RESUMO
Acupuncture has been introduced as an adjuvant therapy to in vitro fertilization (IVF) cycles in many randomized controlled trials (RCTs). However, there has been a debate among trials regarding the effectiveness and safety of the procedure. To determine how effective and safe acupuncture is as an adjunct to IVF cycles for primary and secondary female infertility. We conducted a literature search for relevant RCTs and ultimately included nine studies. The main selected outcomes included the rates of clinical pregnancy, ongoing pregnancy, miscarriage, live birth, and side effects. Patients receiving acupuncture were grouped together regardless of the acupuncture points used or the protocol for the insertion of needles. We performed a subgroup analysis according to whether studies originated inside and outside China to investigate the results of the different RCTs. We pooled outcomes as a risk ratio (RR) with 95% confidence interval (CI). The analysis revealed that in China, acupuncture led to lower clinical [RR=0.80, 95% CI (0.66, 0.97), p=0.02] and ongoing [RR=0.78, 95% CI (0.63, 0.97), p=0.03] pregnancy rates than placebo. Outside China, acupuncture increased clinical pregnancy rates [RR=1.38, 95% CI (1.11, 1.71), p=0.003] and ongoing [RR=1.73, 95% CI (1.29, 2.31), p<0.001] pregnancy rates. Rates of live birth and miscarriage did not significantly differ between the arms. Regarding side effects, acupuncture groups had a significantly higher rate of puncture site itching compared to control groups [RR=1.51, 95% CI (1.12, 2.04), p=0.007]. Overall analysis does not show a statistically significant increase in clinical pregnancy rates worldwide when using acupuncture as an adjunct therapy to IVF. There were no issues regarding patient safety from any included study. Subgroup results indicated that better rates for clinical pregnancy seem to be occurring more often in RCTs performed outside China than within.
RESUMO
BACKGROUND: Despite advancements in cancer treatment, breast cancer (BC) is still one of the leading causes of death among women. The majority of anti-breast-cancer medications induce serious side effects and multidrug resistance. Although several natural compounds, such as evening primrose oil (EPO), have been shown to have anticancer properties when used alone, their combination with the anticancer medicine tamoxifen (TAM) has yet to be investigated. The present study aimed to investigate the anticancer efficacy of EPO, alone or in combination with TAM, in the BC cell lines MCF-7 and MDA-MB-231, as well as to elucidate the mechanism of action. METHODS: The MTT assay was used to investigate the cytotoxic effect of EPO on the two cell lines, and we discovered an acceptable IC50 that was comparable to TAM. The ELISA, qRT-PCR, flow cytometry and colorimetric techniques were used. RESULTS: The combination of EPO and TAM suppressed the VEGF level, VEGF gene expression and Cyclin D1 signaling pathways, arrested the cell cycle, and induced the apoptotic signaling pathways by increasing the Bax/Bcl-2 ratio and caspase 3 activity; this revealed significant anti-tumor activity. CONCLUSIONS: The most significant finding of this study was the confirmation of the anticancer activity of the natural product EPO, which potentiated the activity of the anticancer drug TAM against MCF-7 and MDA-MB-231 BC cell lines through the induction of apoptosis, inhibiting angiogenesis and halting cell proliferation.