| 2 | Effects of Medicines and Supplements on Spontaneous Pregnancy and Semen Parameters in Male Infertility:A Systematic Review Update and Network Meta-Analysis显示文摘In this study,we used a network meta-analysis(NMA)to compare the effectiveness of medicines and supplements for idiopathic male infertility and to identify the best treatment.Medline,Excerpta Medica Database(EMBASE),Ovid,and China National Knowledge Infrastructure(CNKI),were searched for the period from January 1990 to June 2021 using the keywords'male infertility,''medical therapy,''supplement/nutrient therapy,'and related terms.Randomized controlled trials(RCTs)investigating medicines(mainly follicle-stimulating hormone(FSH),androgen,and clomiphene/tamoxifen)or supplements(mainly zinc,selenium,vitamin C or E,carnitine,coenzyme Q10(CoQ10),or combined treatment)for idiopathic infertile men were selected for meta-analysis.Preferred reporting items for systematic reviews and meta-analysis(PRISMA)was used for data extraction,and a risk-of-bias tool and grades of recommendation,assessment,development,and evaluation(GRADE)system adapted to the NMA were employed to assess the quality of the evidence.The primary outcomes were live birth and spontaneous pregnancy rate(SPR).The secondary outcomes were sperm parameters(including concentration,progressive motility,and morphology)and side effects.In total,65 RCTs involving 7541 men with sperm abnormalities but normal hormone levels were included.A total of 36 studies reported SPR but only three reported live birth rates.The quality of the included studies was found to be moderate to high.Compared with a placebo or being untreated,carnitine plus vitamins significantly improved SPR(relative risk(RR)=3.7,95%confidence interval(95%CI),1.6-8.5);fatty acids significantly increased sperm concentrations(mean difference(MD)=12.5×10^(6)mL-1,95%CI,3.1×10^(6)-22.0×10^(6));and selective estrogen receptor modulator(SERM)plus CoQ10 significantly improved sperm progressive motility(MD=11.0%,95%CI,0.1%-21.9%)and normal sperm morphology(MD=11.0%,95%CI,4.6%-17.4%).The most optimal intervention was carnitine plus vitamins and fatty acids for SPR and sperm concentrations,respectively,even after excluding trials at a high risk of bias.Compared with a placebo or being untreated,FSH(RR=4.9,95%CI,1.1-21.3)significantly increased SPR,whereas SERM plus kallikrein increased sperm concentration(MD=16.5×10^(6)mL^(-1),95%CI,1.6×10^(6)-31.4×10^(6)),and SERM plus CoQ10 significantly improved sperm progressive motility(MD=11.3%,95%CI,7.3%-15.4%)and normal morphology(MD=11.2%,95%CI,5.4%-16.9%)in men with oligoasthenozoospermia(OA).In terms of side effects,fatty acids and pentoxifylline were associated with foul breath and/or a bad taste(RR=8.1,95%CI,1.0-63.5)and vomiting(RR=8.0,95%CI,1.0-63.0),respectively.In conclusion,the optimal treatment for male infertility for live birth is still unknown.Carnitine plus vitamins and FSH are likely to be better than other therapies in achieving successful spontaneous pregnancy in couples overall and in cou ples with men with OA,respectively.The efficacy of other treatments on pregnancy outcomes warrants further verification. | Jian Li Qi Wu Ernest Hung Yu Ng Ben Willem J.Mol Xiao Ke Wu Chi Chiu Wang | 2022 | Engineering2022，，9： | 0 |
| 3 | 多囊卵巢综合征无排卵的胰岛素信号和雄激素合成的新遗传风险和代谢特征显示文摘促排卵是多囊卵巢综合征(PCOS)不孕症的一线治疗方案。卵巢对促排卵治疗的排卵应答差被认为与胰岛素抵抗和高雄激素血症相关。在一个包含1000名PCOS不孕妇女(PCOSAct)的前瞻性队列中,我们开展了一项全外显子联合靶向单核苷酸多态性(SNP)测序以及代谢组学研究。在全基因组水平找出与无排卵显著相关的常见变异和罕见突变,并通过机器学习算法构建排卵预测模型。研究发现,ZNF438基因中标记为rs2994652(p=2.47×10^(-8))的常见变异和REC114基因中的一个罕见功能突变(rs182542888,p=5.79×10^(-6))与促排卵治疗失败显著相关。携带rs2994652 A等位基因和REC114 p.Val101Leu(rs182542888)的PCOS不孕妇女进行促排卵治疗的总排卵率更低(分别为比值比(OR)=1.96,95%置信区间(CI)[1.55~2.49];OR=11.52,95%CI[3.08~43.05]),出现排卵的间隔时间更长(平均56.7天vs.49.0天,p<0.001;78.1天vs.68.6天,p=0.014)。对于rs2994652突变者,L-苯丙氨酸水平升高并与胰岛素抵抗稳态模型(HOMA-IR)指数(r=0.22,p=0.05)和空腹血糖(r=0.33,p=0.003)呈正相关;对于rs182542888突变者,花生四烯酸代谢产物水平下降并与升高的抗苗勒管激素(r=-0.51,p=0.01)和总睾酮(r=-0.71,p=0.02)呈负相关。整合基因变异位点、代谢产物及临床特征的联合预测模型可提高对排卵的预测能力[曲线下面积(AUC)=76.7%]。ZNF438基因的一个常见变异和REC114基因的一个罕见功能突变,以及与二者相关的苯丙氨酸和花生四烯酸代谢物改变,与PCOS女性不孕症的促排卵治疗失败相关。 | 吴效科 黄志超 曹义娟 李建 李志强 马红丽 高敬书 常惠 张多加 丛晶 王宇 吴奇 Xiaoxiao Han Pui Wah Jacqueline Chung Yiran Li Xu Zheng Lingxi Chen Lin Zeng Astrid Borchert Hartmut Kuhn Zi-Jiang Chen Ernest Hung Yu Ng Elisabet Stener-Victorin 张和平 Richard S.Legro Ben Willem J.Mol 师咏勇 | 2023 | Engineering2023，，4： | 0 |
| 4 | 特力阿扎维林治疗新冠病毒肺炎的疗效与安全性——一项随机对照试验显示文摘目前,尚无有效疗法可治愈由严重急性呼吸综合征冠状病毒2(severe acute respiratory syndrome coronavirus 2,SARS-CoV-2)引起的新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)。为了评估抗病毒药物特力阿扎维林治疗COVID-19的有效性和安全性,本研究针对感染COVID-19的成年住院患者开展了一项随机双盲对照试验。本研究从10个分中心招募COVID-19患者,并将患者按1:1的比例随机分为两组。试验组的患者每天服用250 mg的特力阿扎维林药物3~4次,对照组患者则服用安慰剂,为期共7 d。主要结局指标为临床改善时间,临床改善时间的定义为随机分组28d内患者的体温、呼吸频率、血氧饱和度、咳嗽频率和肺CT(计算机断层扫描,computed tomography)所显示的肺部感染吸收情况全部恢复正常的时间。次要结局指标包括主要结局指标的5个组成指标,及肺部感染吸收的平均时间和吸收比例,以及用咽拭子采样法连续两次SARS-CoV-2核酸检测阴性的转阴率。与此同时,记录合并的治疗药物、不良事件和严重不良事件。由于需要进行住院治疗的新增感染病例的减少,本研究在招募52名患者后便停止招募。将52名受试者随机分为服用特力阿扎维林药物的试验组(n=26)和服用安慰剂的对照组(n=26)。结果显示,两组临床改善时间并无明显差异[中位数,7 d vs.12 d;风险比(RR)为2.0;95%置信区间(CI)为0.7~5.6;p=0.2]。服用特力阿扎维林的试验组中有10名患者发生临床改善,服用安慰剂的对照组中有6名患者出现临床改善(38.5%vs.23.1%,RR为2.1;95%CI为0.6~7.0;p=0.2)。除了肺部感染的吸收情况外(试验组50.0%,对照组26.1%),其余主要结局所观察指标均在28 d内恢复正常。此外,试验组的患者在呼吸系统、心脏、肾、肝或凝血功能等方面的合并治疗较对照组少。尽管特力阿扎维林药物对COVID-19患者的疗效尚未达到统计学上的显著性水平,但本研究结果表明,由于特力阿扎维林药物具有抗病毒作用,将其用于COVID-19的治疗也可能具有一定的疗效。对此,需要进一步的研究进行验证。 | 吴效科 于凯江 王永晨 徐万海 马红丽 侯艳 李悦 蔡本志 朱丽影 张敏 胡晓丽 高敬书 王宇 秦慧超 王文杰 赵鸣雁 吴霞 张勇 李璐 李康 杜智敏 Ben Willem J.Mol 杨宝峰 | 2020 | Engineering2020，6，10： | 0 |
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