Magnesium supplementation improves indicators of low magnesium status and inflammatory stress in adults older than 51 years with poor quality sleep. Effect of Magnesium Supplementation on Carotid Intima-Media Thickness and Flow-Mediated Dilatation among Hemodialysis Patients: A Double-Blind, Randomized, Placebo-Controlled Trial Common statistical errors in the design and analysis of subfertility trials. The impact of cash transfers on social determinants of health and health inequalities in Sub-Saharan Africa: a systematic review protocol Oral magnesium supplementation decreases alanine aminotransferase levels in obese women. Effect of vitamin D supplementation on inflammation: protocol for a systematic review A systematic review protocol examining the effect of vitamin D supplementation on endothelial function Lutein supplementation reduces plasma lipid peroxidation and C-reactive protein in healthy nonsmokers. Effect of Oral Magnesium Supplementation on Measures of Airway Resistance and Subjective Assessment of Asthma Control and Quality of Life in Men and Women with Mild to Moderate Asthma: A Randomized Placebo Controlled Trial Magnesium Intake in Relation to Systemic Inflammation, Insulin Resistance, and the Incidence of Diabetes Efficacy of omega-3 fatty acid supplementation on serum levels of tumour necrosis factor-alpha, C-reactive protein and interleukin-2 in type 2 diabetes mellitus patients. Herbal and dietary therapies for primary and secondary dysmenorrhoea. Mineral Trioxide Aggregate vs. Calcium Hydroxide in Primary Molar Pulpotomy: A Systematic Review Sources of evidence for systematic reviews of interventions in diabetes. The Effectiveness of Psychosocial Interventions as Adjuncts to Orthopaedic Surgery: A Systematic Review Protocol A prospective study of circulating C-reactive protein, interleukin-6, and tumor necrosis factor α receptor 2 levels and risk of ovarian cancer. Oral testosterone supplementation and chronic low-grade inflammation in elderly men: a 26-week randomized, placebo-controlled trial. Effect of Psyllium Fiber Supplementation on C-Reactive Protein: The Trial to Reduce Inflammatory Markers (TRIM) C-Reactive Protein as a Screening Test for Cardiovascular Risk in a Multiethnic Population Oral magnesium supplementation decreases C-reactive protein levels in subjects with prediabetes and hypomagnesemia: a clinical randomized double-blind placebo-controlled trial. Dietary alpha-linolenic acid decreases C-reactive protein, serum amyloid A and interleukin-6 in dyslipidaemic patients. Plasma C-Reactive Protein Concentrations in Active and Passive Smokers: Influence of Antioxidant Supplementation Can we rely on the best trial? A comparison of individual trials and systematic reviews
Low magnesium status has been associated with numerous conditions characterized as having a chronic inflammatory stress component . Some animal findings indicate that a moderate magnesium deficiency , similar to which apparently commonly occurs in humans , may enhance inflammatory or oxidative stress induced by other factors , including disrupted sleep/sleep deprivation . Thus , an experiment was performed with 100 adults ( 22 males and 78 females ) aged 59 ± 8 years ( range 51 to 85 years ) with poor sleep quality revealed by a Pittsburg Sleep Quality Index ( PSQI ) score higher than five . The participants were r and omly assigned to two groups matched by gender , age , and overall PSQI score . After baseline assessment ( week one ) of body mass index ( BMI ) , diet , blood and urine biochemical variables , and sleep quality , one group was given a 320 mg magnesium/day supplement as magnesium citrate and the other group a sodium citrate placebo for seven weeks . Final assessment s were made five and seven weeks ( which were combined for statistical analysis to reduce intra-individual variation ) after supplement initiation for the 96 participants who completed the study as design ed . Based on food diaries , 58 % of the participants were consuming less than the US . Estimated Average Requirement ( EAR ) for magnesium . Consuming less than the EAR was associated with a significantly higher BMI and plasma C-reactive protein ( CRP ) concentration . Only 40 participants had plasma CRP concentrations higher than 3.0 mg/L ( an indication of chronic inflammatory stress ) . Overall PSQI scores improved ( 10.4 to 6.6 , p < 0.0001 ) and erythrocyte magnesium increased ( 4.75 to 5.05 pg/cell , p = 0.01 ) regardless of magnesium or placebo supplementation . Magnesium vs placebo supplementation did not significantly affect serum magnesium when all participants were included in the analysis . When only the 37 participants with serum magnesium concentrations < 1.8 mg/dL ( indication of deficient magnesium status ) were analyzed , magnesium supplementation , but not the placebo , increased serum magnesium concentrations . Magnesium supplementation vs placebo decreased plasma CRP in participants with baseline values > 3.0 mg/L. The findings show that many individuals have a low magnesium status associated with increased chronic inflammatory stress that could be alleviated by increased magnesium intake . Because dietary magnesium intake did not change during the experimental period , another factor , possibly a placebo effect , improved sleep quality , which result ed in increased erythrocyte magnesium . This factor prevented the determination of whether magnesium deficiency contributes to poor sleep quality . The findings , however , suggest an association between magnesium status and sleep quality that needs further study to definitively determine whether a low magnesium status is a cause or an effect of poor sleep quality Objectives : The aim of the present study was to determine the efficacy of oral magnesium ( Mg ) supplementation on endothelial function through evaluation of carotid intima-media thickness ( cIMT ) , brachial artery flow-mediated dilatation ( FMD ) , and C-reactive protein ( CRP ) among hemodialysis ( HD ) patients . Methods : This r and omized , controlled , double-blind clinical trial consisted of 54 patients on HD . One group was treated orally with 440 mg of Mg oxide 3 times per week for 6 months ( n = 29 ) . The control group ( n = 25 ) was given placebo using the same administration protocol . cIMT , FMD , serum calcium levels , phosphorus , lipid , CRP , and bicarbonate were measured at baseline and at 6 months in both groups . Results : At 6 months , cIMT was significantly decreased in the Mg group ( 0.84 ± 0.13 mm at baseline and 0.76 ± 0.13 mm at 6 months , p = 0.001 ) . However , in the placebo group , cIMT was significantly increased ( 0.73 ± 0.13 and 0.79 ± 0.12 mm , respectively , p = 0.003 ) . When hypertension , diabetes mellitus , smoking , hyperlipidemia , and systemic lupus erythematosus were controlled for in the analysis , the effect of Mg remained significant in both groups ( p = 0.000 ) . Conclusion : Our results indicate that Mg might not improve endothelial function ( CRP level and FMD ) and that a decreased cIMT as a marker of atherosclerosis may be due to the inhibition of calcification through the regulation parathormone , calcium , and phosphorus BACKGROUND The quality of clinical trials has received increasing attention with the growth of evidence -based medicine and systematic review s. We aim ed to identify whether errors and omissions commonly encountered when undertaking Cochrane review s in this field are still passing peer review . METHODS We undertook a review of trials published in 2001 by two major journals . We selected from Medline only trials in which authors compared pregnancy rates under two interventions by allocating women to different groups . RESULTS We identified 39 trials meeting our criteria . Six trials were fatally flawed by design , either by inappropriate use of a cross-over design or by systematic allocation described by the authors as ' r and om ' . Only six reports cl aim ed to apply the intention-to-treat principle , and the principle was misunderstood by four of these . Only five trials reported live birth rates sufficiently to allow valid meta- analysis . Most trials ( 82 % ) included at least one ' unit of analysis ' error . CONCLUSIONS We selected simple trials from respected journals , assuming that our sample would represent trials of highest method ological quality in the field . Nevertheless , the st and ards of design , analysis and reporting of many subfertility trials are not sufficient to allow reliable interpretation of results , or inclusion in meta-analyses Background There is increasing pressure to address the social determinants of health ( SDoH ) and health inequities through the implementation of culturally acceptable interventions particularly in Sub-Saharan Africa ( SSA ) where health outcomes are generally poor . Available evaluation research on cash transfers ( CTs ) suggests that the programs may influence the wider determinants of health in SSA ; yet , there has been no attempt to synthesize the evidence regarding their contribution to tackling the SDoH and health inequalities . To date , nearly all the review s on CTs ' impact on health have predominantly featured evidence from Latin America with limited transferability to the social , cultural , and political environments in SSA . Therefore , the aim of this study is to undertake a systematic review to assess the role of CTs in tackling the wider determinants of health and health inequalities in SSA . Methods / design A systematic review of published and unpublished literature on CTs ’ impact on health and health determinants covering the period 2000–2016 will be undertaken . Studies will be considered for inclusion if they present quantitative or qualitative data , including all relevant study design s. The SDoH conceptual framework will be used to guide the data extraction process . EPPI Review er software will be used for data management and analysis . Studies included in the review will be analyzed by narrative synthesis and /or meta- analysis as appropriate for the nature of the data retrieved . Discussion This review will provide empirical evidence on the impact of CTs on SDoH to inform CT policy , implementation , and research in SSA . The protocol follows the Preferred Reporting Items for Systematic Review and Meta- Analysis Protocol s ( PRISMA -P ) . Systematic review registration This protocol has been registered with the PROSPERO international prospect i ve register of systematic review s , reference CRD42015025015 To evaluate the effect of oral supplementation with magnesium chloride on the systemic and hepatic inflammation , 38 non-hypertensive obese women aged 30 to 65 years were allocated into groups with and without hypomagnesemia . Hypomagnesemic women drank 50 mL of 5 % solution of MgCl2 equivalent to 450 mg of elemental magnesium . Low-carbohydrate diets and physical activity were indicated for women in both groups . Chronic diarrhea , alcohol intake , use of diuretics , previous oral magnesium supplementation , hepatic disease , and renal damage were exclusion criteria . Hypomagnesemia is defined by serum magnesium concentrations < or=1.8 mg/dL , hepatic inflammation by serum alanine aminotransferase ( ALT ) levels > or=40 U/L , and systemic inflammation by serum high-sensitivity C reactive protein ( hs-CRP ) concentration > or=3 mg/L. At baseline ( p=0.06 ) and final of follow-up ( p=0.80 ) , there were no significant differences by body mass index between the groups in the study . In the same way , at baseline ALT ( 48.1+/-25.5 and 34.6+/-24.1 U/L , p=0.14 ) and hs-CRP ( 9.4+/-6.0 and 7.9+/-5.9 mg/dL , p=0.47 ) levels were similar in the supplemented and non-supplemented women . In the magnesium group , ALT ( 24.3+/-10.3 and 34.8+/-13.6 U/L , p=0.02 ) levels , but not hs-CRP ( 5.2+/-1.9 and 8.0+/-5.6 mg/L , p=0.08 ) reached significantly lower levels , in the fourth month of treatment , than in women in the control group . The adjusted odds ratios between the improvement in serum magnesium and reduction in ALT and hs-CRP levels were 0.56 ( 95 % CI : 0.3 - 0.9 ) and 0.93 ( 95 % CI : 0.6 - 29.9 ) , respectively . Results of this study show that in hypomagnesemic obese women , oral supplementation with magnesium chloride reduces plasma ALT levels ; hs-CRP levels only show a reduction trend Introduction The extraskeletal role of vitamin D is being increasingly recognised . This has important clinical implication s , as vitamin D deficiency has reached epidemic proportions worldwide . Vitamin D has proposed anti-inflammatory properties , yet the role of vitamin D supplementation in reducing inflammation remains largely unknown . The purpose of this review is to investigate the impact of vitamin D supplementation on inflammation , and to identify relevant knowledge gaps in the field . Methods and analysis Medline , CINAHL , EMBASE and All EBM will be systematic ally search ed for r and omised controlled trials ( RCTs ) and systematic review s of RCTs , comparing vitamin D supplementation with placebo , usual care or other pharmacological or non-pharmacological interventions . One review er will assess articles for eligibility according to prespecified selection criteria , after which 2 independent review ers will perform data extraction and quality appraisal . Meta-analyses will be conducted where appropriate . Ethics and dissemination Formal ethical approval is not required as no primary data is collected . This systematic review will identify potential clinical implication s of vitamin D deficiency and supplementation , and will be disseminated through a peer- review ed publication and at conference meetings , to inform future research on the efficacy of vitamin D supplementation for inflammation and inflammatory diseases . PROSPERO registration number CRD42016037104 Introduction Vitamin D has potential benefits for extraskeletal health . These could include an anti-inflammatory effect as well as a reduction in endothelial dysfunction . We aim to provide quality evidence for the hypothesis that supplementation with vitamin D will improve endothelial function ( EF ) , possibly through the abrogation of systemic inflammation . Methods and analysis We will conduct a systematic review of all r and omised controlled trials on  vitamin D supplementation and EF lasting 12 weeks or more . The search will cover the period 2000–2015 and include studies that describe direct measures of EF  , markers of endothelial cell ( EC ) activation  and if concurrently reported , indicators of systemic inflammation  . Study selection will follow the Preferred Reporting Items for Systematic Review s and Meta-Analyses ( PRISMA ) guidelines and study quality will be assessed by the Jadad score in addition to an evaluation of allocation concealment and data analysis . If sufficient data are available , a meta- analysis will be conducted . The effect sizes will be generated using Hedges ’ g score , for both fixed and r and om effect models . I2 statistics and Galbraith plots will be used to assess heterogeneity and identify their potential sources . Potential publication and small sample size bias will be assessed by visual inspections of funnel plots and also Egger 's test . Meta-regression analysis ( if feasible ) will be conducted with restricted maximum likelihood ( REML ) estimation method , controlling for potential confounders ( demographics , study methods , location , etc ) . A backward elimination process will be applied in the regression modelling procedure . Subgroup analysis , conditional on number of studies retrieved and their sample size , will be stratified on participant disease category , total dose administered , degree of 25(OH)D change and type of supplement used . Ethics and dissemination Formal ethical approval is not required as primary data will not be collected . The results will be disseminated through a peer- review ed publication , conference presentation and the popular press . Trial registration number International Prospect i ve Register for Systematic Review s ( PROSPERO ) number CRD42014013523 OBJECTIVE The aim of this study was to determine whether lutein affected biomarkers related to cardiovascular diseases ( CVD ) in healthy nonsmokers . METHODS A r and omized , double-blind , placebo-controlled trial of lutein supplementation was conducted in healthy nonsmokers . 117 eligible subjects were r and omly assigned to receive 10 or 20 mg/d of lutein or placebo for 12 weeks . Levels of plasma carotenoid concentrations , total antioxidant capacity ( TAOC ) , the lipoprotein profile , and antioxidant enzymes activities were determined at baseline and at 6 , and 12 weeks after the initiation of treatment . Biomarkers of oxidative damage to protein and lipids , and C-reactive protein ( CRP ) concentrations were measured at baseline and after supplementation . RESULTS Plasma lutein and TAOC significantly increased in both active treatment groups during 12 weeks . A significant reduction was found in malondialdehyde in the 20 mg lutein group . CRP concentration decreased in a dose-dependent manner for lutein supplementation , and there was a significant between-group difference in CRP between the 20 mg lutein and the placebo group . Serum CRP was directly related to the change in plasma lutein and TAOC for both active treatment groups . CONCLUSION The results support the possibility that lutein supplementation reduce biomarkers of CVD risk via decreased lipid peroxidation and inflammatory response by increasing plasma lutein concentrations and antioxidant capacity Background : Epidemiological data shows low dietary magnesium(Mg ) may be related to incidence and progression of asthma . Objective To determine if long term(6.5 month ) treatment with oral Mg would improve asthma control and increase serum measures of Mg status in men and women with mild-to-moderate asthma . Subjects : 55 males and females aged 21 to 55 years with mild to moderate asthma according to the 2002 National Heart , Lung , and Blood Institute(NHLBI ) and Asthma Education and Prevention Program(NAEPP ) guidelines and who used only beta-agonists or inhaled corticosteroids(ICS ) as asthma medications were enrolled . Design : Subjects were r and omly assigned to consume 340 mg(170 mg twice a day ) of Mg or a placebo for 6.5 months . Measurements : Multiple measures of Mg status including serum , erythrocyte , urine , dietary , ionized and IV Mg were measured . Objective : markers of asthma control were : methacholine challenge test(MCCT ) and pulmonary function test(PFT ) results . Subjective vali date d question naires on asthma quality of life(AQLQ ) and control(ACQ ) were completed by participants . Markers of inflammation , including c-reactive protein(CRP ) and exhaled nitric oxide(eNO ) were determined . Results : The concentration of methacholine required to cause a 20 % drop in forced expiratory volume in in minute(FEV1 ) increased significantly from baseline to month 6 within the Mg group . Peak expiratory flow rate(PEFR ) showed a 5.8 % predicted improvement over time(P = 0.03 ) in those consuming the Mg . There was significant improvement in AQLQ mean score units(P < 0.01 ) and in overall ACQ score only in the Mg group(P = 0.05 ) after 6.5 months of supplementation . Despite these improvements , there were no significant changes in any of the markers of Mg status . Conclusion : Adults who received oral Mg supplements showed improvement in objective measures of bronchial reactivity to methacholine and PEFR and in subjective measures of asthma control and quality of life OBJECTIVE To investigate the long-term associations of magnesium intake with incidence of diabetes , systemic inflammation , and insulin resistance among young American adults . RESEARCH DESIGN AND METHODS A total of 4,497 Americans , aged 18–30 years , who had no diabetes at baseline , were prospect ively examined for  incident diabetes based on quintiles of magnesium intake . We also investigated the associations between magnesium intake and inflammatory markers , i.e. , high-sensitivity C-reactive protein ( hs-CRP ) , interleukin-6 ( IL-6 ) , and fibrinogen , and the homeostasis model assessment of insulin resistance ( HOMA-IR ) . RESULTS During the 20-year follow-up , 330 incident cases of diabetes were identified . Magnesium intake was inversely associated with incidence of diabetes after adjustment for potential confounders . The multivariable-adjusted hazard ratio of diabetes for participants in the highest quintile of magnesium intake was 0.53 ( 95 % CI , 0.32–0.86 ; Ptrend < 0.01 ) compared with those in the lowest quintile . Consistently ,  magnesium  intake was significantly inversely associated with hs-CRP , IL-6 , fibrinogen , and HOMA-IR , and serum magnesium levels were inversely correlated with hs-CRP and HOMA-IR . CONCLUSIONS Magnesium intake was inversely longitudinally associated with incidence of diabetes in young American adults . This inverse association may be explained , at least in part , by the inverse correlations of magnesium intake with systemic inflammation and insulin resistance INTRODUCTION Consumption of omega-3 fatty acids can alter the inflammatory response in diabetic patients . This study aim ed to determine the effects of omega-3 fatty acid supplementation on the serum levels of C-reactive protein ( CRP ) , interleukin (IL)-2 and tumour necrosis factor-alpha ( TNF-α ) in type 2 diabetes mellitus patients . METHODS A r and omised , double-blind , placebo-controlled clinical trial was conducted on 84 subjects aged 45 - 85 years with at least a two-year history of type 2 diabetes mellitus . Participants were r and omly assigned to the treatment or control group . Each subject in the treatment group received three omega-3 capsules per day ( eicosapentaenoic acid 1,548 mg ; docosahexaenoic acid 828 mg ; other omega-3 fatty acids 338 mg ) , while each subject in the control group received three placebo capsules ( sunflower oil 2,100 mg ) for a period of eight weeks . At the beginning of the study and post intervention , fasting blood sample s were taken and serum concentrations of IL-2 , TNF-α and CRP were assessed and compared . RESULTS Serum IL-2 and TNF-α levels were significantly reduced in the treatment group compared to the controls ( p < 0.01 ) . There was no significant change in serum CRP levels . CONCLUSION Short-term omega-3 fatty acid supplementation ( 3 g/day for eight weeks ) can decrease the serum levels of TNF-α and IL-2 in diabetic patients , with no change in CRP levels . Consumption of omega-3 fatty acid supplements is highly recommended to alleviate inflammation caused by type 2 diabetes mellitus Background Dysmenorrhoea refers to the occurrence of painful menstrual cramps of uterine origin and is a common gynaecological complaint . Common treatment for dysmenorrhoea is medical therapy such as nonsteroidal anti-inflammatories ( NSAIDs ) or oral contraceptive pills ( OCPs ) which both work by reducing myometrial activity ( contractions of the uterus ) . The efficacy of conventional treatments such as nonsteroidals is considerable , however the failure rate is still often 20 - 25 % . Many consumers are now seeking alternatives to conventional medicine and research into the menstrual cycle suggests that nutritional intake and metabolism may play an important role in the cause and treatment of menstrual disorders . Herbal and dietary therapies number among the more popular complementary medicines yet there is a lack of taxonomy to assist in classifying them . In the US , herbs and other phytomedicinal products ( medicine from plants ) have been legally classified as dietary supplements since 1994 . Included in this category are vitamins , minerals , herbs or other botanicals , amino acids and other dietary substances . For the purpose of this review we use the wider term herbal and dietary therapies to include the assorted herbal or dietary treatments that are classified in the US as supplements and also the phytomedicines that may be classified as drugs in the European Union . Objectives To determine the efficacy and safety of  herbal and dietary therapies  for the treatment of  primary and secondary dysmenorrhoea  when compared to each other , placebo , no treatment or other conventional treatments ( e.g. NSAIDS ) . Search methods Electronic search es of the Cochrane Menstrual Disorders and Subfertility Group Register of controlled trials , CCTR , MEDLINE , EMBASE , CINAHL , Bio extracts , and PsycLIT were performed to identify relevant r and omised controlled trials ( RCTs ) . The Cochrane Complementary Medicine Field 's Register of controlled trials ( CISCOM ) was also search ed . Attempts were also made to identify trials from the National Research Register , the Clinical Trial Register and the citation lists of review articles and included trials . In most cases , the first or corresponding author of each included trial was contacted for additional information . Selection criteria The inclusion criteria were RCTs of herbal or dietary therapies as treatment for primary or secondary dysmenorrhoea vs each other , placebo , no treatment or conventional treatment . Interventions could include , but were not limited to , the following ; vitamins , essential minerals , proteins , herbs , and fatty acids . Exclusion criteria were : mild or infrequent dysmenorrhoea or dysmenorrhoea from an IUD . Data collection and analysis Seven trials were included in the review . Quality assessment and data extraction were performed independently by two review ers . The main outcomes were pain intensity or pain relief and the number of adverse effects . Data on absence from work and the use of additional medication was also collected if available . Data was combined for meta- analysis using Peto odds ratios for dichotomous data or weighted mean difference for continuous data . A fixed effects statistical model was used . If data suitable for meta- analysis could not be extracted , any available data from the trial was extracted and presented as descriptive data . Main results MAGNESIUM :  Three small trials were included that compared magnesium and placebo . Overall magnesium was more effective than placebo for pain relief and the need for additional medication was less . There was no significant difference in the number of adverse effects experienced . VITAMIN B6 : One small trial of vitamin B6 showed it was more effective at reducing pain than both placebo and a combination of magnesium and vitamin B6 . MAGNESIUM AND VITAMIN B6 : Magnesium was shown to be no different in pain outcomes from both vitamin B6 and a combination of vitamin B6 and magnesium by one small trial . The same trial also showed that a combination of magnesium and vitamin B6 was no different from placebo in reducing pain .  VITAMIN B1 : One large trial showed vitamin B1 to be more effective than placebo in reducing pain .  VITAMIN E : One small trial comparing a combination of vitamin E ( taken daily ) and ibuprofen ( taken during menses ) versus ibuprofen ( taken during menses ) alone showed no difference in pain relief between the two treatments . OMEGA-3 FATTY ACIDS : One small trial showed fish oil ( omega-3 fatty acids ) to be more effective than placebo for pain relief . JAPANESE HERBAL COMBINATION : One small trial showed the herbal combination to be more effective for pain relief than placebo , and less additional pain medication was taken by the treatment group . Authors ' conclusions Vitamin B1 is shown to be an effective treatment for dysmenorrhoea taken at 100 mg daily , although this conclusion is tempered slightly by its basis on only one large RCT . Results suggest that magnesium is a promising treatment for dysmenorrhoea . It is unclear what dose or regime of treatment should be used for magnesium therapy , due to variations in the included trials , therefore no strong recommendation can be made until further evaluation is carried out . Overall there is insufficient evidence to recommend the use of any of the other herbal and dietary therapies considered in this review for the treatment of primary or secondary dysmenorrhoea Introduction : The aim of this quantitative systematic review /meta- analysis was to compare the treatment outcomes of mineral trioxide aggregate ( MTA ) and calcium hydroxide ( CH ) in pulpotomy of human primary molars . The focused PICO question was “ in case of pulp exposure in vital primary molars , how does MTA pulpotomy compare to CH in terms of clinical /radiographic success ? ” Methods and Material s : We retrieved published r and omized clinical trials ( RCTs ) of at least 6-month duration ; our search included articles published up to March 2013 in five following data bases : PubMed ( Medline ) , Cochrane data base of systematic review s , Science Citation Index , EMBASE , and Google Scholar . Mantel Haenszel and Inverse Variance-weighted methods were applied by STATA ; the relative risk ( RR ) was calculated with 95 % confidence intervals ( CI ) . Results : A total of 282 English articles were collected . Two authors independently screened the articles and five RCTs were selected ; data extraction and quality assessment were then carried out . Four RCTs were appropriate for meta- analysis according to their follow-up times by Mantel Haenszel method . Statistically significant difference was found between success rate of MTA compared to CH , with RR=0.08 ( 95 % CI , 0.02 - 0.39 ) , RR=0.19 ( 95 % CI , 0.08 - 0.46 ) , and RR=0.38 ( 95 % CI , 0.21 - 0.68 ) for 6- , 12- , and 24-month follow-ups , respectively . A significant difference was also observed for all included RCTs after analyses using the Inverse Variance-weighted method ( RR=0.44 ; 95 % CI , 0.27 - 0.72 ) . Conclusions : Systematic review /meta- analysis of included RCTs revealed that for pulpotomy of vital primary molars , MTA has better treatment outcomes compared to CH AIMS To analyse the effect on systematic review s in diabetes interventions of including only trials that are indexed in medline , and to assess the impact of adding trials from other data bases and the grey literature . METHODS All systematic review s of diabetes interventions which included a meta- analysis of r and omized controlled trials , and were published since 1996 , were selected . The impact on the meta- analysis of including only those trials indexed in medline , and the effect of then adding trials from other sources , was assessed . Where possible this was measured quantitatively , by redoing the meta- analysis , otherwise a qualitative estimate was made . RESULTS Forty-four systematic review s met our inclusion criteria . There were 120 articles reporting trial data which were not indexed in medline . These came from 52 % of the review s. In 34 % of the review s , basing a meta- analysis on a search of only medline would miss trials that could affect the result . Sources of non- medline data which had the biggest effect on the meta-analyses were journal articles from central and embase ( mainly in Diabetes , Nutrition and Metabolism ) and unpublished data ( mainly from industry ) . The exceptions were journal articles on herbal medicine , mostly indexed in Chinese language data bases . CONCLUSIONS A search of only the medline data base is insufficient for systematic review s of diabetes , because in about 34 % of review s the missed trials could affect the results of the meta- analysis . It is recommended that central ( on the Cochrane Library ) also be search ed . Scanning meeting abstract s , and seeking unpublished data are also recommended if the intervention has only recently been introduced AIMS Pain and anxiety are commonly reported among those undergoing orthopaedic surgery . Improvement in anxiety and pain control might be achieved by supplementing st and ard care with psychological interventions . However , the effectiveness of adjunctive psychosocial interventions in anxiety and pain control have not been addressed sufficiently by previous systematic review s in orthopaedic surgeries . The present study aim ed to assess the effectiveness of adjunctive psychosocial techniques to improve perioperative clinical care in orthopaedic surgery , to identify the most effective intervention types and to evaluate potential moderators . METHODS We will perform a systematic review and meta- analysis to address the study aims . PubMed , PsycINFO , CINAHL and ProQuest Dissertations & Theses will be search ed between 1980 and 2015 . Prospect i ve controlled clinical trials completed in adults , contrasting st and ard care and st and ard care supplemented with psychosocial methods  , will be eligible for inclusion . Effectiveness will be assessed through the outcomes of postoperative pain intensity , analgesic requirement , perioperative anxiety , quality of life and postoperative recovery . The results of a r and om-effect meta- analysis will be reported . To aid implementation of best practice , moderating effects of the type and timing of psychosocial intervention , type of surgical intervention and type of anaesthesia will be evaluated through meta-regression . Sensitivity analyses and subgroup contrasts will follow as necessary . DISCUSSION Recommendations will be made to improve medical care in orthopaedic procedures . The quality of evidence will be rated using GRADE criteria . Copyright © 2016 John Wiley & Sons , Chronic inflammation may play a role in ovarian carcinogenesis . We examined associations between 3 plasma biomarkers of inflammation-C-reactive protein ( CRP ) , interleukin 6 , and tumor necrosis factor α receptor 2- and  risk of invasive epithelial ovarian cancer in prospect ively collected sample s from the Nurses ' Health Study ( NHS ; 1989 - 2010 ) , Nurses ' Health Study II ( NHS II ; 1996 - 2009 ) , and the Women 's Health Study ( WHS ; 1992 - 2011 ) and performed a meta- analysis including data from previous publications . Associations with ovarian cancer risk were calculated using logistic regression ( NHS/NHS II ; n = 217 cases ) or Cox proportional hazards regression ( WHS ; n = 159 cases ) . Study -specific results were combined using r and om-effects meta- analysis . In the NHS/NHS II and WHS , we observed a 53 % increased risk of invasive ovarian cancer when comparing women in the fourth quartile of CRP with women in the first quartile ( 95 % confidence interval ( CI ) : 1.05 , 2.23 ) . A CRP level of > 10 mg/L versus a level of ≤1 mg/L was associated with a 2.16-fold increased risk ( 95 % CI : 1.23 , 3.78 ) . In a meta- analysis of published studies , women in the third tertile of CRP had a 35 % increased risk ( 95 % CI : 1.10 , 1.67 ) compared with women in the first tertile . There were no significant associations between interleukin 6 or tumor necrosis factor α receptor 2 and risk in the NHS/NHS II . Our results support the hypothesis that higher levels of circulating CRP are associated with increased risk of ovarian cancer  , indicating that the role of inflammation in ovarian cancer requires further elucidation BACKGROUND To determine the effect of oral testosterone supplementation on systemic low- grade inflammation measured by high-sensitive C-reactive protein ( hs-CRP ) in aging men with low testosterone levels . METHODS Two hundred thirty-seven men aged 60 to 80 years with a testosterone level of < 13.7 nmol/L ( below the 50th percentile of the population distribution ) were recruited into a double-blind r and omized placebo-controlled trial . Participants were r and omized to either 4 capsules of 40 mg testosterone undecanoate ( And riol Testocaps , NV Organon , Oss , The Netherl and s ) or placebo daily for 26 weeks . Serum levels of hs-CRP were measured at baseline and at 26 weeks using a near-infrared particle immunoassay of the Synchron LX System ( Beckman Coulter , Fullteron , CA ) . RESULTS The median baseline hs-CRP level was 1.95 mg/L ( 0.30 - 6.43 ) in the testosterone group compared with 1.90 mg/L ( 0.40 - 5.91 ) in the placebo group . After 26 weeks of testosterone supplementation therapy , the 2 intervention groups were not statistically significantly different ( median hs-CRP 2.20 vs 2.00 mg/L , interquartile range 0.40 - 6.54 vs 0.50 - 5.70 , P = .36 ) . In subgroup analysis , neither baseline testosterone level , nor age , nor baseline CRP-level modified the effect of testosterone supplementation on CRP levels . CONCLUSION Oral testosterone undecanoate supplementation , in dosage of 160 mg daily for 26 weeks , does not increase hs-CRP levels in elderly men PURPOSE Recent evidence supports a significant association between the intake of dietary fiber and levels of inflammatory markers . The objective of this study was to determine whether daily fiber supplementation would reduce levels of inflammatory markers . METHODS This study was a prospect i ve r and omized controlled trial at a single university medical center . Participants were overweight or obese adults with no history of heart disease . The intervention was psyllium supplementation at either 7 or 14 g/d for 3 months compared with no supplements in a control group . The main outcome measure was change in level of high-sensitivity C-reactive protein ( hsCRP ) concentration ; secondary outcomes included changes in interleukin-6 ( IL-6 ) levels , fibrinogen levels , and white blood cell ( WBC ) count . Protocol completers attended at least 2 visits and took more than 75 % of the prescribed fiber dose . RESULTS In this intent-to-treat analysis ( n = 158 ) , there were no significant differences between either of the 2 treatment groups and the control group in the amount of change in CRP , fibrinogen , or IL-6 levels or in WBC count ( P>.05 ) . In the analysis of protocol completers ( n = 132 ) , there also were no significant differences between the groups except for a small decrease in fibrinogen level in the high-fiber group ( −6 mg/dL [ −0.18 μmol/L ] compared with 13 mg/dL [ 0.38 μmol/L ] in the control group , P<.05 ) . CONCLUSION Psyllium fiber supplementation did not significantly reduce  CRP levels in overweight or obese individuals in this trial , and changes in other markers were not consistent . Further research is needed to determine whether other fibers or nutrients can reduce inflammatory markers Background —Small increases in the inflammatory marker C-reactive protein ( CRP ) are predictive of vascular events among asymptomatic individuals . There are few data supporting the use of CRP as a risk marker among nonwhite individuals . Methods and Results —1250 adults of South Asian , Chinese , European , and Aboriginal ancestry were r and omly sample d from 4 communities in Canada . Participants provided fasting blood sample s for CRP , glucose , lipids , and coagulation factors , and they had undergone a carotid B-mode ultrasound .  Cardiovascular disease was determined by history and electrocardiogram . The age- and sex-adjusted mean CRP was 3.74 mg/L ( st and ard error , 0.14 ) among Aboriginals , 2.59 mg/L ( 0.12 ) among South Asians , and 1.18 mg/L ( 0.13 ) among Chinese compared with 2.06 mg/L ( 0.12 ) among Europeans ( overall P < 0.0001 ) . Differences in the CRP concentration between ethnic groups were substantially diminished , but not abolished , after adjustment for metabolic factors . CRP was independently associated with CVD after adjusting for the Framingham risk factors , atherosclerosis , anthropometric measurements , and ethnicity ( OR=1.03 for a 0.1-increase in CRP ; P = 0.02 ) . Conclusions —CRP varies substantially between people of different ethnic origin and is influenced by their differences in metabolic factors . Prospect i ve validation of CRP as a risk predictor for cardiovascular disease among nonwhite ethnic groups is required BACKGROUND AND AIMS It has been suggested that magnesium deficiency is associated with the triggering of acute phase response , which may contribute to type 2 diabetes and cardiovascular disease risk . We undertook this study to determine whether oral magnesium supplementation modifies serum levels of high-sensitivity C-reactive protein ( hsCRP ) in apparently healthy subjects with prediabetes and hypomagnesemia . METHODS A total of 62 men and non-pregnant women aged 18 - 65 year , with new diagnosis of prediabetes ( glucose 5.6 < 7.0 mmol/L and /or post-load glucose ≥7.7 < 11.1 mmol/L ) and hypomagnesemia ( serum magnesium levels < 0.74 mmol/L ) were enrolled in a clinical double-blind placebo-controlled trial and r and omly allocated to receive either magnesium chloride ( 30 mL of MgCl2 5 % solution ) or NaHCO3 0.1 % solution , once daily for 3 months . RESULTS At basal conditions , anthropometric and biochemical variables were similarly distributed in both groups . At the end of follow-up , participants who received magnesium chloride showed higher serum magnesium levels ( 0.86 ± 0.08 vs. 0.69 ± 0.16 mmol/L , p = 0.002 ) and lower hsCRP levels ( 4.8 ± 15.2 vs. 17.1 ± 21.0 nmol/L , p = 0.01 ) compared with participants in the control group . CONCLUSIONS Oral magnesium supplementation decreases hsCRP levels in apparently healthy subjects with prediabetes and hypomagnesemia BACKGROUND Inflammation plays an important role in the pathogenesis of coronary artery disease . We examined whether dietary supplementation with alpha-linolenic acid ( ALA , 18:3n-3 ) affects the levels of inflammatory markers in dyslipidaemic patients . METHODS We recruited 76 male dyslipidaemic patients ( mean age=51+/-8 years ) following a typical Greek diet . They were r and omly assigned either to 15 ml of linseed oil ( rich in ALA ) per day ( n=50 ) or to 15 ml of safflower oil ( rich in linoleic acid ( LA , 18:2n-6 ) ) per day ( n=26 ) . The ratio of n-6:n-3 in linseed oil supplemented group was 1.3:1 and in safflower oil supplemented group 13.2:1 . Dietary intervention lasted for 3 months . Blood lipids and C-reactive protein ( CRP ) , serum amyloid A ( SAA ) , and interleukin-6 ( IL-6 ) levels were determined prior and after intervention . CRP and SAA were measured by nephelometry and IL-6 by immunoassay . RESULTS Dietary supplementation with ALA decreased significantly CRP , SAA and IL-6 levels . The median decrease of CRP was 38 % ( 1.24 vs. 0.93 mg/l , P=0.0008 ) , of SAA 23.1 % ( 3.24 vs. 2.39 mg/l , P=0.0001 ) and of IL-6 10.5 % ( 2.18 vs. 1.7 pg/ml , P=0.01 ) . The decrease of inflammatory markers was independent of lipid changes . Dietary supplementation with LA did not affect significantly CRP , SAA and IL-6 concentrations but decreased cholesterol levels . CONCLUSIONS Dietary supplementation with ALA for 3 months decreases significantly CRP , SAA and IL-6 levels  in dyslipidaemic patients . This anti-inflammatory effect may provide a possible additional mechanism for the beneficial effect of plant n-3 polyunsaturated fatty acids in primary and secondary prevention of coronary artery disease Objective : C-reactive protein ( CRP ) may directly affect the progression of atherosclerosis , and therefore , may be a target for reducing disease risk . The objective was to determine whether antioxidant supplementation reduces plasma CRP in active and passive smokers . Design : R and omized , double-blind , placebo-controlled , parallel group trial with 2 months exposure to study supplements . Setting : Berkeley and Oakl and , California . Subjects : Healthy adult men and women , consuming < 4 daily servings of fruits and vegetables , and who were actively or passively exposed to cigarette smoke . Analysis was limited to participants with detectable baseline CRP concentrations and no evidence of inflammation associated with acute illness at baseline or follow-up as reflected in CRP elevations ( ≥10.0 mg/L ) . A total of 1393 individuals were screened , 216 r and omized , 203 completed the study , and 160 were included in the analysis . Interventions : Participants were r and omized to receive a placebo or vitamin C ( 515 mg/day ) or antioxidant mixture ( per day : 515 mg vitamin C , 371 mg α-tocopherol , 171 mg γ-tocopherol , 252 mg mixed tocotrienols , and 95 mg α-lipoic acid ) . Measures of Outcome : Change in plasma CRP concentration . Results : Vitamin C supplementation yielded a 24.0 % reduction ( 95 % confidence interval , −38.9 % to −5.5 % , p = 0.036 compared to control ) in plasma CRP , whereas the antioxidant mixture and placebo produced a nonsignificant 4.7 % reduction ( −23.9 % to 19.3 % ) and 4.3 % increase ( −15.1 % to 28.2 % ) , respectively . Results were adjusted for baseline body mass index and CRP concentrations . Conclusions : Plasma CRP itself may serve as a potential target for reducing the risk of atherosclerosis , and antioxidants , including vitamin C , should be investigated further to confirm their CRP-lowering and anti-inflammatory effects Background The ideal evidence to answer a question about the effectiveness of treatment is a systematic review . However , for many clinical questions a systematic review will not be available , or may not be up to date . One option could be to use the evidence from an individual trial to answer the question ? Methods We assessed how often ( a ) the estimated effect and ( b ) the p-value in the most precise single trial in a meta- analysis agreed with the whole meta- analysis . For a r and om sample of 200 completed Cochrane Review s ( January , 2005 ) we identified a primary outcome and extracted : the number of trials , the statistical weight of the most precise trial , the estimate and confidence interval for both the highest weighted trial and the meta- analysis overall . We calculated the p-value for the most precise trial and meta- analysis . Results Of 200 review s , only 132 provided a meta- analysis of 2 or more trials , with a further 35 effect estimates based on single trials . The average number of trials was 7.3 , with the most precise trial contributing , on average , 51 % of the statistical weight to the summary estimate from the whole meta- analysis . The estimates of effect from the most precise trial and the overall meta-analyses were highly correlated ( rank correlation of 0.90).There was an 81 % agreement in statistical conclusions . Results from the most precise trial were statistically significant in 60 of the 167 evaluable review s , with 55 of the corresponding systematic review s also being statistically significant . The five discrepant results were not strikingly different with respect to their estimates of effect , but showed considerable statistical heterogeneity between trials in these meta-analyses . However , among the 101 cases in which the most precise trial was not statistically significant , the corresponding meta-analyses yielded 31 statistically significant results . Conclusions Single most precise trials provided similar estimates of effects to those of the meta-analyses to which they contributed , and statistically significant results are generally in agreement . However , " negative " results were less reliable , as may be expected from single underpowered trials . For systematic review ers we suggest that : ( 1 ) key trial(s ) in a review deserve greater attention ( 2 ) systematic review ers should check agreement of the most precise trial and the meta analysis . For clinicians using trials we suggest that when a meta- analysis is not available , a focus on the most precise trial is reasonable provided it is adequately powered
These findings were robust in sensitivity analyses .
Conclusions This meta- analysis suggests that Mg supplementation significantly reduces serum CRP level .
Introduction The aim of the study was to undertake a systematic review and meta- analysis of prospect i ve studies to determine the effect of magnesium ( Mg ) supplementation on  C-reactive protein ( CRP ) .