Acupuncture in treating obesity combined with type 2 diabetes mellitus: A systematic review and meta-analysis of randomized controlled clinical trials

Backgroundand purpose: Most type 2 diabetes mellitus (T2DM) patients are accompanied by overweight or obesity, and it is difficult to concurrently solve these two issues with conventional treatment regimens without experiencing adverse effects. While clinical practice demonstrates that acupuncture is beneficial in treating obesity combined with T2DM, there is a lack of evidence-based medicine to support this claim. The study aims to systematically evaluate the efficacy and safety of acupuncture in treating obesity combined with T2DM.MethodsBy searching eight electronic databases, we collected randomized controlled trials on acupuncture in treating obesity combined with T2DM. Two reviewers independently screened the literature, extracted the data, and assessed the risk of bias in the included studies. Meta-analysis was then performed using RevMan 5.4 software.ResultsA total of 13 randomized controlled trials (RCTs) involving 993 patients were eventually included. Meta-analysis results demonstrated the effective rate of clinical symptoms: [RR = 1.19, 95% CI: 1.11, 1.28, P < 0.00001]; body mass index: [MD = −2.11, 95% CI: −2.56, −1.66, P < 0.00001]; fasting plasma glucose: [MD = −1.09, 95% CI: −1.60, −0.59, P < 0.00001]; haemoglobin A1c: [MD = −0.58, 95% CI: −0.95, −0.20, P = 0.002]; triglyceride: [MD = −0.29, 95% CI: −0.46, −0.11, P = 0.001]; waist circumference: [MD = −5.36, 95% CI: −8.68, −2.05, P = 0.002]; body fat rate: [MD = −3.59, 95% CI: −4.28, −2.90, P < 0.00001].ConclusionCurrent evidence suggests that acupuncture has advantages in treating obesity combined with T2DM. However, due to low-quality evidence of included research, additional large-sample and high-quality research are required to validate the findings of this study.     

Effects of progressive muscle relaxation on health-related outcomes in cancer patients: A systematic review and meta-analysis of randomized controlled trials

Background and purposeProgressive muscle relaxation training (PMRT) has been widely applied to improve the physical and mental health of patients. The aim of this study was to evaluate the effects of PMRT on the symptoms and quality of life (QOL) of cancer patients.MethodsNine databases (Web of Science, CENTRAL, PubMed, Embase, CINAHL, OpenGrey, CNKI, Wanfang, and VIP database) were searched to identify randomized controlled trials (RCTs) that assessed the effects of PMRT on health-related outcomes for cancer patients. The risk of bias of the included studies and the evidence quality were appraised using the Cochrane Risk of Bias 2.0 tool and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach, respectively. Meta-analysis was performed using RevMan 5.4.ResultsTwelve RCTs sampling 1147 patients were included. PMRT showed significant effects of alleviating anxiety [standardized mean difference (SMD) = −1.32, 95% CI (−1.88, −0.75), P < 0.001] and pain [SMD = −1.02, 95% CI (−1.93, −0.11), P = 0.030], and improving QOL [SMD = 1.65, 95% CI (0.53, 2.76), P = 0.004] in cancer patients. Regarding depression, self-esteem, nausea, and vomiting, PMRT showed better effects compared to the control group. However, no significant effect of reducing fatigue was detected [SMD = −1.00, 95% CI (−2.27, 0.27), P = 0.120]. The overall quality of evidence was moderate to very low.ConclusionPMRT is a promising complementary therapy that may improve the health-related outcomes of cancer patients. Future studies with rigorous research design are needed to obtain valid conclusions.     

Trial of Labor After Cesarean in Adolescents – A Multicenter Study

Study ObjectiveData regarding trial of labor after cesarean delivery (TOLAC) among young women are limited. The aim of this study was to assess the TOLAC success rate and its related factors among adolescent women who had never delivered vaginally.DesignA multicenter retrospective cohort study of all adolescent women aged ≤21 years with a history of 1 previous cesarean delivery, who delivered in 2 tertiary medical centers during 2007-2019. Women were allocated to 2 groups: 1) women who underwent TOLAC, and 2) women who had a repeat cesarean delivery with no trial of labor. Maternal and neonatal outcomes were compared between the two groups. In addition, perinatal outcomes were compared between women with successful and unsuccessful TOLAC.ResultsThe study cohort included 167 women who had a previous caesarean delivery; 117 underwent TOLAC and 50 underwent a repeat cesarean delivery with no trial of labor. Neonatal birthweight (median 2937 vs 3170 g, P = .03) and gestational age at delivery (median 38 weeks vs 39, P = .009) were lower in the repeat cesarean group as compared to those undergoing TOLAC. Overall, 97 of 117 participants (83%) had a successful TOLAC. Failed TOLAC was associated low birthweight as compared to successful TOLAC (5 [25%] vs 7 [7%], odds ratio [OR] 4.3, 95% confidence interval [CI] 1.2-15.3, P = .02), and birthweight difference between current and previous deliveries was higher in the failed TOLAC group (median 315 vs 197 g, P = .04). Rates of neonatal Apgar score at 1 minute < 7 and of neonatal intensive care unit admission were higher in the TOLAC failure group (4 [20%] vs 5 [5%], OR 4.6, 95% CI 1.1-19.0, P = .03, and 4 [20%] vs 4 [4%], OR 5.8, 95% CI 1.3-25.6, P = .02), respectively). In a multivariable logistic regression analysis, only low birthweight was independently associated with TOLAC failure (adjusted OR 9.9, 95% CI 2.1-45.4, P = .003). Two cases of uterine rupture occurred in the no trial of labor group, whereas none were encountered in participants undergoing TOLAC.ConclusionsTOLAC in adolescent women who had never delivered vaginally is associated with a relatively high success rate.     

The influence of massage on neonatal hyperbilirubinemia: a meta-analysis of randomized controlled trials

Introduction: The efficacy of massage to treat neonatal hyperbilirubinemia remains controversial. We conducted a systematic review and meta-analysis to explore the influence of massage on the neonatal hyperbilirubinemia.

Methods: We search PubMed, Embase, Web of science, EBSCO, and Cochrane Library databases through November 2017 for randomized controlled trials (RCTs) assessing the effect of massage on neonatal hyperbilirubinemia. This meta-analysis is performed using the random-effect model.

Results: Six RCTs involving 357 patients are included in the meta-analysis. Overall, compared with the control group in neonatal hyperbilirubinemia, massage therapy is associated with substantially reduced serum bilirubin level within 4?d (mean difference (MD)?=??2.31; 95% CI?=??2.92 to ?1.70; p?p?p?=?.23), transcutaneous bilirubin level on 2?d (MD?=??0.17; 95% CI?=??1.34 to 1.00; p?=?.77), frequency of defecation daily on 2?d (MD?=?0.57; 95% CI?=??0.03 to 1.16; p?=?.06), and frequency of defecation daily within 4?d (MD?=?0.83; 95% CI?=??0.11 to 1.76; p?=?.08).

Conclusions: Massage therapy can significantly reduce serum bilirubin level and transcutaneous bilirubin level within 4?d, but demonstrates no influence on serum bilirubin level and transcutaneous bilirubin level on 2?d, frequency of defecation daily on 2 and 4?d for neonatal hyperbilirubinemia.     

Perinatal and obstetric outcomes in singleton pregnancies following fresh versus cryopreserved blastocyst transfer: a meta-analysis

The transfer of cryopreserved blastocysts is increasing in IVF centres. However, little is known about the perinatal and obstetric outcomes of this procedure. In an attempt to further elucidate these issues, a systematic review and meta-analysis was conducted to compare cryopreserved transfer with fresh blastocyst embryo transfer. The results show that the risk of both preterm (odds ratio [OR] 0.89, 95% confidence interval [CI] 0.80–0.99, P = 0.04) and low birthweight births (OR 0.82, 95% CI 0.68–0.99, P = 0.04) was significantly lower after cryopreserved blastocyst transfer than after fresh blastocyst transfer. The rate of large for gestational age births was significantly higher (OR 1.68, 95% CI 1.55–1.82, P < 0.00001) and the rate of small for gestational age births significantly lower (OR 0.59, 95% CI 0.54–0.65, P < 0.00001) after cryopreserved blastocyst transfer. The transfer of cryopreserved blastocysts was associated with a significantly lower risk of placental abruption (OR 0.58, 95% CI 0.40–0.83, P = 0.003) but a significantly higher risk of Caesarean section (OR 1.21, 95% CI 1.01–1.43, P = 0.03). In conclusion, the perinatal and obstetric outcomes associated with the transfer of cryopreserved blastocysts differ from those associated with fresh blastocyst transfer.     

A Systematic Review and Meta-Analysis of the Effect of Intraoperative Bupivacaine in Gynaecologic Surgery After 24 Hours or 9 Half-Lives

ObjectiveTo review all high quality available evidence regarding the effect of intraoperative bupivacaine 24 hours (or 8.9 half-lives) after intraoperative administration at time of gynaecologic surgery and to ascertain whether a second mechanism of action, beyond the initial prevention of sodium channel depolarization and blockade of nerve impulses, may be occurring.Data SourcesWe searched all major databases with an algorithm designed to include all randomized trials that used any form of local bupivacaine, regardless of dose or route of administration, at the time of any gynaecologic surgery and compared its use with saline placebo.ResultsAs expected, we found that bupivacaine showed a significant improvement for all gynaecologic surgeries with respect to pain intensity at 6 hours after surgery when compared with a saline group (mean difference [MD] –1.28; 95% CI –1.96 to –0.61], P = 0.07). We also found a significant difference at 24 hours after surgery, giving evidence to the possibility of a second mechanism of action (MD –0.57; 95% CI –1.10 to –0.05], P = 0.01). Further subgroup analysis for pain levels at 24 hours showed significant decreases in pain for the laparoscopy (MD –0.74; 95% CI –0.93 to –0.54, P < 0.01) and laparotomy (MD –2.60; 95% CI –2.93 to –2.27, P < 0.01)) subgroups but not for the vaginal hysterectomy (MD 0.20; 95% CI –0.69 to 1.09, P = 0.66) or prolapse surgery (MD –0.11; 95% CI –0.41 to 0.19, P = 0.48) subgroups. There was no significant difference with respect to the length of hospital stay (MD –0.11; 95% CI –0.59 to 0.38, P = 0.67).ConclusionAs expected, bupivacaine significantly reduced visual analog pain scores when compared with placebo at 6 hours after surgery, but also showed a significant difference at 24 hours after surgery, giving evidence of a second mechanism of action following the initial sodium channel blockade.     

Cupping therapy for treating knee osteoarthritis: The evidence from systematic review and meta-analysis

ObjectiveCupping therapy is widely used in East Asia, the Middle East, or Central and North Europe to manage the symptom of knee osteoarthritis (KOA). The purpose of this systematic review was to evaluate the available evidence from randomized controlled trials (RCTs) of cupping therapy for treating patients with KOA.MethodsThe following databases were searched from their inception until January 2017: PubMed, Embase, the Cochrane Central Register of Controlled Trials and four Chinese databases [WanFang Med Database, Chinese BioMedical Database, Chinese WeiPu Database, and China National Knowledge Infrastructure (CNKI)]. Only the RCTs related to the effects of cupping therapy on KOA were included in this systematic review. A quantitative synthesis of RCTs will be conducted using RevMan 5.3 software. Study selection, data extraction, and validation was performed independently by two reviewers. Cochrane criteria for risk-of-bias were used to assess the methodological quality of the trials.ResultsSeven RCTs met the inclusion criteria, and most were of low methodological quality. Study participants in the dry cupping therapy plus the Western medicine therapy group showed significantly greater improvements in the pain [MD = −1.01, 95%CI (−1.61, −0.41), p < 0.01], stiffness [MD = −0.81, 95%CI (−1.14, −0.48), p < 0.01] and physical function [MD = −5.53, 95%CI (−8.58, −2.47), p < 0.01] domains of Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) compared to participants in the Western medicine therapy group, with low heterogeneity (Chi² = 0.00 p = 1.00, I² = 0% in pain; Chi² = 0.45 p = 0.50, I² = 0% in stiffness; Chi² = 1.09 p = 0.30, I² = 9% in physical function). However, it failed to do so on a Visual Analog Scale (VAS) [MD = −0.32, 95%CI (−0.70, 0.05), p = 0.09]. In addition, when compared with Western medicine therapy alone, meta-analysis of four RCTs suggested favorable statistically significant effects of wet cupping therapy plus western medicine on response rate [MD = 1.06, 95%CI (1.01, 1.12), p = 0.03; heterogeneity: Chi² = 1.13, p = 0.77, I² = 0%] and Lequesne Algofunctional Index (LAI) [MD = −2.74, 95%CI (−3.41, −2.07), p < 0.01; heterogeneity: Chi² = 2.03, p = 0.57, I² = 0% ].ConclusionOnly weak evidence can support the hypothesis that cupping therapy can effectively improve the treatment efficacy and physical function in patients with KOA.     

Effect of oral magnesium supplementation for relieving leg cramps during pregnancy: A meta-analysis of randomized controlled trials

Leg cramps are one of the common symptoms during pregnancy. About 30%–50% of pregnant women experience leg cramps twice a week. Leg cramps may cause severe pain and sleep disturbance, hinder performance of daily activities and may lengthen the duration of pregnancy and the type of childbirth. Several randomized controlled trial (RCT) studies focused on the effects of the magnesium supplement for relieving leg cramps. However, the results were inconsistent. Five databases were searched from their inception to July 2, 2020. We summarized the weighted mean difference (WMD) with 95% CIs for “the frequency of leg cramps after treatment”, and summarized the odds ratio (OR) with 95% confidence intervals (CIs) for “recovery from leg cramps” and “side effects”. Four RCTs with a total of 332 pregnant women were identified. The frequency of leg cramps after treatment was not decreased in the treatment group compared to the control group (WMD = ?0.47, 95% CI: ?1.14–0.20, P = 0.167). Magnesium supplementation cannot improve the recovery from leg cramps compared to the control group (OR = 0.47, 95% CI: 0.14–1.52, P = 0.207). Magnesium supplementation had no significant side effects in the treatment group compared to the control group (OR = 1.82, 95% CI: 0.90–3.69, P = 0.094). Oral magnesium supplementation is not effective in the treatment of leg cramps during pregnancy.ProsperoCRD42020196572.     

Cytomegalovirus and systemic inflammation at time of surgery is associated with worse outcomes in serous ovarian cancer

Objectives: Cytomegalovirus (CMV) is a common infection that establishes latency in healthy people. CMV has been associated with alterations of the immune compartment leading to improved responses, while inflammation has been shown to adversely impact outcomes. We investigated whether CMV serostatus predicts outcomes in ovarian cancer in the presence or absence of inflammation.Methods: A total of 106 patients with serous ovarian cancer from 2006 to 2009 were analyzed. CMV and systemic inflammation was measured using CMV immunoglobulin G (IgG) and C-reactive protein (CRP), respectively, in serum collected prior to cytoreduction. Patients were stratified by CMV IgG (non-reactive, reactive/borderline) and CRP (≤10, >10 mg/L) status. Overall survival (OS) and recurrence-free survival (RFS) were compared by group using log-rank tests and Cox proportional hazards regression models adjusting for age at surgery.Results: Of 106 eligible patients, 40 (37.7%) were CMV+/CRP+, 24 (22.6%) CMV+/CRP-, 19 (17.9%) CMV?/CRP+, and 23 (21.7%) CMV?/CRP?. CRP+ had higher CA-125 levels (P = 0.05) and higher rates of suboptimal debulking (P = 0.03). There were no other significant differences in demographic, surgical, or pathologic factors between groups. CMV+/CRP+ patients median RFS and OS were 16.9 months (95% CI: 9.0–21.1) and 31.7 months (95% CI: 25.0–48.7), respectively, with a significantly worse RFS (aHR: 1.85, 95% CI: 1.05–3.24, P = 0.03) and OS (aHR: 2.12, 95% CI: 1.17–3.82, P = 0.01) compared to CMV?/CRP? (RFS = 31.2 months (95% CI: 16.0–56.4) and OS = 63.8 months (95% CI: 50.7–87.0)). CMV+/CRP? group displayed the longest OS (89.3 months).Conclusions: Previous exposure to CMV and high CRP at surgery portended worse RFS and OS compared to women who tested negative. The CMV+/CRP? group had the longest OS, indicating that CMV status alone, in the absence of inflammation, may be protective.     

Effectiveness of cognitive behavioral therapy on mood symptoms in patients with implantable cardioverter defibrillator: A systematic review and meta-analysis

Backgroundand purpose: Cognitive behavioral therapy (CBT) has gained increasing attention in the treatment of psychological disorders, but evidence is required to support practice. This systematic review was conducted to evaluate the current evidence for CBT's effectiveness in relieving symptoms of anxiety and depression experienced by patients with an implantable cardioverter-defibrillator (ICD).MethodsPubMed, Cochrane Library, Web of Science, and Embase databases were systematically searched from inception to March 27, 2020. Both randomized controlled trials and cluster-randomized controlled trials were included in our review. Meta-analysis was conducted using RevMan 5.3 and Stata 15.1 software.ResultsA total of six trials, including 675 participants, were analyzed. The results demonstrated that CBT was superior to standard care in relieving symptoms of depression (standardized mean difference = −0.20; 95% confidence interval (CI): −0.39 to −0.01; P = 0.004). The effectiveness of CBT in relieving symptoms of anxiety experienced by patients with ICDs (standardized mean difference = −0.70; 95% CI: −1.10 to −0.30; P < 0.001) as well as the heterogeneity (I² = 77%) were significant.ConclusionThis meta-analysis indicates that CBT effectively relieves symptoms of anxiety and depression experienced by patients with ICDs. Clinical personnel should pay close attention to the mental health of patients with ICDs and adopt CBT as a management strategy for such patients.     

Maternal hyperglycemia and adverse pregnancy outcomes in Dar es Salaam,Tanzania

Objective

To evaluate maternal glucose levels during pregnancy as a predictor of adverse perinatal outcomes in Dar es Salaam, Tanzania.

Methods

Random blood glucose measurements were analyzed from 3383 pregnant women enrolled in a randomized trial to assess the impact of multivitamins on pregnancy outcomes in Dar es Salaam between August 2001 and July 2004. Information on maternal and neonatal morbidity was recorded at monthly study visits, delivery, and 6 weeks postpartum. Binomial regression and generalized estimating equations were used to determine the relationship between elevated glucose (> 7.8 mmol/L) and pregnancy outcomes.

Results

In total, 25 women had elevated glucose (0.7%). Hyperglycemia was associated with an increased risk of delivery before 37 weeks [relative risk (RR), 2.11; 95% confidence interval [CI], 1.07–4.13; P = 0.03), delivery before 34 weeks (RR, 4.15; 95% CI, 1.43–12.03, P = 0.009), incident gestational hypertension (RR, 2.90; 95% CI, 1.24–6.76; P = 0.01), low birth weight (RR, 2.87; 95% CI, 1.18–6.99; P = 0.02), reduced newborn head circumference (mean difference, –1.57; 95% CI, –2.51 to − 0.62; P = 0.001), and fetal loss (RR, 3.38; 95% CI, 1.13–10.08; P = 0.03).

Conclusion

Maternal hyperglycemia is uncommon among pregnant Tanzanian women, but nonetheless seems to increase the risk of several adverse perinatal outcomes.     

CO2-Laser therapy and Genitourinary Syndrome of Menopause: A Systematic Review and Meta-Analysis

BackgroundGenitourinary syndrome of menopause (GSM) is a widespread condition with a great impact on quality of life and self-image.AimWe aimed to systematically review the current literature on CO2-Laser therapy efficacy for the treatment of GSM.MethodsMEDLINE and Embase databases were systematically queried in December 2020 Studies included women with a diagnosis of Vulvo-Vaginal Atrophy (VVA) or GSM without an history of gynaecological and/or breast cancer, pelvic organ prolapse staged higher than 2, pelvic radiotherapy or Sjogren's Syndrome. The quality of the evidence was assessed with the Cochrane risk of bias tool. This study is registered on PROSPERO, number CRD42021238121.OutcomesEffects of CO2-Laser therapy on GSM symptoms assessed through subjective or objective efficacy measurement methods.ResultsA total of 803 articles were identified. Of these, 25 studies were included in this review for a total of 1,152 patients. All studies showed a significant reduction in VVA and/or GSM symptoms (dryness, dyspareunia, itching, burning, dysuria). The pooled mean differences for the symptoms were: dryness -5.15 (95% CI:-5.72,-4.58; P < .001; I²:62%; n = 296), dyspareunia -5.27 (95% CI:-5.93,-4.62; P < .001; I²:68%; n = 296), itching -2.75 (95% CI:-4.0,-1.51; P < .001; I²:93%; n = 281), burning -2.66 (95% CI:-3.75, -1.57; P < .001; I²:86%; n = 296) and dysuria -2.14 (95% CI:-3.41,-0.87; P < .001; I²:95%; n = 281). FSFI, WHIS and VMV scores also improved significantly. The pooled mean differences for these scores were: FSFI 10.8 (95% CI:8.41,13.37; P < .001; I²:84%; n = 273), WHIS 8.29 (95% CI:6.16,10.42; P < .001; I²:95%; n = 262) and VMV 30.4 (95% CI:22.38,38.55; P < .001; I²:24%; n = 68). CO2-Laser application showed a beneficial safety profile and no major adverse events were reported.Clinical ImplicationsVaginal laser treatment resulted in both a statistically and clinically significant improvement in GSM symptoms. FSFI improved significantly in all 8 included studies but it reached a clinically relevant level only in 2 of them.Strengths & LimitationsThe strength of the current meta-analysis is the comprehensive literature search. We reported data from a high number of patients (1,152) and high number of laser applications (more than 3,800). The main limitations are related to the high heterogeneity of the included studies investigating laser effects. Moreover, most of them are single center and nonrandomized studies.ConclusionThe data suggest that CO2-Laser is a safe energy-based therapeutic option for the management of VVA and/or GSM symptoms in postmenopausal women; however, the quality of the body of evidence is “very low” or “low”.Filippini M, Porcari I, Ruffolo AF, et al., CO2-Laser therapy and Genitourinary Syndrome of Menopause: A Systematic Review and Meta-Analysis. J Sex Med 2022;19:452–470.     

Impact of Third-Trimester Measurement of Low Uterine Segment Thickness and Estimated Fetal Weight on Perinatal Morbidity in Women With Prior Cesarean Delivery

ObjectivesThis study aimed to estimate the impact of third-trimester ultrasound with measurement of the lower uterine segment thickness (LUST) and estimation of fetal weight (EFW) on maternal and perinatal morbidity among women with a prior cesarean delivery.MethodsWe performed a secondary analysis of the QUARISMA trial, including women who delivered at term after one prior cesarean delivery in tertiary care centres. Major and minor maternal and perinatal morbidities were compared between centres that had introduced LUST and EFW measurements into routine practice and those that had not, using generalised estimating equations and adjusted odds ratios (aOR). In a secondary analysis, we compared women who underwent a trial of labour with and without LUST and EFW measurements.ResultsWe observed a significant reduction in major perinatal morbidity (aOR 0.52; 95% CI 0.28–0.96, P = 0.04), minor perinatal morbidity (aOR 0.49; 95% CI 0.25–0.96, P = 0.04), and minor maternal morbidity (aOR 0.56; 95% CI 0.34– 0.94, P = 0.03) but no significant difference in major maternal morbidity (aOR 0.40; 95% CI 0.04–3.69, P = 0.42) in the 2 centres that had introduced third-trimester ultrasound with EFW and LUST measurements (1458 women), compared with the 4 centres (1247 women) that had not. Among women who underwent a trial of labour, we observed a reduction in major perinatal morbidity (aOR 0.25; 95% CI 0.11–0.54, P < 0.001) and a lower rate of uterine rupture (0% vs. 0.3%, P = 0.045) with LUST and EFW measurements.ConclusionThird-trimester ultrasound with EFW and LUST measurement is associated with a significant reduction in major perinatal morbidity in women with a prior cesarean delivery.     

Efficacy and safety of Buyang-Huanwu-Tang (Boyang-Hwano-Tang) in patients with vascular dementia: A systematic review and meta-analysis

BackgroundBuyang-Huanwu-Tang (Boyang-Hwano-Tang, BHT) is a widely used traditional Chinese herbal medicine for treating ischemic stroke in South Korea and China. Its efficacy in vascular dementia has been reported. There has been no comprehensive systematic review of BHT for vascular dementia.MethodsWe searched 15 electronic databases from inception to November 25, 2021. We included only randomised controlled clinical trials. Studies that used BHT alone or with Western medicine were included. Two independent reviewers conducted the screening, data extraction, and the Cochrane risk of bias and quality of evidence assessment. A meta-analysis was performed.ResultsA total of 18 eligible trials with 1254 participants were included. Of these, 15 were included in the meta-analysis. The pooled results suggested that BHT alone (mean difference [MD] 1.31; 95% confidence interval [CI] −2.94 to 5.56; P = 0.55) was similar to Western medicine alone in terms of the Mini-Mental State Examination(MMSE). Additive BHT therapy showed a significant improvement in the MMSE (MD 1.42; 95% CI 0.28 to 2.56; P = 0.01), Hasegawa Dementia Scale score (MD 3.91; 95% CI 2.87 to 4.94; P < 0.001) and total effective rate (risk ratio 1.35; 95% CI 1.20 to 1.52; P < 0.001). The overall risk of bias was unclear or high. The quality of evidence was very low to moderate. Only four studies reported minor or no adverse events.ConclusionsThe results support the clinical use of BHT for the improvement of cognitive function in patients with vascular dementia. The methodological quality of the included studies was relatively poor. Therefore, further rigorously designed trials are required.     

Effects of motor imagery on walking function and balance in patients after stroke: A quantitative synthesis of randomized controlled trials

ObjectiveThis study aimed to evaluate the effects of motor imagery (MI) on walking function and balance in patients after stroke.MethodsRelated randomized controlled trials (RCTs) were searched in 12 electronic databases (Cochrane Central Register of Controlled Trials, PubMed, Science Direct, Web of Science, Allied and Complementary Medicine, Embase, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, WanFang, and VIP) from inception to November 30, 2016, and Review Manager 5.3 was used for meta-analysis. References listed in included papers and other related systematic reviews on MI were also screened for further consideration.ResultsA total of 17 studies were included. When compared with “routine methods of treatment or training”, meta-analyses showed that MI was more effective in improving walking abilities (standardized mean difference [SMD] = 0.69, random effect model, 95% confidence interval [CI] = 0.38 to 1.00, P < 0.0001) and motor function in stroke patients (SMD = 0.84, random effect model, 95% CI = 0.45 to 1.22, P < 0.0001), but no statistical difference was noted in balance (SMD = 0.81, random effect model, 95% CI = −0.03 to 1.65, P = 0.06). Statistically significant improvement in walking abilities was noted at short-term (0 to < six weeks) (SMD = 0.83, fixed effect model, 95% CI = 0.24 to 1.42, P = 0.006) and long-term (≥six weeks) assessments (SMD = 0.45, fixed effect model, 95% CI = 0.25 to 0.64, P < 0.00001). Subgroup analyses suggested that MI had a positive effect on balance with short-term duration (0 to < six weeks) (SMD = 4.67, fixed effect model, 95% CI = 2.89 to 6.46, P < 0.00001), but failed to improve balance (SMD = 0.82, random effect model, 95% CI = −0.27 to 1.90, P = 0.14) with long-term (≥six weeks) duration.ConclusionMI appears to be a beneficial intervention for stroke rehabilitation. Nonetheless, existing evidence regarding the effects of MI in patients after stroke remains inconclusive because of significantly statistical heterogeneity and methodological flaws identified in the included studies. More large-scale and rigorously designed RCTs in future research with sufficient follow-up periods are needed to provide more reliable evidence on the effects of MI in post-stroke patients.     

Influence of the Quality of Antenatal Care on Early Breastfeeding Initiation and Exclusive Breastfeeding Among Haitian Women

ObjectiveTo assess the influence of the quality of antenatal care on early breastfeeding initiation and exclusive breastfeeding among Haitian women.DesignSecondary analysis of a cross-sectional household survey.SettingHaiti Demographic and Health Survey, 2016 to 2017.ParticipantsWomen (N = 2,489) who were 15 to 49 years of age with children younger than 24 months of age.MethodsWe used multivariable adjusted logistic regression analysis to examine the independent associations between quality of antenatal care and early breastfeeding initiation and exclusive breastfeeding.ResultsThe prevalence of early breastfeeding initiation and exclusive breastfeeding were 47.7% and 39.9%, respectively. Approximately 76.0% of the participants received intermediate antenatal care. The odds of early breastfeeding initiation were greater among participants who received antenatal care of intermediate quality than among those who did not receive antenatal care, adjusted OR (AOR) = 1.58, 95% confidence interval (CI) [1.13, 2.20]. Additionally, maternal age of 35 to 49 years (AOR = 1.53, 95% CI [1.10, 2.12]) was positively associated with early breastfeeding initiation. Factors negatively associated with early breastfeeding initiation were cesarean birth (AOR = 0.23, 95% CI [0.12, 0.42]), birth at home (AOR = 0.75, 95% CI [0.34, 0.96]), and birth in a private facility (AOR = 0.57, 95% CI [0.34, 0.96]). Factors negatively associated with exclusive breastfeeding were employment (AOR = 0.57, 95% CI [0.36, 0.90]) and birth in a private facility (AOR = 0.21, 95% CI [0.08, 0.52]).ConclusionAntenatal care of intermediate quality was positively associated with early breastfeeding initiation among women in Haiti, which highlights the influence that care during pregnancy can have on breastfeeding outcomes.     

Factors That Affect Perinatal Outcomes of the Second Pregnancy of Adolescents

Study ObjectiveWe assessed factors that might affect perinatal outcomes in second pregnancies in adolescents.Design, Setting, Participants, Interventions, Main Outcome MeasuresThis longitudinal retrospective study was carried out on 66 adolescents who experienced 2 deliveries during their adolescence. Data were collected for the first and second pregnancies. Odds ratios (ORs) and 95% confidence intervals (CIs) for adverse perinatal outcomes in the second pregnancy were calculated using a logistic regression model and SPSS software (version 17.0 for Windows; SPSS Inc, Chicago, IL). A P value < .05 was considered to indicate statistical significance.ResultsBody mass index, number of antenatal care visits, weight gain during pregnancy, incidence of anemia, smoking status, gestational week at delivery, cesarean section rate, and birth weight were similar between the first and second pregnancies of these adolescents. Neonatal intensive care unit admission rate, preeclampsia rate, low neonatal birth weight rate, and 5-minute Apgar scores <7 were significantly higher in the first than in the second pregnancy (P < .001). Age of 16 years or younger at the time of first pregnancy (OR = 1.5; 95% CI, 0.9-2.1; P < .01), less than an 18-month interval between births (OR = 1.4; 95% CI, 0.2-1.7; P < .04), presence of gestational complications in the first pregnancy (OR = 1.9; 95% CI, 1.0-3.4; P < .01), and the presence of perinatal complications in the first pregnancy (OR = 1.3; 95% CI, 1.0-1.9; P < .01) were found to be significant indicators for adverse neonatal outcomes in second pregnancies of adolescents.ConclusionWe found that the second pregnancies of adolescents were associated with fewer adverse perinatal outcomes than were their first pregnancies. However, some factors regarding the presence of perinatal complications in the first pregnancy, such as maternal age of 16 years or younger at the time of the first pregnancy and interval between first and second pregnancy of less than 18 months, were found to increase the risk of adverse perinatal outcomes for the second births.     

Increased obstetric and neonatal risks in artificial cycles for frozen embryo transfers?

Research questionWhat are the obstetric and neonatal risks for women conceiving via frozen–thawed embryo transfer (FET) during a modified natural cycle compared with an artificial cycle method.DesignA follow-up study to the ANTARCTICA randomized controlled trial (RCT) (NTR 1586) conducted in the Netherlands, which showed that modified natural cycle FET (NC-FET) was non-inferior to artificial cycle FET (AC-FET) in terms of live birth rates. The current study collected data on obstetric and neonatal outcomes of 98 women who had a singleton live birth. The main outcome was birthweight; additional outcomes included hypertensive disorder of pregnancy, premature birth, gestational diabetes, obstetric haemorrhage and neonatal outcomes including Apgar scores and admission to the neonatal ward or the neonatal intensive care unit and congenital anomalies.ResultsData from 82 out of 98 women were analysed according to the per protocol principle. There was no significant difference in the birthweights of children born between groups (mean difference –124 g [–363 g to 114 g]; P = 0.30). Women who conceived by modified NC-FET have a decreased risk of hypertensive disorders of pregnancy compared with AC-FET (relative risk 0.27; 95% CI 0.08–0.94; P = 0.031). Other outcomes, such as rates of premature birth, gestational diabetes or obstetric haemorrhage and neonatal outcomes, were not significantly different.ConclusionsThe interpretation is that modified NC-FET is the preferred treatment in women with ovulatory cycles undergoing FET when the increased risk of obstetrical complications and potential neonatal complications in AC-FET are considered.     

Long-term Quality of Life and Sexual Function After Neoadjuvant Chemotherapy and Radical Surgery for Locally Advanced Cervical Cancer

BackgroundCervical cancer survivors report the worst quality of life (QoL) among all cancer survivors and this is mainly due to their younger age and the long-term treatment sequelae.AimThe purpose of this study is to assess the long-term QoL and sexual function of locally advanced cervical cancer (LACC) patients treated with neoadjuvant chemotherapy (NACT) and radical hysterectomy (RH) instead of the standard chemoradiotherapy.MethodsThis is a retrospective case-control study including LACC patients (FIGO stage IIB-IVA) treated with the NACT-RH strategy and a control group of healthy women undergoing hysterectomy for uterine fibromatosis in the same period.OutcomesMain outcome measures were the EORTC QLQ-C30 and EORTC QLQ-CX24 for quality of life and Female Sexual Function Index (FSFI) for sexual function.ResultsOverall, 96 patients were included: 48 LACC and 48 controls. The mean age at diagnosis was 45.5 ± 9.0 and 47.0 ± 7.8, respectively (P = .38). Compared to controls, LACC patients reported lower mean scores for the global health status (69.4 ± 22.6 vs 81.2 ± 24.3; Mean Difference (MD): -11.80 [95% CI: -21.19, -2.41]; P = .016), QLQ-C30 functional scale (80.1 ± 22.6 vs 92.4 ± 14.9; MD: -12.30 [95% CI: -19.96, -4.64]; P = .002), QLQ-Cx24 functional scale (55.5 ± 25.0 vs 80.4 ± 22.4; MD: -24.00 [95% CI: -34.40, -15.40]; P < .001), and the total FSFI (19.3 ± 9.6 vs 26.2 ± 9.9; MD: -6.90 [95% CI: -10.80, -3.00]; P < .001). On the other hand, LACC patients reported higher mean scores on the QLQ-C30 (16.9 ± 22.1 vs 8.4 ± 16.6; MD: 8.50 [95% CI: 0.68, 16.32]; P = .03) and QLQ-CX24 (26.0 ± 28.8 vs 15.0 ± 11.7; MD: 11.00 [95% CI: -2.21, 19.79]; P = .01) symptoms scales.Clinical implicationsThe confirmed poor quality of life even in surgically treated LACC survivors underlines the importance of tailoring parametrectomy based on lymph node status and developing personalized strategies.Strengths and limitationsThe study assessed the long-term QoL and sexual function in the specific subpopulation of LACC patients treated with NACT-RH. Main limitations include the small sample size and the retrospective design.ConclusionLACC long-term survivors treated with NACT-RH experience poor QoL and sexual dysfunction.Palaia I, Santangelo G, Caruso G, et al. Long-term Quality of Life and Sexual Function After Neoadjuvant Chemotherapy and Radical Surgery for Locally Advanced Cervical Cancer. J Sex Med 2022;19:613–619.     

Adverse Maternal and Neonatal Outcomes in Adolescent Pregnancy

Study ObjectiveTo investigate the outcomes of adolescent pregnancy.DesignRetrospective cohort study from the Consortium on Safe Labor between 2002 and 2008.SettingTwelve clinical centers with 19 hospitals in the United States.ParticipantsNulliparous women (n = 43,537) younger than 25 years of age, including 1189 younger adolescents (age ≤ 15.9 years), 14,703 older adolescents (age 16-19.9 years), and 27,645 young adults (age 20-24.9 years).InterventionsAdjusted odds ratio (aOR) with 95% confidence interval (CI) were calculated, controlling for maternal characteristics and pregnancy complications (young adults as a reference group).Main Outcome MeasuresMaternal, neonatal outcomes, cesarean indications, and length of labor.ResultsYounger adolescents had an increased risk of maternal anemia (aOR = 1.25; 95% CI, 1.07-1.45), preterm delivery at less than 37 weeks of gestation (aOR = 1.36; 95% CI, 1.14-1.62), postpartum hemorrhage (aOR = 1.46; 95% CI, 1.10-1.95), preeclampsia or hemolysis, increased liver enzyme levels, and low platelet syndrome (aOR = 1.44; 95% CI, 1.17-1.77) but had a decreased risk of cesarean delivery (aOR = 0.49; 95% CI, 0.42-0.59), chorioamnionitis (aOR = 0.63; 95% CI, 0.47-0.84), and neonatal intensive care unit admission (aOR = 0.80; 95% CI, 0.65-0.98). Older adolescents had an increased risk of maternal anemia (aOR = 1.15; 95% CI, 1.09-1.22), preterm delivery at less than 37 weeks of gestation (aOR = 1.16; 95% CI, 1.08-1.25), and blood transfusion (aOR = 1.21; 95% CI, 1.02-1.43), but had a decreased risk of cesarean delivery (aOR = 0.75; 95% CI, 0.71-0.79), chorioamnionitis (aOR = 0.83; 95% CI, 0.75-0.91), major perineal laceration (aOR = 0.82; 95% CI, 0.71-0.95), and neonatal intensive care unit admission (aOR = 0.89; 95% CI, 0.83-0.96). Older adolescents were less likely to have a cesarean delivery for failure to progress or cephalopelvic disproportion (aOR = 0.89; 95% CI, 0.81-0.98). For adolescents who entered spontaneous labor, the second stage of labor was shorter (P < .01).ConclusionAdolescents were less likely to have a cesarean delivery. Failure to progress or cephalopelvic disproportion occurred less frequently in older adolescents. Adolescents who entered spontaneous labor had a shorter second stage of labor.