Induced abortion and ectopic pregnancy: A systematic review and meta-analysis.

OBJECTIVE: Existing evidence of the relationship between induced abortion and ectopic pregnancy has not been assessed rigorously. This systematic review provides a comprehensive evaluation to examine whether induced abortion (IA) can increase the rate of ectopic pregnancy (EP). METHODS: We searched PubMed, EMBASE, Web of Science, Cochrane, CNKI, WanFang, and Sinomed databases since their inception until February 2023. Eligibility criteria included case-control studies and cohort studies that analyzed induced abortion associated with ectopic pregnancy. Data analyses were conducted by using R-studio Version 1.1.383 software. RESULTS: A total of 33 case-control studies and 7 cohort studies involving 132,926 participants were included. In case-control studies, there was a significant association between induced abortion and ectopic pregnancy by using single-factor analysis data (OR = 2.32, 95% CI = 1.81-2.98). Subgroup analysis by region suggested no statistical significance in the Americas (OR = 1.15, 95% CI = 0.92-1.43) and Eastern Mediterranean (OR = 3.64, 95% CI = 0.88-15.18). The relationship was significant by using multiple regression analysis data (OR = 1.97, 95% CI = 1.38-2.80). In cohort studies, statistical significance was found (OR = 1.42, 95% CI = 1.001-2.018) after omitting one study in sensitivity analysis. The combined results of the two types of studies suggested that induced abortion would increase the risk of ectopic pregnancy to some degree, but the conclusion needs to be considered with caution. CONCLUSION: This study indicated that IA could increase the risk of EP to some degree and the times of IA had a negative impact on the risk. Safe abortion and avoiding repeat abortion due to unintended pregnancy could protect women's fertility.

Effectiveness of post-abortion care services to protect women's fertility in China: A systematic review with meta-analysis.

OBJECTIVE: This study aimed to evaluate the effectiveness of post-abortion care services in Chinese women who have undergone induced abortion. METHODS: A systematic literature search was conducted in five databases from January 2011 to June 2023 (PROSPERO registration CRD42023440458). Estimates of intervention effects were represented as relative risk (RR) with 95% confidence intervals (CI). The Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to evaluate the strength of recommendations. RESULTS: The meta-analysis of 42 randomized controlled studies involving 70,126 participants indicated that post-abortion care services could significantly increase rate of effective contraceptive use (RR = 2.33, 95%CI = 1.80-3.00, 10 studies, GRADE (Medium)), reduce repeat abortion rate (RR = 0.26, 95%CI = 0.20-0.36, 19 studies, GRADE (High)), increase follow-up visit rate (RR = 1.37, 95%CI = 1.06-1.75, 5 studies, GRADE (Very low)) in one year after abortions, and improve patient satisfaction rate (RR = 1.37, 95%CI = 1.03-1.83, 9 studies, GRADE (High)). CONCLUSION: Post-abortion care services could help increase the rate of continuation of post-abortion effective contraceptives, prevent repeat abortions, and promote female fertility. Exploring strategies for better provision of post-abortion services requires more high-quality research.

Impact of perioperative low-molecular-weight heparin therapy on clinical events of elderly patients with prior coronary stents implanted > 12 months undergoing non-cardiac surgery: a randomized, placebo-controlled trial.

BACKGROUND: Little is known about the safety and efficacy of discontinuing antiplatelet therapy via LMWH bridging therapy in elderly patients with coronary stents implanted for > 12 months undergoing non-cardiac surgery. This randomized trial was designed to compare the clinical benefits and risks of antiplatelet drug discontinuation via LMWH bridging therapy. METHODS: Patients were randomized 1:1 to receive subcutaneous injections of either dalteparin sodium or placebo. The primary efficacy endpoint was cardiac or cerebrovascular events. The primary safety endpoint was major bleeding. RESULTS: Among 2476 randomized patients, the variables (sex, age, body mass index, comorbidities, medications, and procedural characteristics) and percutaneous coronary intervention information were not significantly different between the bridging and non-bridging groups. During the follow-up period, the rate of the combined endpoint in the bridging group was significantly lower than in the non-bridging group (5.79% vs. 8.42%, p = 0.012). The incidence of myocardial injury in the bridging group was significantly lower than in the non-bridging group (3.14% vs. 5.19%, p = 0.011). Deep vein thrombosis occurred more frequently in the non-bridging group (1.21% vs. 0.4%, p = 0.024), and there was a trend toward a higher rate of pulmonary embolism (0.32% vs. 0.08%, p = 0.177). There was no significant difference between the groups in the rates of acute myocardial infarction (0.81% vs. 1.38%), cardiac death (0.24% vs. 0.41%), stroke (0.16% vs. 0.24%), or major bleeding (1.22% vs. 1.45%). Multivariable analysis showed that LMWH bridging, creatinine clearance < 30 mL/min, preoperative hemoglobin < 10 g/dL, and diabetes mellitus were independent predictors of ischemic events. LMWH bridging and a preoperative platelet count of < 70 × 109/L were independent predictors of minor bleeding events. CONCLUSIONS: This study showed the safety and efficacy of perioperative LMWH bridging therapy in elderly patients with coronary stents implanted > 12 months undergoing non-cardiac surgery. An alternative approach might be the use of bridging therapy with half-dose LMWH. TRIAL REGISTRATION: ISRCTN65203415.

Intervention Effect of Baduanjin Exercise on the Fatigue State in People with Fatigue-Predominant Subhealth: A Cohort Study.

OBJECTIVES: To observe the effect of a Baduanjin exercise intervention on fatigue in people with fatigue-predominant subhealth (FPSH). PARTICIPANTS: A total of 131 participants were included in this cohort study. Those who met the inclusion criteria were grouped into the Baduanjin cohort (n=64) or the control cohort (n=67). INTERVENTION: The Baduanjin cohort exercised for 30 minutes twice a day for 6 weeks; the control cohort received no treatments. The study period was 18 weeks. OUTCOME MEASURES: The fatigue states of all participants were evaluated by using the Fatigue Self-Assessment Scale (FSAS) at baseline, the fourth and sixth weeks of treatment, and during post-treatment follow-ups at the end of the 12th and 18th weeks. RESULTS: The scores for the six factors on the FSAS at baseline did not significantly differ between the two groups. In the Baduanjin cohort, the total score on the FSAS (TSF) and scores for physical fatigue (PF), mental fatigue (MF), consequence of fatigue (CF), and response of fatigue to sleep and rest (RFSAR) were significantly decreased at the end of the sixth week. These patients also had significantly decreased scores for TSF, PF, MF, and CF at baseline, at the end of the fourth and sixth weeks of the intervention, and during post-treatment follow-ups at the end of the 12th and 18th weeks. No adverse effects of treatment were reported. CONCLUSIONS: This study suggests that Baduanjin exercise has an effect on relieving fatigue in patients with FPSH.

The alcohol dehydrogenase 1C(rs698) genotype and breast cancer: a meta-analysis.

Published data regarding the association between alcohol dehydrogenase (ADH) 1C genotypes and breast cancer risk show conflicting results. The authors performed this meta-analysis on 1969 patients and 2244 controls from 4 (including 7 study populations) related case-control studies to estimate the association between ADH1C(rs698) genotyping information and breast cancer risk. According to the 6 eligible populations, the odds ratios (ORs) and 95% confidence intervals (CIs) for breast cancer risk for ADH1C (1-2) versus ADH1C (2-2) , ADH1C (1-1) versus ADH1C (2-2) genotype, and ADH1C (1) versus ADH1C (2) were 1.16 (0.95-1.42), 1.17 (0.95-1.44), and 1.05 (0.96-1.16), respectively. The OR (95% CI) for ADH1C (1-1) + ADH1C (1-2) versus ADH1C (2-2) from the 7 study populations was 1.14 (0.96-1.36). Meanwhile, genotypes of ADH1C (1-1) + ADH1C (1-2) increased the risk of breast cancer in drinkers (OR = 1.35; 95% CI = 1.03-1.76). This meta-analysis suggested that the ADH1C (1) allele might modestly influence the effect of alcohol on breast cancer but is not an independent risk factor for breast cancer. However, more restricted prospective studies are needed.

Tea consumption and risk of type 2 diabetes mellitus: a systematic review and meta-analysis update.

OBJECTIVE: Tea has been suggested to decrease blood glucose levels and protect pancreatic ß cells in diabetic mice. However, human epidemiological studies showed inconsistent results for the association between tea consumption and type 2 diabetes mellitus (T2DM) risk. The aim of this study was to conduct a meta-analysis to further explore the association between tea consumption and incidence of T2DM. DESIGN: Systematic review and meta-analysis. METHODS: We performed a systematic literature search up to 30 August 2013 in PubMed, EMBASE, Chinese Wanfang Database and CNKI database. Pooling relative risks (RRs) were estimated by random-effect models. Two kinds of subgroup analyses (according to sex and regions) were performed. Sensitive analyses were performed according to types of tea. RESULTS: Overall, no statistically significant relationship between tea consumption and risk of T2DM was found based on 12 eligible studies (pooling RR 0.99, 95% CI 0.95 to 1.03). Compared with the lowest/non-tea group, daily tea consumption (≥3 cups/day) was associated with a lower T2DM risk (RR 0.84, 95% CI 0.73 to 0.97). Subgroup analyses showed a difference between men and women. Overall, the RRs (95% CI) were 0.92 (0.84 to 1.00) for men, and 1.00 (0.96 to 1.05) for women, respectively. Tea consumption of ≥3 cups/day was associated with decreased T2DM risk in women (RR 0.84, 95% CI 0.71 to 1.00). Overall, the RRs (95% CIs) were 0.84 (0.71 to 1.00) for Asians, and 1.00 (0.97 to 1.04) for Americans and Europeans, respectively. No obvious change was found in sensitivity analyses. CONCLUSIONS: The results suggest that daily tea consumption (≥3 cups/day) is associated with a lower T2DM risk. However, further studies are needed to enrich related evidence, especially with regard to types of tea or sex.

Peroxisome proliferator-activated receptor γ2 Pro12Ala (rs1801282) polymorphism and breast cancer susceptibility: a meta-analysis.

Several studies have investigated the correlation between the peroxisome proliferator-activated receptor γ2 (PPAR­Î³2) Pro12Ala (rs1801282) polymorphism and the risk of breast cancer, with inconsistent results. For this reason, a meta-analysis was conducted to identify the potential correlation after pooling data from eligible case-control studies. Search strategies were conducted in PubMed, EMBASE and the COCHRANE Library in English and from VIP, CNKI and Sinomed in Chinese (all the papers were published before November 11, 2012) using appropriate terms. A total of 2,279 cases and 2,360 controls from four related case-control studies were included in this meta-analysis. According to the three eligible populations, the odds ratios (ORs) and 95% confidence intervals (CIs) on the risk of breast cancer for the CG versus CC and GG versus CC genotypes and the G versus C allele were 0.84 and 0.72-0.98, 0.92 and 0.32-2.61, and 0.98 and 0.84-1.13, respectively. The OR and 95% CI for CG+GG versus CC from the four study populations were 0.85 and 0.73-0.98, respectively. This meta-analysis supported the fact that the G allele of PPAR­Î³2 Pro12Ala (rs1801282) modestly affects the risk of breast cancer. Nevertheless, further studies are required to enrich the evidence of this correlation.

Influence of omega-3 polyunsaturated fatty acid-supplementation on platelet aggregation in humans: a meta-analysis of randomized controlled trials.

OBJECTIVE: Increased platelet activity predicts adverse cardiovascular events. The objective was to assess the effects of long-chain omega-3 polyunsaturated fatty acid (n-3 PUFA)-supplementation on platelet aggregation. METHODS AND RESULTS: We conducted a meta-analysis of randomized controlled trials identified using PubMed, Embase and the Cochrane Library. Fifteen studies were included. In comparison to placebo using the random-effect model, n-3 PUFA-supplementation significantly reduced adenosine diphosphate-induced platelet aggregation (standard mean difference [SMD] = -1.23 with 95% confidence interval [CI] -2.24 to -0.23, p = 0.02) and platelet aggregation units, determined using the VerifyNow(®) rapid platelet-function assay system (SMD = -6.78 with 95% CI -12.58 to -0.98, p = 0.02). There was a trend toward decreased collagen-induced (SMD = -0.70 with 95% CI -0.72 to 0.33, p = 0.18) and arachidonic acid-induced platelet aggregation (SMD = -0.43 with 95% CI -2.26 to 1.40, p = 0.64) compared with controls; however, statistical significance was not reached. CONCLUSIONS: Our meta-analysis demonstrates that n-3 PUFA-supplementation is associated with a significant reduction in platelet aggregation when the participants were at poor health status, but not in healthy persons. High-risk patients with cardiovascular disease and even diabetics may potentially benefit from n-3 PUFAs therapy. However, n-3 PUFAs may not be effective in primary prevention. Larger trials need to be carried out to confirm the present findings.

The A10389G polymorphism of ND3 gene and breast cancer: A meta-analysis.

Previous studies have reported the association between A10389G polymorphism of the dehydrogenase subunit 3 (ND3) gene and breast cancer risk with conflicting results. To explore this association, we conducted a meta-analysis on 5,580 patients and 5,749 controls from eligible published studies. Six reports (11 study populations) were included in this meta-analysis. Compared with the individuals with the G allele, individuals carrying the A allele did not exhibit increased breast cancer risk. The odds ratio (OR) and 95% confidence interval (CI) were 1.02 and 0.79-1.31, respectively. Stratified analyses were carried out according to ethnicity and source of controls. The corresponding ORs (95% CIs) were 1.20 (0.90-1.86) for African-American, 0.47 (0.03-7.64) for European and 0.89 (0.70-1.14) for mixed populations, respectively. A single study on Asian populations yielded an OR (95% CI) of 0.56 (0.32-1.00). The corresponding ORs (95% CIs) were 1.12 (0.23-5.47) for hospital-based studies, and 0.98 (0.76-1.27) for population-based studies. Only one study did not mention the source of control, the OR (95% CI) of which was 1.80 (1.15-2.82). Results of the present study suggested that the ND3 gene A10389G polymorphism may not be an independent risk factor for breast cancer. However, additional studies should be performed to clarify the possible roles of the ND3 A10398G polymorphism in the etiology of breast cancer.

A cross-sectional study of contraceptive use among married women living in rural China.

OBJECTIVE: To examine the prevalence of contraceptive use in rural China and to determine factors that influence choice of contraceptive method. METHODS: A cross-sectional study was conducted using multistage cluster sampling to identify married women aged 20-49 years residing in Shaanxi Province, China. Data on demographics and contraceptive use were collected via detailed questionnaire. RESULTS: The prevalence of contraceptive use in the study population was 93.9% (19 599/20 878 eligible women). Among the women using contraceptives, 10 408 (53.1%) used sterilization (female and male) and 6947 (35.4%) chose an intrauterine device. In total, 2244 (11.4%) women used short-acting contraceptive (SAC) methods: condoms and pills accounted for 8.7% (n=1712) and 1.0% (n=216), respectively. Young age; high level of education; low parity; increased number of abortions; low frequency of sexual intercourse; long duration between marriage and delivery; and marriage after 1994 were all associated with SAC usage. CONCLUSION: Although contraceptive use was high in rural China, the participants' awareness of free selection of contraceptive method and the rate of SAC use were both low. Appropriate and diverse family-planning services should be provided to meet the needs of women living in rural areas.

Effects of coenzyme Q10 on vascular endothelial function in humans: a meta-analysis of randomized controlled trials.

OBJECTIVE: The purpose of this study was to quantify the effect of coenzyme Q10 on arterial endothelial function in patients with and without established cardiovascular disease. BACKGROUND: Endothelial dysfunction has been implicated in the pathogenesis of atherosclerosis. METHODS AND RESULTS: The search included MEDLINE, Cochrane Library, Scopus, and EMBASE to identify studies up to 1 July 2011. Eligible studies were randomized controlled trials on the effects of coenzyme Q10 compared with placebo on endothelial function. Two reviewers extracted data on study characteristics, methods, and outcomes. Five eligible trials enrolled a total of 194 patients. Meta-analysis using random-effects model showed treatment with coenzyme Q10 significantly improvement in endothelial function assessed peripherally by flow-mediated dilatation (SMD 1.70, 95% CI: 1.00-2.4, p<0.0001). However, the endothelial function assessed peripherally by nitrate-mediated arterial dilatation was not significantly improved by using fix-effects model (SMD -0.19, 95% CI: -1.75 to 1.38, p = 0.81). CONCLUSION: Coenzyme Q10 supplementation is associated with significant improvement in endothelial function. The current study supports a role for CoQ10 supplementation in patients with endothelial dysfunction.

The effect of beta-blocker therapy on progressive aortic dilatation in children and adolescents with Marfan's syndrome: a meta-analysis.

AIM: To assess the effect of beta-blockade therapy on progressive aortic dilatation and on clinical outcome in children and adolescents with Marfan's syndrome (MFS). METHODS: The meta-analysis was instituted, which included studies identified by a systematic review of MEDLINE of peer-reviewed publications. Echocardiogram measurements of the aortic root dimension and outcome measures of mortality and major morbidity were compared between patients who were treated and untreated with beta-blockade therapy. RESULTS: Five studies were included. A total of 224 young patients treated with beta-blocker therapy and 168 patients did not accept medical management. Compared with non-beta-blockade treatment, beta-blockade therapy significantly decreased the rate of aortic dilatation (SMD = -1.30 with 95% CI -2.11 to -0.49). A tendency of clinical outcome beneficial was observed in the beta-blocker treatment group when compared with no beta-blocker treatment group (odds ratio = 0.87 with 95% CI 0.37-2.04). CONCLUSION: There is evidence that beta-blockade therapy can slow down the rate of dilatation of the aorta and has clinical benefits on children and adolescents with MFS.

Fluoro jade-C staining in the assessment of brain injury after deep hypothermia circulatory arrest.

OBJECTIVE: To evaluate the efficacy of Fluoro Jade-C staining (FJC) in the assessment of brain injury after deep hypothermia circulatory arrest (DHCA). METHODS: Six healthy adult miniature male pigs underwent DHCA, the rectal temperature was down to 18°C, circulation was stopped , circulatory arrest was maintained for 60 minutes. On postoperative day 1, perfusion-fixation was performed on brain tissue. Cerebral cortex, hippocampus, cerebellum were taken for sampling. FJC, hematoxylin-eosin staining (HE), nissl staining (NISSL), terminal deoxynucleotidyl transferase biotin-dUTP nick end labeling (TUNEL) were performed to detect the histological and pathological changes. Histological scores of all slices were ranked. Comparison between the FJC and other techniques was done by analysis of variance (ANOVA) according to histological scores. RESULTS: All animals survived the operation. On the cerebral cortex, in comparison of FJC between HE, NISSL and TUNEL, the p value was 0.90, 0.40, 0.16 respectively (p>0.05). On the hippocampus, the comparison of FJC with HE, NISSL and TUNEL had a p value of 0.12, 0.23, 0.62 respectively (p>0.05). On the cerebellum, in comparing FJC with HE, NISSL and TUNEL, the p value was 0.96, 0.77, 0.96 respectively (p>0.05). On representative regions, the results of FJC were in accordance with that of TUNEL, NISSL and HE. Furthermore, ascertainment of brain injury is easier with FJC. CONCLUSION: FJC is a reliable and convenient method to assess brain injury after DHCA.

Heart rate influence on incidence of cardiovascular disease among adults in China.

BACKGROUND: Higher heart rate is associated with mortality, whereas its association with clinical cardiovascular events is much more challenged. METHODS: A prospective study was conducted for 169,871 Chinese adults ≥40 years in 1991 and followed during 1999-2000 with a response rate of 93.4%. Hazard ratios (HRs) were estimated by Cox proportional hazard regression model. Cardiovascular disease (CVD) was defined as diagnosis of acute myocardial infarction or stroke or death due to CVD (International Classification of Diseases, Ninth Revision: 390.0-398.9, 401.0-429.9 and 430.0-438.9). RESULTS: After an average of 8.3 years' follow-up (836,811 person-years), 6837 participants (3932 men, 2905 women) developed CVD. Compared with the participants with heart rate 60-74 beats per minute (bpm), heart rate 75-89 and ≥90 bpm in men increased the risk of CVD after multivariate adjustment, with corresponding HRs [95% confidence intervals (CIs)] 1.12 (1.04-1.20) and 1.32 (1.18-1.47). Heart rate ≥90 bpm increased women's risk of CVD with HR (95% CI) 1.23 (1.09-1.38). Heart rate ≥75 bpm in men increased the risk of heart disease. Heart rate ≥90 bpm increased the risks of coronary heart disease (CHD) and stroke in men, and the risks of heart disease and CHD in women. CONCLUSIONS: Elevated heart rate was associated with high CVD incidence in Chinese adults. This suggests that higher heart rate might be a risk marker for CVD in Chinese adults.

[Markov Chain Monte Carlo Method of multiple imputation for longitudinal data with missing values in the survey of maternal and children health].

OBJECTIVE: To deal with arbitrary missing pattern in longitudinal data of the Survey of Maternal and Child Health and make the most appropriate inferences with multiple imputation (MI) for further analysis. METHODS: SAS 9.0 was used for Markov Chain Monte Carlo (MCMC) method of MI procedure to impute missing values and combine inferences. RESULTS: The result is acceptable as the data set was imputed 5 times. CONCLUSION: MI is able to solve a variety of problems in missing data sets and to improve the statistical power, especially with the use of MCMC method, for complicated missing data sets.