The Effects of Acupuncture on Cancer-Related Fatigue: Updated Systematic Review and Meta-Analysis.

BACKGROUND: Several studies have identified fatigue as one of the major symptoms experienced during and after cancer treatment. However, there are limited options to manage cancer related fatigue (CRF) with pharmacological interventions. Several acupuncture studies suggested that acupuncture has a positive impact on CRF. This review aims to assess the evidence of acupuncture for the treatment of CRF. METHOD: Electronic database searches were conducted on 4 English databases (Medline, PubMed, Embase, and ScienceDirect). Search keywords were; "acupuncture" and "cancer," or "cancer related fatigue." Studies published as full text randomized controlled trials (RCTs) in English were included. Estimates of change in fatigue cores were pooled using a random effects meta-analysis where randomized comparisons were available for true acupuncture versus sham acupuncture and true acupuncture versus usual care. The quality of original papers were assessed using the Cochrane Collaboration's tool for assessing risk of bias (ROB). RESULTS: Nine RCTs were selected for review with a total of 809 participants and a range of 13 to 302 participants within the studies. Six RCTs reported significant improvement of CRF for the acupuncture intervention compared to the control groups. Pooled estimates suggest Brief Fatigue Inventory scores are 0.93 points lower 95% CI (-1.65, -0.20) in true acupuncture versus sham acupuncture and 2.12 points lower 95% C (-3.21, -1.04) in true acupuncture versus usual care. Six studies had low risk of bias (ROB) and 3 studies had a moderate ROB predominantly in blinding of participants, blinding of assessors and incomplete data outcomes. Among the 9 RCTs, 2 studies have reported the occurrence of minor adverse effects (spot bleeding and bruising) related to acupuncture treatment. No serious adverse reactions related to acupuncture were reported. CONCLUSION: The current literature review suggests that acupuncture has therapeutic potential in management of CRF for cancer survivors. Promotion of acupuncture in cancer care to manage CRF may improve the quality of life of cancer survivors.

Acupuncture in Oncology: The Effectiveness of Acupuncture May Not Depend on Needle Retention Duration.

BACKGROUND: Guidelines surrounding optimum needle retention duration in acupuncture have not been established, despite a growing evidence base for acupuncture over recent decades. This retrospective study explored the effect of varying acupuncture needle retention durations in cancer patients. METHOD: Patients received either 2 (n = 35), 10 (n = 53), or 20 minutes (n = 54) of acupuncture once a week for 6 weeks. Outcomes of anxiety and depression, stress, fatigue, and quality of life (QOL), with the Hospital Anxiety and Depression Scale, Perceived Stress Scale, Functional Assessment of Cancer Therapy-Fatigue, and European Organization for Research and Treatment of Cancer Quality of Life, were measured at baseline and at 6 weeks following the intervention. RESULTS: The mean age of participants was 58 years (n = 152). The majority were female, diagnosed with breast cancer. Depression, stress, fatigue, and QOL were significantly improved in all 3 groups at 6 weeks postintervention. No significant differences in all outcomes were found between the 3 groups (≤2 vs 10 minutes vs 20 minutes). There were no differences with the satisfaction of the acupuncture services and perceived efficacy of acupuncture among the 3 groups. More than 95% of participants indicated that they would recommend acupuncture to other cancer patients, friends, and their family members. CONCLUSION: The efficacy of acupuncture may not only depend on needle retention duration, but may also be associated with multiple factors. Considering the limitations of this study design, robust randomized controlled studies are warranted to confirm the findings.

Protonolysis and thermolysis reactions of functionalised NHC-carbene boranes and borates.

A set of ß-ketoimidazolium and ß-ketoimidazolinium salts of the general formula [R(1)C(O)CH2{CH[NCR(3)CR(3)N(R(2))]}]X (R(1) = (t)Bu, naphth; R(2) = (i)Pr, Mes, (t)Bu; R(3) = H, Me, (H)2; X = Cl, Br) show contrasting reactivity with superhydride bases MHBEt3; two are reduced to chiral ß-alcohol carbene-boranes R(1)CH(OH)CH2{C(BEt3)[NCR(3)CR(3)N(R(2))]} 2 (R(1) = (t)Bu; R(2) = (i)Pr, Mes; R(3) = H), two with bulky R(2) substituents are reduced to chiral ß-borate imidazolium salts [R(1)CH(OBEt3)CH2{CH[NCR(3)CR(3)N(R(2))]}]X 3 (R(1) = (t)Bu, naphth; R(2) = Mes, (t)Bu; R(3) = H, Me; X = Cl, Br), and the two saturated heterocycle derivatives remain unreduced but form carbene-borane adducts R(1)C(O)CH2{C(BEt3)[NCR(3)CR(3)N(R(2))]} 4 (R(1) = (t)Bu, naphth; R(2) = Mes; R(3) = (H)2). Heating solutions of the imidazolium borates 3 results in the elimination of ethane, in the first example of organic borates functioning as Brønsted bases and forming carbene boranes R(1)CH(OBEt2)CH2{C[NCR(3)CR(3)N(R(2))]} 5 (R(1) = naphth; R(2) = Mes; R(3) = Me). The 'abnormal' carbene borane of the form 2 R(1)CH(OH)CH2{CH[NC(BEt3)CR(3)N(R(2))]} (R(1) = (t)Bu; R(2) = (t)Bu; R(3) = H), is also accessible by thermolysis of 3, suggesting that the carbene-borane alcohol is a more thermodynamically stable combination than the zwitterionic imidazolium borate. High-temperature thermolysis also can result in complete cleavage of the alcohol arm, eliminating tert-butyloxirane and forming the B-N bound imidazolium borate 7. The strong dependence of reaction products on the steric and electronic properties of each imidazole precursor molecule is discussed.

Homo- and heteroleptic alkoxycarbene f-element complexes and their reactivity towards acidic N-H and C-H bonds.

The reactivity of a series of organometallic rare earth and actinide complexes with hemilabile NHC-ligands towards substrates with acidic C-H and N-H bonds is described. The synthesis, characterisation and X-ray structures of the new heteroleptic mono- and bis(NHC) cyclopentadienyl complexes LnCp2(L) 1 (Ln = Sc, Y, Ce; L = alkoxy-tethered carbene [OCMe2CH2(1-C{NCHCHN(i)Pr})]), LnCp(L)2 (Ln = Y) , and the homoleptic tetrakis(NHC) complex Th(L)4 4 are described. The reactivity of these complexes, and of the homoleptic complexes Ln(L)3 (Ln = Sc 3, Ce), with E-H substrates is described, where EH = pyrrole C4H4NH, indole C8H6NH, diphenylacetone Ph2CC(O)Me, terminal alkynes RC≡CH (R = Me3Si, Ph), and cyclopentadiene C5H6. Complex 1-Y heterolytically cleaves and adds pyrrole and indole N-H across the metal carbene bond, whereas 1-Ce does not, although 3 and 4 form H-bonded adducts. Complexes 1-Y and 1-Sc form adducts with CpH without cleaving the acidic C-H bond, 1-Ce cleaves the Cp-H bond, but 2 reacts to form the very rare H(+)-[C5H5](-)-H(+) motif. Complex 1-Ce cleaves alkyne C-H bonds but the products rearrange upon formation, while complex 1-Y cleaves the C-H bond in diphenylacetone forming a product which rearranges to the Y-O bonded enolate product.

Activation of carbon dioxide and carbon disulfide by a scandium N-heterocyclic carbene complex.

A Sc NHC complex readily activates three equivalents of CO2 showing 'Frustrated Lewis Pair' type reactivity with each metal-carbene bond, but whilst CS2 is also activated by the labile carbenes, no metal involvement is observed.