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curative surgery for various solid malignant tumours, and the immunostimulatory effects of a Buy Virility Pills regimen comprising intramuscular E, purpurea extract, low-dose intramuscular cyclophosphamide and intravenous thymostimulin in patients with advanced colorectal cancer. In another study, the effects of a polysaccharide fraction of E. purpurea herb obtained from cell cultures in reducing the adverse effects of cancer chemotherapy were explored in patients with advanced gastric cancer receiving palliative Buy Virility Pills therapy with etoposide, leucovorin and 5-fluorouracil. Although these studies reported some positive findings with echinacea, no firm conclusions can be drawn because Buy Virility Pills of the nature of the study designs, therefore further research in this area is required. Upper respiratory tract infections (URTIs) Numerous studies have explored the effects of echinacea preparations in preventing or treating the common cold and other URTIs. Overall, several, but not all, studies have reported beneficial effects for certain echinacea preparations, compared with placebo, for the prevention and treatment of URTIs. However, for the reasons given (see Pharmacological Actions, Therapeu- tic effects), current consensus is that there is insufficient evidence to recommend any specific echinacea preparations, or to advise on optimal dose and treatment duration. Prophylaxis A Cochrane systematic review included 16 randomised and quasi-randomised controlled trials involving a total of almost 3400 participants - of extracts of echinacea for preventing (n 8) or treating (n 8) URTIs. The eight 'prevention' trials comprised five which were placebo-controlled (n - 1272 participants), and which largely were considered to be of adequate methodological quality, and three (n 1139 participants) in which Buy Virility Pills the control group received no treatment. The five placebo- controlled trials tested combination echinacea preparations (n - 2) or monopreparations of E. purpurea herb or root, or E. angustifolia root (n 3), administered orally typically for 8-12 weeks. Two of these studies reported a statistically significant reduction in Buy Virility Pills the incidence of URTIs in echinacea recipients, compared with placebo recipients (odds ratios, 95% confidence interval (CI): 0.45, 0.22-0.92 and 0.27, 0.11-0.66). One of these studies also found that in participants who did acquire infections, the duration was significantly shorter in those who had received echinacea compared with placebo recipients, although two other studies reported no difference in this outcome. The three other 'prevention' trials all involved children and compared a combination preparation containing extracts of E. angustifolia and E. pallida root, Baptisia tinctoria root and Thuja occidentalis herb, as well as several homeopathic dilutions, with no Buy Virility Pills treatment. All three studies reported that the frequency of infection was significantly lower in the treatment compared with no treatment group (pooled odds ratio 0.36; 95% CI 0.28-0.46), although the methodological quality of all three studies was considered inadequate. An updated Cochrane review used more restrictive inclusion criteria for trials (e.g. randomised controlled trials only, trials assessing multi-herb products excluded), such that the revised review included only five trials that had been included in the earlier review, and 11 new trials. Two of the 16 included trials involving children, and the others, adults; 15 trials used a placebo control design, one compared an echinacea preparation with another herbal product and no treatment, three Buy Virility Pills trials involved two echinacea arms, and one involved comparisons with both placebo and no treatment, thus the total number of comparisons in the review was 22. In contrast with the earlier review, only three compar- isons (from two trials 9 ' l ) investigated echinacea pre- parations for the prevention of colds, and none of these found statistically significant differences between the echinacea and placebo groups with respect to proportion of participants experiencing one or more colds. Details of the two prevention trials included in the review, ' as well as those of several excluded trials, are given below. These trials did not show beneficial effects for echinacea preparations, compared with placebo, on main outcome measures.' 101 " 104 ' A randomised, double-blind, placebo-controlled trial involved 302 healthy volunteers recruited from military institutions and an industrial plant who received an ethanolic extract of E. purpurea root Buy Virility Pills or E. angustifolia root (drug : extract ratio, 1:11 in 30% alcohol), or placebo, 50 drops twice daily on five days per week (Monday to Friday) for 12 weeks. <99) In an intention-to-treat analysis (n - 289), the proportion of participants who experienced at least one URTI was 32% (95% CI: 23-41%) for Buy Virility Pills E. angustifolia recipients, 29% (95% CI: 20-38%) for E. purpurea recipients, and 37% (95% CI: 27-47%) for placebo recipients; these differences were not statistically significant (p - 0.55). Similarly, there were no statistically significant differences between groups in time to occurrence of the first URTI (p 0.49), or in the duration of infections (p 0.29), although it is possible that the study was not large enough to detect differences. However, a greater proportion of Buy Virility Pills echinacea recipients believed they had benefited from the study medication than did placebo recipients (78%, 70% and 56% for E. angustifolia, E, purpurea and placebo, respectively; p 0.04). In another randomised, double-blind, placebo-controlled trial, involving 109 individuals who had experienced more than three colds or respiratory infections in the previous year, a fluid extract of E. purpurea prepared from the aerial parts of fresh flowering plants, administered at a dose of 4mL twice daily for eight weeks, had no statistically significant effect compared with placebo on the incidence of colds and URTIs (rate ratio for number of participants in each group with at least one cold or URTI = 0.88, 95% CI: 0.60-1.22). Likewise, there was no statistically signifi- cant difference between groups in the duration and severity of occurring colds or URTIs. Three further studies' 101-103 ' tested the effects of echinacea for the prevention of colds due to experimental rhinovirus infection. In one study, adult volunteers (n 117
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