Management of cognitive impairment in bipolar disorder: a systematic review of randomized controlled trials.

Cognitive impairment is common in bipolar disorder and is emerging as a therapeutic target to enhance quality of life and function. A systematic search was conducted on PubMed, PsycInfo, Cochrane, clinicaltrials.gov, and Embase databases for blinded or open-label randomized controlled trials evaluating the pro-cognitive effects of pharmacological, neurostimulation, or psychological interventions for bipolar disorder. Twenty-two trials were identified, evaluating a total of 16 different pro-cognitive interventions. The methodological quality of the identified trials were assessed using the Cochrane Risk of Bias tool. Currently, no intervention (i.e., pharmacologic, neurostimulation, cognitive remediation) has demonstrated robust and independent pro-cognitive effects in adults with bipolar disorder. Findings are preliminary and methodological limitations limit the interpretation of results. Methodological considerations including, but not limited to, the enrichment with populations with pre-treatment cognitive impairment, as well as the inclusion of individuals who are in remission are encouraged. Future trials may also consider targeting interventions to specific cognitive subgroups and the use of biomarkers of cognitive function.

In vitro fertilisation in Hong Kong: the situation in 2019.

The popularity of in vitro fertilisation has continuously increased throughout the past 40 years owing to an increased incidence of infertility and delayed planning for pregnancy. The aim of this paper is to review the current situation of in vitro fertilisation in Hong Kong. In Hong Kong, in 2018, 7995 women underwent 5055 fresh and 5050 frozen-thawed embryo in vitro fertilisation cycles, resulting in an ongoing pregnancy rate of 33.7% per transfer. However, in vitro fertilisation is associated with several problems, including a high rate of multiple pregnancies and risks associated with cross-border reproductive care. Single embryo transfer is a simple strategy to reduce multiple pregnancies without compromising the cumulative live birth rate.

Three-dimensional versus two-dimensional laparoscopy for ovarian cystectomy: a prospective randomised study.

INTRODUCTION: Three-dimensional (3D) laparoscopy is now available as an alternative to conventional two-dimensional (2D) laparoscopy for ovarian cystectomy. However, the clinical value of 3D laparoscopy in benign gynaecological surgery remains uncertain. This study evaluated whether 3D laparoscopy had any advantages over 2D laparoscopy for ovarian cystectomy for apparently benign ovarian cysts. METHODS: This prospective randomised study involved patients undergoing laparoscopic ovarian cystectomy. The primary outcomes were the duration of cystectomy and surgeon's Global Operative Assessment of Laparoscopic Skills (GOALS) score. The secondary outcomes were the preferences, perceptions, and adverse effects reported by the participating surgeons. RESULTS: There were 38 patients assigned to the 2D laparoscopy group and 37 patients assigned to the 3D laparoscopy group. Participating surgeons in the 2D group reported more efficient tissue handling than did those in the 3D group (mean [standard deviation] rating score, 4.2 [0.8] vs 3.8 [0.8]; P=0.033). Duration of cystectomy (47.6 [32.0] min vs 51.6 [36.2] min; P=0.198) and overall GOALS score (20.8 [3.9] vs 20.1 [3.3]; P=0.393) were similar between both groups. Participating surgeons in the 2D group reported nausea, dizziness, ocular fatigue, and blurring of vision less frequently than did those in the 3D group (5.3% vs 45.9%; P<0.001). CONCLUSION: There were no significant benefits to using 3D laparoscopy compared with conventional 2D laparoscopy for ovarian cystectomy, and 3D laparoscopy may cause more frequent adverse effects in surgeons.

A randomised, controlled trial of rectus sheath bupivacaine and intrathecal bupivacaine, without or with intrathecal morphine, vs. intrathecal bupivacaine and morphine after caesarean section.

We recruited 144 women of whom 131 underwent scheduled caesarean section and were allocated to intrathecal bupivacaine without (46) or with (47) morphine and postoperative rectus sheath bupivacaine; or intrathecal bupivacaine with morphine and postoperative rectus sheath saline (38). We measured postoperative pain with a 10-point numeric rating scale. The mean (SD) areas under the curve for pain on movement during 48 postoperative hours were 273.5 (63.6), 223.8 (80.7) and 223.8 (80.7), respectively, p = 0.008. There was no difference between women who had intrathecal morphine with or without rectus sheath bupivacaine, p = 1. The equivalent values for pain at rest were 160.8 (64.7), 85.8 (79.4) and 82.8 (74.3), respectively, p < 0.001. There was no difference between women who had intrathecal morphine with or without rectus sheath bupivacaine, p = 0.98.