Combined traditional Chinese medicine therapy for the treatment of infertility with polycystic ovary syndrome: A network meta-analysis of randomized controlled trials.

BACKGROUND: Polycystic ovary syndrome (PCOS) infertility has attracted great attention from researchers due to its high incidence. Numerous studies have shown that Chinese medicine is effective in treating this disease, but there is a wide variety of Chinese medicine therapies available, and there is a lack of comparative evaluation of the efficacy of various Chinese medicine combination therapies in the clinic, which requires further in-depth exploration. This study aims to evaluate the efficacy of a combined traditional Chinese medicine (TCM) therapy for the treatment of infertility with PCOS using network meta-analysis (NMA). METHODS: In PubMed, web of Science, Cochrane Library, Embase, China Knowledge Network, Wanfang Data, VIP Database, China Biomedical Literature Database (SinoMed) databases, searchs were conducted for information about the randomized controlled trials (RCTs) of combined TCM therapy for the treatment of infertility with PCOS. Quality evaluation was performed using the Cochrane 5.3 risk of bias assessment tool, and NMA using Stata 16.0. RESULTS: This study comprised 28 RCTs using 8 combined TCM therapies in total. The results of the NMA showed that moxibustion + herbal, fire acupuncture + herbal, acupuncture + herbal, electroacupuncture + herbal, and acupoint application + herbal improved the clinical pregnancy rate better than acupuncture, herbal, and western medicines monotherapy (P < .05). Additionally, ear point pressure + herbal enema + herbal, acupuncture and moxibustion + herbal, fire acupuncture + herbal, and acupuncture + herbal improved the ovulation rate better than acupuncture, herbal, and western medicines monotherapy (P < .05). Moxibustion + herbal, fire acupuncture + herbal, and acupuncture + herbal are the 3 most effective therapies for improving the clinical pregnancy rate. Fire acupuncture + herbal, acupuncture + herbal, and ear point pressure + herbal enema + herbal are the 3 most effective therapies for improving the ovulation rate. CONCLUSION: The combined TCM therapy demonstrated better efficacy for the treatment of infertility with PCOS compared to acupuncture, herbal, and western medicines monotherapy. However, the optimal treatment therapy varied depending on the outcome indicators. Further large sample, high-quality, and standardized RCTs are needed to verify these findings.

The Concentration of Non-structural Carbohydrates, N, and P in Quercus variabilis Does Not Decline Toward Its Northernmost Distribution Range Along a 1500 km Transect in China.

Understanding the mechanisms that determine plant distribution range is crucial for predicting climate-driven range shifts. Compared to altitudinal gradients, less attention has been paid to the mechanisms that determine latitudinal range limit. To test whether intrinsic resource limitation contributes to latitudinal range limits of woody species, we investigated the latitudinal variation in non-structural carbohydrates (NSC; i.e., total soluble sugar plus starch) and nutrients (nitrogen and phosphorus) in mature and juvenile Chinese cork oak (Quercus variabilis Blume) along a 1500 km north-south transect in China. During the growing season and dormant season, leaves, branches, and fine roots were collected from both mature and juvenile oaks in seven sites along the transect. Tissue concentration of NSCs, N, and P did not decrease with increasing latitude irrespective of sampling season and ontogenetic stage. Furthermore, higher levels of NSCs and N in tissues of juveniles relative to mature trees were found during the dormant season. Partial correlation analysis also revealed that during the dormant season, soluble sugar, NSC, the ratio of soluble sugar to starch, and tissue nitrogen concentration were correlated positively with latitude but negatively with precipitation and mean temperature of dormant season. Our results suggest that carbon or nutrient availability may not be the driving factors of the latitudinal range limit of the studied species. Further studies should be carried out at the community or ecosystem level with multiple species to additionally test the roles of factors such as regeneration, competition, and disturbance in determining a species' northern distribution limit.

Defense pattern of Chinese cork oak across latitudinal gradients: influences of ontogeny, herbivory, climate and soil nutrients.

Knowledge of latitudinal patterns in plant defense and herbivory is crucial for understanding the mechanisms that govern ecosystem functioning and for predicting their responses to climate change. Using a widely distributed species in East Asia, Quercus variabilis, we aim to reveal defense patterns of trees with respect to ontogeny along latitudinal gradients. Six leaf chemical (total phenolics and total condensed tannin concentrations) and physical (cellulose, hemicellulose, lignin and dry mass concentration) defensive traits as well as leaf herbivory (% leaf area loss) were investigated in natural Chinese cork oak (Q. variabilis) forests across two ontogenetic stages (juvenile and mature trees) along a ~14°-latitudinal gradient. Our results showed that juveniles had higher herbivory values and a higher concentration of leaf chemical defense substances compared with mature trees across the latitudinal gradient. In addition, chemical defense and herbivory in both ontogenetic stages decreased with increasing latitude, which supports the latitudinal herbivory-defense hypothesis and optimal defense theory. The identified trade-offs between chemical and physical defense were primarily determined by environmental variation associated with the latitudinal gradient, with the climatic factors (annual precipitation, minimum temperature of the coldest month) largely contributing to the latitudinal defense pattern in both juvenile and mature oak trees.