 0.001) compared to hepatectomy alone. There were significant concerns regarding the risk of bias in most of the included studies. Overall, adjuvant TACE may be associated with an oncologic benefit in select HCC patients. However, the applicability of these findings may be limited to Eastern Asian populations, due to the geographically restricted sample. High-quality multinational RCTs, as well as predictive tools to optimize patient selection, are necessary before adjuvant TACE can be routinely implemented into standard practice. PROSPERO Registration ID: CRD42021245758.

Download Full-text

Acupuncture for Improving Cognitive Impairment After Stroke: A Meta-Analysis of Randomized Controlled Trials

Frontiers in Psychology ◽

10.3389/fpsyg.2020.549265 ◽

2020 ◽

Vol 11 ◽

Author(s):

Liang Zhou ◽

Yao Wang ◽

Jun Qiao ◽

Qing Mei Wang ◽

Xun Luo

Keyword(s):

Cognitive Impairment ◽

Randomized Controlled Trials ◽

Randomized Clinical Trials ◽

Meta Analysis ◽

Sham Acupuncture ◽

Cochrane Library ◽

Controlled Trials ◽

Post Stroke ◽

Randomized Controlled ◽

Therapeutic Benefits

Objective: This meta-analysis evaluated the efficacy of acupuncture in improving cognitive impairment of post-stroke patients.Design: Randomized controlled trials (RCTs) investigating the effects of acupuncture compared with no treatment or sham acupuncture on post-stroke cognitive impairment (PSCI) before December 2019 were identified from databases (PubMed, EMBASE, Ovid library, Cochrane Library, Chinese National Knowledge Infrastructure, VIP Chinese Periodical Database, Wanfang Database, and SinoMed). The literature searching and data extracting were independently performed by two investigators. Study quality was assessed using the Cochrane Handbook for Systematic Reviews of Interventions. Meta-analyses were performed for the eligible RCTs with Revman 5.3 software.Results: Thirty-seven RCTs (2,869 patients) were included in this meta-analysis. Merged Random-effects estimates of the gain of MMSE (Mini-Mental State Examination) or MoCA (Montreal Cognitive Assessment) were calculated for the comparison of acupuncture with no acupuncture or sham acupuncture. Following 2–8 weeks of intervention with acupuncture, pooled results demonstrated significant effects of acupuncture in improving PSCI assessed by MMSE (MD [95% CI] = 2.88 [2.09, 3.66], p < 0.00001) or MoCA (MD [95% CI] = 2.66 [1.95, 3.37], p < 0.00001).Conclusion: The results suggest that acupuncture was effective in improving PSCI and supported the needs of more rigorous design with large-scale randomized clinical trials to determine its therapeutic benefits.

Download Full-text

Efficacy of remdesivir versus placebo for the treatment of COVID-19: A protocol for systematic review and meta-analysis of randomized controlled trials

10.1101/2020.04.09.20059196 ◽

2020 ◽

Cited By ~ 1

Author(s):

Desye Gebrie ◽

Desalegn Getnet ◽

Tsegahun Manyazewal

Keyword(s):

Systematic Review ◽

Randomized Controlled Trials ◽

Meta Analysis ◽

Antiviral Drug ◽

Risk Of Bias ◽

Cochrane Library ◽

Controlled Trials ◽

Significant Heterogeneity ◽

List Type ◽

Randomized Controlled

AbstractBackgroundIn spite of the global containment on prevention efforts, the spread of coronavirus disease 2019 (COVID-19) is continuing to rise, with 1.1 million confirmed cases and 60,124 deaths recorded worldwide since 04 April 2020. The outbreak has a significant threat to international health and economy. At present, there is no approved vaccine or treatment for the disease, while efforts are underway. Remdesivir, a nucleotide-analogue antiviral drug developed for Ebola, is determined to prevent and stop infections with COVID-19, while results are yet controversial. Here, we aim to conduct a systematic review and meta-analysis of randomized controlled trials to compare the effectiveness of remdesivir and placebo in patients with COVID-19.Method and analysisWe will search MEDLINE-PubMed, Embase, Cochrane Library, ClinicalTrials.gov, and Google scholar databases without restriction in year of publication. We will include randomized controlled trials that assessed the effectiveness of remdesivir versus placebo for patients confirmed with COVID-19. We will follow the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA 2015) guidelines for the design and reporting of the results. The primary endpoint will be time to clinical recovery. The secondary endpoints will be all cause mortality, discharged date, frequency of respiratory progression, and treatment-emergent adverse events. Two independent authors will perform study selection, data extraction, and methodology quality assessment. RevMan 5.3 software will be used for statistical analysis. Random/fixed effect model will be carried out to calculate mean differences for continuous outcomes and risk ratio for dichotomous outcomes between remdesivir and placebo.Ethics and disseminationThis study does not require ethical approval, because no participant’s data will be involved in this systematic review and meta-analysis. The findings of this study will be published in reputable and peer-reviewed journal.RegistrationThis review protocol is submitted in PROSPERO database for registration and we will include the registration number in the revised version of the manuscript.Strengths and limitations of this study➣This systematic review and meta-analysis will be derived from only randomized controlled trials which will increase the quality of evidences.➣This systematic review and meta-analysis will be derived from only randomized controlled trials which will reduce between study heterogeneity.➣Subgroup and sensitivity analysis will be carried out to identify possible reasons that may cause significant heterogeneity between studies.➣The use of Cochrane risk of bias tool to assess risk of bias for each included studies to extract and synthesize evidence based conclusions.➣One of the limitation of this study might be the restriction of trials published in English language.

Download Full-text

Are Randomized Controlled Trials on Pharmacotherapy and Psychotherapy for Positive Symptoms of Schizophrenia Comparable? A Systematic Review of Patient and Study Characteristics

Schizophrenia Bulletin ◽

10.1093/schbul/sbz090 ◽

2019 ◽

Vol 46 (3) ◽

pp. 496-504 ◽

Cited By ~ 1

Author(s):

Irene Bighelli ◽

Claudia Leucht ◽

Maximilian Huhn ◽

Cornelia Reitmeir ◽

Felicitas Schwermann ◽

...

Keyword(s):

Randomized Controlled Trials ◽

Meta Analysis ◽

Treatment Strategies ◽

Patient Characteristics ◽

Risk Of Bias ◽

Cochrane Library ◽

Controlled Trials ◽

Positive Symptoms ◽

Randomized Controlled ◽

Study Characteristics

Abstract Background We examined patient and study characteristics of pharmacotherapy and psychotherapy trials to establish whether the effects of these 2 treatment strategies can be compared meaningfully. Methods We inspected all randomized controlled trials included in 2 recent meta-analyses on antipsychotics and psychotherapy in patients with positive symptoms of schizophrenia, searching EMBASE, MEDLINE, PsycINFO, Cochrane Library, and ClinicalTrials.gov. Differences between psychotherapy and pharmacotherapy trials were analyzed with Wilcoxon–Mann–Whitney and chi-square tests. Results Eighty studies with 18 271 participants on antipsychotic drugs and 53 studies with 4068 participants on psychotherapy were included. Psychotherapy studies included less severely ill patients (P < .0001), with a shorter duration of illness (P = .021), lasted for a longer period (P < .0001), administered the intervention as add-on to antipsychotics (P < .0001), had higher risk of bias in some domains including blinding of outcome assessment (P < .0001), and were funded publicly more frequently (P < .0001). Antipsychotic trials had larger sample sizes (P < .0001) and more study centers (P < .0001), included more males (P = .0001), inpatients (P < .0001), and slightly older patients (P = .031), more often used diagnostic operationalized criteria (P = .006), and were sponsored by pharmaceutical companies. They did not differ in conflict of interest (P = .24). Conclusions We found key differences between the 2 groups of studies that encompass higher risk of bias in psychotherapy studies and the inclusion of more severe patients in drug trials. These differences imply that study and patient characteristics should be carefully taken into account before considering a network meta-analysis. In the interest of patients, psychopharmacologists and psychotherapists should optimize their treatments rather than seeing them in competition.

Download Full-text

Electro-Acupuncture is Beneficial for Knee Osteoarthritis: The Evidence from Meta-Analysis of Randomized Controlled Trials

The American Journal of Chinese Medicine ◽

10.1142/s0192415x17500513 ◽

2017 ◽

Vol 45 (05) ◽

pp. 965-985 ◽

Cited By ~ 43

Author(s):

Na Chen ◽

Jing Wang ◽

Attilio Mucelli ◽

Xu Zhang ◽

Changqing Wang

Keyword(s):

Knee Osteoarthritis ◽

Randomized Controlled Trials ◽

Physical Function ◽

Pharmacological Treatment ◽

Meta Analysis ◽

Risk Of Bias ◽

Cochrane Library ◽

Controlled Trials ◽

Great Opportunity ◽

Randomized Controlled

Knee osteoarthritis (KOA) is a common chronic degenerative disease of the elderly. Electro-acupuncture (EA) is considered as a beneficial treatment for KOA, but the conclusion is controversial. This systematic review compiled the evidence from 11 randomized controlled trials to objectively assess the effectiveness and safety of EA for KOA. Eight databases including PubMed, Cochrane Library, Clinic trials, Foreign Medical Literature Retrial Service (FMRS), Science Direct, China National Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP), and Wanfang Data were extensively searched up to 5 July 2016. The outcomes included the evaluation of effectiveness, pain and physical function. Risk of bias was evaluated according to the Cochrane risk of bias tool. Eleven RCTs with 695 participants were included. Meta-analysis indicated that EA was more effective than pharmacological treatment (RR [Formula: see text] 1.14; 95% CI [Formula: see text] 1.01,1.28; [Formula: see text]) and manual acupuncture (RR [Formula: see text] 1.12; 95% CI [Formula: see text] 1.02,1.22; [Formula: see text]). Also, EA had a more significant effect in reducing the pain intensity (SMD [Formula: see text]; 95% CI [Formula: see text]; [Formula: see text]) and improving the physical function in the perspective of WOMAC (MD [Formula: see text]; 95% CI [Formula: see text], 5.56; [Formula: see text]) and LKSS (pharmacological treatment: MD [Formula: see text]; 95% CI [Formula: see text], 6.64; [Formula: see text]). Furthermore, these studies implied that EA should be performed for at least 4 weeks. Conclusively, the results indicate that EA is a great opportunity to remarkably alleviate the pain and improve the physical function of KOA patients with a low risk of adverse reaction. Therefore, more high quality RCTs with rigorous methods of design, measurement and evaluation are needed to confirm the long-term effects of EA for KOA.

Download Full-text

The Protective Effect of Dexmedetomidine Against Ischemia-Reperfusion Injury after Hepatectomy: A Meta-Analysis of Randomized Controlled Trials

Frontiers in Pharmacology ◽

10.3389/fphar.2021.747911 ◽

2021 ◽

Vol 12 ◽

Author(s):

Ya-Qun Huang ◽

Rui-Ting Wen ◽

Xiao-Tong Li ◽

Jiao Zhang ◽

Zhi-Ying Yu ◽

...

Keyword(s):

Protective Effect ◽

Randomized Controlled Trials ◽

Ischemia Reperfusion ◽

Meta Analysis ◽

Postoperative Recovery ◽

Risk Of Bias ◽

Cochrane Library ◽

Controlled Trials ◽

Remnant Liver ◽

Randomized Controlled

Background: Hepatic inflow occlusion proceeded to reduce blood loss during hepatectomy induces ischemia-reperfusion (IR) injury in the remnant liver. Dexmedetomidine, a selective α2-adrenoceptor agonist used as an anesthetic adjuvant, has been shown to attenuate IR injury in preclinical and clinical studies. However, a meta-analysis is needed to systematically evaluate the protective effect of perioperative dexmedetomidine use on IR injury induced by hepatectomy.Methods: A prospectively registered meta-analysis following Cochrane and PRISMA guidelines concerning perioperative dexmedetomidine use on IR injury after hepatectomy was performed via searching Cochrane Library, PubMed, EMBASE, ClinicalTrials.gov, Web of Science, CNKI, WanFang, and Sinomed for eligible randomized controlled trials up to 2021.3.31. The main outcome is postoperative liver function. Risk of bias was assessed by the Cochrane Risk of Bias tool. Review Manager 5.3 and Stata12.0 were applied to perform data analyses.Results: Eight RCTs enrolling 468 participants were included. Compared with 0.9% sodium chloride, dexmedetomidine decreased serum concentration of ALT (WMD = −66.54, 95% CI: −92.10–−40.98), AST (WMD= −82.96, 95% CI: −106.74–−59.17), TBIL (WMD = −4.51, 95% CI: −7.32–−1.71), MDA (WMD = −3.09, 95% CI: −5.17–−1.01), TNF-α (WMD = −36.54, 95% CI: −61.33–−11.95) and IL-6 (WMD = −165.05, 95% CI: −225.76–−104.34), increased SOD activity (WMD = 24.70, 95% CI: 18.09–31.30) within postoperative one day. There was no significant difference in intraoperative or postoperative recovery parameters between groups.Conclusions: Perioperative administration of dexmedetomidine can exert a protective effect on liver IR injury after hepatectomy. Additional studies are needed to further evaluate postoperative recovery outcomes of dexmedetomidine with different dosing regimens.

Download Full-text

Suhuang Zhike Capsules for the Treatment of Cough Variant Asthma: A Meta-analysis

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2020/9485746 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Cheng Gu ◽

Wenpan Peng ◽

Zhichao Wang ◽

Yong Xu ◽

Di Han ◽

...

Keyword(s):

Chinese Medicine ◽

Traditional Chinese Medicine ◽

Randomized Controlled Trials ◽

Meta Analysis ◽

Biomedical Literature ◽

Cochrane Library ◽

Controlled Trials ◽

Efficacy Rate ◽

Cough Variant Asthma ◽

Randomized Controlled

Cough variant asthma (CVA) is a unique type of asthma characterized by cough as the only or primary clinical presentation. Inhaled glucocorticoid is the main treatment in clinical practice currently, but its efficacy remains relatively unsatisfactory. Traditional Chinese medicine has certain advantages in the treatment of CVA, and at present, the most commonly used traditional Chinese medicine is Suhuang Zhike Capsule (SZC). The aim of this study was to systematically evaluate the efficacy and safety of SZC in the treatment of CVA using a meta-analysis. A comprehensive search of papers published in the PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature database (CBM), Wanfang Database, and VIP Information (VIP) from January 2018 to June 2019 was conducted. Review Manager 5.3 was used to carry out a meta-analysis of 10 studies that fulfilled the inclusion criteria. In a total of 10 randomized controlled trials, 896 CVA patients were included. The results showed the following: (1) compared with conventional Western medicine, SZC can effectively increase the efficacy rate of CVA (RR 1.25, 95% CI, 1.16–1.35, P < 0.00001 ) and (2) compared with other traditional Chinese medicines, SZC can effectively increase the efficacy rate of CVA (RR 1.44, 95% CI, 1.01–2.05, P = 0.05 ), In conclusion, our study builds on existing clinical evidence showing that SZC is safe and effective in treating CVA. However, larger randomized controlled trials are required for further validation.

Download Full-text

Acupuncture for Essential Hypertension: A Meta-Analysis of Randomized Sham-Controlled Clinical Trials

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2014/279478 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 29

Author(s):

Dong-Ze Li ◽

Yu Zhou ◽

Yi-Ning Yang ◽

Yi-Tong Ma ◽

Xiao-Mei Li ◽

...

Keyword(s):

Blood Pressure ◽

Essential Hypertension ◽

Randomized Controlled Trials ◽

Meta Analysis ◽

Sham Acupuncture ◽

Mean Difference ◽

Cochrane Library ◽

Controlled Trials ◽

Antihypertensive Medications ◽

Randomized Controlled

Background. Acupuncture is frequently advocated as an adjunct treatment for essential hypertension. The aim of this review was to assess its adjunct effectiveness in treating hypertension.Methods. We searched PubMed, the Cochrane Library, EMBASE, and the Chinese databases Sino-Med, CNKI, WanFang, and VIP through November, 2012, for eligible randomized controlled trials that compared acupuncture with sham acupuncture. Outcome measures were changes in diastolic (DBP) and systolic blood pressure (SBP).Results. A total of 4 randomized controlled trials were included. We found no evidence of an improvement with the fact that acupuncture relative to sham acupuncture in SBP change (n=386; mean difference = −3.80 mmHg, 95% CI = −10.03–2.44 mmHg;I2=99%), and an insignificant improvement in DBP change (n=386; mean difference = −2.82 mmHg, 95% CI = −5.22–(−0.43) mmHg;I2=97%). In subgroup analyses, acupuncture significantly improved both SBP and DBP in patients taking antihypertensive medications. Only minor acupuncture-related adverse events were reported.Conclusions. Our results are consistent with acupuncture significantly lowers blood pressure in patients taking antihypertensive medications. We did not find that acupuncture without antihypertensive medications significantly improves blood pressure in those hypertensive patients.

Download Full-text

Acupuncture for Functional Dyspepsia: What Strength Does It Have? A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2016/3862916 ◽

2016 ◽

Vol 2016 ◽

pp. 1-17 ◽

Cited By ~ 17

Author(s):

Bo Pang ◽

Tao Jiang ◽

Yuan-Hao Du ◽

Jing Li ◽

Bo Li ◽

...

Keyword(s):

Acupuncture Therapy ◽

Randomized Controlled Trials ◽

Functional Dyspepsia ◽

Short Form ◽

Meta Analysis ◽

Sham Acupuncture ◽

Current Evidence ◽

Controlled Trials ◽

Postprandial Fullness ◽

Randomized Controlled

Background. Although the effectiveness of acupuncture therapy on functional dyspepsia (FD) has been systematically reviewed, the available reports are still contradictive and no robust evidence has been provided to date. Objective. To assess the current evidence of high quality on the effects of acupuncture for patients with FD. Methods. A comprehensive literature database search was conducted to identify randomized controlled trials (RCTs) comparing acupuncture therapies (including manual acupuncture and electroacupuncture) to sham acupuncture and medication use. A meta-analysis was performed following a strict methodology. Results. 16 RCTs involving 1436 participants were included. The majority of the trials were determined to be of low quality. Positive results were found for acupuncture in improving the Nepean Dyspepsia Index (NDI) and scores of the MOS 36-Item Short-Form Health Survey (SF-36), as well as in alleviating relevant symptoms (especially postprandial fullness and early satiation) of FD patients. Conclusion. Based on current available evidence, acupuncture therapy achieves statistically significant effect for FD in comparison with sham acupuncture and is superior to medication (prokinetic agents) in improving the symptoms and quality of life of FD patients. Nonetheless, despite stringent methodological analyses, the conclusion of our review still needs to be strengthened by additional RCTs of higher quality.

Download Full-text

Application of Intravenous Vitamin C in Adult Patients with Sepsis: A Meta-Analysis of Randomized Controlled Trials

10.21203/rs.3.rs-850576/v1 ◽

2021 ◽

Author(s):

Han-Bing Chen ◽

Peng Chen ◽

Kang Li ◽

Jun Shao

Keyword(s):

Vitamin C ◽

Randomized Controlled Trials ◽

Meta Analysis ◽

Risk Of Bias ◽

Adult Patients ◽

Cochrane Library ◽

Controlled Trials ◽

Randomized Controlled ◽

Intravenous Vitamin ◽

Quality Evidence

Abstract Background: The efficacy of intravenous vitamin C among sepsis patients is uncertain according to recent randomized controlled trials (RCTs). We conducted a meta-analysis to evaluate the efficacy of vitamin C application in adults with sepsis.Methods: We performed a systematic literature search in PubMed, Web of Science, Embase and the Cochrane Library. Eligible studies were RCTs that investigated the application of intravenous vitamin C in adult patients with sepsis. We assessed the risk of bias of the included studies using the Cochrane risk of bias tool and the certainty of evidence according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach, for each outcome.Results: Fourteen trials involving a total of 1823 patients were included. We found that there was no significant effect of vitamin C on 28-day mortality [risk ratio (RR) 0.87, 95% confidence interval (CI) 0.73 to 1.04, p = 0.12, TSA-adjusted CI 0.70 to 1.08, low quality evidence], but among patients who were treated with vitamin C monotherapy instead of combination therapy, the mortality was reduced (RR 0.66, 95% CI 0.49 to 0.88, p = 0.004). Vitamin C was associated with a significant improvement of 72-h ΔSOFA score (SMD = 0.20, 95% CI 0.07 to 0.32, p = 0.002, I2=11%, moderate quality evidence).Conclusions: In this meta-analysis of patients with sepsis, the use of vitamin C was not associated with reduction in 28-day mortality, but vitamin C may have a positive effect in improving organ function. As the certainty of evidence was low, Larger RCTs were needed.

Download Full-text