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Figure 2.7 Ambiguity in the focal mechanism solution of a strike-slip fault. Regions of compressional rst motions are shaded.

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It improves both cerebral and peripheral blood ow by the effects upon blood viscosity and also by relaxing vascular walls It may affect neurotransmitter metabolism It may increase neuronal regeneration in some experimental brain injury models in animals There have been dozens of clinical trials of Ginkgo biloba extracts for the clinical indications listed earlier and a few for other indications, and there have been a number of systematic reviews of these trials Many of the early trials were not published in English, usually in French or German One of the earlier reviews published in English evaluated the literature relating to the effects of Ginkgo biloba on cerebral insuf ciency (Kleijnen and Knipschild 1992) Cerebral insuf ciency is a term that was used to describe a myriad of psychological symptoms including poor concentration and memory, thought to result from an age-related reduction in cerebral blood ow.

Kleijnen and Knipschild identi ed forty controlled trials of Ginkgo biloba for cerebral insuf ciency but described only eight of these as well performed Despite their reservations about the quality of most of the trials, they did nd that almost all of the studies reported positive results for the extract (most used 120 mg of extract for at least 4 6 weeks) They suggested that the presence of no negative trials within a large number of small and methodologically poor trials probably indicated a publication bias towards positive trials They concluded that overall the evidence for Ginkgo biloba was similar to that for a regulated drug then being used (co-dergocrine) A Cochrane review conducted a decade after this rst review (Birks et al 2002) provided more concrete support for the bene cial effects of Ginkgo biloba for cognitive impairment and dementia.

1. Choose Window Databases to display the Databases panel. 2. Click the Modify Data Sources button (see Figure 19-6) to open the ColdFusion Administrator home page.

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They conducted a meta-analysis of all studies of Ginkgo biloba for cognitive impairment, including dementia, that met their quality criteria Ginkgo biloba was found to be safe in that there were no more adverse events in the Ginkgo than in the placebo groups The physician-determined Clinical Global Improvement scale showed statistically signi cant positive bene ts for Ginkgo at doses above and below 200 mg/day at 12, 24 and 52 weeks There were also signi cantly positive results for measures of mood and emotional function and an index to measure capacity to cope with the activities of daily life The authors concluded that Ginkgo is safe and that despite the poor quality and small size of many of the early trials it shows promising evidence of improvements in cognition and functioning The one less than positive note was an observation that the three modern trials showed inconsistent results.

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