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Endocrine Journal Sep 2020Androgen regulates the function of lacrimal and meibomian glands, and its deficiency is a pathological factor underlying dry eye disease (DED). However, no androgen has...
Androgen regulates the function of lacrimal and meibomian glands, and its deficiency is a pathological factor underlying dry eye disease (DED). However, no androgen has been approved for treating DED due to lack of definite evidence regarding its efficacy and safety in clinics. In this systematic review, we have summarized the clinical studies on the safety and efficacy of androgen replacement therapy (ART) for DED. Medline (via Pubmed), Embase, Clinicaltrials.gov, Wanfang and Chinese Clinical Trials Registry Database were searched for the relevant prospective studies, and 7 studies wherein androgen was applied topically via eye drops or systemically via oral or transdermal administration were included. The quality of these studies was assessed with the Cochrane Collaboration's tool for assessing risk of bias and methodological index for non-randomized studies. Most studies showed that androgen effectively improved dry eye-related symptoms and increased tear secretion. Furthermore, elderly men and peri-menopausal women with lower levels of circulating androgens responded better to ART. However, one study involving patients with Sjögren's syndrome showed no improvement in the ART group compared to the placebo control, or to the baseline level. Adverse effects were also common but limited to mild skin problems. In conclusion, androgen is a potential treatment for dry eye disease, especially for people with primary androgen deficiency. Short-term application is relatively safe.
Topics: Androgens; Dry Eye Syndromes; Hormone Replacement Therapy; Humans; Treatment Outcome
PubMed: 32814731
DOI: 10.1507/endocrj.EJ20-0178 -
Zhejiang Da Xue Xue Bao. Yi Xue Ban =... May 2020To evaluate the efficacy of black cohosh extracts (BCE) in improving the low estrogen status induced by postoperative gonadotropin-releasing hormone agonist (GnRHa) in...
OBJECTIVE
To evaluate the efficacy of black cohosh extracts (BCE) in improving the low estrogen status induced by postoperative gonadotropin-releasing hormone agonist (GnRHa) in patients with endometriosis.
METHODS
Randomized clinical controlled trial about the improvement of low estrogen status caused by GnRHa with the treatment of BCE in patients with endometriosis after laparoscopic surgery were retrieved from Medline (Ovid), PubMed, Cochrane Library, CNKI, CBMdisc, Wanfang and VIP databases before January 2020, and meta-analysis of included studies was performed by Revman 5.3 software.
RESULTS
Seven randomized controlled trials involving 745 patients were included in this study. Meta-analysis results showed that the addition of BCE did not alter hormone levels of patients, including serum estradiol levels [ =1.24, 95% (-4.58, 7.08), >0.05] and luteinizing hormone levels [ =-0.02, 95% (-0.15, 0.11), >0.05]. BCE effectively improved the perimenopausal symptoms induced by low estrogen status:improving hectic fever and sweating [ =0.1, 95% (0.02, 0.47), < 0.01], reducing the occurrence of insomnia symptoms [ =0.23, 95% (0.13, 0.39), < 0.01], improving fatigue [ =0.09, 95% (0.04, 0.20), < 0.01], reducing the occurrence of vaginal dryness [ =0.04, 95% (0.01, 0.30), < 0.01]. BCE affected Kupperman's menopausal index (KMI) score 12 weeks after the surgery [ =-11.50, 95% (-20.09, -2.90), < 0.01] and KMI score 24 weeks after the surgery [ =-23.68, 95% (-39.66, -7.69), < 0.01].
CONCLUSIONS
The limited evidence so far indicates that BCE could efficiently improve perimenopausal symptoms cause by low estrogen status of the patients recieved GnRHa treatment after surgery for endometriosis, but does not alter hormone levels of patients.
Topics: Cimicifuga; Endometriosis; Estrogens; Female; Humans; Plant Extracts
PubMed: 32762163
DOI: 10.3785/j.issn.1008-9292.2020.06.06 -
Journal of the National Cancer Institute Nov 2020Cyclin-dependent kinases 4 and 6 (CDK4/6) inhibitors + endocrine therapy (ET) prolonged progression-free survival as first- or second-line therapy for hormone... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Cyclin-dependent kinases 4 and 6 (CDK4/6) inhibitors + endocrine therapy (ET) prolonged progression-free survival as first- or second-line therapy for hormone receptor-positive (HR+)/HER2-negative metastatic breast cancer prognosis. Given the recent publication of overall survival (OS) data for the 3 CDK4/6-inhibitors, we performed a meta-analysis to identify a more precise and reliable benefit from such treatments in specific clinical subgroups.
METHODS
We conducted a systematic literature search to select all available phase II or III randomized clinical trials of CDK4/6-inhibitors + ET reporting OS data in first- or second-line therapy of HR+/HER2-negative pre- or postmenopausal metastatic breast cancer. A random effect model was applied for the analyses. Heterogeneity was assessed with I2statistic. Subgroup analysis was performed to explore the effect of study-level factors. The project was registered in the Open Science Framework database (doi: 10.17605/OSF.IO/TNZQP).
RESULTS
Six studies were included in our analyses (3421 patients). A clear OS benefit was observed in patients without (hazard ratio [HR] = 0.68, 95% confidence interval [CI] = 0.54 to 0.85, I2 = 0.0%) and with visceral involvement (HR = 0.76, 95% CI = 0.65 to 0.89, I2 = 0.0%), with at least 3 metastatic sites (HR = 0.75, 95% CI = 0.60 to 0.94, I2 = 11.6%), in an endocrine-resistant (HR = 0.79, 95% CI = 0.67 to 0.93, I2 = 0.0%) and sensitive subset (HR = 0.73, 95% CI = 0.61 to 0.88, I2 = 0.0%), for younger than 65 years (HR = 0.80, 95% CI = 0.67 to 0.95, I2 = 0.0%) and 65 years or older (HR = 0.71, 95% CI = 0.53 to 0.95, I2 = 44.4%), in postmenopausal (HR = 0.76, 95% CI = 0.67 to 0.86, I2 = 0.0%) and pre- or perimenopausal setting (HR = 0.76, 95% CI = 0.60 to 0.96, I2 = 0.0%) as well as in chemotherapy-naïve patients (HR = 0.72, 95% CI = 0.55 to 0.93, I2 = 0.0%).
CONCLUSIONS
CDK4/6-inhibitors + ET combinations compared with ET alone improve OS independent of age, menopausal status, endocrine sensitiveness, and visceral involvement and should be preferred as upfront therapy instead of endocrine monotherapy.
Topics: Antineoplastic Combined Chemotherapy Protocols; Breast Neoplasms; Clinical Trials, Phase II as Topic; Clinical Trials, Phase III as Topic; Cyclin-Dependent Kinase 4; Cyclin-Dependent Kinase 6; Female; Humans; Letrozole; Neoplasm Metastasis; Piperazines; Protein Kinase Inhibitors; Pyridines; Randomized Controlled Trials as Topic
PubMed: 32407488
DOI: 10.1093/jnci/djaa071 -
The Cochrane Database of Systematic... Mar 2020Diagnosis of endometrial (womb) cancer is normally made at an early stage, as most women with the disease experience abnormal vaginal bleeding, which prompts them to... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Diagnosis of endometrial (womb) cancer is normally made at an early stage, as most women with the disease experience abnormal vaginal bleeding, which prompts them to seek medical advice. However, delays in presentation and referral can result in delay in diagnosis and management, which can lead to unfavourable treatment outcomes. This is particularly a problem for pre- and peri-menopausal women. Providing educational information to women and healthcare providers regarding symptoms relating to endometrial cancer may raise awareness of the disease and reduce delayed treatment.
OBJECTIVES
To assess the effectiveness of health education interventions targeting healthcare providers, or individuals, or both, to promote early presentation and referral for women with endometrial cancer symptoms.
SEARCH METHODS
We searched CENTRAL, MEDLINE and Embase. We also searched registers of clinical trials, abstracts of scientific meetings and reference lists of review articles.
SELECTION CRITERIA
We planned to include randomised controlled trials (RCTs), both individually randomised and cluster-RCTs. In the absence of RCTs we planned to include well-designed non-randomised studies (NRS) with a parallel comparison assessing the benefits of any type of health education interventions.
DATA COLLECTION AND ANALYSIS
Two review authors independently evaluated whether potentially relevant studies met the inclusion criteria for the review, but none were found.
MAIN RESULTS
A comprehensive search of the literature yielded the following results: CENTRAL (1022 references), MEDLINE (2874 references), and Embase (2820 references). After de-duplication, we screened titles and abstracts of 4880 references and excluded 4864 that did not meet the review inclusion criteria. Of the 16 references that potentially met the review inclusion, we excluded all 16 reports after reviewing the full texts. We did not identify any ongoing trials.
AUTHORS' CONCLUSIONS
There is currently an absence of evidence to indicate the effectiveness of health education interventions involving healthcare providers or individuals or both to promote early presentation and referral for women with endometrial cancer symptoms. High-quality RCTs are needed to assess whether health education interventions enhance early presentation and referral. If health education interventions can be shown to reduce treatment delays in endometrial cancer, further studies would be required to determine which interventions are most effective.
Topics: Awareness; Endometrial Neoplasms; Female; Health Education; Health Knowledge, Attitudes, Practice; Humans; Randomized Controlled Trials as Topic; Referral and Consultation; Uterine Hemorrhage
PubMed: 32168393
DOI: 10.1002/14651858.CD013253.pub2 -
Current Medicinal Chemistry 2021Objective and Aims: This study aims to conduct a systematic review and meta-analysis for prospective studies to investigate the improvement effects of natto on bone... (Meta-Analysis)
Meta-Analysis
UNLABELLED
Objective and Aims: This study aims to conduct a systematic review and meta-analysis for prospective studies to investigate the improvement effects of natto on bone mineral density (BMD) in perimenopausal women.
METHODS
PubMed, EMBASE and Cochrane database searched upto February 2019. This study was carried out according to the PRISMA guidelines10 for systematic reviews. The protocol of the review was registered in the PROSPERO registry (CRD42019133183).
RESULTS
The review identified 3 unique prospective studies comprising 1658 non-overlapping participants. Meta-analysis showed that natto could significantly improve lumbar bone mineral density (BMD) (P=0.002, WMD=0.26; 95% CI:0.09-0.43) in cohort studies. However, the randomized controlled study showed no statistical difference between the two (P=0.31, WMD=0.05; 95% CI:- 0.05-0.15). In addition, natto significantly improved the BMD of the femoral neck in a cohort study and randomized control study (P=0.03, WMD=0.42). 95% CI:0.05-0.79, I2= 72%); (P < 0.0001, WMD=0.16; 95% CI:0.08-0.24), respectively. However, all studies demonstrated that natto has no improvement effects on a hip joint (BMD). In that, the cohort study showed no statistical significance between the natto intake group and the control group (P=0.21, WMD=0.10). 95% CI:-0.06-0.25, I2= 18%) and the randomized controlled study also showed no statistical significance between the natto intake group and the control group (P=0.09, WMD=-0.06). 95% CI:-0.13- 0.01).
CONCLUSION
Through our current systematic review and meta-analyize of these prosepctive studies of natto's anti-osteoporostic effecs on BMD, we found that the dietary intake of natto demonstrated a improving effects on the BMD of the femoral neck, but has no effects on the hip joint. Such interesting results may be related to the differences between anatomical structure between various tissues. Besides that, the results of the RCT study and cohort study on the lumbar spine were not the same, which may be related to the fact that participants in the RCT study were Caucasian and participants in the cohort study were Asian. Therefore, more large-sample and high-quality RCT studies are needed to further clarify the improvement effect of natto on osteoporosis.
Topics: Bone Density; Cohort Studies; Female; Humans; Osteoporosis; Perimenopause; Prospective Studies; Randomized Controlled Trials as Topic; Soy Foods
PubMed: 32141414
DOI: 10.2174/0929867327666200306123140 -
Evidence-based Complementary and... 2020To determine the effectiveness and safety of acupuncture for perimenopausal depression. (Review)
Review
OBJECTIVE
To determine the effectiveness and safety of acupuncture for perimenopausal depression.
METHODS
We searched the Cochrane Central Register of Controlled Trials, PubMed, EMBASE, CNKI, VIP Citation Databases, Wan Fang, and online trial registries such as ClinicalTrials.gov for randomized controlled trials (RCTs) assessing the efficacy and safety of acupuncture for perimenopausal depression. Literature screening, data extraction, and determination of the risk of bias were performed by two researchers independently. The extracted data were pooled and meta-analyzed using RevMan5.3 software.
RESULTS
In total, 16 RCTs covering 1311 patients were enrolled. Overall, the results showed that acupuncture was more effective in the treatment of perimenopausal depression than antidepressants (OR = 2.68, 95% CI (1.84, 3.90), < 0.00001). Furthermore, HAMD scores in the manual acupuncture group and electroacupuncture group were lower than those of antidepressants (manual acupuncture vs. antidepressants (MD = -2.35, 95% CI (-2.93, -1.77), < 0.00001) and electroacupuncture vs. antidepressants (MD = -1.2, 95% CI (-1.92, -0.48), =0.001)). Data analysis revealed that the treatment effect of acupuncture was more stable than that of antidepressants (MD = -2.4, 95% CI (-3.37, -1.43), < 0.00001). Moreover, acupuncture was safer than antidepressants based on the incidence of adverse events (OR = 0.23, 95% CI (0.1, 0.52), =0.0004). But acupuncture has no effect on estrogen levels ( ≥ 0.05).
CONCLUSIONS
Acupuncture for perimenopausal depression is safe and effective. Moreover, it has more stable long-term effects than antidepressants and hormone replacement therapy (HRT). We recommend acupuncture as a clinical treatment of perimenopausal depression.
PubMed: 32051687
DOI: 10.1155/2020/5865697 -
Journal of Advanced Nursing May 2020To evaluate the efficacy of exercise-based interventions and mind-body therapies on quality of life, menopausal symptoms, and depression among Asian perimenopausal women. (Meta-Analysis)
Meta-Analysis
Efficacy of mind-body therapies and exercise-based interventions on menopausal-related outcomes among Asian perimenopause women: A systematic review, meta-analysis, and synthesis without a meta-analysis.
AIMS
To evaluate the efficacy of exercise-based interventions and mind-body therapies on quality of life, menopausal symptoms, and depression among Asian perimenopausal women.
DESIGN
A systematic review, meta-analysis, and synthesis without meta-analysis (SWiM).
DATA SOURCES
Six electronic databases were systematically searched: PubMed, CINAHL, Embase, PsycINFO, Scopus, and ProQuest.
REVIEW METHODS
The point of inception of each database to 15 November 2018 were systematically searched. A meta-analysis and SWiM were used to present the results. Review Manager 5.3 and The Cochrane Risk of Bias tool were used for meta-analyses and assessing of risk of bias, respectively.
RESULTS
In all, 23 studies were reviewed. Significant effects in exercise-based interventions and mind-body therapies were found for quality of life, menopausal symptoms, and depression but not for hot flashes. Limitations of this review include insufficient blinding of participants and/or researchers found in most of the included studies and high levels of heterogeneity in the meta-analyses. Evidence found in this review is to be interpreted with caution.
CONCLUSION
Healthcare professionals can consider exercise-based interventions or mind-body therapies to manage menopausal symptoms. Future trials of good quality can examine the cost-effectiveness and optimal intervention duration. Intervention effects on specific menopausal symptoms such as sleeplessness in Asia can be examined in future.
IMPACT
Exercise-based interventions and mind-body therapies suggest effectiveness on quality of life, menopausal symptoms, and depression among Asian perimenopausal women. Exercise-based interventions and mind-body therapies improve quality of life, menopausal symptoms, and depression but not hot flashes. Long-term exercise-based interventions is effective in managing depression. Due to varied limitations in the review and included studies, firm conclusions cannot be reached. Healthcare professionals in Asia can consider implementing exercise-based interventions and mind-body therapies for symptomatic perimenopausal Asian women.
Topics: Adult; Asia; Asian People; Depressive Disorder; Exercise Therapy; Female; Hot Flashes; Humans; Menopause; Middle Aged; Mind-Body Therapies; Perimenopause; Quality of Life
PubMed: 31950541
DOI: 10.1111/jan.14304 -
Maturitas Feb 2020The aim of this systematic review and meta-analysis was to clarify the effect of a specific standardised extract of red clover (Trifolium pratense) on the lipid profile... (Meta-Analysis)
Meta-Analysis
AIM
The aim of this systematic review and meta-analysis was to clarify the effect of a specific standardised extract of red clover (Trifolium pratense) on the lipid profile of perimenopausal and postmenopausal women.
METHODS
Medline (PubMed), EMBASE, and Cochrane Library electronic databases were searched for papers in English reporting randomized controlled trials published up to 2017. Reference lists from those papers were checked for further relevant publications. Studies were identified and reviewed for their eligibility for inclusion in this review. The changes from baseline in the levels of individual components of the lipid profiles were used to assess differences between the active treatment and placebo groups. Weighted mean differences and 95 % confidence intervals were calculated for continuous data using a random-effects model.
RESULTS
Ten eligible studies (twelve comparisons) with 910 peri- and postmenopausal women were selected for systematic review. The meta-analysis showed changes in serum levels: total cholesterol, -0.29 (95 % CI: -0.53 to -0.06) mmol/L [-11.21 (95 % CI: -20.49 to -13.92) mg/dL], p = 0.0136; LDL-cholesterol, -0.13 (95 % CI: -0.35 to 0.09) mmol/L [-5.02 (95 % CI: -13.53 to 3.48) mg/dL], p = 0.2418; triglycerides, -0.15 (95 % CI: -0.32 to 0.01) mmol/L [-13.28 (95 % CI: -28.34 to 0.88) mg/dL], p = 0.0592; and HDL-cholesterol, 0.14 (95 % CI: -0.08 to 0.36) mmol/L [5.41 (95 % CI: -3.09-13.92) mg/dL], p = 0.2103. TheI statistic ranged from 87.95%-98.30 %, indicating significant heterogeneity.
CONCLUSIONS
The results suggest that a red clover extract is efficacious in reducing the concentrations of total cholesterol; however, changes in HDL-C, LDL-C and triglycerides are not as pronounced. Potentially, this means that women takingTrifolium pratense for menopausal symptoms can derive additional benefits from the plant's specific effect that corrects abnormal cholesterol levels. Additional studies are needed to assess its effects on post-menopausal women.
Topics: Cholesterol, HDL; Cholesterol, LDL; Female; Humans; Isoflavones; Lipids; Perimenopause; Plant Extracts; Postmenopause; Trifolium; Triglycerides
PubMed: 31883666
DOI: 10.1016/j.maturitas.2019.11.001 -
BMC Musculoskeletal Disorders Dec 2019The aim of this systematic review was to identify principles of exercise interventions associated with improved physical function, weight management or musculoskeletal...
BACKGROUND
The aim of this systematic review was to identify principles of exercise interventions associated with improved physical function, weight management or musculoskeletal pain relief among young and middle-aged adults with obesity and propose an evidence-based exercise prescription that could assist in secondary prevention of osteoarthritis.
METHODS
A structured electronic review was conducted using MEDLINE, PubMed, and SPORTDiscus. The search string included 1) "obes*" AND "exercise" AND "interven*" AND "musculoskeletal pain OR knee pain OR hip pain". Studies 1) were randomized controlled trials of humans, with a non-exercise control, 2) included participants aged 18-50 years, and 3) had outcomes that included physical function, musculoskeletal pain, and/or body composition. Studies were excluded if participants had peri-menopausal status, cancer, or obesity-related co-morbidities. A recommended exercise prescription was developed based on common principles used in the included exercise interventions with greatest change in function or pain.
RESULTS
Seven studies were included. Similarities in exercise intensity (40-80% VO), frequency (three times per week), duration (30-60 min), and exercise mode (treadmill, cross-trainer, stationary bike, aquatic exercise) were observed in exercise interventions that resulted in improved physical function and/or pain, compared to non-exercise control groups.
CONCLUSION
Common principles in exercise prescription for improvements in weight management, physical function and pain relief among otherwise healthy people with obesity. Exercise prescription including moderate intensity exercise for 30-60 min, three times per week can be considered an effective treatment for weight management and obesity-related musculoskeletal symptoms. Exercise should be recommended to at-risk individuals as part of secondary prevention of osteoarthritis.
Topics: Exercise; Humans; Obesity; Osteoarthritis; Randomized Controlled Trials as Topic; Weight Reduction Programs
PubMed: 31861990
DOI: 10.1186/s12891-019-3004-3 -
Complementary Therapies in Medicine Dec 2019Depression is common in women during perimenopause and menopause. Complementary therapies such as acupuncture and Chinese herbal medicine (CHM) are often utilized by... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Depression is common in women during perimenopause and menopause. Complementary therapies such as acupuncture and Chinese herbal medicine (CHM) are often utilized by these women. However, the efficacy and safety of these treatments have not been systematically evaluated.
METHODS
We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs). Nine English and Chinese databases were searched and search terms included perimenopause, menopause, depression, Chinese herbal medicine, acupuncture, RCTs, and their synonyms. Methodological quality was assessed using the Cochrane Risk of Bias Tool.
RESULTS
A total of 18 RCTs were identified (6 CHM, 11 acupuncture related therapies, 1 combination of CHM and acupuncture). For Hamilton Rating Scale of Depression (HRSD) and Kuppermans Index of Menopause, tuina-massage, combined therapy of CHM plus acupuncture showed significant benefits at end of treatment compared to antidepressants. Either CHM and acupuncture reduced HRSD scores, indicating less severe depression, showing comparable effects to antidepressants.
CONCLUSION
CHM and acupuncture treatment in perimenopause and menopausal women resulted in reduced severity of depression. Results should be interpreted with caution given the small number of studies included in this review and further RCTs are warranted to validate findings from this review.
Topics: Acupuncture Therapy; Depression; Drugs, Chinese Herbal; Female; Humans; Medicine, Chinese Traditional; Menopause; Perimenopause; Randomized Controlled Trials as Topic
PubMed: 31780032
DOI: 10.1016/j.ctim.2019.03.019