The maintenance effect of acupuncture on breast cancer-related menopause symptoms: a systematic review.

Background: Acupuncture has been used for many breast cancer treatment-related problems, but how long the effect lasts is unknown. This meta-analysis aims to evaluate how long the effect of acupuncture on breast cancer-related hot flushes and menopause symptoms lasts.Methods: The research design followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement, without language restrictions. Seven databases from inception through February 2019 were accessed; only randomized clinical trials (RCTs) that examined the maintenance effect of acupuncture on hot flushes or menopause symptoms after treatment were included. Cochrane criteria were followed and RevMan 5.2 software was used to analyze trials.Results: In total, 943 patients from 13 RCTs were analyzed. The meta-analysis showed that acupuncture had no significant long-term maintenance effect on the frequency or severity of hot flushes (p = 0.29; p = 0.34), but had a significant 3-month maintenance effect of ameliorating menopause symptoms at 3 months after treatment ended (p = 0.001). No adverse events were reported.Conclusions: Acupuncture significantly alleviated menopause symptoms for at least 3 months, but not hot flushes. Breast cancer patients concerned about the adverse effects of hormone therapy could consider acupuncture as an alternative. Additional acupuncture at 3 months after the initial treatment course could be considered. A large-scale study may help to define the optimal guideline for this issue.

Conformation of T4 lysozyme in solution. Hinge-bending motion and the substrate-induced conformational transition studied by site-directed spin labeling.

T4 lysozyme and mutants thereof crystallize in different conformations that are related to each other by a bend about a hinge in the molecule. This observation suggests that the wild type protein may undergo a hinge-bending motion in solution to allow substrate access to an otherwise closed active site cleft [Faber, H.R., & Matthews, B.W. (1990) Nature 348, 263-266]. To test this hypothesis, either single or pairs of nitroxide side chains were introduced into the protein to monitor tertiary contact interactions and inter-residue distances, respectively, in solution. A set of constraints for these structural parameters was derived from a reference state, a covalent enzyme-substrate adduct where the enzyme is locked in the closed state. In the absence of substrate, differences in both inter-residue distances and tertiary contact interactions relative to this reference state are consistent with a hinge-bending motion that opens the active site cleft. Quantitative analysis of spin-spin interactions between nitroxide pairs reveals an 8 A relative domain movement upon substrate binding. In addition, it is demonstrated that the I3P mutation, which produces a large hinge-bending angle in the crystal, has no effect on the solution conformation. Thus, the hinge motion is not the result of the mutation but is an integral part of T4 lysozyme catalysis in solution, as suggested recently [Zhang, X.J., Wozniak, J.A., & Matthews, B.W. (1995) J. Mol. Biol. 250, 527-552]. The strategy employed here, based on site-directed spin labeling, should be generally applicable to the study of protein conformation and conformational changes in solution.

Clinical implications of left atrial spontaneous echo contrast in nonrheumatic atrial fibrillation.

The prevalence and clinical significance of left atrial (LA) spontaneous echo contrast were investigated in 103 consecutive patients with chronic nonrheumatic atrial fibrillation (AF) using transesophageal echocardiography. LA spontaneous echo contrast was visualized in 25 of 103 patients (24.3%). Age, sex, LA diameter, left ventricular diastolic and systolic dimensions, left ventricular ejection fraction, and the percentage of lone AF were not significantly different between patients with and without LA spontaneous echo contrast; however, those with LA spontaneous echo contrast were less likely to have moderate or severe mitral regurgitation. LA thrombi were observed in 7 patients (6.8%), and all 7 thrombi were found in the atria with spontaneous echo contrast. History of cerebral ischemia or peripheral embolism, or both, was significantly more frequent in patients with than without LA spontaneous echo contrast (84 vs 18%; p less than 0.001). The presence of LA spontaneous echo contrast was highly specific (94%) and predictive for thromboembolic events (positive and negative predictive values of 84 and 82%, respectively). Thus, transesophageal echo-detected LA spontaneous echo contrast is frequently found in patients with chronic nonrheumatic AF. This phenomenon may represent a precursor of thrombus formation, and its presence is associated with an increased thromboembolic risk.