影响乳牙生长发育有关因素的调查分析

目的:通过调查分析,了解影响乳牙生长发育的有关因素。方法:通过调查幼儿出生后的喂养方式、近一年内的呼吸道感染次数以及目前身高,比较乳牙萌出数及乳牙出齐率之间的关系。结果:显示幼儿乳牙萌出数及乳牙出齐率与其出生后的喂养方式无关,而与幼儿近一年内的呼吸道感染次数呈负相关、与目前身高呈正相关。结论:幼儿乳牙发育明显受呼吸道感染次数影响,与身高发育同步。     

Levels of multiple proteins in gingival crevicular fluid and intra-amniotic complications in women with preterm prelabor rupture of membranes

Objective: The primary aim of this study was to identify the association between the local inflammatory response in gingival crevicular fluid measured by the levels of multiple proteins and maternal and intra-amniotic inflammatory responses measured by maternal serum C-reactive protein (CRP) and amniotic fluid interleukin (IL)-6 concentrations, respectively, in women with preterm prelabor rupture of membranes (PPROM).

Methods: A prospective study was performed in which 78 women with singleton pregnancies complicated by PPROM between 24?+?0 and 36?+?6 weeks of gestation were included. Transabdominal amniocenteses were performed at the time of admission. A bedside assessment of amniotic fluid IL-6 was performed. Maternal serum CRP concentration was also measured at the time of admission. Gingival crevicular fluid was collected from the pocket of the selected tooth (the tooth with the deepest pocket) using standard sterile paper strips within 72?h after admission. Twenty-six proteins in the gingival crevicular fluid were assessed by multiplex the Meso-Scale technology.

Results: No correlations between the levels of proteins in the gingival crevicular fluid and maternal serum CRP and amniotic fluid IL-6 concentrations were found, except for a weak positive correlation between granulocyte macrophage colony-stimulating factor and CRP.

Conclusions: The local inflammatory response in the gingival crevicular fluid is not related to the maternal and intra-amniotic inflammatory responses in women with PPROM.     

High-visfatin levels in women with polycystic ovary syndrome: evidence from a meta-analysis

Abstract

Objective: Previous studies regarding visfatin levels in women with polycystic ovary syndrome (PCOS) showed conflicting results. To evaluate the visfatin levels in PCOS, a meta-analysis was performed. Methods: A comprehensive literature search of eligible studies in Embase, Pubmed and the Cochrane Library was undertaken through November 2014. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated to estimate the strength of the association. Results: A total of 1341 subjects (695 cases and 646 controls) were included in this meta-analysis. The pooled analysis results indicated that the visfatin levels were significantly higher in PCOS patients than that of controls (SMD?=?1.19, 95% CI 0.77–1.60, p?=?0.000). The results from stratified analysis and univariate analysis suggested that high-visfatin levels were not related to body mass index (BMI), insulin resistance (IR) and total testosterone ratio. Significant heterogeneity was observed in all analysis. Conclusion: Our results indicate that high-circulating visfatin level is an intrinsic characteristic of PCOS, which suggests visfatin could be a potential biomarker for PCOS.     

Extracorporeal Shockwave Therapy in Peyronie's Disease: Systematic Review and Meta-Analysis

BackgroundPeyronie's disease (PD) is associated with penile pain, deviation, and sexual dysfunction. Up till now, there is no conservative standard treatment for PD. However, the role of Extracorporeal Shock Wave Therapy (ESWT) is gaining increasing interest.AimTo evaluate the effect of ESWT on penile deviation, plaque size, erectile function, pain scale, and the rate of complications in PD patients.MethodsPubMed database was searched for articles published from January 2000 to November 2020, using related keywords and including randomized controlled trials (RCTs) only. Meta-analysis and forest plots were carried out using RevMan, and outcomes were reviewed by 2 authors independently. PRISMA guidelines were used in this article to achieve the quantitative and qualitative synthesis of data.OutcomesChanges in penile deviation, plaque size, erectile function, pain scale, and the rate of ESWT related complications.ResultsThe search yielded 73 articles. Three RCTs, including 117 patients in the ESWT group and 121 patients in the placebo group, were reviewed. ESWT is associated with reduction in plaque size (OR = 2.59, 95% CI (1.15–5.85), P= .02). No significant difference in reduction of penile deviation angle or rate of bruises were detected in post ESWT group when compared to placebo. No evidence was found to show an effect of ESWT on erectile function or pain scale.Clinical ImplicationsBased on the available RCTs, ESWT fails to improve penile curvature or pain in men with PD.  Although ESWT may reduce plaque size, this remains of questionable clinical significance.Strengths & LimitationsRCTs used different metrics to report the same outcome. Missed data were imputed to match the requirements of meta-analysis. However, there is still much data that cannot be estimated.ConclusionThe current data suggest that ESWT fails to improve penile curvature or pain in men with PD.  Although ESWT may reduce plaque size, this remains of questionable clinical significance, and further studies are required to confirm findings.Bakr AM, El-Sakka A. Extracorporeal Shockwave Therapy in Peyronie's Disease: Systematic Review and Meta-Analysis. J Sex Med 2021;18:1705–1714.     

A model to predict risk of postpartum infection after Caesarean delivery

Purpose: The purpose of this study is to build and validate a statistical model to predict infection after caesarean delivery (CD).

Methods: Patient and surgical variables within 30 d of CD were collected on 2419 women. Postpartum infection included surgical site infection, urinary tract infection, endomyometritis and pneumonia. The data were split into model development and internal validation (1 January–31 August; N?=?1641) and temporal validation subsets (1 September–31 December; N?=?778). Logistic regression models were fit to the data with concordance index and calibration curves used to assess accuracy. Internal validation was performed with bootstrapping correcting for bias.

Results: Postoperative infection occurred in 8% (95% CI 7.3–9.9), with 5% meeting CDC criteria for surgical site infections (SSI) (95% CI 4.1–5.8). Eight variables were predictive for infection: increasing BMI, higher number of prior Caesarean deliveries, emergent Caesarean delivery, Caesarean for failure to progress, skin closure using stainless steel staples, chorioamnionitis, maternal asthma and lower gestational age. The model discriminated between women with and without infection on internal validation (concordance index?=?0.71 95% CI 0.67–0.76) and temporal validation (concordance index?=?0.70, 95% CI 0.62, 0.78).

Conclusions: Our model accurately predicts risk of infection after CD. Identification of patients at risk for postoperative infection allows for individualized patient care and counseling.     

Circulating Angiopoietin-like 8 protein (ANGPTL8/Betatrophin) in patients with polycystic ovary syndrome: a systematic review and multi effect size meta-analysis

The association between circulating betatrophin levels and polycystic ovary syndrome (PCOS) is controversial and the studies in the literature are inconsistent. The aim of our study was to systematically review and meta-analyze all available literature comparing circulating betatrophin levels between human PCOS patients and controls. Relevant studies were retrieved by online database and manual searching. A total of 11 studies were included in this meta-analysis. The standardized mean differences (SMDs) with 95% confidence intervals (CIs) were obtained by a random-effects meta-analysis. Meta-analysis of correlations was performed for the associations of betatrophin with anthropometric, lipid and hormonal covariates in PCOS patients. The results indicated that the betatrophin levels were significantly elevated in PCOS patients as compared to non-PCOS controls (SMD = 0.73, 95% CI = 0.22–1.24, Z?=?2.83, p = .005). A one-study leave-out sensitivity analysis indicated that no single study had a significant influence on the overall outcome, suggesting the robustness of this meta-analysis. Our sub-group analysis indicated that this increase in betatrophin concentrations was regardless of normo-weight or obese body mass index (BMI) and insulin resistance might have an important role. There were significant positive correlations of betatrophin with age, free androgen index and free-testosterone in PCOS patients. In summary, regardless of BMI, the circulatory betatrophin levels are elevated in PCOS patients compared to controls. PCOS patients with higher insulin resistance had substantially higher circulating betatrophin concentrations.     

2％氟化钠防龋功效在托幼机构3～4岁儿童组三年应用观察及分析

目的：寻找简便有效的儿童防龋措施，以降低乳牙龋齿发病率。方法：选取托幼机构3～4岁儿童进行3年氟化物应用并观察疗效。结果：2％氟化钠涂布可以抑制乳牙龋齿的进展。结论：氟化钠涂布可有效防龋，但同时需要家庭和幼儿园共同配合，督促儿童养成良好的口腔卫生习惯，以期达到更好的防龋效果。     

Is There a Relationship Between Chronic Periodontitis and Erectile Dysfunction?

IntroductionChronic periodontitis (CP) is characterized with inflammation of the gingival tissues, which causes endothelial dysfunction in different organs.AimIn this study, we investigated the association of CP with the erectile dysfunction (ED).MethodsThe study group included 80 male patients with ED and 82 male patients without ED (control), aged between 30 and 40 years. The International Index of Erectile Function (IIEF) questionnaire was used to assess male sexual function, particularly the presence or absence of ED.Main Outcome MeasuresThe patients in the study and control groups were statistically compared according to their plaque index (PI), bleeding on probing (BoP), probing depth (PD), and clinical attachment level (CAL).ResultsIn the non‐ED and the ED groups, the mean age was 35.7 ± 4.8 and 34.9 ± 4.9 years, respectively. Patients' characteristics including body mass index, household income, and education status were similar in both groups (P > 0.05). Nineteen patients (23%) had severe CP in the non‐ED group; 42 patients (53%) had severe CP in the ED group. Logistic regression analysis showed a significantly high association between ED and the severity of CP (odds ratio: 3.29, 95% confidence interval: 1.36–9.55, P < 0.01). The mean values of PI, BoP, and the percentages of sites with PD >4 mm and sites with CAL >4 mm were significantly higher in the ED group than in the control group (P < 0.05). The mean values of PD and CAL were not significantly different in the two groups (P > 0.05). The decayed, missing, filled teeth scores were also significantly higher in the ED group than in the non‐ED group (P < 0.05).ConclusionOur results have suggested that CP had a high association with ED in young adults at 30–40 years. We think that it will be of benefit to consider periodontal disease as a causative clinical condition of ED in such patients. O?uz F, Eltas A, Beytur A, and Akdemir E. Is there a relationship between chronic periodontitis and erectile dysfunction? J Sex Med 2013;10:838–843.     

The effects of vitamin D supplementation on indices of glycemic control in Iranian diabetics: A systematic review and meta-analysis

Background and purposeThis systematic review and meta-analysis aimed to assess the effects of vitamin D supplements on indices of glycemic control [homeostatic model assessment-insulin resistance (HOMA-IR), hemoglobin A1C (HbA1C), fasting blood glucose (FBG), and quantitative insulin-sensitivity check index (QUICKI) and lipid profile in diabetic patients.MethodsEight databases were searched, for randomized controlled trials (RCTs) or cross-sectional and cohort studies that have been published up to December 2017. We used the comprehensive meta-analysis (CMA) software for all statistical analysis and used the I² index for assessing heterogeneity. A p value of <0.05 was considered as statistically significant.ResultsWe found 621 articles, and after the exclusion of ineligible publications, 82 studies remained to be assessed of which 37 were used for meta-analysis. Vitamin D supplementation was associated with a significant improvement in FBG (p = 0.001 and 95% CI: −0.526 to −0.136) and HbA1C (p = 0.003 and 95% CI: 1.719 to −0.361) in individuals with type 2 diabetes mellitus (T2DM); while in women with gestational diabetes mellitus (GDM) the reduction in FBG (p = 0.071 and 95% CI: −0.873 to −0.035) and HbA1C (p = 0.199 and 95% CI: 3.270 to 0.681) failed to reach statistical significance. Treatment with vitamin D supplements was associated with an improvement in HOMA-IR in pregnant diabetic women (p = 0.028 and 95% CI: 0.924 to −0.053) and for individuals with diabetes mellitus (p = 0.005 and 95% CI: 1.772 to −0.319). The pooled result of the cross-sectional meta-analysis indicated that serum vitamin D concentrations were significantly lower in diabetic patients than in healthy controls (p = 0.018 and 95% CI: 0.587 to −0.054).ConclusionThis meta-analysis suggests that vitamin D supplementation improves indices of glycemic control (FBG, HOMA-IR, and HbA1C) in patients with diabetes mellitus. Hence, vitamin D supplements may be of potential therapeutic value in diabetic patients, as an adjuvant therapy along with other treatments.     

Effect of Local Anesthetics on Postoperative Pain in Patients Undergoing Gynecologic Laparoscopy: A Systematic Review and Meta-analysis of Randomized Trials

ObjectivePain remains a common complication after gynecologic laparoscopy. Use of local anesthesia may be beneficial in reducing postoperative pain. We performed a systematic review and meta-analysis to assess whether local anesthetic decreases postoperative pain after laparoscopic gynecologic procedures.Data SourcesWe searched Cumulative Index to Nursing and Allied Health Literature, Embase, and Medline from inception to November 2020 using Medical Subject Headings and free text combinations.Methods of Trial SelectionWe included randomized controlled trials of patients undergoing gynecologic laparoscopy receiving port site subcutaneous, subfascial, or intraperitoneal local anesthetic compared with placebo or no intervention. We included 20 trials (1861 participants) with size varying between 28 and 164 participants.Tabulations, Integration, and ResultsMeta-analysis was performed with RevMan 5.3 (Cochrane Collaboration, London, United Kingdom), with standard mean differences (SMDs) and random-effects model. Port site infiltration reduces postoperative pain at 4 hours (SMD –0.25; 95% confidence interval [CI], –0.44 to –0.06; 4 trials; 545 participants) and 6 hours (SMD –0.44; 95% CI, –0.82 to –0.06; 4 trials; 455 participants) after surgery. The administration of intraperitoneal local anesthetics reduces pain at 6 hours (–1.42; 95% CI, –3.22 to –0.30; 4 trials; 277 participants) after surgery.ConclusionsThe use of port site and intraperitoneal local anesthetic decreases immediate postoperative pain in patients undergoing gynecologic laparoscopy, although its impact on analgesia requirements is unclear. Routine usage of local anesthetics should be considered for people undergoing gynecologic laparoscopy.     

Enfermedad periodontal y diabetes mellitus gestacional: estudio caso-control

BackgroundStudies linking periodontal disease (PD) and gestational diabetes mellitus (GDM) are not consistent. Our main objective is to evaluate the possible association between PD and GDM. We also analysed the risk factors for GDM in our sample.Methods180 pregnant women participated, 90 with GDM and 90 controls, from Valencia's Hospital La Fe. A questionnaire was completed and a periodontal examination was performed, assessing the following parameters: number of teeth, plaque and bleeding on probing indices, probing depth (PD) and clinical attachment level (CAL). Periodontitis was defined according to the criteria of CDC-AAP.ResultsThe GDM group had a higher mean value of PD (p = .001) and CAL (p = .028). Of the patients with GDM, 74.4% had gingival inflammation compared to 57.8% of the non-diabetic patients. Periodontitis was more prevalent in patients with GDM (p < .05). Maternal age, educational level and periodontitis are independent risk factors for GDM (OR = 1.16, 95% CI 1.07 to 1.25, p < .001), (OR = .37, 95% CI .19 to .72, p < .005) and (OR = 2.79, 95% CI 1.40 to 5.59, p < .005) respectively.ConclusionsThe results suggest that pregnant women with gestational diabetes have more associated periodontal disease than those without gestational diabetes. In our sample, the risk for GDM can be estimated from periodontitis, age, and educational level.     

Meta-analysis and bias in research reviews

This article provides an overview of meta-analysis, a statistical technique that has become common within the health sciences in recent years. In comparison with the traditional narrative review, meta-analysis provides a more effective means of tackling the difficulties that arise in the production of an integrative survey of research on a phenomenon. Even when a solution to a particular methodological problem has not yet been found, meta-analysis often serves a useful function by supplying a framework for characterizing and exploring the nature and extent of the problem. Publication bias is an enduring unsolved problem faced by all methods of research synthesis. Using the framework provided by meta-analysis, it is possible to determine the impact of publication bias on the frequency of spurious conclusions in a discipline. By ascertaining the strength of publication bias in a wide variety of circumstances, it is possible to distinguish those conclusions of a research review in which one can have confidence from those that are less well-founded.     

Maternal anemia during pregnancy and small for gestational age: a systematic review and meta-analysis

Objective: Anemia is a major public health and nutritional problem in the world. Studies have reported the relationship between anemia during pregnancy and small for gestational age (SGA). Therefore, the present systematic review and meta-analysis was conducted to determine the relationship between maternal anemia during pregnancy and SGA.

Method: This meta-analysis was conducted without time limit until April 2017 based on the PRISMA protocol. Several international databases including Cochrane, Scopus, Web of Science (ISI), Pubmed, Embase, and Google Scholar search engine were searched independently by two researchers. The keywords include: anemia, pregnant women, gestational age, and pregnancy. The relative risk (RR) and 95% confidence interval were estimated regarding to the significance of the I² index based on the random effects model. Data were analyzed using Comprehensive Meta-Analysis Software version 2.

Results: Ten studies with a sample size including 620 080 pregnant women entered the meta-analysis process. The overall relationship between maternal anemia during pregnancy and SGA was not significant (RR?=?1.11 [95%CI: 0.99–1.24, p?=?.074]). The relationship between anemia during pregnancy and SGA based on pregnancy trimester showed that maternal anemia was significant in the first trimester, (RR?=?1.11 [95%CI: 1–1.22, p?=?.044]), but this relationship was not significant in the second trimester (RR?=?1.11 [95%CI: 0.85–1.18, p?=?.91]).

Conclusions: Maternal anemia in the first trimester of pregnancy can be considered as a risk factor for negative pregnancy outcomes (SGA).     

A systematic review and meta-analysis of lifestyle and body mass index predictors of successful assisted reproductive technologies

Objective: Lifestyle (smoking, drinking alcohol) and body mass index (BMI) predictors of successful outcomes in assisted reproductive technology (ART) treatments were examined in this meta-analysis.

Method: A bibliographic search was undertaken using six databases. The review was informed by PRISMA/MOOSE guidelines. Meta-analytic data were analysed using random effects models.

Results: We included 77 studies examining effects of BMI, smoking and drinking alcohol. Patients with a BMI<?=24.9 were significantly more likely to achieve LB/pregnancy than with BMI>?=25 OR?=?1.219 (95% CI:1.128–1.319, z?=?4.971, p?<?.001; I²?=?53.779%, p?=?.001). Non-smokers were significantly more likely to achieve a LB or pregnancy than smokers OR?=?1.457 (95% CI:1.228–1.727, z?=?4.324, p?<?.001; I²?=?51.883; p?=?.001). Meta-regression revealed the number of embryos transferred significantly moderated the effects of smoking on ART outcomes, and there was a trend indicating primary infertility and high BMI were also significant moderators. The evidence for drinking alcohol was inconclusive due to the small number of studies.

Conclusions: This meta-analysis confirms that ART treatment success can be predicted with lifestyle factors. Further, non-smokers’ relative odds of pregnancy/live birth increase as more embryos were transferred but there was a trend that the odds of pregnancy/live birth decrease with primary infertility and high BMI.     

Effect of aromatherapy massage on pain in primary dysmenorrhea: A meta-analysis

ObjectiveThis meta-analysis investigates the effect of aromatherapy massage on pain in primary dysmenorrhea.MethodsRandomized controlled trials were searched by keywords in several databases (Pubmed, ISI Web of Sciences, and Google Scholar). Six randomized controlled trials that included 362 participants with primary dysmenorrhea, comparing abdominal aromatherapy massage (n = 184) with massage with placebo oils (n = 178), were analyzed in the meta-analysis. The change in the visual analogue scale (VAS) pain score from the first menstruation cycle to the second cycle at the first menstruation day was used as the primary outcome.ResultsAromatherapy massage with essential oils was superior to massage with placebo oils (standardized mean difference = −1.06 [95% CI: −1.55 to −0.55]).ConclusionAbdominal aromatherapy massage with essential oils is an effective complementary method to relieve pain in primary dysmenorrhea.     

The effect of intestinal flora intervention on bone development in children: A systematic review and meta-analysis

BackgroundThe intestinal flora is involved in the bone development of children through a variety of mechanisms, but it remains unclear whether intervention of the intestinal flora can enhance children's bone development.MethodsSix databases (PubMed, Web of Science, Embase, Cochrane Library, Cumulative Index to Nursing and Allied Health, and China National Knowledge Infrastructure) were searched for all English and Chinese studies published up to August 2021. Stata version 16.0 (StataCorp, College Station, TX, USA) was used. Bone mass density and biochemical markers related to bone metabolism were reported as the primary outcome, and the secondary outcomes were anthropometric parameters such as height, height Z score for age, and height velocity. Intergroup differences were determined by standardized mean differences (SMDs) and 95% confidence intervals (CIs).ResultsA total of 3245 participants from 20 RCTs and 370 participants from 8 crossover trials were included in the study. Significant differences were found in bone mineral density (SMD 0.47; 95% CI, 0.28 to 0.66; p < 0.001; I² = 0.00%) and total serum calcium (SMD 1.07; 95% CI, 0.39 to 1.74; p < 0.001; I² = 61.9%), as well as in height Z score for age (SMD = 0.11; 95% CI, 0.00 to 0.22; P = 0.044; I² = 0%). The overall quality of evidence ranged from moderate to very low.ConclusionsThis systematic review and meta-analysis suggested that intestinal flora intervention was an effective method of improving bone mineral density, serum calcium, and height in infants, children, and adolescents. Future studies with a larger sample size and longer intervention period are needed.The protocol of this systematic review was registered in PROSPERO and the registered number was CRD42021282606.     

Endothelial Nitric Oxide Synthase Polymorphisms and Erectile Dysfunction: A Meta-Analysis

Introduction and AimsErectile dysfunction (ED) is a frequent disorder in men and has a serious impact on the quality of the patient's life. Recent studies have examined the relationship between endothelial nitric oxide synthase (eNOS) polymorphisms and ED. However, the results remain inconclusive. The present study aimed to offer an actual view of estimating the correlation between eNOS polymorphisms and ED.MethodsWe performed a meta-analysis to estimate the association between eNOS polymorphisms and ED risk. Databases employed for data mining until December 1, 2014 included PubMed, Web of Science, and the Chinese National Knowledge Infrastructure. Two study investigators independently conducted a literature search and data extraction. Odds ratios (ORs) with 95% confidence intervals for the risk were calculated by using a random effects model or fixed effects model.ResultsA total of 20 studies in 13 publications were included in the meta-analysis. In the overall comparison, the eNOS G984T polymorphism was associated with an increased ED risk in allele contrast, dominant, heterozygote, and homozygote models (allele contrast: OR = 1.514, 95% confidence interval [CI]: 1.019–2.248). For 4 VNTR polymorphisms, the overall analysis showed a significant association between homozygote comparison and recessive genetic model (homozygote comparison: OR = 1.917, CI: 1.073–3.424). The eNOS T786C polymorphism increased ED risk in allele contrast, homozygote, and recessive models (allele contrast: OR = 1.588, CI: 1.316–1.915). Significant heterogeneity was mainly observed in studies on the G894T polymorphism. No publication bias was detected in all of the variants.ConclusionThe eNOS polymorphisms G894T, 4 VNTR, and T786C were associated with an increased risk for ED. However, these results are still preliminary. Further studies based on different confounders and using a large population size should be conducted to generate more accurate and reliable conclusions. Liu C, Lu K, Tao T, Zhang L, Zhang X, Jiang L, Huang Y, Guan H, Chen M, and Xu B. Endothelial nitric oxide synthase polymorphisms and erectile dysfunction: A meta-analysis. J Sex Med 2015;12:1319–1328.     

The effectiveness and safety of Jihwang-eumja (Dihuang Yizi) compared to Western medications in patients with Alzheimer's disease: A systematic review and meta-analysis

Background and purposeJihwang-eumja is reported to be effective in decreasing β-amyloid expression and activating monoamine oxidase and acetylcholinesterase in rat models. This systematic review aims to evaluate the effectiveness of Jihwang-eumja in Alzheimer's disease compared to Western medications.MethodsWe searched Medline, Embase, CENTRAL, CINAHL, CNKI, ScienceON, KISS, and Kmbase. Randomized controlled trials comparing the effectiveness of Jihwang-eumja and Western medications on the cognition and the activities of daily living in Alzheimer's disease were included. The results were synthesized using meta-analysis. The risk of bias was evaluated using the Cochrane risk-of-bias tool, and the evidence level of each outcome was suggested using the GRADE system.ResultsA total of 165 studies were screened, and six were included in the systematic review and meta-analysis. A total of 245 and 240 participants were included in the intervention and comparison groups, respectively. The results showed that Mini-Mental State Examination was 3.19 (95%CI: 1.68–4.70) higher, and the standardized mean difference of activities of daily living was 1.13 (95%CI: 0.89–1.37) higher in the Jihwang-eumja group than in Western medications group. The included studies contained some concerns of the risk of bias, and the certainty of the evidence was considered moderate.ConclusionDespite the small number of studies and high heterogeneity, we could verify the applicability of Jihwang-eumja for Alzheimer's disease.     

Penile Rehabilitation Therapy Following Radical Prostatectomy: A Meta-Analysis

BackgroundPenile rehabilitation, defined as the use of any drug or device at or after radical prostatectomy to maximize erectile function recovery, is commonly used for post-prostatectomy erectile dysfunction; however, conflicting results based on each study make it difficult to give a recommendation for clinical practice.AimTo clarify the effect of oral phosphodiesterase type 5 inhibitors (PDE5is), vacuum erection devices, intracorporeal injection therapy, and the combination of these treatments on penile rehabilitation.MethodsA comprehensive publication search was done through the PubMed and Embase databases up to February 8, 2017. The reference lists of the retrieved studies also were investigated. Data were analyzed using STATA 12.0. A fixed- or random-effects model was used to calculate the overall combined odds ratio (OR) or standard mean differences (SMDs). Publication bias was assessed using the Begg and Egger tests.OutcomesChange in sexual function before and after treatment.ResultsAfter screening, 11 randomized controlled trials and 5 case-control studies were included. The overall meta-analysis showed that penile rehabilitation with PDE5is, vacuum erection devices, and intracorporeal injection significantly increased the number of patients with erectile function improvement (OR = 2.800, 95% CI = 1.932–4.059, P = .000) and International Index of Erectile Function (IIEF) score (SMD = 5.896, 95% CI = 4.032–7.760, P = .000). In subgroup analysis based on study design, randomized controlled trials and case-control studies showed that penile rehabilitation increased the number of patients with erectile function improvement (randomized controlled trials: OR = 2.154, 95% CI = 1.600–2.895, P = .000; case-control studies: OR = 2.800, 95% CI = 1.932–4.059, P = .000). Subgroup analysis for PDE5i treatment also only demonstrated an increased patient response rate (OR = 2.161, 95% CI = 1.675–2.788, P = .000) and IIEF scores (SMD = 0.922, 95% CI = 0.545–1.300, P = .000). However, after PDE5i washout, there was no improvement of spontaneous erectile function (OR = 1.027, 95% CI = 0.713–1.478, P = .610).Clinical TranslationThis study provides information about the efficacy of penile rehabilitation that can help clinicians decide treatment strategies.Strengths and LimitationsThis meta-analysis has higher statistical power than each study. Preoperative patient characteristics, various treatment methods, and different follow-up times might bring bias to pooled effects.ConclusionOur meta-analysis confirmed that administration of PDE5is, vacuum erection devices, and intracorporeal injection after radical prostatectomy can increase erection function during treatments. However, current evidence does not support that penile rehabilitation with PDE5is can improve recovery of spontaneous erectile function. Further studies with adequate follow-up and larger samples should be conducted to generate a comprehensive conclusion.Liu C, Lopez DS, Chen M, Wang R. Penile Rehabilitation Therapy Following Radical Prostatectomy: A Meta-Analysis. J Sex Med 2017;14:1496–1503.