Add-on effect of the Guizhi Fuling formula for management of reduced fertility potential in women with polycystic ovary syndrome: A systematic review and meta-analysis of randomized controlled trials.

Background: Guizhi Fuling (GZFL) pill, a traditional Chinese herbal formula including Semen Persicae, Ramulus Cinnamomi, Poria, Radix Paeoniae Alba, and Cortex Moutan, has been widely applied in the management of gynecological diseases. Objective: To evaluate the add-on effect of the GZFL formula for treating reduced fertility potential in women with polycystic ovary syndrome (PCOS) by conducting a systematic review and meta-analysis. Methods: Two reviewers independently searched the PubMed, Embase, Cochrane Library, Wanfang, SinoMed, and CKNI databases until 09/11/2022. Eligible studies were randomized controlled trials (RCTs) of the GZFL formula plus Western medicine versus the Western medicine for treating PCOS. The primary endpoint was the ovulation, pregnancy, and miscarriage rate. The secondary endpoints included the serum follicle-stimulating hormone (FSH), total testosterone, luteinizing hormone (LH), estradiol, and homeostasis model assessment insulin resistance (HOMA-IR). Results: There were 16 RCTs with 1,385 patients identified. The GZFL formula plus Western medicine significantly improved the ovulation rate (risk ratios [RR] 1.24; 95% confidence intervals [CI] 1.15-1.34) and pregnancy rate (RR 1.53; 95% CI 1.38 to 1.69) than the Western medicine alone. Adjuvant treatment with the GZFL formula also significantly decreased the serum FSH (mean difference [MD] -0.48 U/l; 95% CI -0.80 to -0.15), total testosterone (standard mean difference [SMD] -1.07; 95% CI -1.71 to -0.44), LH level (MD -2.19 U/l; 95% CI -3.04 to -1.34), and HOMA-IR (MD -0.47; 95% CI -0.60 to -0.34). However, there was no significant difference in the miscarriage rate (RR 0.89; 95% CI 0.36-2.20) and serum estradiol level (SMD 0.34; 95% CI -0.25 to 0.94) between two groups. Conclusions: The GZFL formula as adjuvant therapy can improve the ovulation and pregnancy rates in women with PCOS. Its beneficial effects may correlate with reducing FSH, total testosterone, and LH and ameliorating insulin resistance. However, more well-designed RCTs with larger samples and multicenter trials are required to confirm the current findings due to uncertainty of the evidence. Systematic review registration: PROSPERO identifier, CRD42022354530.

Postoperative acute kidney injury and early and long-term mortality in acute aortic dissection patients: A meta-analysis.

OBJECTIVE: To evaluate the impact of postoperative acute kidney injury (AKI) on early and long-term mortality in patients with acute aortic dissection by conducting a meta-analysis. METHODS: An extensive literature search was performed in PubMed and Embase databases until February 15, 2020. Observational studies that reported the associations between postoperative AKI and early (in-hospital and within 30 days) or long-term mortality in patients with acute aortic dissection were included. RESULTS: Seven studies comprising 1525 acute aortic dissection patients were identified. A random effect meta-analysis showed that postoperative AKI was significantly associated with higher risk of long-term mortality (risk ratio [RR] 2.32; 95% confidence interval [CI] 1.50-3.59). Subgroup analysis revealed that the pooled RR of long-term mortality was 1.42 (95% CI 0.90-2.22) for stage 1 AKI, 1.72 (95% CI 0.95-3.12) for stage 2 AKI, and 4.46 (95% CI 2.72-7.32) for stage 3 AKI, respectively. Furthermore, postoperative stage 3 AKI was associated with an increased risk of early mortality (RR 11.3; 95% CI 4.2-30.5). CONCLUSIONS: This meta-analysis provided clinical evidence that postoperative stage 3 AKI is associated with higher risk of early and long-term mortality, even after adjusting important confounding factors. However, the current findings should be interpreted with caution due to the retrospective nature and limited number of studies analyzed.

Circulating dehydroepiandrosterone sulfate level and cardiovascular or all-cause mortality in the elderly population: a meta-analysis.

Studies have yielded contradictory results concerning the association between dehydroepiandrosterone sulfate (DHEAS) and mortality in the elderly population. This meta-analysis aimed to evaluate the association of low serum DHEAS level with cardiovascular or all-cause mortality in the elderly population. A comprehensive literature search was conducted in PubMed and Embase databases up to 4 February, 2019. Longitudinal observational studies reporting multivariate adjusted risk ratio (RR) and corresponding 95% confidence intervals (CI) for cardiovascular or all-cause mortality with respect to baseline low DHEAS level were included. Both fixed-effect and random effect model were used to pool the overall risk estimate. Methodological quality of the included studies was evaluated using a 9-point Newcastle-Ottawa Scale. Six prospective studies enrolling 6,744 individuals were identified. Five studies were graded as high methodological quality. When compared the lowest to the reference higher circulating DHEAS level, the pooled RR of all-cause and cardiovascular mortality was 1.46 (95% CI: 1.25-1.70) and 1.49 (95% CI: 1.11-1.99), respectively. Subgroup analysis indicated that the association of low DHEAS level with all-cause mortality risk was only found in men (RR 1.41;95% CI: 1.18-1.69) but not in women (RR 1.72; 95% CI: 0.99-2.99). This meta-analysis provides evidence that low circulating DHEAS level is associated with increased risk all-cause mortality in the elderly population.

Efficacy and safety of motherwort injection add-on therapy to carboprost tromethamine for prevention of post-partum blood loss: A meta-analysis of randomized controlled trials.

Motherwort (YiMuCao), a traditional Chinese herb, has been shown beneficial effects for women's diseases. This meta-analysis aimed to evaluate the efficacy and safety of motherwort injection add-on therapy to carboprost tromethamine for prevention of post-partum blood loss. A systematic literature search was conducted in PubMed, Embase, Cochrane Library, CNKI, VIP and Wanfang from their inception to December 2017. Randomized controlled trials that determined the add-on effects of motherwort injection to carboprost for prevention of post-partum blood loss were eligible. Pooled risk ratio (RR) and mean difference (MD) with 95% confidence interval (CI) were used to summarize the effect sizes. Eight trials including 1276 pregnant women fulfilled the inclusion criteria. Prophylactic use of motherwort injection add-on therapy significantly reduced the post-partum 2 h (MD -127.5 mL; 95% CI -149.13 to -105.88) and 24 h (MD -146.85 mL; 95% CI -179.77 to -113.94) blood loss and incidence of post-partum hemorrhage (RR 0.28; 95% CI 0.17-0.45) than carboprost. Moreover, adjunctive treatment with motherwort injection significantly decreased the length of the third stage of labor (MD -3.41 min; 95% CI -4.33 to -2.49) and duration of lochia (MD -7.13 days; 95% CI -8.49 to -5.76). There was no statistical significant difference in the incidence of adverse events (RR 0.76; 95% CI 0.50-1.16). Prophylactic use of motherwort injection add-on therapy to carboprost tromethamine could reduce post-partum blood loss. However, more well-designed trials are necessary to confirm the findings of this study due to the methodological flaws of the included trials.

Mechanical properties of a resin-modified glass ionomer cement for luting: effect of adding spherical silica filler.

This study investigated the effects of spherical silica filler (SSF) on the workability and mechanical properties of resin-modified glass ionomer cements for luting (RMGICL). Varying powder/liquid ratios (P/L=2.0, 2.2, 2.4, and 2.6) of a commercially available glass ionomer cement (Fuji Lute, GC Corp.) were mixed with SSF at different weight percentages (5, 7.5, and 10%). On film thickness, statistically significant effects of SSF addition were noted at 2.5 minutes after mixing started, notably at P/L=2.4 and 2.6 when 7.5 and 10 wt% of SSF were added. The same result was also obtained for consistency evaluation. On mechanical and bonding strengths to the tooth substrate, no statistically significant differences were observed among all the SSF weight percentages within each P/L ratio. SSF-added RMGICL at a higher powder/liquid ratio exhibited increased mechanical and bonding strengths when compared to a control without SSF addition, but nonetheless maintained the film thickness with no further increase.

Correlation between craniofacial and condylar path asymmetry.

PURPOSE: The purpose of this study was to examine the correlation between the condylar path length and craniofacial morphology in patients with mandibular prognathism and deviation, and investigate changes in the condylar path length and temporomandibular joint disorders after intraoral vertical ramus osteotomy (IVRO). PATIENTS AND METHODS: Sixteen Japanese patients exhibiting mandibular prognathism and deviation were studied. For their correction, all patients underwent IVRO. In the case of patients with severe occlusal cant after cant correction by Le Fort I osteotomy, IVRO was carried out on the same day. The change in craniofacial morphology was assessed with frontal cephalograms and submentovertex radiograms. Condylar path changes were assessed using a 6 degrees of freedom measuring device. All patients were examined with regard to their temporomandibular joint (TMJ) function. RESULTS: Before treatment, mandibular deviation was moderately related to the asymmetries of craniofacial morphology and condylar path length. The rate of incidence of TMJ sounds on the deviated side was significantly higher than that on the nondeviated side. After treatment, although the condylar path length as well as condylar position had changed to become bilaterally symmetric, there was still a significant difference during protrusive excursion and maximal open-close movements. TMJ sounds disappeared in 64.3% of patients. CONCLUSION: Mandibular deviation was found to be strongly related to the morphologic and functional asymmetries in patients with mandibular prognathism and deviation. The condylar path length and condylar position were improved after the correction of mandibular deviation with IVRO.

Flexural performance of flowable versus conventional light-cured composite resins in a long-term in vitro study.

The purpose of this study was to evaluate the flexural strength, flexural modulus, modulus of resilience, and water sorption of four flowable light-cured composite resins (FCRs). Results were then compared with four conventional composite resins (CCRs) and a minifilled hybrid light-cured composite resin, which served as a control. Twenty specimens were flexural tested immediately after curing, while others were stored in water at 37 degrees C for 1 month, 3 months, 6 months, or 1 year before flexural testing. The 1-year specimens were weight-measured at designated time intervals to examine water sorption. All FCRs, except Point 4 Flowable, showed higher flexural strength values than their CCR counterparts (p < 0.05, Scheffé's test). After one-year water storage, the flexural strengths and flexural moduli of FCRs increased 1.5-fold or more when compared with the immediate condition. In most cases, the moduli of resilience of FCRs were higher than those of CCRs. In conclusion, it was found that FCR and CCR with the same brand name had very different characteristics and mechanical properties.