Effects of curcumin/turmeric supplementation on obesity indices and adipokines in adults: A grade-assessed systematic review and dose–response meta-analysis of randomized controlled trials

In the present study, we explored the effect of curcumin/turmeric supplementation on anthropometric indices of obesity, leptin, and adiponectin. We searched PubMed, Scopus, Web of Science, Cochrane Library, and Google Scholar up to August 2022. Randomized clinical trials (RCTs) investigating the impact of curcumin/turmeric on obesity indices and adipokines were included. We applied the Cochrane quality assessment tool to evaluate the risk of bias. The registration number is CRD42022350946. Sixty eligible RCTs, with a total sample size of 3691 individuals were included for quantitative analysis. We found that supplementation with curcumin/turmeric significantly reduced body weight (WMD: −0.82 kg, 95% CI: −1.30, −0.35; p = 0.001), body mass index (WMD: −0.30 kg/m², 95% CI: −0.53, −0.06, p = 0.013), waist circumference (WMD: −1.31 cm, 95% CI: −1.94, −0.69, p < 0.001), body fat percentage (WMD: −0.88%, 95% CI: −1.51, −0.25, p = 0.007), leptin (WMD = −4.46 ng/mL; 95% CI: −6.70, −2.21, p < 0.001), and increased adiponectin (WMD = 2.48 μg/mL; 95% CI: 1.34, 3.62, p < 0.001). Overall, our study shows that supplementation with curcumin/turmeric significantly improves anthropometric indices of obesity and adiposity-related adipokines (leptin and adiponectin). However, due to high between-studies heterogeneity, we should interpret the results with caution.     

Capecitabine in early breast cancer: A meta-analysis of randomised controlled trials

PurposeCapecitabine is an effective therapy for metastatic breast cancer. Its role in early breast cancer is uncertain due to conflicting data from randomised controlled trials (RCTs).MethodsPubMed and major conference proceedings were searched to identify RCTs comparing standard chemotherapy with or without capecitabine in the neoadjuvant or adjuvant setting. Hazard ratios (HRs) for disease-free survival (DFS) and overall survival (OS), as well as odds ratios (ORs) for toxicities were extracted or calculated and pooled in a meta-analysis. Subgroup analysis compared triple-negative breast cancer (TNBC) to non-TNBC and whether capecitabine was given in addition to or in place of standard chemotherapy. Meta-regression was used to explore the influence of TNBC on OS.ResultsEight studies comprising 9302 patients were included. In unselected patients, capecitabine did not influence DFS (hazard ratio [HR] 0.99, p = 0.93) or OS (HR 0.90, p = 0.36). There was a significant difference in DFS when capecitabine was given in addition to standard treatment compared with in place of standard treatment (HR 0.92 versus 1.62, interaction p = 0.002). Addition of capecitabine to standard chemotherapy was associated with significantly improved DFS in TNBC versus non-TNBC (HR 0.72 versus 1.01, interaction p = 0.02). Meta-regression showed that adding capecitabine to standard chemotherapy was associated with improved OS in studies with higher proportions of patients with TNBC (R = −0.967, p = 0.007). Capecitabine increased grade 3/4 diarrhoea (odds ratio [OR] 2.33, p < 0.001) and hand-foot syndrome (OR 8.08, p < 0.001), and resulted in more frequent treatment discontinuation (OR 3.80, p < 0.001).ConclusionAdding capecitabine to standard chemotherapy appears to improve DFS and OS in TNBC, but increases adverse events in keeping with its known toxicity profile.     

针刺辅助治疗改善急性胰腺炎患者胃肠功能的Meta分析

【目的】评价针刺疗法辅助治疗急性胰腺炎的疗效。【方法】检索中国期刊全文数据库(CNKI)、维普中文科技期刊数据库(VIP)、中国生物医学文献数据库(CBM)、万方、Pub Med、EMBase、Cochrane Library等数据库中有关以西医常规治疗作为对照组、以西医常规治疗结合针刺疗法作为观察组的急性胰腺炎疗效观察的随机对照临床试验(RCT),对符合纳入和排除标准的入选文献的质量进行系统评价;提取相关数据,采用Rev Man5.3软件进行Meta分析。【结果】共有7项RCT合计371例AP患者纳入本研究。针刺疗法辅助治疗组的腹痛缓解时间(WMD=-1.44;95%CI:-2.38,-0.50)、腹胀缓解时间(WMD=-2.50;95%CI:-4.07,-0.73)、肛门排气恢复时间(WMD=-1.79;95%CI:-3.73,-0.14)、排便时间(WMD=-1.95;95%CI:-3.51,-0.39)、肠鸣音恢复时间(WMD=-1.39;95%CI:-2.44,-0.34)、血淀粉酶恢复正常时间(WMD=-2.09;95%CI:-3.22,-0.96)、住院时间(WMD=-3.70;95%CI:-6.04,-1.36)均明显低于对照组,除肛门排气恢复时间外,其余各指标的差异均有统计学意义(P0.05)。【结论】针刺辅助治疗急性胰腺炎能显著改善患者的胃肠功能,缩短血淀粉酶恢复时间及住院时间。但由于纳入的RCT方法学质量较低,建议开展更为严格的RCT以提供充分证据支持针刺辅助治疗AP的疗效。     

Robotic assisted radical cystectomy versus open radical cystectomy: a review of what we do and don’t know

Radical cystectomy (RC) is the gold standard treatment for muscle-invasive and high-risk, noninvasive bladder cancer. Since 2003, robot-assisted radical cystectomy (RARC) has been gaining popularity. Metanalyses show that the primary advantage of RARC is less blood loss and the primary advantage of open radical cystectomy (ORC) is shorter operative times. There do not appear to be significant differences in complications, cancer-related outcomes or survival between the two approaches. Cost analyses comparing RARC and ORC are complicated by the often-ill-defined distinction between the cost to the hospital versus the cost to payors. However, it is likely that for both hospitals and payors, RARC is cost effective at high-volume centers. It is feasible that in the future, increased experience with RARC will lead to improved outcomes and justify the use of RARC over ORC.     

Effect of vitamin D supplementation on polycystic ovary syndrome: A systematic review and meta-analysis of randomized controlled trials

ObjectiveTo evaluate the effect of vitamin D supplementation on patients with PCOS.MethodsWe performed a literature search in database and identified all of the RCTs published before December 2015 that compared the effect of vitamin D supplementation with placebo or metformin in PCOS patients.Main resultsNine out of 463 identified studies were included, involving 502 women presenting with PCOS. Vitamin D supplementation had significant effect on the improvement of follicular development with a higher number of dominant follicles (OR, 2.34; 95% CI, 1.39 to 3.92). Differences in regular menstrual cycles were also observed when metformin plus vitamin D was compared with metformin alone (OR, 1.85; 95% CI, 1.01 to 3.39).ConclusionsEvidence from available RCTs suggests vitamin D supplementation may be beneficial for follicular development and menstrual cycle regulation in patients with PCOS. Additional high-quality RCTs are required to confirm the effectiveness of vitamin D on PCOS.     

Herbal medicine (Shaofu Zhuyu decoction) for treating primary dysmenorrhea: A systematic review of randomized clinical trials

Shaofu Zhuyu decoction (SFZY) or Sobokchugeo-tang, a traditional herbal formula, is used as a treatment for primary dysmenorrhea. We searched four English, seven Korean, three Chinese, and one Japanese database from inception through January 2016 without a language restriction. All randomized controlled trials (RCTs) of SFZY or modified SFZY (MSFZY) were included. Data extraction and risk of bias assessments were performed by two independent reviewers. A total of 51 potentially relevant studies were identified, and 9 RCTs met our inclusion criteria. Seven RCTs tested the effects of SFZY or modified SFZY in treating dysmenorrhea. Three RCTs showed superior effects of (M)SFZY on the response rate, while the other three RCTs failed to do so (n = 531, RR: 1.17, 95% CI: 1.09 to 1.26, P < 0.0001, I² = 0%). Three RCTs showed favorable effects of MSFZY for pain reduction compared with conventional drugs (n = 340, SMD: −1.39, 95% CI: −2.23 to −0.55, P = 0.01). Two RCTs examined the effects of modified SFZY plus conventional drugs and conventional drugs alone. The meta-analysis showed favorable effects of MSFZY (n = 206; RR, 1.12; 95% CI 1.08 to 1.36; P = 0.0009, I² = 0%). Our systemic review and meta-analysis provide suggestive evidence of the superiority of SFZY over conventional drugs for treating primary dysmenorrhea. However, the level of evidence is low because of a high risk of bias.     

Increased risk of thrombosis in antiphospholipid syndrome patients treated with direct oral anticoagulants. Results from an international patient-level data meta-analysis

Background

Direct oral anticoagulants (DOACs) are widely used for secondary prevention of venous thromboembolism (VTE) but their clinical efficacy and safety are not established in Antiphospholipid Syndrome (APS) patients. There is only one randomized controlled trial published while others are still ongoing. Many non-randomized studies have been published in this field with conflicting opinions.