Acupuncture for symptoms in menopause transition: a randomized controlled trial.

BACKGROUND: Acupuncture has been used for women during menopause transition, but evidence is limited. OBJECTIVE: We sought to evaluate the efficacy of electroacupuncture on relieving symptoms of women during menopause transition. STUDY DESIGN: We conducted a prospective, multicenter, randomized, participant-blinded trial in China mainland. Subjects were randomized to receive 24 treatment sessions of electroacupuncture at traditional acupoints or sham electroacupuncture at nonacupoints over 8 weeks with 24 weeks' follow-up. Primary outcome was the change from baseline in the total score of Menopause Rating Scale at week 8. Secondary outcomes included the changes from baseline in the average 24-hour hot flash score, the Menopause Rating Scale subscale scores, the total score of Menopause-Specific Quality of Life Questionnaire and its subscales, and serum female hormones. All analyses were performed with a 2-sided P value of < .05 considered significant based on the intention-to-treat principle. RESULTS: A total of 360 women (180 in each group) with menopause-related symptoms during menopause transition were enrolled from June 9, 2013, through Dec 28, 2015. At week 8, the reduction from baseline in the Menopause Rating Scale total score was 6.3 (95% confidence interval, 5.0-7.7) in the electroacupuncture group and 4.5 (95% confidence interval, 3.2-5.8) in the sham electroacupuncture group with a between-group difference of 1.8 (95% confidence interval, 0.9-2.8; P = .0002), less than the minimal clinically important difference of 5 points' reduction. For secondary outcomes, the between-group differences for the decrease in the mean 24-hour hot flash score were significant at weeks 8, 20, and 32, but all were less than the minimal clinically important difference in previous reports. Interestingly, the between-group differences for the Menopause-Specific Quality of Life Questionnaire total score reduction were 5.7 at week 8, 7.1 at week 20, and 8.4 at week 32, greater than the minimal clinically important difference of 4 points. Changes from baseline in follicle-stimulating hormone, luteinizing hormone, and estradiol levels at weeks 8 and 20 (P > .05 for all), with the exception of follicle-stimulating hormone/luteinizing hormone ratios (P = .0024 at week 8 and .0499 at week 20), did not differ between groups. CONCLUSION: Among women during menopause transition, 8 weeks' electroacupuncture treatment did not seem to relieve menopausal symptoms, even though it appeared to improve their quality of life. Generalizability of the trial results may be limited by mild baseline menopausal symptoms in the included participants.

Cystic intraductal papillary neoplasms with infiltrating carcinoma of the intrahepatic bile duct: A case report.

INTRODUCTION: Intraductal papillary neoplasms of the bile duct (IPNB) is a kind of rare disorder with low incidence but high misdiagnosis due to untypical symptoms and non-specific laboratory indicators. Herein, we report a case of cystic type IPNB with infiltrating carcinoma of the intrahepatic bile duct presented as a single giant cystic mass of the liver. PATIENT CONCERNS: A 51-year-old woman was admitted due to right upper abdominal discomfort for 10 months. Physical examination indicated no specific finding. Laboratory tests showed that serum total bilirubin and carcinoembryonic antigen level was mildly elevated. Ultrasonography, computed tomography (CT) and magnetic resonance imaging (MRI) of abdomen indicated a giant lobulated cystic lesion involving the left, right and the caudate lobes of liver. There were multiple small nodules of different sizes with papillary or coral reef-like pattern protruding into the cystic lumen from the inner wall. DIAGNOSIS: The patient was diagnosed as malignant tumors of intrahepatic bile duct. INTERVENTIONS: She received radical resection of the lesion by hepatectomy. OUTCOMES: The postoperative pathological examination revealed an IPNB with infiltrating carcinoma of the intrahepatic bile duct. This patient had an uneventful postoperative recovery and was discharged on day 21 post-surgery. Until 35 months after surgery, there is no recurrence or metastasis. CONCLUSION: The CT and MRI can show certain morphologic features including the segmental cystic dilatation of intrahepatic bile ducts and the pathological details of papillary tumors inside the lesion. Cystic IPNB with infiltrating carcinoma of the intrahepatic bile duct can be treated with surgery.

Effects of vegetation type on the microbial characteristics of the fissure soil-plant systems in karst rocky desertification regions of SW China.

In karst regions, shallow karst fissure (SKF) soil has proven to be an important plant habitat and soil resource. However, how plants affect the microbial abundance and community composition of SKF soil remains poorly studied. We explored the soil microbial community structure differences in fractured soil-plant systems by determining phospholipid fatty acid (PLFA) profiles under three vegetation types (herbs, shrubs and trees) in SKF and used a bare SKF without vegetation as the control in a karst rocky desertification area. The total microbial biomass and microbial community composition differed between surface soil and SKF soil. The total microbial biomass in surface soil was higher than that in SKF soil. In addition, in contrast to surface soil, the microbial communities in SKF soil were more vulnerable to the effects of environmental variables. Furthermore, plants had a significant positive effect on the accumulation of microbial biomass in surface and SKF soil: shrubs had the strongest effect, followed by trees. Vegetation types significantly affected the ratios of saturated PLFAs to monounsaturated PLFAs (SAT/MONO ratio) and cyclopropyl PLFAs to precursors (cy/pre ratio). In contrast to the SKF without vegetation, the SAT/MONO ratio and cy/pre ratio under grasslands, shrublands and trees were low. Herbs and shrubs had the greatest capacity to enhance the ability of soil to respond to environmental stress compared to trees. Our results suggest that, as an important plant habitat in karst regions, the condition of SKF soil should be urgently improved. The stereoscopic collocation of shrub-grass vegetation may be the preferred measure for vegetation restoration. Deep-rooted shrubs and grasses are best at improving soil and plant growth. Our study can be useful for developing strategies for vegetation rehabilitation in karst regions.

Concomitant fulvestrant with reirradiation for unresectable locoregional recurrent estrogen receptor positive (ER+) breast cancer: A case report and narrative review.

RATIONALE: Locoregional recurrence of breast cancer is a challenging issue for clinicians. Treatment options for unresectable recurrent estrogen receptor positive (ER+) breast cancer in previously irradiated area are limited. Some studies showed concomitant fulvestrant with radiation therapy might increase radiosensitivity compared with radiation alone in vitro, no in vivo reports yet. PATIENT CONCERN: Here, we present a case report and make a narrative review of concomitant fulvestrant with radiation therapy for unresectable locoregional recurrent ER+ breast cancer. The patient was treated with modified radical mastectomy in 2015, adjuvant chemotherapy, radiotherapy, followed by exemestane until November 2018, relapsed in internal mammary lymph nodes with sternum involved. DIAGNOSIS: The final diagnosis was breast cancer internal mammary lymph nodes metastasis with sternum involved. INTERVENTIONS: After diagnosis was made, concurrent fulvestrant with reirradiation as a palliative treatment were proposed under multiple disciplinary team. OUTCOMES: There was a good clinical response, enabling curative chance with radiation therapy to a total dose of 60 Gy. Computed tomography scan revealed no evidence of residual tumor. LESSONS: As far as we know, this is the first report concerning concomitant fulvestrant with reirradiation for unresectable locoregional recurrent ER+ breast cancer. Since no severe adverse events were observed, this strategy could be a suitable "loco-regional rescue therapy" to further reduce tumor progression or even reach a curative effect. Studies of this treatment strategy in randomized clinical trials are warranted to further assess its safety and effectiveness.

Polysaccharides Derived from Saposhnikovia divaricata May Suppress Breast Cancer Through Activating Macrophages.

BACKGROUND: Saposhnikovia divaricata (SD) has been used in traditional Chinese medicine to treat pain, inflammation, and arthritis. Recently, it has been reported that SD extract may inhibit tumor growth, but the mechanism involved is elusive. The aim of this study was to investigate the anti-tumor activity of polysaccharides derived from SD in breast cancer and the underlying mechanisms. MATERIALS AND METHODS: Polysaccharides isolated from SD were analyzed using Fourier transform infrared (FT-IR) spectroscopy and gas chromatography-mass spectroscopy (GC-MS). Their effects on cell growth of U937, MCF-7, and MDA-MB-231, and tumor growth in a mouse MDA-MB 231 xenograft model were examined. Their role in U937 activation, MCF-7, and MDA-MB 231 cytokine release profiles were also tested. RESULTS: In vitro studies showed that SD polysaccharides (SDPs) promoted U937 cell growth dose-dependently, with no obvious effect on growth of breast cancer cell lines MCF-7 and MDA-MB-231. SDP also showed an antagonistic effect against the growth inhibition of U937 by the culture supernatants of MCF-7 and MDA-MB-231, and reversed the polarization status of U937. Treatment of SCID mice bearing MDA-MB-231-derived xenograft tumors with SDP significantly reduced tumor growth. At all tested concentrations, no obvious toxic side-effects were recorded. DISCUSSION: We tentatively concluded that SDPs potently promote the growth of U937 and activate it to inhibit the tumor growth of SCID mice bearing MDA-MB-231-derived xenograft tumors indirectly, with no obvious growth inhibition effects on MCF-7 and MDA-MB-231 in vitro. Our finding indicated that SDP could be a potential anticancer agent for breast cancer.