title: Mailuoning for acute ischaemic stroke.
abstract: BACKGROUND
  Mailuoning is widely used in the treatment of acute ischaemic stroke in China. Animal experimental studies and clinical pharmacological research indicate that mailuoning might improve blood circulation, prevent ischaemic injury, and protect heart and brain tissue. This review was last published in 2009. As new data have become available, it is necessary to reassess the evidence from randomised controlled trials.
  
  
  OBJECTIVE
  To determine the effects and safety of mailuoning agents (injection or oral liquid) in the treatment of people with acute ischaemic stroke.
  
  
  METHODS
  We searched the Cochrane Stroke Group Trials Register (May 2014), the Cochrane Central Register of Controlled Trials (CENTRAL;2014, Issue 4), MEDLINE (1966 to May 2014), Embase (1980 to May 2014), AMED (1985 to May 2014), the Chinese Stroke Trials Register (June 2014), the China Biological Medicine Database (CBM-disc; 1979 to June 2014), China Science and Technology Journal database (CSTJ; 1979 to June 2014), Wanfang Data Chinese databases (1979 to June 2014), and the China National Knowledge Infrastructure (1979 to June 2014). We searched clinical trials and research registers, handsearched 10 Chinese journals including relevant conference proceedings, scanned reference lists, and contacted the pharmaceutical company that manufactures mailuoning. We also attempted to contact trial authors to obtain further data.
  
  
  METHODS
  Randomised controlled trials comparing mailuoning with placebo or mailuoning plus other treatment compared with that other treatment in people with acute ischaemic stroke.
  
  
  METHODS
  Two review authors independently selected trials for inclusion, assessed trial quality, and extracted data.
  
  
  RESULTS
  We included 21 trials, involving 1746 participants, in this update; six trials were new. The included trials did not report the numbers of dead and dependent participants at the end of at least three months' follow-up. Of the 12 trials that reported adverse events, five events occurred in two trials. There was no significant difference between the treatment group and the control group. We assessed 20 trials to be of a poor quality: When analysing these trials together, mailuoning was associated with a significant increase in the number of participants with an improved neurological deficit (risk ratio (RR) 0.31, 95% confidence interval (CI) 0.23 to 0.42) and showed a significant improvement of neurological deficit with the European Stroke Scale (ESS) (mean difference (MD) (fixed) 8.29, 95% CI 3.44 to 13.15). One placebo-controlled trial, assessed to be of a better methodological quality, failed to show a significant improvement of neurological deficit at the end of three months' follow-up (MD (fixed) 2.49, 95% CI -1.45 to 6.43) or in quality of life. One trial, which reported cognitive function using the Montreal Cognitive Assessment as a continuous scale, showed a significant improvement of cognitive function (MD (fixed) 2.68, 95% CI 1.82 to 3.54). Two trials assessed activities of daily life: One trial showed a significant improvement, but the other did not.
  
  
  CONCLUSIONS
  This review did not provide sufficient evidence to support the routine use of mailuoning for the treatment of people with acute ischaemic stroke. High-quality large-scale randomised controlled trials are needed to confirm the efficacy of mailuoning.
authors.affiliation: Department of Neurology, First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe Road East, Zhengzhou, Henan Province, China, 450052.
authors.forename: Weimin
authors.initials: W
authors.lastname: Yang
authors.forename: Zhaobo
authors.initials: Z
authors.lastname: Shi
authors.forename: Hong-Qi
authors.initials: HQ
authors.lastname: Yang
authors.forename: Junfang
authors.initials: J
authors.lastname: Teng
authors.forename: Jun
authors.initials: J
authors.lastname: Zhao
authors.forename: Guoliang
authors.initials: G
authors.lastname: Xiang
mesh_terms: D002545:Brain Ischemia / Q000188:drug therapy*; D004365:Drugs, Chinese Herbal / Q000009:adverse effects / Q000627:therapeutic use*; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008517:Phytotherapy / Q000009:adverse effects; D016032:Randomized Controlled Trials as Topic; D020127:Recovery of Function; D020521:Stroke / Q000188:drug therapy*
chemical_list: D004365:Drugs, Chinese Herbal; D005343:Fibrinolytic Agents; C534919:mailuoning