Acupuncture for post-operative cognitive dysfunction: a systematic review and meta-analysis of randomized controlled trials

Objective: Post-operative cognitive dysfunction (POCD) is a common post-surgical complication, which is associated with increased costs and extended hospital stays. Recently, interest in acupuncture as a potential therapy for POCD has grown. The objective of this meta-analysis was to assess the effectiveness of acupuncture for POCD. Methods: PubMed, Embase, CENTRAL, Medline, Web of Science, CNKI, Wanfang, and VIP databases were searched through March 2018. Randomized controlled trials (RCTs) in which patients with POCD treated with acupuncture (acupuncture group) were compared with those receiving a no treatment control were included. Meta-analyses were conducted using Review Manager 5.3. Results: Sixteen studies containing 1241 participants were included. POCD incidence in the acupuncture group was significantly lower than that in the control groups on the first (odds ratio (OR) = 0.32, 95% confidence interval (CI) = 0.23–0.45) and third (OR = 0.41, 95% CI = 0.30–0.56) post-operative days, with no statistically significant difference on the seventh day (OR = 0.58, 95% CI = 0.32–1.04). Acupuncture therapy also improved mini–mental state examination (MMSE) scores on the first (mean difference (MD) = 3.28, 95% CI = 2.79–3.77) and third (MD = 2.52, 95% CI = 2.18–2.87) post-operative days, with no effect on the seventh (MD = 0.14, 95% CI = –0.24 to 0.51). Visual analogue scale (VAS) scores on the first post-operative day were not impacted by acupuncture but were likely associated with post-operative nausea and vomiting on the seventh post-operative day. With respect to methodological quality, most RCTs were found to have an unclear risk of bias. Conclusion: Acupuncture may successfully treat/prevent POCD. However, the current evidence is limited and further research is needed.

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Influences of remote ischemic preconditioning on postoperative delirium and cognitive dysfunction in adults after cardiac surgery: a meta-analysis of randomized controlled trials

Perioperative Medicine ◽

10.1186/s13741-021-00216-1 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Yuchen Jing ◽

Bai Gao ◽

Xi Li

Keyword(s):

Cardiac Surgery ◽

Randomized Controlled Trials ◽

Cognitive Dysfunction ◽

Ischemic Preconditioning ◽

Postoperative Delirium ◽

Meta Analysis ◽

Remote Ischemic Preconditioning ◽

Current Evidence ◽

Controlled Trials ◽

Randomized Controlled

Abstract Background Remote ischemic preconditioning (RIPC) has been suggested to confer neuroprotective effect. However, influences of RIPC on postoperative delirium (POD) and cognitive dysfunction (POCD) in adults after cardiac surgery are less known. We performed a meta-analysis of randomized controlled trials (RCTs) to evaluate the effects of RIPC on POD and POCD. Methods Relevant studies were obtained by search of PubMed, Embase, and Cochrane’s Library databases. A random-effect model was used to pool the results. Results Ten RCTs including 2303 adults who received cardiac surgery were included. Pooled results showed that RIPC did not significantly affect the incidence of POD (six RCTs, odds ratio [OR] 1.07, 95% confidence interval [CI] 0.81 to 1.40, P = 0.65) with no significant heterogeneity (I2 = 0%). In addition, combined results showed that RIPC did not significantly reduce the incidence of POCD either (six RCTs, OR 0.64, 95% CI 0.37 to 1.11, P = 0.11) with moderate heterogeneity (I2 = 44%). Sensitivity analysis by excluding one RCT at a time showed consistent results (P values all > 0.05). Conclusions Current evidence from RCTs did not support that RIPC could prevent the incidence of POD or POCD in adults after cardiac surgery. Although these findings may be validated in large-scale RCTs, particularly for the results of POCD, based on these findings, RIPC should not be routinely used as a preventative measure for POD and POCD in adult patients after cardiac surgery.

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Early Versus Routine Stoma Closure in Patients With Colorectal Resection: A Meta-Analysis of 7 Randomized Controlled Trials

Surgical Innovation ◽

10.1177/1553350620907812 ◽

2020 ◽

Vol 27 (3) ◽

pp. 291-298

Author(s):

Yinyin Guo ◽

Yanxin Luo ◽

Hui Zhao ◽

Liangliang Bai ◽

Juan Li ◽

...

Keyword(s):

Colorectal Surgery ◽

Randomized Controlled Trials ◽

Bowel Obstruction ◽

Meta Analysis ◽

Cochrane Library ◽

Wound Complications ◽

Controlled Trials ◽

Stoma Closure ◽

Randomized Controlled ◽

Significant Difference

Background. A substantial proportion of patients undergoing colorectal surgery receive a temporary stoma, and the timing for stoma closure remains unclear. The aim of this study was to evaluate the safety and feasibility of early stoma closure (ESC) compared with routine stoma closure (RSC) after colorectal surgery. Methods. We comprehensively searched PubMed, Embase, and the Cochrane Library for randomized controlled trials that compared ESC and RSC after colorectal surgery. Results. A total of 7 randomized controlled trials with 814 enrolled patients were identified for this meta-analysis. There were no significant differences between the ESC and RSC groups regarding the complications of stoma closure (26.8% and 16.6%, respectively; odds ratio [OR]: 1.30; 95% confidence interval [CI]: 0.89-1.90; P = .17). A subgroup analysis was conducted by Clavien-Dindo grade of complication, and no significant difference was observed in any subgroup ( P > .05). However, the ESC group had a significantly higher risk of wound complications than the RSC group (17.6% and 7.8%, respectively; OR: 2.61; 95% CI: 1.43-4.76; P = .002), and the RSC group had more cases of small bowel obstruction than the ESC group (3.1% and 8.4%, respectively; OR: 0.37; 95% CI: 0.15-0.87; P = .02). Conclusions. ESC is a safe and effective therapeutic approach in patients who have undergone colorectal surgery; it is associated with a reduced risk of bowel obstruction but a higher risk of wound complications.

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The Effect of Virtual Reality on Preoperative Anxiety: A Meta-Analysis of Randomized Controlled Trials

Journal of Clinical Medicine ◽

10.3390/jcm9103151 ◽

2020 ◽

Vol 9 (10) ◽

pp. 3151

Author(s):

Chang-Hoon Koo ◽

Jin-Woo Park ◽

Jung-Hee Ryu ◽

Sung-Hee Han

Keyword(s):

Virtual Reality ◽

Randomized Controlled Trials ◽

Pediatric Patients ◽

Meta Analysis ◽

Random Effect Model ◽

Preoperative Anxiety ◽

Control Group ◽

Controlled Trials ◽

Randomized Controlled ◽

Significant Difference

Virtual reality (VR), a technology that provides a stimulated sensory experience, has recently been implemented in various fields of medicine. Several studies have investigated the efficacy of VR on preoperative anxiety. The purpose of this meta-analysis was to validate whether VR could relieve preoperative anxiety in patients undergoing surgery. Electronic databases were searched to identify all randomized controlled trials (RCTs) investigating the effect of VR on preoperative anxiety. The primary outcome was defined as the preoperative anxiety scores. We estimated the effect size using the standard mean difference (SMD) with a 95% confidence interval (CI) using a random effect model. Ultimately, 10 RCTs, with a total of 813 patients, were included in the final analysis. Preoperative anxiety was significantly lower in the VR group than in the control group (SMD −0.64, 95% CI −1.08 to −0.20, p = 0.004). In a subgroup analysis, the preoperative anxiety scores were lower in the VR group than in the control group in pediatric patients (SMD −0.71, 95% CI −1.14 to −0.27, p = 0.002), whereas a significant difference was not observed between the two groups in adult patients (p = 0.226). The results of this meta-analysis indicated that VR could decrease preoperative anxiety, especially in pediatric patients.

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Eye Acupuncture Treatment for Stroke: A Systematic Review and Meta-Analysis

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2015/871327 ◽

2015 ◽

Vol 2015 ◽

pp. 1-11 ◽

Cited By ~ 5

Author(s):

Zeng-Hua Bai ◽

Zhi-Xing Zhang ◽

Chun-Ri Li ◽

Mei Wang ◽

Meong-Ju Kim ◽

...

Keyword(s):

Systematic Review ◽

Randomized Controlled Trials ◽

Western Medicine ◽

Current Evidence ◽

Effect Estimate ◽

Controlled Trials ◽

Search Activity ◽

Randomized Controlled ◽

Significant Difference ◽

Eye Acupuncture

There were applications of eye acupuncture for stroke patients. Unfortunately, similar to many other Traditional Chinese Medicine (TCM) treatments, it lacks comprehensive evaluation and system review for its effect and safety.Objective. This study is a systematic review to appraise the safety and effectiveness of eye acupuncture for stroke.Methods. “Eye acupuncture therapy” in eleven databases was searched by randomized controlled trials and quasi-randomized controlled trials. The search activity was ended in April 2014. The data were extracted and assessed by three independent authors. Rev Man 5.0 software was used for data analysis with effect estimate presented as relative risk (RR) and mean difference (MD) with a 95% confidence interval.Results. Sixteen trials (1120 patients) were involved with generally poor methodological quality. The study indicated that when eye acupuncture was combined with western medicine compared to western medicine, there was a significant difference in the areas of mental state, swallow function, and NDS. When eye acupuncture was combined with western medicine and rehabilitation compared to western medicine and rehabilitation, there was significant difference in the changes of SSS, FMA, and constipation symptoms evaluation. No adverse events or side effects have been reported.Conclusions. The current evidence is insufficient and the rigorously designed trials are warranted.

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Intravenous Colistin Monotherapy versus Combination Therapy against Carbapenem-Resistant Gram-Negative Bacteria Infections: Meta-Analysis of Randomized Controlled Trials

Journal of Clinical Medicine ◽

10.3390/jcm7080208 ◽

2018 ◽

Vol 7 (8) ◽

pp. 208 ◽

Cited By ~ 8

Author(s):

I-Ling Cheng ◽

Yu-Hung Chen ◽

Chih-Cheng Lai ◽

Hung-Jen Tang

Keyword(s):

Combination Therapy ◽

Randomized Controlled Trials ◽

Meta Analysis ◽

Controlled Trials ◽

Gram Negative Bacteria ◽

Gram Negative ◽

Randomized Controlled ◽

Carbapenem Resistant ◽

Significant Difference ◽

All Cause Mortality

This meta-analysis aims to compare intravenous colistin monotherapy and colistin-based combination therapy against carbapenem-resistant gram-negative bacteria (GNB) infections. PubMed, Embase, and Cochrane databases were searched up to July 2018. Only randomized controlled trials (RCTs) evaluating colistin alone and colistin-based combination therapy in the treatment of carbapenem-resistant GNB infections were included. The primary outcome was all-cause mortality. Five RCTs including 791 patients were included. Overall, colistin monotherapy was associated with a risk ratio (RR) of 1.03 (95% confidence interval (CI), 0.89–1.20, I2 = 0%) for all-cause mortality compared with colistin-based combination therapy. The non-significant difference was also detected in infection-related mortality (RR, 1.23, 95% CI, 0.91–1.67, I2 = 0%) and microbiologic response (RR, 0.86, 95% CI, 0.72–1.04, I2 = 62%). In addition, no significant difference was observed in the subgroup analysis—high or low dose, with or without a loading dose, carbapenem-resistant Acinetobacter baumannii infections, and in combination with rifampicin. Finally, colistin monotherapy was not associated with lower nephrotoxicity than colistin combination therapy (RR, 0.98; 95% CI, 0.84–1.21, I2 = 0%). Based on the analysis of the five RCTs, no differences were found between colistin monotherapy and colistin-based combination therapy against carbapenem-resistant GNB infections, especially for A. baumannii infections.

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Protective Effects of Vitamin E on Chemotherapy-Induced Peripheral Neuropathy: A Meta-Analysis of Randomized Controlled Trials

10.21203/rs.2.22123/v1 ◽

2020 ◽

Author(s):

Huikai Miao ◽

Rongzhen Li ◽

Dongni Chen ◽

Jia Hu ◽

Youfang Chen ◽

...

Keyword(s):

Vitamin E ◽

Peripheral Neuropathy ◽

Randomized Controlled Trials ◽

Lower Incidence ◽

Meta Analysis ◽

Controlled Trials ◽

Modest Improvement ◽

Randomized Controlled ◽

Significant Difference ◽

Vitamin E Supplementation

Abstract Background Chemotherapy often causes chemotherapy-induced peripheral neuropathy (CIPN), but effective prevention measures are still lacking. Whether vitamin E can prevent peripheral neurotoxicity caused by chemotherapy is inconclusive. Therefore, we collected related randomized controlled trials (RCTs) and conducted a meta-analysis to examine whether vitamin E could prevent CIPN. Methods We searched PubMed, EMBASE and the Cochrane databases in November 2019 for eligible trials. Two reviewers conducted the analysis independently when studies were homogeneous enough. Results Eight RCTs, involving 555 patients, were identified. Upon pooling these RCTs, patients who received vitamin E supplementation of 600 mg/day had a significantly lower incidence of peripheral neuropathy (RR 0.31; 95% CI 0.14 to 0.65; P = 0.002) induced by chemotherapy compared with the placebo group. Vitamin E played a key role in decreasing the incidence of peripheral neuropathy in the cisplatin chemotherapy group (RR 0.28; 95% CI 0.14 to 0.54; P = 0.0001). With regard to improvements in sural amplitude, vitamin E supplementation significantly decreased patients’ sural amplitude after three rounds of chemotherapy (RR -2.66; 95% CI -5.09 to -0.24; P =0.03) in contrast with that of placebo supplementation, while no significant difference was observed when patients were treated with vitamin E after six rounds of chemotherapy. In addition, the vitamin E group had better improvement in the neurotoxicity score (RR -2.65; 95% CI -4.01to -1.29; P = 0.0001) and a lower incidence of reflexes and distal paraesthesias (RR 0.50; 95% CI 0.29 to 0.87; P = 0.01) compared to the control group. Conclusion Available data included in this meta-analysis showed that vitamin E supplementation can confer modest improvement in the prevention of CIPN. However, large-scale, well-designed RCTs are needed to confirm the exact role of vitamin E supplementation in the prevention of CIPN.

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Comparative Efficacy of Pharmacological and Nonpharmacological Interventions for Acne Vulgaris: A Network Meta-Analysis

Frontiers in Pharmacology ◽

10.3389/fphar.2020.592075 ◽

2020 ◽

Vol 11 ◽

Author(s):

Qingyang Shi ◽

Lizi Tan ◽

Zhe Chen ◽

Long Ge ◽

Xiaoyan Zhang ◽

...

Keyword(s):

Adverse Events ◽

Randomized Controlled Trials ◽

Meta Analysis ◽

Physical Symptoms ◽

Current Evidence ◽

Controlled Trials ◽

Cochrane Central Register ◽

Comparative Efficacy ◽

Inflammatory Lesions ◽

Randomized Controlled

Acne has several effects on physical symptoms, but the main impacts are on the quality of life, which can be improved by treatment. There are several acne treatments but less evidence comparing their relative efficacy. Thus, we assessed the comparative efficacy of pharmacological and nonpharmacological interventions for acne. We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials from inception to April 2019, to include randomized controlled trials for acne that compared topical antibiotics (TA), benzoyl peroxide (BPO), topical retinoids (TR), oral antibiotics (OA), lasers, light devices including LED device (LED), photodynamic therapy (PDT), and intense pulsed light, chemical peels (CP), miscellaneous therapies or complementary and alternative medicine (MTCAM), or their combinations. We performed Bayesian network meta-analysis with random effects for all treatments compared with placebo and each other. Mean differences (MDs) of lesions count and risk ratios of adverse events with their 95% credible intervals (CrIs) were calculated, and all interventions were ranked by the Surface Under the Cumulative Ranking (SUCRA) values. Additional frequentist additive network meta-analysis was performed to detect the robustness of results and potential interaction effects. Sensitivity analyses were carried out with different priors, and metaregression was to adjust for nine potential effect modifiers. In the result, seventy-three randomized controlled trials (27,745 patients with mild to moderate acne), comparing 30 grouped intervention categories, were included with low to moderate risk of bias. For adverse effects, OA had more risk in combination treatment with others. For noninflammatory lesions reduction, seventeen interventions had significant differences comparing with placebo and three interventions (TR+BPO: MD = −21.89, 95%CrI [−28.97, −14.76]; TR+BPO+MTCAM: −22.48 [−34.13, −10.70]; TA+BPO+CP: −20.63 [−33.97, −7.13]) were superior to others with 94, 94, and 91% SUCRA values, respectively. For inflammatory lesions reduction, nineteen interventions were significantly better than placebo, and three interventions (TR+BPO: MD = −12.13, 95%CrI [−18.41, −5.80]; TR+BPO+MTCAM: −13.21 [−.39, −3.04]; LED: −11.30 [−18.34, −4.42]) were superior to others (SUCRA: 81, 81, and 77%, respectively). In summary of noninflammatory and inflammatory lesions results, TR+BPO and TA+BPO were the best options compared to others. The frequentist model showed similar results as above. In summary, current evidence supports the suggestion that TR+BPO and TA+BPO are the best options for mild to moderate acne. LED is another option for inflammatory lesions when drug resistance occurs. All the combinations involved with OA showed more risk of adverse events than others. However, the evidence of this study should be cautiously used due to the limitations.

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Efficacy and Safety of Sinomenine Preparation for Ankylosing Spondylitis: A Systematic Review and Meta-Analysis of Clinical Randomized Controlled Trials

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2020/4593412 ◽

2020 ◽

Vol 2020 ◽

pp. 1-16

Author(s):

Shan-Shan Lin ◽

Chun-Xiang Liu ◽

Jun-Hua Zhang ◽

Hui Wang ◽

Jing-Bo Zhai ◽

...

Keyword(s):

Ankylosing Spondylitis ◽

Randomized Controlled Trials ◽

Methodological Quality ◽

Morning Stiffness ◽

Meta Analysis ◽

Cochrane Library ◽

Controlled Trials ◽

Efficacy And Safety ◽

Randomized Controlled ◽

Significant Difference

Objectives. To systematically evaluate the efficacy and safety of sinomenine preparation (SP) for treating ankylosing spondylitis (AS). Methods. Clinical randomized controlled trials (RCTs) of SP for treating AS were systematically identified in six electronic databases including PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP), and Wanfang Databases from the inception up to 31 October 2019. Cochrane’s risk of bias tool was used to assess the methodological quality and Review Manager 5.3 software was used to analyze data. Results. A total of 12 RCTs involving 835 patients were finally included. According to interventions, RCTs were divided into two types. The intervention in 10 RCTs was SP combined with conventional pharmacotherapy (CPT) versus CPT and that in 2 RCTs was SP alone versus CPT. The results of the meta-analysis showed that, compared with CPT alone, SP combined with oral CPT has better improvement in BASDAI (WMD = −1.84, 95% CI [−3.31, −0.37], P=0.01), morning stiffness time (WMD = −13.46, 95% CI [−16.12, −10.79], P<0.00001), the Schober test (WMD = 1.26, 95% CI [0.72, 1.80], P<0.00001), the occipital wall test (WMD = −0.55, 95% CI [−0.96, −0.14], P=0.009), the finger-to-ground distance (WMD = −3.28, 95% CI [−5.64, −0.93], P=0.006), 15 m walking time (WMD = −8.81, 95% CI [−13.42, −4.20], P=0.0002), the C-reactive protein (CRP) (WMD = −1.84, 95% CI [−3.24, −0.45], P=0.01), and the total effective rate (RR = 1.10, 95% CI [1.01, 1.20], P=0.03). Besides, it also showed that oral SP alone may be more effective in improving morning stiffness time (WMD = −31.89, 95% CI [−34.91, −28.87], P<0.00001) compared with CPT alone. However, this study cannot provide evidence that loading the injectable SP based on CPT can significantly increase the efficacy due to the insufficient number of studies included. In terms of adverse events, there was no statistically significant difference between the experimental group and the control group. Conclusions. This study shows that oral SP may be effective and safe in the treatment of AS. Due to the low methodological quality of the included RCTs and the limitations of the meta-analysis, it is still necessary to carry out more multicenter, large-sample, and high-quality RCTs to further verify the conclusions. The review protocol was registered on PROSPERO (CRD42018099170), and the review was constructed following the PRISMA guidelines (Annex 1).

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Acupuncture Treatment for Chronic Pelvic Pain in Women: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2018/9415897 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Soo-Hyun Sung ◽

Angela-Dong-Min Sung ◽

Hyun-Kyung Sung ◽

Tteul-E-Bom An ◽

Kyeong Han Kim ◽

...

Keyword(s):

Systematic Review ◽

Randomized Controlled Trials ◽

Pelvic Pain ◽

Chronic Pelvic Pain ◽

Acupuncture Treatment ◽

Meta Analysis ◽

Modern Technology ◽

Current Evidence ◽

Controlled Trials ◽

Randomized Controlled

Aim of the Study. This systematic review and meta-analysis aims to evaluate the current evidence from randomized controlled trials (RCTs) related to the effectiveness and safety of acupuncture treatment (AT), including electroacupuncture or thread-embedding therapy in combination with modern technology, for chronic pelvic pain (CPP) in women. Materials and Methods. We searched 12 electronic databases up to December 2017. All randomized controlled trials evaluating the effect of AT for CPP were considered. Results. Four RCTs with 474 participants were included. The methodological quality of included studies was generally low. The results of meta-analysis of two studies showed that AT combined with conventional treatment (CT) was associated with significantly reduced CPP, based on the total effectiveness rate (n=277, mean difference = 1.29, confidence interval = 1.13 to 1.47, P=0.0001, I2 = 0%). Conclusions. This review suggests the potential of AT combined with CT compared to CT alone for treating female CPP. However, there is insufficient evidence to conclude that AT can be recommended as a complementary and alternative (CAM) treatment for women with CPP. To draw a firm conclusion, future studies should require not only lager, more rigorously designed RCTs but also research on different AT types. Protocol Registration Number. This study is registered with PROSPERO 2018 (CRD42018088627).

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The effect of folate fortification on folic acid-based homocysteine-lowering intervention and stroke risk: a meta-analysis

Public Health Nutrition ◽

10.1017/s1368980014002134 ◽

2014 ◽

Vol 18 (8) ◽

pp. 1514-1521 ◽

Cited By ~ 28

Author(s):

Rui Zeng ◽

Chun-Hua Xu ◽

Yuan-Ning Xu ◽

Ya-Li Wang ◽

Mian Wang

Keyword(s):

Folic Acid ◽

Randomized Controlled Trials ◽

Stroke Risk ◽

Meta Analysis ◽

Folic Acid Supplementation ◽

Folate Intake ◽

Controlled Trials ◽

Acid Supplementation ◽

Randomized Controlled ◽

Significant Difference

AbstractObjectiveFolate and vitamin B12 are two vital regulators in the metabolic process of homocysteine, which is a risk factor of atherothrombotic events. Low folate intake or low plasma folate concentration is associated with increased stroke risk. Previous randomized controlled trials presented discordant findings in the effect of folic acid supplementation-based homocysteine lowering on stroke risk. The aim of the present review was to perform a meta-analysis of relevant randomized controlled trials to check the how different folate fortification status might affect the effects of folic acid supplementation in lowering homocysteine and reducing stroke risk.DesignRelevant randomized controlled trials were identified through formal literature search. Homocysteine reduction was compared in subgroups stratified by folate fortification status. Relative risks with 95 % confidence intervals were used as a measure to assess the association between folic acid supplementation and stroke risk.SettingThe meta-analysis included fourteen randomized controlled trials,SubjectsA total of 39 420 patients.ResultsHomocysteine reductions were 26·99 (sd 1·91) %, 18·38 (sd 3·82) % and 21·30 (sd 1·98) %, respectively, in the subgroups without folate fortification, with folate fortification and with partial folate fortification. Significant difference was observed between the subgroups with folate fortification and without folate fortification (P=0·05). The relative risk of stroke was 0·88 (95 % CI 0·77, 1·00, P=0·05) in the subgroup without folate fortification, 0·94 (95 % CI 0·58, 1·54, P=0·82) in the subgroup with folate fortification and 0·91 (95 % CI 0·82, 1·01, P=0·09) in the subgroup with partial folate fortification.ConclusionsFolic acid supplementation might have a modest benefit on stroke prevention in regions without folate fortification.

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