Effect of serotonin-norepinephrine reuptake inhibitors for patients with chemotherapy-induced painful peripheral neuropathy: A meta-analysis.

BACKGROUND: To compare the efficacy of serotonin-norepinephrine reuptake inhibitors (SNRIs) treatment for chemotherapy-induced peripheral neuropathy (CIPN) METHODS:: Two authors independently searched MEDLINE, Embase, Cochran Library, and Web of Science to identify and review articles published from January 1998 until December 2018 according to selection criteria. Outcomes were expressed as mean difference, the pooled odds ratio, or relative risk in a meta-analysis model. RESULTS: A total of 10 studies were included in this meta-analysis: 6 randomized-controlled studies and 4 observational studies. Meta-analysis showed that CIPN was improved after treatment with SNRI (standardized mean difference = 2.20; 95% confidence interval, 0.90-3.49; I = 93% in 3 randomized controlled studies). Somnolence and insomnia occurred in <15% of patients. Incidence of somnolence was lower than with pregabalin treatment, and insomnia was comparable to that in expectant management or pregabalin treatment. Incidence of nausea and vomiting was higher than in expectant management, but no significant difference was found when compared to expectant management. CONCLUSION: From the several available studies suitable for indirect comparison, SNRI shows excellent efficacy and tolerability to CIPN. SNRI could provide an important treatment option for CIPN.

Effect of pretreatment with combined oral contraceptives on outcomes of assisted reproductive technology for women with polycystic ovary syndrome: a meta-analysis.

OBJECTIVE: To evaluate the effect of pretreatment with combined oral contraceptives (COC) on outcomes in women with polycystic ovary syndrome (PCOS) who underwent assisted reproductive technology for subfertility. METHODS: Two authors independently searched MEDLINE, EMBASE, and the Cochran Library to identify and review articles published from October 1995 until December 2018 according to selection criteria. Outcomes are expressed as mean difference and odds ratio (OR) in a meta-analysis model. RESULTS: A total of seven studies were included in this meta-analysis: one randomized controlled study and two prospective and four retrospective cohort studies. Meta-analysis showed that the COC pretreatment did not affect rate of clinical pregnancy (OR = 0.93, 95% confidence interval CI 0.65-1.34, I2 = 76%) or ovarian hyperstimulation syndrome (OR = 0.90, 95% CI 0.57-1.44, I2 = 0%). However, the rate of miscarriage in the COC group was significantly higher (OR = 1.33, 95% CI 1.02-1.72, I2 = 9%) and the rate of cumulative live birth was significantly lower compared with the control group (OR = 0.72, 95% CI 0.54-0.98, I2 = 55%). Subgroup analysis showed higher rates of miscarriage and lower rates of cumulative live birth in studies with a gonadotropin-releasing hormone (GnRH) antagonist protocol (OR = 1.69, 95% CI 1.17-2.44, I2 = 0% and OR = 0.38, 95% CI 0.29-0.50, respectively). CONCLUSION: Pretreatment with COC in women with PCOS before assisted reproductive technology may have an adverse effect on clinical outcomes, especially with a GnRH antagonist protocol.

Efficacy of levonorgestrel releasing intrauterine system as a postoperative maintenance therapy of endometriosis: A meta-analysis.

OBJECTIVE: To compare the efficacy of levonorgestrel releasing intrauterine system (LNG-IUS) with other treatments as a postoperative maintenance therapy for endometriosis in terms of pain reduction, recurrence prevention, side effects and patients' satisfaction. STUDY DESIGN: We searched MEDLINE, EMBASE, and the Cochrane Library from January 1986 until February 2018. Two evaluators independently extracted and reviewed prospective and retrospective articles based on pre-determined selection criteria. Outcomes were expressed as mean difference (MD), risk ratios (RR) or odds ratios (OR) in a meta-analysis model, using Revman software. RESULTS: Among the 962 studies, 7 studies were selected: 7 studies included 4 randomized controlled trials with 212 patients, 1 prospective cohort study with 88 patients, and 2 retrospective studies with 191 patients. A meta-analysis showed that LNG-IUS was significantly effective in reducing pain after surgery (MD = 12.97, 95% confidence interval (CI): 5.55-20.39), with a comparable effect to gonadotropin-releasing hormone analogues (MD = -0.16, 95% CI: -2.02 to 1.70). LNG-IUS was also effective in decreasing the recurrence rate (RR = 0.40, 95% CI: 0.26-0.64), with an effect comparable to OC (OR = 1.00, 95% CI: 0.25-4.02) and danazol (RR = 0.30, 95% CI: 0.03-2.81). Furthermore, patients' satisfaction with LNG-IUS was significantly higher than that with OC (OR = 8.60, 95% CI: 1.03-71.86). However, vaginal bleeding was significantly higher in the LNG-IUS group than in the gonadotropin-releasing hormone analogue group (RR = 27.0, 95% CI: 1.71-425.36). CONCLUSION: Our meta-analysis found a positive effect of LNG-IUS as a postoperative maintenance therapy for endometriosis on pain relief, prevention of dysmenorrhea recurrence, and patients' satisfaction.

Obesity and colorectal adenomatous polyps: a cross-sectional study in Korean adults.

OBJECTIVE: This study aimed to examine the association between obesity and the risk of colorectal adenomatous polyps. DESIGN AND METHODS: The design of this study is a cross-sectional study. A total of 1,574 participants (818 males and 756 females), who had undergone colonoscopy for health examinations at the National Cancer Center hospital in South Korea from February to September 2009, were included in the analysis. RESULTS: The prevalence of colorectal adenomatous polyps was 39.5% in males and 22.6% in females. In multiple logistic regression analysis, obesity (odds ratio [OR] = 1.69, 95% CI = 1.16-2.48) and abdominal obesity (OR = 1.59, 95% CI = 1.13-2.23) were significantly associated with an increased risk of colorectal adenomatous polyps in males, but not in females. In the subgroup analyses by age, obesity (OR = 2.27, 95% CI = 1.32-3.89), and abdominal obesity (OR = 1.76, 95% CI = 1.12-2.76) significantly increased a risk of colorectal adenomatous polyps in males aged <50 years, but not in males aged ≥50 years. However, interaction terms were not significant between obesity and gender (P = 0.397) and between obesity and age (P = 0.531) in the overall analyses. CONCLUSION: Our findings should be explored in further research.

Interleukin-6 but not tumour necrosis factor-alpha predicts survival in patients with advanced cancer.

PURPOSE: The purpose of this study was to evaluate the prognostic role of interleukin-6 (IL-6) and tumour necrosis factor-alpha (TNF-α) in the survival of patients with advanced cancer. METHODS: In this prospective cohort study between three hospice and palliative care centres in South Korea, we followed 98 advanced cancer patients until death or the end of the study. Approximately 60 % of the patients had poor functional status (Eastern Cooperative Oncology Group score ≥3). We investigated the symptoms of cancer cachexia anorexia syndrome, possible cytokine-related confounders such as infection and medication records. Influence from clinical variables was adjusted using the Cox proportional hazard model. RESULTS: The median survival time was 27 days. On multivariate analysis, elevated IL-6 (hazard ratio, 2.139; p = 0.003) was found to be an independent significant prognostic factor. TNF-α was not a significant factor. Poor performance status and male gender were also independently related to shortened survival. CONCLUSIONS: IL-6 level can be a useful indicator of survival time of patients with advanced cancer at the very end of life. In contrast, the prognostic role of TNF-α requires further study.

The relationship between interleukin-6, tumor necrosis factor-α, and fatigue in terminally ill cancer patients.

Although many cancer patients receiving palliative care experience distressing levels of fatigue, no well-designed studies have investigated contributing factors in Korean patients. We conducted a cross-sectional study using the Brief Fatigue Inventory-K (BFI-K) to measure fatigue while assessing a variety of possible correlates. Ninety patients with incurable cancer in the terminal stage (median survival: 27 days) participated in a structured interview and questionnaire related to their medical conditions and underwent blood sampling for laboratory data and cytokines, including interleukin (IL)-6 and tumor necrosis factor (TNF)-α. Body mass index, dyspnea, the Eastern Cooperative Oncology Group performance status, and levels of albumin, blood urea nitrogen (BUN), total bilirubin, and C-reactive protein were significantly associated with fatigue. However, levels of the two proinflammatory cytokines, IL-6 and TNF-α, were not significantly correlated with the BFI-K score. In stepwise multiple linear regression, fatigue was related to elevated BUN (ß = 0.376, p = 0.002), severe pain intensity (ß = 0.349, p = 0.004), and impaired performance status (ß = 0.268, p = 0.027), but not related to levels of inflammatory cytokines. In conclusion, the diagnostic work-up and therapeutic plan for patients with cancer-related fatigue should include an evaluation of laboratory parameters, pain severity, and physical performance.