OBJECTIVE:The aim of this study was to examine changes in resting electroencephalography (EEG) activity associated with an 8-week acupuncture intervention for women with endometriosis and chronic pelvic pain. METHODS:Eighteen women aged 18-45 years with laparoscopic diagnosis of endometriosis completed this study. The treatment group (n = 13) received 16 acupuncture sessions over eight weeks, administered in 45-min sessions twice weekly. Self-reported daily pain ratings and eyes-closed resting state EEG were obtained pre- and post-intervention (T1, T2). The control group was insufficient and omitted. Frequency principal components analysis (fPCA) was used to decompose EEG data for each timepoint. RESULTS:Four fPCA component pairs showed suitable correspondence between T1 and T2: Alpha-II (9 Hz), alpha-III/IV (~10-11 Hz), beta-I (19 Hz), and beta-II (~26 Hz). From T1 to T2, global alpha-II amplitude increased, peak alpha-III/IV frequency increased and amplitude decreased, whilst beta-I amplitude decreased. The relative alpha-III/IV amplitude reduction was associated with the relative reduction in pain severity scores. CONCLUSIONS:Changes in alpha-III/IV peak frequency and amplitude, and the relationship with chronic pelvic pain suggest that ~10-11.5 Hz alpha may index pain severity in women with endometriosis. However, the potential acupuncture-related modulation of alpha could not be determined due to the lack of a suitable control group. SIGNIFICANCE:Resting state EEG may be a viable tool to further characterise changes in chronic pain states in a clinical setting and provide objective quantification of responsivity to treatment. Further research with an appropriate control group is recommended to test this.

BACKGROUND AND PURPOSE:Heart failure (HF) is associated with multi-organ dysfunction and significant morbidity and mortality. Despite advances in treatment, prognosis remains poor, highlighting the need to explore adjunctive therapies such as integrative medicine. This umbrella review synthesises top-tier evidence from systematic reviews and meta-analyses of randomised controlled trials (RCTs) assessing the safety and effectiveness of integrative medicine in patients with HF, in order to inform clinical decision-making. METHODS:We searched MEDLINE, Cochrane, PsycINFO and EMBASE until April 2024. Primary outcomes included mortality, hospitalisation rates, and severity or prognostic indicators, including brain natriuretic peptide (BNP) and exercise capacity. A hierarchical evidence synthesis method was used whereby we included the most recent, highly ranked and comprehensive reviews for our research question. We assessed review quality using 'A MeaSurement Tool to Assess systematic Reviews' and, where possible, evidence certainty for our primary outcomes using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS:Twenty-two reviews were included. Co-enzyme Q10 or Tai Chi may reduce mortality and hospitalisation rates (moderate certainty evidence), and acupuncture or intravenous Chinese herbal medicines may improve BNP (low to very low certainty evidence). The benefits of yoga and other nutrient supplements including L-carnitine remain unclear. Vitamin E may increase hospitalisation rates and should be avoided. CONCLUSION:The evidence for most integrative medicine modalities for adjunctive management of HF remains limited. Well-designed and rigorous RCTs are needed, particularly with long-term follow up and evaluation of clinically meaningful outcomes.

Subjective Cognitive Impairment (SCI) is a self-perceived worsening of cognitive decline, carrying an increased risk of developing Mild Cognitive Impairment (MCI) and Alzheimer's Disease (AD). Due to the self-report nature of SCI, an understanding of the biological mechanisms that contribute to an increased dementia risk is needed. This study aims to assess the differences in resting state electroencephalography (EEG) (eyes-open, eyes-closed; EO, EC) between older adults with SCI and healthy controls (HCs) utilising frequency principal components analysis (fPCA), a novel data driven approach. Participants (n = 14 per group: SCI, HCs) were matched on age, sex, years of education, mood, cognition, and pre-morbid function. Continuous resting EEG was recorded during 2-minute conditions (EO, EC) and were submitted to 4 separate fPCAs (each condition, group). Corresponding components were assessed between groups and conditions, correlated with demographics, mood, and cognition variables; multivariate logistic regression was also carried out. Component amplitudes were larger in HCs for delta-theta and alpha-beta, while theta-alpha was larger for SCI. DASS anxiety scores contributed to higher amplitudes for HCs in EO delta-theta and alpha-beta, while male sex and depressive symptoms contributed to higher amplitudes for the SCI group in EO and EC theta-alpha. Findings demonstrate a distinct divergent signature of neurological activity in older people with SCI, despite normal objective cognitive function. This is the first fPCA study to investigate neuronal differences between HCs and older adults with SCI at rest. Novel confounders and effect modifiers were identified that should be controlled in future studies.

Sokolov described both phasic and tonic aspects of the Orienting Reflex (OR), but subsequent research and theory development has focussed primarily on the phasic OR at the expense of the tonic OR. The present study used prestimulus skin conductance level (SCL) during a dishabituation paradigm to model the tonic OR, examining its amplitude patterning over repeated standard stimulus presentations and a change stimulus. We expected sensitisation (increased amplitude) following the initial and change trials, and habituation (decrement) over the intervening trials. Prestimulus EEG alpha level was explored as a potential central measure of the tonic OR (as an inverse correlate), examining its pattern over stimulus repetition and change in relation to the SCL model. We presented a habituation series of innocuous auditory stimuli to two groups (each N = 20) at different ISIs (Long 13-15 s and Short 5-7 s) and recorded electrodermal and EEG data during two counterbalanced conditions; Indifferent: no task requirements; Significant: silent counting. Across groups and conditions, prestimulus SCLs and alpha amplitudes generally showed the expected trials patterns, confirming our main hypotheses. Findings have important implications for including the assessment of Sokolov's tonic OR in modelling central and autonomic nervous system interactions of fundamental attention and learning processes.

Background and Aims: Numerous endometriosis treatments exist, ranging from surgical to traditional medications to complementary and alternative medicines (CAMs). The ranking of treatments across management categories remains unknown. To address this research gap, this network meta-analysis (NMA) aims to rank endometriosis treatments in terms of efficacy and safety for endometriosis-related pain and quality of life. Method: A systematic literature search and fixed effects NMA was conducted. Eight databases were searched from inception to August 2022. All randomised control trials (RCTs) in women with surgically confirmed endometriosis were considered. Results: After screening 8,668 studies, 165 RCTs were included, consisting of 26,762 participants, investigating 48 medical, 13 CAMs and 16 surgical interventions. Preliminary analysis of the CAMs interventions (9 RCTs, n=522) suggested acupuncture (SMD -1.96; 95%CI: -2.63, -1.29), olive oil (SMD -1.68; 95%CI: -2.69, -0.67), fatty acid supplements (SMD -1.48; 95% CI: -2.15, -0.81), contraception + Chinese medicines (SMD -1.28; 95%CI: -2.39, -0.16), Chinese medicine (SMD -0.91, 95%CI: -1.78, -0.04) and vitamin C&E (SMD -0.38; 95%CI -0.89, 0.13) demonstrated a reduction in pain compared to placebo. There was insufficient evidence to detect a difference in pain using Vitamin D compared to placebo (SMD 0.09 95% CI: -0.55, 0.73). Complete results, including the individual and combined categories within a Bayesian framework and intervention ranking, will be available for ASPIRE 2023. Conclusion: This is the first NMA to compare the evidence of all endometriosis treatments. The findings have the potential to guide treatment decisions and guideline development.

Abstract INTRODUCTION This study primarily aimed to evaluate the efficacy and safety of SaiLuoTong (SLT) on cognition in mild cognitive impairment (MCI). METHODS Community‐dwelling people with MCI aged ≥60 years were randomly assigned to 180 mg/day SLT or placebo for 12 weeks. RESULTS Thirty‐nine participants were randomized to each group (N = 78); 65 were included in the final analysis. After 12 weeks, the between‐groups difference in Logical Memory delayed recall scores was 1.40 (95% confidence interval [CI]: 0.22 to 2.58; P = 0.010); Delis–Kaplan Executive Function System Trail Making Test Condition 4 switching and contrast scaled scores were 1.42 (95% CI: –0.15 to 2.99; P = 0.038) and 1.56 (95% CI: –0.09 to 3.20; P = 0.032), respectively; Rey Auditory Verbal Learning Test delayed recall was 1.37 (95% CI: –0.10 to 2.84; P = 0.034); and Functional Activities Questionnaire was 1.21 (95% CI: –0.21 to 2.63; P = 0.047; P < 0.001 after controlling for baseline scores). DISCUSSION SLT is well tolerated and may be useful in supporting aspects of memory retrieval and executive function in people with MCI. Highlights SaiLuoTong (SLT) improves delayed memory retrieval and executive function in people with mild cognitive impairment (MCI). SLT is well tolerated in people ≥ 60 years. The sample of community dwellers with MCI was well characterized and homogeneous.

Objective: Endometriosis is associated with neuroplastic changes in cognitive control and pain processing networks. This was the first study to assess eyes-closed resting electroencephalogram (EEG) oscillatory amplitudes in women with endometriosis compared to healthy controls, and explore the relationship with chronic pelvic pain. Methods: Women with endometriosis-related chronic pelvic pain and individually age-matched painfree controls (N = 20 per group) documented pelvic pain for 28 days before having continuous EEG recorded during a 2 min eyes closed resting state. Natural frequency components were extracted for each group using frequency principal components analysis. Corresponding components were assessed for group differences and correlated with pain scores. Results: Relative to controls, the endometriosis group had greater component amplitudes in delta (0.5 Hz) and beta (-28 Hz), and reduced alpha (-10 Hz). Delta and beta amplitudes were positively associated with pain severity, but only beta maintained this association after delta-beta amplitude coupling was controlled. Conclusions: Enhanced resting delta and beta amplitudes were seen in women with endometriosis experiencing chronic pelvic pain. This delta-beta coupling varied with pelvic pain severity, perhaps reflecting altered cholinergic tone and/or stress reactivity. Significance: Endometriosis-related changes in central pain processing demonstrate a distinct neuronal oscillatory signature detectable at rest. & COPY; 2023 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.

Abstract Although the P300 event-related potential (ERP) is the most likely central measure of Sokolov’s Orienting Reflex (OR), there are few systematic comparisons with the skin conductance response (SCR), the “gold standard” electrodermal OR measure. We examine habituation, stimulus significance, and inter-stimulus interval (ISI) effects in SCRs and components of the P300 from single-trial ERPs in an auditory dishabituation paradigm. Single trial ERP components were separated by temporal principal components analysis, and five components of the P300 were examined as potential phasic OR measures: P3a, P3b, Novelty P3, and two Slow Waves (SW1, SW2). Across the factors of ISI and significance, SCRs showed decrement over trials, recovery at a deviant, and dishabituation at the subsequent standard. This general pattern was not present in any of the components of the P300. SCRs were also larger to significant stimuli and at the long ISI; effects differed between P300 components. The electrodermal SCR showed the complete profile over trials expected of the phasic OR, and was enhanced by stimulus significance, confirming it as the model measure of Sokolov’s phasic OR. Components of the P300 failed to match this profile, but instead appear to reflect different aspects of the stimulus processing involved in OR elicitation.

Although the P300 event-related potential (ERP) is the most likely central measure of Sokolov's Orienting Reflex (OR), there are few systematic comparisons with the skin conductance response (SCR), the "gold standard" electrodermal OR measure. We examine habituation, stimulus significance, and inter-stimulus interval (ISI) effects in SCRs and components of the P300 from single-trial ERPs in an auditory dishabituation paradigm. Single trial ERP components were separated by temporal principal components analysis, and five components of the P300 were examined as potential phasic OR measures: P3a, P3b, Novelty P3, and two Slow Waves (SW1, SW2). Across the factors of ISI and significance, SCRs showed decrement over trials, recovery at a deviant, and dishabituation at the subsequent standard. This general pattern was not present in any of the components of the P300. SCRs were also larger to significant stimuli and at the long ISI; effects differed between P300 components. The electrodermal SCR showed the complete profile over trials expected of the phasic OR, and was enhanced by stimulus significance, confirming it as the model measure of Sokolov's phasic OR. Components of the P300 failed to match this profile, but instead appear to reflect different aspects of the stimulus processing involved in OR elicitation.

Background Subjective cognitive impairment (SCI) substantially increases dementia risk and is often conceptualised as the preclinical asymptomatic phase of the cognitive decline continuum. Due to the lack of pharmacological interventions available to treat SCI and reduce dementia risk, and the popularity of herbal and nutritional medicines, the primary aim of this review was to investigate the efficacy on cognitive function and safety of herbal and nutritional medicines (relative to a control) for older adults with and without SCI. The secondary aims were to describe the study characteristics and assess the methodological quality of included studies. Method Five databases (Cochrane, MEDLINE, CINAHL, PsycInfo, and EMBASE) were searched from database inception with weekly alerts established until review finalisation on 18 September 2022. Articles were eligible if they included the following: study population of older adults with and without SCI, herbal and nutritional medicines as an intervention, evaluated cognitive outcomes and were randomised control trials. Results Data were extracted from 21/7666 eligible full-text articles, and the risk of methodological bias was assessed (with SCI = 9/21; without SCI = 12/21). Most studies (20/21) employed parallel, randomised, placebo-controlled designs and were 12 weeks in length. Herbal supplements were widely used (17/21), namely a form of Ginkgo biloba (8/21) or Bacopa monnieri (6/21). Measures of cognition varied across studies, with 14/21 reporting improvements in at least one domain of cognitive functioning over time, in the intervention group (compared to control). A total of 14/21 studies were deemed as having an overall high methodological risk of bias, 6/21 had some concerns, and only one study (using an SCI population) was assessed as having a low risk of methodological bias. Conclusions Overall, this review found that there is a low quality of evidence regarding the efficacy of cognitive function and safety of herbal and nutritional medicines for older adults with and without SCI, due to a high risk of bias across studies. Additionally, further work needs to be done in classifying and understanding SCI and selecting appropriate trial primary outcomes before future studies can more accurately determine the efficacy of interventions for this population.

Purpose: Weight gain after breast cancer is common. The aim of this study was to determine factors associated with weight gain after breast cancer in Australian women.Methods: A cross-sectional online survey was conducted between November 2017 and January 2018. Women living in Australia who self-identified as having breast cancer or ductal carcinoma in-situ were eligible. We created stepwise linear and logistic regression models to evaluate predictors for absolute and clinically significant (& GE;5%) weight gain respectively.Results: Data from 276 women were analysed. Most were Caucasian and 92% had been diagnosed with Stage 0-III breast cancer. Absolute weight gain was associated with hot flushes, being in the menopausal transition at diagnosis, being less physically active than at diagnosis, lower eating self-efficacy when watching television or using a computer, and higher self-efficacy when anxious or nervous (F-ratio = 3.26, R2-adjusted = 0.16, p < .001). Clinically significant weight gain was associated with tamoxifen use (OR 2.7), being less physically active than at diagnosis (OR 3.1), and lower eating self-efficacy when watching television or using a computer (OR 0.82) (Chi-square 64.94, df = 16, p < .001). Weight gain was not associated with chemotherapy, radiotherapy, aromatase inhibitor use, number of lymph nodes removed, or body mass index at diagnosis.Conclusions: Interventions to prevent weight gain after breast cancer, particularly aiming to maintain physical activity, should be targeted at women receiving tamoxifen. The role of eating self-efficacy, especially attentive eating, in managing weight after breast cancer should be explored.

BACKGROUND:There is a need for evidence-based guidance on complementary medicines and therapies (CMT) use during pregnancy due to high prevalence of use and lack of guidance on the balance of benefit and harms.AIM:Evaluate the extent to which current clinical practice guidelines relevant to Australian healthcare professionals make clear and unambiguous recommendations about CMT use in pregnancy, and synthesise these recommendations.METHODS:The search included EMBASE, PubMed, the National Health and Medical Research Council's Clinical Practice Guidelines Portal, and websites of Australian maternity hospitals and professional/not-for-profit organisations for published guidelines on pregnancy care. Data were synthesised narratively. Guidelines were appraised by two independent reviewers using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument.FINDINGS:A total of 48 guidelines were found, of which 41% provided recommendations that were not limited to routine vitamin and mineral supplementation. There were wide variations in recommendations, particularly for vitamin D and calcium. There was some consensus on recommending ginger and vitamin B6 for nausea and vomiting, and additional supplementation for women with obesity. Guidelines generally scored poorly in the domains of editorial independence and rigour of development.DISCUSSION:There is a lack of guidance with regard to appropriate CMT use during pregnancy, which may result in less-than-optimal care. Inconsistency between guidelines may lead to variations in care.CONCLUSION:Guidelines should include clear and unambiguous guidance on appropriate CMT use during pregnancy, be based on a structured search of the evidence and informed by stakeholder engagement.

Our previous studies of the equiprobable auditory Go/NoGo task have been used to substantiate a perceptual/cognitive Processing Schema in young and older adults, and in children. The processes in the Schema are linked to PCA components derived separately from Go and NoGo ERPs. Here we investigated sex differences in the child Schema. Two groups of fourteen children (aged 8 to 13 years) were individually matched on age and presented with four stimulus blocks of the equiprobable Go/NoGo task, each containing 75 NoGo and 75 Go tones in random order. Separate NoGo and Go ERPs were obtained from each child and submitted to temporal Principal Components Analyses (PCAs). Each ERP was analysed in two epochs (-100-400 ms and 300-800 ms) to improve the cases:variables ratio. Four pairs of temporal PCAs, each with unrestricted VARIMAX rotation, separately quantified the NoGo and Go ERPs of each epoch in each group. After these pairs were combined in temporal order, four sets of similar components were extracted. Many identified components were differentially enhanced to either NoGo or Go, as in previous work with children. The Female group had NoGo component latencies that were systematically some 3.5% greater than in Males, but there were no sex differences in Go latencies. Females also displayed fewer NoGo commission and Go omission errors, and faster Go RT than Males. Females had larger NoGo N2b, and larger Go components from N2b through to the late positivity. These results, including their ERP component/behaviour correlations, can be integrated as a task-specific behavioural and ERP processing enhancement in girls that suggests their developmental advantage over boys in this age range.

The equiprobable go/no-go task lacks the dominant go imperative found in the usual go/no-go task, and hence we previously regarded it as involving little inhibition. However, children have relative difficulty with this task, and demonstrate large frontal no-go N2s. We investigated whether this child N2 plays an inhibitory role, using performance measures to illuminate the link between N2 and inhibition. Forty children aged 8 to 13 were presented with four stimulus blocks each containing 75 go and 75 no-go tone stimuli in random order. A temporal PCA with unrestricted varimax rotation quantified the mean go and no-go ERP component amplitudes. Most identified components were differentially enhanced to go or no-go as in adults, supporting a previously proposed differential processing schema. Between subjects, larger frontocentral no-go N2bs were associated with fewer commission errors. Hence, the no-go N2b in this paradigm can be interpreted as an individual marker of inhibition in children.

Background: Overweight and obesity are strongly implicated in breast cancer (BC) development and are also a risk factor for BC-related lymphedema (BCRL). Materials and Methods: An online cross-sectional survey was conducted between November 2017 and January 2018. Analyses were restricted to women with localized BC, who provided information about BCRL (n = 238). Most women were not experiencing BCRL (55.46%). Results: Mean self-reported weight at diagnosis was 68.55 kg for women without BCRL and 74.43 kg for women with BCRL (p = 0.0021). In this study, 50.9% with BCRL were overweight/obese at diagnosis (body mass index [BMI] >= 25) compared with 36.4% of women without BCRL (p = 0.003). For women without BCRL, 12.12% were classified as obese (BMI >= 30) versus 20.75% with BCRL. Women with BCRL were more likely to have gained > 5% of body weight (p = 0.03), be currently overweight or obese (p = 0.004), and less active (48.11%) than they were at diagnosis than women without BCRL (33.33%) (p = 0.042). Having a structured exercise program, following a prescribed diet, and being accountable to someone else were identified as the main facilitators to successful weight loss and weight maintenance. Conclusions: Clinicians should consider obesity when personalizing axillary treatment and encourage lifestyle interventions and lymphedema screening after BC treatment.

Auditory stimulus intensity of innocuous tones is generally thought to have a direct effect on the amplitude of ERP components, but these effects have rarely been explored across a wide component range, or in multiple paradigms. Here we investigate component sensitivity to stimulus intensity differences in two studies. Study 1 (N = 36) employed a between-participants paradigm in which repeated trains of standard stimuli were presented as 50 or 80 dB SPL 1000 Hz tones. Study 2 (N = 18) used a within-participant presentation of alternating 60 and 80 dB SPL 1000 Hz tones. Electrode caps with 19 channels (referred to linked ears) generated ERPs covering the first 600 ms of each participant's EEG responses; these were submitted to separate temporal PCAs in each study. A similar series of components was obtained in each study: P1, N1a, N1b, N1c, P2, P3a, P3b, nP3, SW1, and SW2; an N2 was found in Study 2 only. Loud tones in Study 1 produced greater amplitudes in all components except SW1. In Study 2, Loud cf. Soft tones produced smaller P1 and nP3, larger N1 components, P2, and P3a, with no effect on N2, P3b, SW1 or SW2. These results indicate similar sequential processes underlying sensory processing in one- and two-stimulus paradigms, with the later stimulus intensity effects varying with paradigm.

BACKGROUND:Chronic pelvic pain (CPP) is a common gynaecological condition accounting for 20% of all gynaecological referrals. There are wide ranges of causes with overlapping symptomatology, therefore the management of the condition is a formidable challenge for clinicians. The aetiology of CPP is heterogeneous and in many cases, no clear diagnosis can be reached. It is in this scenario that the label of chronic pelvic pain syndrome (CPPS) can be applied. We defined women with CPPS as having a minimum duration of pain of at least 6 months, including with a diagnosis of pelvic congestion syndrome, but excluding pain caused by a condition such as endometriosis. Many surgical interventions have been tried in isolation or in conjunction with non-surgical interventions in the management with variable results. Surgical interventions are invasive and carry operative risks. Surgical interventions must be evaluated for their effectiveness prior to their prevalent use in the management of women with CPPS. OBJECTIVES:To review the effectiveness and safety of surgical interventions in the management of women with CPPS. SEARCH METHODS:We searched the Cochrane Gynaecology and Fertility Group (CGF) Specialised Register of Controlled Trials, CENTRAL, MEDLINE, Embase and PsycINFO, on 23 April 2021 for any randomised controlled trials (RCT) for surgical interventions in women with CPPS. We also searched the citation lists of relevant publications, two trial registries, relevant journals, abstracts, conference proceedings and several key grey literature sources. SELECTION CRITERIA:RCTs with women who had CPPS. The review authors were prepared to consider studies of any surgical intervention used for the management of CPPS. Outcome measures were pain rating scales, adverse events, psychological outcomes, quality of life (QoL) measures and requirement for analgesia. DATA COLLECTION AND ANALYSIS:Two review authors independently evaluated studies for inclusion and extracted data using the forms designed according to Cochrane guidelines. For each included trial, we collected information regarding the method of randomisation, allocation concealment, blinding, data reporting and analyses. We reported pooled results as mean difference (MDs) or odds ratios (OR) and 95% confidence interval (CI) by the Mantel-Haenszel method. If similar outcomes were reported on different scales, we calculated the standardised mean difference (SMD). We applied GRADE criteria to judge the overall certainty of the evidence. MAIN RESULTS:Four studies met our inclusion criteria involving 216 women with CPP and no identifiable cause. Adhesiolysis compared to no surgery or diagnostic laparoscopy We are uncertain of the effect of adhesiolysis on pelvic pain scores postoperatively at three months (MD -7.3, 95% CI -29.9 to 15.3; 1 study, 43 participants; low-certainty evidence), six months (MD -14.3, 95% CI -35.9 to 7.3; 1 study, 43 participants; low-certainty evidence) and 12 months postsurgery (MD 0.00, 95% CI -4.60; 1 study, 43 participants; very low-certainty evidence). Adhesiolysis may improve both the emotional wellbeing (MD 24.90, 95% CI 7.92 to 41.88; 1 study, 43 participants; low-certainty evidence) and social support (MD 23.90, 95% CI -1.77 to 49.57; 1 study, 43 participants; low-certainty evidence) components of the Endometriosis Health Profile-30, and both the emotional component (MD 32.30, 95% CI 13.16 to 51.44; 1 study, 43 participants; low-certainty evidence) and the physical component of the 12-item Short Form (MD 22.90, 95% CI 10.97 to 34.83; 1 study, 43 participants; low-certainty evidence) when compared to diagnostic laparoscopy. We are uncertain of the safety of adhesiolysis compared to comparator groups due to low-certainty evidence and lack of structured adverse event reporting. No studies reported on psychological outcomes or requirements for analgesia. Laparoscopic uterosacral ligament ablation or resection compared to diagnostic laparoscopy/other treatment We are uncertain of the effect of laparoscopic uterosacral ligament/nerve ablation (LUNA) or resection compared to other treatments postoperatively at three months (OR 1.26, 95% CI 0.40 to 3.93; 1 study, 51 participants; low-certainty evidence) and six months (MD -2.10, 95% CI -4.38 to 0.18; 1 study, 74 participants; very low-certainty evidence). At 12 months post-surgery, we are uncertain of the effect of LUNA on the rate of successful treatment compared to diagnostic laparoscopy. One study of 56 participants found no difference in the effect of LUNA on non-cyclical pain (P = 0.854) or dyspareunia (P = 0.41); however, there was a difference favouring LUNA on dysmenorrhea (P = 0.045) and dyschezia (P = 0.05). We are also uncertain of the effect of LUNA compared to vaginal uterosacral ligament resection on pelvic pain at 12 months (MD 2.00, 95% CI 0.47 to 3.53; 1 study, 74 participants; very low-certainty evidence). We are uncertain of the safety of LUNA or resection compared to comparator groups due to the lack of structured adverse event reporting. Women undergoing LUNA may require more analgesia postoperatively than those undergoing other treatments (P < 0.001; 1 study, 74 participants). No studies reported psychological outcomes or QoL. AUTHORS' CONCLUSIONS:We are uncertain about the benefit of adhesiolysis or LUNA in management of pain in women with CPPS based on the current literature. There may be a QoL benefit to adhesiolysis in improving both emotional wellbeing and social support, as measured by the validated QoL tools. It was not possible to synthesis evidence on adverse events as these were only reported narratively in some studies, in which none were observed. With the inadequate objective assessment of adverse events, especially long-term adverse events, associated with adhesiolysis or LUNA for CPPS, there is currently little to support these interventions for CPPS.

Resting EEG, measured in eyes-closed (EC) and eyes-open (EO) states, can provide insight into behavioural differences between groups. Surprisingly, differences in resting EEG between females and males have not been investigated systematically in previous literature. The present study utilised the four traditional EEG bands to confirm their baseline EC topographies and reactivity (EO minus EC) across groups, to clarify topographical differences between sexes, and to confirm alpha as a measure of arousal. Participants were eighty healthy young adults (40 female), with a mean age of 20.4 (range 18-26) years. Continuous resting EEG was recorded from 30 scalp sites during three 2-minute conditions (EO1, EC, EO2), and EOG-corrected. Data from each condition were divided into 60 sequential 2-second epochs. Accepted artefact-free epochs were Fourier Transformed, and absolute amplitudes in the delta (0.5-3.5 Hz), theta (4.0-7.5 Hz), alpha (8.0-13.0 Hz), and beta (13.5-29.5 Hz) bands were calculated. Across groups in EC, significant topographical differences were found between the band amplitudes, broadly compatible with previous reports. Females had greater overall amplitudes in delta, alpha and beta, enhanced midline activity in theta, and parietal and midline activity in the alpha and beta bands. From EC to EO, reactivity was apparent across the bands as significant reductions, particularly in the parietal region. For females compared to males, the reduction in parietal midline delta and theta, parietal alpha and parietal midline beta was significantly larger. Additionally, across groups, alpha activity was confirmed as an inverse measure of arousal. These findings indicate significant differences in neuronal activity between young adult females and males, and help our interpretation of alpha changes.

Endometriosis is a debilitating women's health condition and is the most common cause of chronic pelvic pain. Impaired cognitive control is common in chronic pain conditions, however, it has not yet been investigated in endometriosis. The aim of this study was to explore the neuronal correlates of cognitive control in women with endometriosis. Using a cross-sectional study design with data collected at a single time-point, event-related potentials were elicited during a cued continuous performance test from 20 women with endometriosis (mean age = 28.5 ± 5.2 years) and 20 age- and gender-matched controls (mean age = 28.5 ± 5.2 years). Event-related potential components were extracted and P3 component amplitudes were derived with temporal principal components analysis. Behavioral and ERP outcomes were compared between groups and subjective pain severity was correlated with ERP component amplitudes. No significant behavioral differences were seen in task performance between the groups (all p > 0.094). Target P3b (all p < 0.034) and SW (all p < 0.040), and non-target early P3a (eP3a; all p < 0.023) and late P3a (lP3a; all p < 0.035) amplitudes were smaller for the endometriosis compared to the healthy control group. Lower non-target eP3a ( p < 0.001), lP3a ( p = 0.013), and SW ( p = 0.019) amplitudes were correlated with higher pain severity scores. Findings suggest that endometriosis-associated chronic pelvic pain is linked to alterations in stimulus-response processing and inhibitory control networks, but not impaired behavioral performance, due to compensatory neuroplastic changes in overlapping cognitive control and pain networks.