Efficacy of metformin combined with vitamin D in the treatment of polycystic ovarian syndrome: A meta-analysis.

Polycystic ovary syndrome (PCOS), as an endocrine and metabolic disorder, affects approximately 6% -20% of women of childbearing age. This study aims to assess the therapeutic effects of Metformin combined with vitamin D in PCOS patients. Eight databases were searched to obtain randomized controlled trials, both domestically and internationally, on the effects of Metformin combined with vitamin D in patients with PCOS. Data analysis was performed using RevMan 5.3 software. Nine studies were ultimately included in this meta-analysis. Six studies reported the homeostatic model assessment for insulin resistance of the test group and the control group, which was significantly lower (SMD: -0.23; 95% Cl: -0.42,-0.04; P<0.05) than the control group, body mass index (BMI) (SMD: -1.86; 95% Cl: -2.77,-0.96; P<0.01), Serum 25 (OH) D (SMD: 14.28; 95% Cl: 12.26,16.29; P<0.01), testosterone (SMD: -0.11; 95% Cl: -0.15,-0.07; P<0.01) and regulated menstrual cycles (OR: 1.27; 95% Cl: 0.99,1.63; P=0.063). Our meta-analysis of nine trials demonstrates significant reductions in insulin resistance, BMI, and testosterone levels, along with increased serum vitamin D levels and improved menstrual cycle regulation after Metformin and vitamin D treatment. These findings suggest the potential of this combined therapy in managing the multifaceted aspects of PCOS.

Le syndrome des ovaires polykystiques (SOPK), en tant que trouble endocrinien et métabolique, touche environ 6 à 20 % des femmes en âge de procréer. Cette étude vise à évaluer les effets thérapeutiques de la metformine associée à la vitamine D chez les patients atteints du SOPK. Huit bases de données ont été consultées pour obtenir des essais contrôlés randomisés, tant au niveau national qu'international, sur les effets de la metformine associée à la vitamine D chez les patients atteints du SOPK. L'analyse des données a été réalisée à l'aide du logiciel RevMan 5.3. Neuf études ont finalement été incluses dans cette méta-analyse. Six études ont rapporté l'évaluation du modèle homéostatique pour la résistance à l'insuline du groupe test et du groupe témoin, qui était significativement inférieure (DMS : -0,23 ; IC à 95 % : -0,42, -0,04 ; P <0,05) par rapport au groupe témoin, la masse corporelle indice (IMC) (DMS : -1,86 ; Cl 95 % : -2,77, -0,96 ; P<0,01), Sérum 25 (OH) D (SMD : 14,28 ; Cl 95 % : 12,26,16,29 ; P<0,01), testostérone (DMS : -0,11 ; Cl à 95 % : -0,15, -0,07 ; P<0,01) et cycles menstruels régulés (OR : 1,27 ; Cl à 95 % : 0,99, 1,63 ; P=0,063). Notre méta-analyse de neuf essais démontre des réductions significatives de la résistance à l'insuline, de l'IMC et des taux de testostérone, ainsi qu'une augmentation des taux sériques de vitamine D et une amélioration de la régulation du cycle menstruel après un traitement à la metformine et à la vitamine D. Ces résultats suggèrent le potentiel de cette thérapie combinée dans la gestion des aspects multiformes du SOPK.

Distinct Cognitive Function Profiles Are Associated With a Higher Presurgery Symptom Burden in Patients With Breast Cancer.

BACKGROUND: Cancer-related cognitive impairment (CRCI) is a common symptom in patients with breast cancer. In our previous study of 397 women with breast cancer, we identified 3 groups of patients with distinct CRCI profiles (ie, high, moderate, and low-moderate attentional function). Compared with the other 2 classes, the low-moderate class was younger, had more comorbidities, and with lower functional status. OBJECTIVES: In this study, we expand on this work and evaluate for differences among these latent classes in the severity of psychological (depression and anxiety) and physical (fatigue, decrements in energy, sleep disturbance, and pain) symptoms before surgery. METHODS: Cancer-related cognitive impairment was assessed using the Attentional Functional Index from before through 6 months after surgery. Lower Attentional Functional Index scores indicate higher levels of CRCI. Psychological and physical symptoms were assessed with valid instruments. Parametric and nonparametric tests were used to evaluate for differences in symptom severity scores among the latent classes. RESULTS: Approximately 60% of patients experienced CRCI (ie, moderate and low-moderate classes). Significant differences were found among the 3 classes in the severity of trait and state anxiety, depressive symptoms, fatigue, and sleep disturbance (ie, high < moderate < low-moderate). In addition, compared with the other 2 classes, the low-moderate class reported higher pain interference scores. CONCLUSIONS: These findings suggest that women with clinically meaningful levels of persistent CRCI have a relatively high symptom burden before surgery. IMPLICATIONS FOR PRACTICE: Clinicians need to routinely perform preoperative assessments of CRCI and associated symptoms and initiate therapeutic interventions.

Pre-Surgery Demographic, Clinical, and Symptom Characteristics Associated with Different Self-Reported Cognitive Processes in Patients with Breast Cancer.

Cancer related cognitive impairment (CRCI) is a common and persistent symptom in breast cancer patients. The Attentional Function Index (AFI) is a self-report measure that assesses CRCI. AFI includes three subscales, namely effective action, attentional lapses, and interpersonal effectiveness, that are based on working memory, inhibitory control, and cognitive flexibility. Previously, we identified three classes of patients with distinct CRCI profiles using the AFI total scores. The purpose of this study was to expand our previous work using latent class growth analysis (LCGA), to identify distinct cognitive profiles for each of the AFI subscales in the same sample (i.e., 397 women who were assessed seven times from prior to through to 6 months following breast cancer surgery). For each subscale, parametric and non-parametric statistics were used to determine differences in demographic, clinical, and pre-surgical psychological and physical symptoms among the subgroups. Three-, four-, and two-classes were identified for the effective action, attentional lapses, and interpersonal effectiveness subscales, respectively. Across all three subscales, lower functional status, higher levels of anxiety, depression, fatigue, and sleep disturbance, and worse decrements in energy were associated with worse cognitive performance. These and other modifiable characteristics may be potential targets for personalized interventions for CRCI.

Changes in Attentional Function in Patients From Before Through 12 Months After Breast Cancer Surgery.

CONTEXT: Although approximately 75% of patients with breast cancer report changes in attentional function, little is known about how demographic, clinical, symptom, and psychosocial adjustment (e.g., coping) characteristics influence changes in the trajectories of attentional function over time. OBJECTIVES: This study evaluated interindividual variability in the trajectories of self-reported attentional function and determined which demographic, clinical, symptom, and psychosocial adjustment characteristics were associated with initial levels and with changes in attentional function from before through 12 months after breast cancer surgery. METHODS: Before surgery, 396 women were enrolled. Attentional Function Index (AFI) was completed before and nine times within the first 12 months after surgery. Hierarchical linear modeling was used to determine which characteristics were associated with initial levels and trajectories of attentional function. RESULTS: Given an estimated preoperative AFI score of 6.53, for each additional month, the estimated linear rate of change in AFI score was an increase of 0.054 (P < 0.001). Higher levels of comorbidity, receipt of adjuvant chemotherapy, higher levels of trait anxiety, fatigue, and sleep disturbance, and lower levels of energy and less sense of control were associated with lower levels of attentional function before surgery. Patients who had less improvements in attentional function over time were nonwhite, did not have a lymph node biopsy, had received hormonal therapy, and had less difficulty coping with their disease. CONCLUSION: Findings can be used to identify patients with breast cancer at higher risk for impaired self-reported cognitive function and to guide the prescription of more personalized interventions.