[Systematic Review and Meta-Analysis of Non-Invasive Acupoint Therapy as an Approach to Urinary Itching Control in Dialysis Patients].

BACKGROUND: Uremic pruritus, one of the most painful symptoms experienced by patients receiving dialysis, seriously affects patient quality of life and health, causes physical and mental damage, and increases hospitalization and mortality rates. Multi-modal therapies with evidence-based healthcare are needed to provide patients receiving dialysis with more convenient and feasible medical resources. PURPOSE: Relevant domestic and international research on the effectiveness and methods of non-invasive acupoint therapy in improving uremic pruritus in dialysis patients was reviewed. Discussing related knowledge can facilitate the evidence-based use of non-invasive acupoint therapy in clinical practice by clinical medical personnel. METHODS: Based on the PRISMA (preferred reporting items for systematic reviews and meta-analyses) systematic literature review and integrated analysis method, a keyword search of related articles published before September 2023 was conducted in the following databases: PubMed, Cochrane Library, Embase, Web of Science, Airiti Library, Taiwan Master and Doctoral Dissertation System, Chinese Journal Full-text Database and Wanfang Data Knowledge Service Platform. In 2019, the second version of the Risk of Bias Tool for Randomized Controlled Trials was used to evaluate research quality, after which RevMan 5.4 and Stata 14.0 suite software were used for meta-analysis. RESULTS: Nine of the 112 articles selected, including 10 sets of data and 597 participants, were included in the meta-analysis. The results indicate non-invasive acupoint therapy significantly reduces the degree of uremic pruritus (synthetic effect size = -1.30, 95% confidence interval [-1.67, -0.93], p < .00001). Because the heterogeneity test I² = 76%, showed a high degree of heterogeneity, a subgroup analysis was performed, showing that acupoint massage combined with traditional Chinese medicine fumigation and washing, a general simple itching assessment scale, and the Chinese region achieved better effect sizes. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: Non-invasive acupoint therapy is easy to implement, inexpensive, non-invasive, and associated with few side effects. The authors hope these findings may increase the awareness and understanding of patients with dialysis regarding the practical operation techniques of itching acupoints. According to the results of this systematic review and meta-analysis, massage of the lung and endocrine acupoints at ST-6, SP-10, and LI-11 as well as the relevant points on the ear may be most effective in achieving urinary itching relief. Also, acupoint massage combined with traditional Chinese medicine fumigation, ST-6 far-infrared irradiation, or LI11 transcutaneous acupoint electrical stimulation can further relieve uremic pruritus in this patient population. Based on the results, acupoint massage combined with traditional Chinese medicine fumigation and washing is a complementary method of treatment for uremic pruritus that may be recommended to patients in the future.

Atypical chemokine receptor ACKR3/CXCR7 controls postnatal vasculogenesis and arterial specification by mesenchymal stem cells via Notch signaling.

Mesenchymal stem cells (MSCs) are known to play a role in postnatal vasculogenesis and hold great promise for vascular regeneration. However, the mechanisms by which the endothelial differentiation and specification of MSCs remain unclear. We examined the potential role and molecular mechanisms of atypical chemokine receptor ACKR3/CXCR7 in MSC-mediated endothelial cell differentiation and specification. Here, we showed that vascular endothelial growth factor (VEGF) and platelet-derived growth factor (PDGF) activate CXCR7 expression on MSCs through PDGF receptors, PDGFRα and PDGFRß-mediated phosphoinositide 3-kinase (PI3K)/Akt signaling. Genetic and pharmacologic blockage of CXCR7 on MSCs suppressed the VEGF or stromal cell-derived factor 1 (SDF)-1-induced the capacity for vasculogenesis in vitro and in vivo. Moreover, CXCR7 gain of function markedly promoted vasculogenesis by MSCs in vitro and in vivo and induced endothelial differentiation along the arterial endothelial cell lineage via upregulation of Notch signaling. However, blockade of Notch signaling inhibited CXCR7-induced vasculogensis by MSCs. These results indicate CXCR7 is a critical regulator of MSC-mediated postnatal vasculogenesis and arterial specification via Notch signaling.

Intentional cryopreservation of epididymal spermatozoa from percutaneous aspiration for dissociated intracytoplasmic sperm injection cycles.

BACKGROUND: To investigate the possibility of cryopreservation of spermatozoa obtained from percutaneous epididymal sperm aspiration (PESA) in patients with obstructive azoospermia and the feasibility of intentional dissociation of PESA and intracytoplasmic sperm injection (ICSI) cycles. METHODS: Fifty-six patients with obstructive azoospermia underwent diagnostic PESA before ovarian stimulation. If spermatozoa were found, they were frozen for subsequent ICSI. The outcome was compared with 17 fresh PESA/ICSI cycles. RESULTS: Among the 56 patients, diagnostic PESA obtained spermatozoa in 51 patients. The mean motility of the spermatozoa decreased from 15.2% to 4.2% after freezing and thawing. These patients underwent 96 frozen PESA/ICSI cycles. The rates of fertilization, implantation and clinical pregnancy for frozen-thawed spermatozoa (71.6, 14.0 and 40.6%, respectively) were similar to those for fresh spermatozoa (69.2, 13.2 and 41.2%, respectively). CONCLUSIONS: Sufficient numbers of spermatozoa can be obtained for cryopreservation through PESA and the spermatozoa work well after thawing. The strategy of performing diagnostic PESA before ovarian stimulation and freezing the recovered spermatozoa for subsequent ICSI is feasible for patients with obstructive azoospermia.

Ovarian stimulation by clomiphene citrate and hMG in combination with cetrorelix acetate for ICSI cycles.

BACKGROUND: The introduction of GnRH antagonists such as cetrorelix acetate has made possible the simplification of ovarian stimulation. However, the most effective protocol for their administration has not yet been clearly defined. METHODS: Forty women with male-factor infertility undergoing 40 ICSI cycles were included in the study. Clomiphene citrate at 100 mg a day was given from cycle day 3 through day 7. hMG at 150 IU was given on cycle days 4, 6 and 8, and was adjusted from day 9 according to the follicular and hormone responses. Cetrorelix acetate at 2.5 mg was administered when the leading follicle reached 14 mm. The remaining 0.5 mg was divided into two 0.25 mg injections for possible later use. Serum FSH, LH, estradiol and progesterone levels were measured daily from the day of cetrorelix acetate injection until hCG was given. RESULTS: Serum LH level was suppressed effectively for 4 days. Four patients (10%) needed one or two additional injections of 0.25 mg cetrorelix acetate. No premature LH surge was detected in any of the women treated. Sixteen women became pregnant (40%), of which 14 pregnancies (35%) were ongoing at the time of writing. CONCLUSIONS: This study demonstrates that this new protocol is feasible for couples with male-factor infertility undergoing ICSI.

Heterotopic triplet pregnancy: report of a case with bilateral tubal pregnancy and an intrauterine pregnancy.

The first report of an ectopic pregnancy following IVF was published in 1976, and since then heterotopic pregnancies (HPs) have been reported at an increasing rate. Although cases of the co-existence of a bilateral tubal and an intrauterine pregnancy following IVF-embryo transfer have been reported, a case of heterotopic triplet pregnancy caused by unilateral tubal embryo transfer has not yet been published in the literature. Here we report on a 38-year-old women (gravida 3, para 1) with a history of infertility who presented to our infertility clinic for evaluation. Hysterosalpingography revealed bilaterally patent Fallopian tubes and stricture of the cervical canal. She conceived after receiving HMG combined with pure FSH, followed by IVF-tubal embryo transfer. Four embryos were replaced into the right tube. Approximately 5 weeks after tubal embryo transfer, the patient presented with lower abdominal tenderness and shock due to internal bleeding. She underwent an emergency laparotomy under the impression of HP. Bilateral tubal pregnancy with right tubal rupture was noted during the operation. The post-operative course was uneventful. Early intervention and thorough inspection of the peritoneal cavity in patients with haemodynamic instability can prevent jeopardizing the life of the mother as well as the ongoing pregnancy.