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Microbial dysbiosis in the upper digestive tract is linked to an increased risk of esophageal squamous cell carcinoma (ESCC). Overabundance of Porphyromonas gingivalis is associated with shorter survival of ESCC patients. We investigated the molecular mechanisms driving aggressive progression of ESCC by P. gingivalis. Intracellular invasion of P. gingivalis potentiated proliferation, migration, invasion, and metastasis abilities of ESCC cells via transforming growth factor-ß (TGFß)-dependent Drosophila mothers against decapentaplegic homologs (Smads)/Yes-associated protein (YAP)/Transcriptional coactivator with PDZ-binding motif (TAZ) activation. Smads/YAP/TAZ/TEA domain transcription factor1 (TEAD1) complex formation was essential to initiate downstream target gene expression, inducing an epithelial-mesenchymal transition (EMT) and stemness features. Furthermore, P. gingivalis augmented secretion and bioactivity of TGFß through glycoprotein A repetitions predominant (GARP) up-regulation. Accordingly, disruption of either the GARP/TGFß axis or its activated Smads/YAP/TAZ complex abrogated the tumor-promoting role of P. gingivalis. P. gingivalis signature genes based on its activated effector molecules can efficiently distinguish ESCC patients into low- and high-risk groups. Targeting P. gingivalis or its activated effectors may provide novel insights into clinical management of ESCC.
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Infecções por Bacteroidaceae/complicações , Neoplasias Esofágicas/patologia , Carcinoma de Células Escamosas do Esôfago/patologia , Porphyromonas gingivalis/fisiologia , Fator de Crescimento Transformador beta/fisiologia , Aciltransferases , Proteínas Adaptadoras de Transdução de Sinal/metabolismo , Adulto , Idoso , Animais , Infecções por Bacteroidaceae/metabolismo , Infecções por Bacteroidaceae/mortalidade , Infecções por Bacteroidaceae/patologia , Células Cultivadas , Progressão da Doença , Drosophila , Neoplasias Esofágicas/metabolismo , Neoplasias Esofágicas/microbiologia , Neoplasias Esofágicas/mortalidade , Carcinoma de Células Escamosas do Esôfago/metabolismo , Carcinoma de Células Escamosas do Esôfago/microbiologia , Carcinoma de Células Escamosas do Esôfago/mortalidade , Feminino , Seguimentos , Células HCT116 , Humanos , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Nus , Pessoa de Meia-Idade , Transdução de Sinais/fisiologia , Proteínas Smad/metabolismo , Análise de Sobrevida , Fatores de Transcrição/metabolismo , Fator de Crescimento Transformador beta/metabolismo , Proteínas de Sinalização YAPRESUMO
OBJECTIVE: To study the inhibitory effect of flavonoids from Glycyrrhiza uralensis on thioacetamide-induced chonic hepatic fibrosis in rats and the effect on the protein expressions of transforming growth factor-ß1 (TGF-ß1) and Caspase-3 in livers. METHOD: Male Sprague-Dawley rats were randomly divided into totally seven groups: the normal control group, the model group, LF groups s (400, 200, 100, 50 mg · kg(-1) · d(-1)) and the silymarin positive control group (30 mg · kg(-1) · d(-1)). The hepatic fibrosis model was induced in the rats through intraperitoneal injection with 3% thioacetamide (TAA) at a dose of 150 mg · kg(-1) body weight twice a week for 12 weeks. During the course, the control group and the model group were orally administered with saline (1 mL · kg(-1) · d(-1)). After the modeling and drug intervention, the pathologic changes and fibrosis in liver tissues were observed by HE staining and Masson's Trichrome staining. The serum alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP) and liver hydroxyproline (HYP) contents were assayed by biochemical process. The serum hyaluronic acid (HA) was assessed by radioimmunoassay. In addition, the protein expressions of liver TGF-ß1 and Caspase-3 were examined by immunohistochemical method. The mRNA expression of TGF-ß1 in hepatic tissues was examined by quantitative Real-time PCR analysis. RESULT: Compared with the model group, flavonoids can protect the integrity of the structure of liver tissues, significantly reduce the hepatic cell degeneration and necrosis and the proliferation of fibrous tissues, notably reduce the serum AST, ALT, ALP and HA and HYP in hepatic tissues and down-regulate the protein expressions of liver TGF-ß1 and Caspase-3 and the mRNA expression of TGF-ß1 in hepatic tissues. CONCLUSION: The licorice flavonoids can resist the thioacetamide-induced hepatic fibrosis in rats. Its mechanism may be related to the down-regulation of the protein expressions of TGF-ß1 and Caspase-3.
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Caspase 3/análise , Flavonoides/farmacologia , Glycyrrhiza uralensis/química , Cirrose Hepática Experimental/prevenção & controle , Fator de Crescimento Transformador beta1/análise , Animais , Ácido Hialurônico/sangue , Fígado/patologia , Cirrose Hepática Experimental/induzido quimicamente , Cirrose Hepática Experimental/metabolismo , Masculino , RNA Mensageiro/análise , Ratos , Ratos Sprague-Dawley , Tioacetamida , Fator de Crescimento Transformador beta1/genéticaRESUMO
Background: The family Nemouridae, belonging to Plecoptera, comprises 21 genera and over 700 species found globally, with the greatest diversity observed in temperate regions. Nemoura Latreille, 1796 and Amphinemura Ris, 1902 are two largest genera of the family with the highest diversity in China. New information: Two new species of Nemoura Latreille, 1796 of the family Nemouridae, Nemouraexterclava Zhu, Rehman & Du sp. nov. and Nemouracerciserrata Zhu, Du & Rehman sp. nov., are described and illustrated from the Nanling Mountains Region in Guangdong Province, southern China. The morphological characteristics of the new species are compared with related taxa. Additionally, the status of Indonemouravoluta Li & Yang, 2008, originally from Maoershan National Natural Reserve in Guangxi Zhuang Autonomous Region, was addressed and moved to the genus Amphinemura Ris, 1902 on the basis of newly-caught topotypes.
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Purpose: The aim of this study was to identify factors associated with difficult video laryngoscopy in obese patients. Methods: A total of 579 obese patients undergoing elective laparoscopic weight loss surgery were intubated with a single-lumen endotracheal tube using a video laryngoscopy under general anesthesia, and the patients were divided into two groups based on the Cormack-Lehane classification (difficult video laryngoscopy defined as ≥ 3): the easy video laryngoscopy group and the difficult video laryngoscopy group. Record the general condition of the patient, bedside testing indicators related to the airway, Cormack-Lehane classification during intubation, and intubation failure rate. Results: The findings of this study show that the incidence of difficult video laryngoscopy in obese patients is 4.8%. Multivariate logistic regression analysis indicated that body mass index was significantly associated with difficult video laryngoscopy (OR = 1.082, 95% CI [1.033-1.132], P < 0.001). Conclusion: For Chinese obese patients without known difficult airways, the incidence of difficult video laryngoscopy is 4.8%. Body mass index is associated factors for the occurrence of difficult video laryngoscopy, with an increased risk observed as body mass index rise.
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Índice de Massa Corporal , Intubação Intratraqueal , Laringoscopia , Obesidade , Humanos , Laringoscopia/métodos , Laringoscopia/efeitos adversos , Masculino , Feminino , Estudos Prospectivos , Obesidade/cirurgia , Intubação Intratraqueal/métodos , Intubação Intratraqueal/efeitos adversos , Pessoa de Meia-Idade , Adulto , China/epidemiologia , Laparoscopia/métodos , Fatores de Risco , Cuidados Pré-Operatórios/métodos , Gravação em Vídeo , Anestesia GeralRESUMO
The aim of this study was to apply phosphorus fertilizer scientifically and reasonably and reduce the pollution risk to the facility agricultural environment. Taking the facility agriculture concentration area in Daxing District of Beijing as the research object, the phosphorus content in soil (0-100 cm) of the facility agriculture profile with different planting years was measured and analyzed to explore the characteristics of phosphorus accumulation, migration, and transformation. The results showed that the contents of total phosphorus and available phosphorus in the surface soil of facility agriculture varied widely, which was significantly higher than that in the surrounding grain field soil, which was mainly related to the amount of phosphorus applied by farmers in different planting years. With the increase in soil depth, the contents of total phosphorus and available phosphorus decreased gradually, showing surface aggregation ω (total phosphorus) ranging from 0.38 to 2.58 g·kg-1 and ω (available phosphorus) ranging from 1.60 to 256.00 mg·kg-1. With the increase in planting years, the contents of soil total phosphorus and available phosphorus first increased and then decreased, reached a peak in approximately 15 years, then gradually decreased, tended to be stable, and generally remained at a high level. Inorganic phosphorus was mainly concentrated in the surface soil of the facility agriculture, in which Ca-P accounted for the largest proportion of inorganic phosphorus, up to 98.38%; Ca10-P was the main form of Ca-P, up to 78.70% of Ca-P, and Ca2-P accounted for the smallest proportion, only 9.50% of Ca-P. The contents of different forms of inorganic phosphorus showed the vertical distribution characteristics of enrichment in the surface soil and a decrease downward. There were differences in the proportion of different forms of inorganic phosphorus to total phosphorus in different soil depths, in which the change in Ca-P was obvious, whereas the change in Fe-P and 0-P was not significant, indicating that the migration and transformation of Fe-P and O-P in the facility agricultural soil was poor, and the migration and transformation of inorganic phosphorus was mainly Ca-P. According to the correlation and path analysis, the direct path coefficient of Ca2-P to available phosphorus was the largest (0.787), which was not only the main source of soil available phosphorus but also the main form of inorganic phosphorus migration and transformation. Under the condition of protected cultivation, soil phosphorus showed a large accumulation trend, the availability of Ca10-P was low, and the accumulation was large. How to improve this portion of phosphorus sources is the key to the management of protected soil phosphorus.
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Fósforo , Solo , Fósforo/análise , Agricultura/métodos , Fertilizantes/análise , Pequim , ChinaRESUMO
OBJECTIVE: To investigate the utility of the controlled attenuation parameter (CAP), as measured by a liver elastography technique, in predicting varying degrees of liver steatosis in children with obesity. METHODS: Children with obesity attending the pediatric obesity clinic at the Affiliated Hospital of Hangzhou Normal University from July 2020 to May 2021 were retrospectively analysed. The 71 subjects were divided into four groups according to the degree of liver steatosis obtained by magnetic resonance imaging-proton density fat fraction (MRI-PDFF). The gender, age, CAP, LSM, ALT, AST, BMI, uric acid, fasting blood glucose, total cholesterol, triglyceride, high-density lipoprotein, low-density lipoprotein, insulin, and blood 25-hydroxyvitamin D levels of the four groups were compared, and the differences were analysed. Clinical data with significant differences were included in the logistic regression analysis. The receiver operating characteristic (ROC) curve for the CAP for the 71 subjects with different degrees of liver steatosis was plotted to evaluate the diagnostic value. RESULTS: The 71 children were divided into groups according to the degree of hepatic steatosis obtained by MRI-PDFF, and the clinical data for each group were compared. It was found that there was statistical significance for CAP, ALT, and AST in cases of moderate and severe hepatic steatosis (p < 0.05). Logistic regression analysis was conducted between CAP, ALT, AST, and moderate to severe hepatic steatosis in children with obesity, and it was found that CAP was a factor related to moderate to severe hepatic steatosis in children with obesity. The ROC curve indicated that CAP has diagnostic value for NAFLD in children with obesity. CONCLUSION: There is diagnostic value in the use of CAP for hepatic steatosis in children with obesity, and there is greater diagnostic value in the use of CAP for children with moderate to severe hepatic steatosis.
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Técnicas de Imagem por Elasticidade , Hepatopatia Gordurosa não Alcoólica , Obesidade Infantil , Biópsia , Criança , Técnicas de Imagem por Elasticidade/métodos , Humanos , Fígado/diagnóstico por imagem , Fígado/patologia , Imageamento por Ressonância Magnética/métodos , Hepatopatia Gordurosa não Alcoólica/diagnóstico por imagem , Hepatopatia Gordurosa não Alcoólica/patologia , Obesidade Infantil/complicações , Obesidade Infantil/diagnóstico por imagem , Obesidade Infantil/patologia , Curva ROC , Estudos RetrospectivosRESUMO
ETHNOPHARMACOLOGICAL RELEVANCE: Mu-Xiang-You-Fang (MXYF) is a classic prescription of Hui medicine. It is composed of five herbs and has been used to treat ischemic stroke for many years. However, the potential pharmacological mechanisms of MXYF remain unclear. The present research is aimed to investigate the protective effect and possible mechanisms of MXYF treatment in an in vitro model of cerebral ischemia-reperfusion injury. MATERIALS AND METHODS: An oxygen-glucose deprivation and reperfusion (OGD/R) model of PC12 cells was established. The effect of MXYF on the cell viability after OGD/R injury was determined using a cell counting kit (CCK-8) assay. The colorimetric method was used to determine the lactate dehydrogenase (LDH) leakage rate. The calcium concentration was determined by the chemical fluorescence method, and mitochondrial membrane potential was determined using flow cytometry. Monodansylcadaverine (MDC) staining and electron microscopic analysis were then conducted to detect autophagy after oxygen-glucose deprivation and reperfusion in PC12 cells. Immunofluorescence and western blot analyses were used to detect the expression of proteins associated with autophagy. RESULTS: It was found that MXYF (1, 2, 4 µg/mL) could significantly increase cell viability and mitochondrial membrane potential and decrease the calcium concentration and LDH release rate in PC12 cells. After OGD/R injury in PC12 cells, the number of autophagosomes and autophagolysosome significantly increased. MXYF (4 µg/mL) inhibited the autophagy induced by OGD/R and inhibited the expression of LC3, beclin1, p-AMPK, and ULK1. In contrast, the expression of p-mTOR, p-p70s6k, and p62 was significantly enhanced. CONCLUSIONS: These findings suggest that MXYF inhibits autophagy after OGD/R-induced PC12 cell injury through the AMPK-mTOR pathway. Thus, MXYF might have therapeutic potential in treating ischemic stroke.
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Autofagia/efeitos dos fármacos , Medicamentos de Ervas Chinesas/farmacologia , Fármacos Neuroprotetores/farmacologia , Traumatismo por Reperfusão/tratamento farmacológico , Proteínas Quinases Ativadas por AMP/metabolismo , Animais , Hipóxia Celular , Glucose/deficiência , Oxigênio , Células PC12 , Ratos , Traumatismo por Reperfusão/metabolismo , Transdução de Sinais/efeitos dos fármacos , Serina-Treonina Quinases TOR/metabolismoRESUMO
OBJECTIVE: To explore the pathogenesis of respiratory syncytial viruses (RSV) bronchiolitis and its treatment with glucocorticoids. METHODS: The pediatric patients with RSV bronchiolitis were divided into an atopic group (n = 50) and a non-atopic group (n = 50) based on whether there were IgE elevation, eczema and dermatitis. Another 25 normal subjects were chosen as a control group. Divided into mild, medium and severe groups, they were finally randomly divided into hormone (dexamethasone) and non-hormone groups. The proportion of CD4+ CD25+ regulatory T cells (Treg) and the expression of Foxp3 mRNA were tested by flow cytometry and RT-PCR retrospectively. RESULTS: The proportion of CD4+ CD25+ Treg and the Foxp3 mRNA expression in the control, non-atopic, and atopic groups reached (10.5 +/- 1.6)% and 0.34 +/- 0.11, (8.8 +/- 2.2)% and 0.26 +/- 0.08, (7.6 +/- 1.8)% and 0.21 +/- 0.09, respectively. There were significant differences among these groups (all P < 0.05). The mild, medium and severe bronchiolitis groups reached (9.7 +/- 1.6)% and 0.28 +/- 0.08, (7.8 +/- 2.1)% and 0.24 +/- 0.06, (6.7 +/- 1.3)% and 0.20 +/- 0.07 respectively (all P < 0.05). The proportion of CD4+ CD25+ Treg and the expression of Foxp3 showed significantly negative correlations with severity (r = -0.62, -0.71, both P < 0.01). That is, they correlated with the severity of disease. The proportion of the CD4+ CD25+ Treg and the expression of Foxp3 mRNA of the hormone group were higher than those of the non-hormone group [(9.5 +/- 2.1)% and 0.33 +/- 0.10 vs (8.5 +/- 1.8)% and 0.27 +/- 0.12, P < 0.05 and < 0.01] respectively. CONCLUSION: CD4+ CD25+ Treg and Foxp3 mRNA are involved in the inflammation of bronchiolitis. And the levels of CD4+ CD25+ Treg and Foxp3 mRNA level is an objective indicator of the severity of RSV bronchiolitis. The effect of glucocorticoids upon RSV bronchiolitis may be in part due to the direct enhancement of production and functions of CD4+ CD25+ Treg and Foxp3 mRNA.
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Bronquiolite Viral/imunologia , Bronquiolite Viral/metabolismo , Fatores de Transcrição Forkhead/metabolismo , Glucocorticoides/uso terapêutico , Linfócitos T Reguladores/imunologia , Bronquiolite Viral/tratamento farmacológico , Estudos de Casos e Controles , Pré-Escolar , Fatores de Transcrição Forkhead/genética , Humanos , Lactente , Subunidade alfa de Receptor de Interleucina-2 , RNA Mensageiro/metabolismo , Infecções por Vírus Respiratório Sincicial/metabolismo , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Linfócitos T Reguladores/metabolismoRESUMO
OBJECTIVE: To study the roles of CD4(+)CD25(+) regulatory T cells and Foxp3 mRNA in peripheral blood as well as serum total immunoglobulin E (IgE) in the pathogenesis of bronchiolitis caused by respiratory syncytial virus (RSV). METHODS: The proportion of CD4(+)CD25(+) regulatory T cells and expression of Foxp3 mRNA in peripheral blood, and total serum IgE level were tested by flow cytometry, RT-PCR and ELISA respectively in 57 children with RSV bronchiolitis (26 atopic patients and 31 nonatopic patients). Twenty five healthy children were used as the control group. RESULTS: The proportion of CD4(+)CD25(+) regulatory T cells in peripheral blood in children with bronchiolitis, either in the atopic (7.7+/- 1.6%)or the nonatopic group (8.8+/- 2.1%), was significantly lower than that in the control group (10.5+/- 1.6%) (P< 0.01). Foxp3 mRNA expression in peripheral blood was significantly lower in both atopic and nonatopic children with bronchiolitis than that in the control group (P< 0.01). Significantly increased total serum IgE level was noted in both atopic (241.2+/- 102.5 IU/mL) and nonatopic children (125.5+/- 63.2 IU/mL) with bronchiolitis compared with that in the control group (27.2+/- 10.5 IU/ml) (P< 0.01). There were significant differences in the proportion of CD4(+)CD25(+) regulatory T cells and Foxp3 mRNA expression in peripheral blood (P< 0.05) as well as total serum IgE level (P< 0.01) between the atopic and the nonatopic group. The proportion of CD4(+)CD25(+) regulatory T cells (r=-0.70, P< 0.01) and Foxp3 mRNA expression in peripheral blood (r=-0.79, P< 0.01) were closely negatively correlated to total serum IgE level. CONCLUSIONS: Both the proportion of CD4(+)CD25(+) regulatory T cells and Foxp3 mRNA expression in peripheral blood were reduced, in contrast, the total serum IgE level increased in children with RSV bronchiolitis. This suggested that CD4(+)CD25(+) regulatory T cells and Foxp3 mRNA together with IgE participated in the pathogenesis of RSV bronchiolitis.
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Bronquiolite/imunologia , Fatores de Transcrição Forkhead/genética , Imunoglobulina E/sangue , RNA Mensageiro/sangue , Infecções por Vírus Respiratório Sincicial/imunologia , Linfócitos T Reguladores/fisiologia , Bronquiolite/etiologia , Linfócitos T CD4-Positivos/imunologia , Feminino , Humanos , Lactente , Masculino , Infecções por Vírus Respiratório Sincicial/etiologiaRESUMO
The surface composition and structure of solid organic polymers influence many of their properties and applications. Oligomers such as poly(ethylene glycol) (PEG), poly(methyl methacrylate) (PMMA) poly(butyl methacrylate) (PBMA) and their graft copolymers of polybutadiene and polypropylene were used as the macromolecular surface modifiers of polypropylene. The compositions on surface and in bulk of the polypropylene (PP) blends were determined quantitatively using attenuated total reflectance FTIR spectroscopic (ATR-FTIR) technique with a variable-angle multiple-reflection ATR accessory and FTIR measurements, respectively. By validating by Lambert-Beer law, 1103 and 1733 cm(-1) can be used to represent modifiers characteristic absorbance band to determine quantitatively the surface composition of modifiers including poly(ethylene glycol) and carbonyl segment in PP blends, respectively. The determination error can be effectively eliminated by calibrating wavelength and using absorption peak area ratio as the calibrating basis for the quantitative analysis. To minimize the effect of contact between the polymer film and the internal reflection element on the results of absolute absorbance, the technique of "band ratioing" was developed, and it was testified that the error of the peak area ratios of interest can be reduced to 5% or below, which was suitable for ATR-FTIR used as a determining quantitative tool for surface composition. The working curves were then established and used to calculate the composition of the responding functional groups in the film surface of the PP blends. The depth distribution of modifiers on the surface of blend films also can be determined by changing the incident angle of interest on the basis of the equation of the depth of penetration of the excursion wave in ATR spectra. The results indicated that ATR-FTIR can be used to determine quantitatively the surface composition and distribution of modifiers with reproducible and reliable measurement results.
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OBJECTIVE: To investigate effect and possible mechanisms of silencing human WFDC2 (HE4) gene on biological behavior changes as cell proliferation, apoptosis, movement and invasion of human serous ovarian cancer cell line SKOV3. METHODS: Lentiviral WFDC2 gene sequence of small interfering siRNA was stablely transfected into SKOV3 identified by Q-PCR and western-blot. Obtained SKOV3 stable strains with silenced HE4 were measured by proliferation, apoptosis, migration, and invasion. RESULTS: Gene sequencing showed that the oligonucleotides were successfully inserted into the expected site. After silencing HE4 in the SKOV3, proliferation was significantly inhibited (P<0.05). G(0)/G(1) phase was arrested by the cell cycle (P<0.01) and capacity of the migration and invasion decreased significantly (P<0.01). Slight early apoptosis ratio and no change of late apoptosis were found without change of Caspase-3 or Bcl-2 protein. Proteins involved in ERK pathway as phosphorylated protein as p-EGFR, p-ERK decreased and protease protein involved in tissue remodeling as matrix metalloproteinases MMP-9, MMP-2 and cathepsin B decreased compared with control group. CONCLUSIONS: HE4 gene plays an important role in regulating proliferation, apoptosis, migration, invasion of serous ovarian cancer cells by ERK pathway and protease system. Its role in apoptosis needs to be further explored, and it may be a potential target for serous ovarian cancer.
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Inativação Gênica/fisiologia , Neoplasias Ovarianas/genética , Proteínas/genética , RNA Interferente Pequeno/farmacologia , Apoptose/genética , Ciclo Celular , Linhagem Celular Tumoral , Movimento Celular/genética , Proliferação de Células , Feminino , Técnicas de Silenciamento de Genes , Vetores Genéticos , Humanos , Lentivirus/genética , Invasividade Neoplásica/genética , Neoplasias Ovarianas/patologia , Transfecção , Proteína 2 do Domínio Central WAP de Quatro DissulfetosRESUMO
OBJECTIVE: To investigate the value of serum human epididymis protein 4 (HE4) in differential diagnosis of patients with low-grade serous (LGSC) and high-grade serous carcinoma (HGSC) serous ovarian cancer. METHODS: LGSC and HGSC serous ovarian cancer were diagnosed by the two-tier grade system, serum levels of HE4 and carbohydrate antigen 125 (CA125) were measured by ELISA and radioisotope method, respectively in 60 serous ovarian cancer patients. HE4 and TP53 protein in cancer tissue were measured by immunohistochemical method. RESULTS: The difference in density of HE4 and TP53 protein was significant between LGSC and HGSC tissue, while serum CA125 did not show significant difference between different serum samples. There was significant difference in serum HE4 levels between LGSC and HGSC, and the result was different within FIGO (I+II) stage, suggesting HE4 was not a reliable biomarker for the discrimination between LGSC and HGSC. HE4 had potential as a biomarker for the discrimination between LGSC and HGSC but the role in early diagnosis was limited. CONCLUSIONS: HE4 may be a reliable marker for differential diagnosis of LGSC and HGSC. But its role in early diagnosis of LGSC and HGSC need to be confirmed from the perspective of two-tier grade system.
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Biomarcadores Tumorais/sangue , Cistadenocarcinoma Seroso/sangue , Neoplasias Ovarianas/sangue , Proteínas/metabolismo , Biomarcadores Tumorais/biossíntese , Antígeno Ca-125/sangue , Distribuição de Qui-Quadrado , Cistadenocarcinoma Seroso/diagnóstico , Cistadenocarcinoma Seroso/patologia , Diagnóstico Diferencial , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Imuno-Histoquímica , Proteínas de Membrana/sangue , Gradação de Tumores , Neoplasias Ovarianas/diagnóstico , Neoplasias Ovarianas/patologia , Proteína Supressora de Tumor p53/sangue , Proteína 2 do Domínio Central WAP de Quatro DissulfetosRESUMO
BACKGROUND: Inside out transobturator vaginal tape (TVT-O) and tension-free vaginal tape (TVT) are predominant surgical treatments for female stress urinary incontinence. This meta-analysis evaluated the complications and cure rates of TVT-O versus TVT. METHODS: A comprehensive literature search was conducted according to the Cochrane Collaboration methodology to identify randomized controlled clinical trials with no language restriction. Two authors independently assessed papers for eligibility and methodological quality. Estimates were measured by relative risk with 95% confidence intervals. Outcome measures were objective cure, subjective cure and complications. Quality rating for each outcome of the meta-analysis and recommendations were performed by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. RESULTS: Twenty randomized controlled trials met the inclusion criteria, and a pooled estimate of effectiveness and complications was made. Relative risks with 95% confidence intervals for pooled effects under the fixed effects model were: 0.20 (0.09 - 0.45), for bladder injury, 0.37 (0.16 - 0.86) for hematoma, and 2.35 (1.57 - 3.51) for postoperative pain, suggesting an 80% risk reduction of bladder injury, 63% risk reduction of hematoma, and a 1.35% risk elevation for postoperative pain with TVT-O. There was no significant difference between complications of urinary tract infection 1.14 (0.78 - 1.65), lower urinary tract symptoms 1.60 (0.67 - 3.79), recatheterization 0.93 (0.59 - 1.44), and tape erosion 0.90 (0.48 - 1.67), total objective cure rate 1.06 (0.39 - 2.84) and for the subjective cure rate 0.98 (0.93 - 1.04). The quality rating for each outcome and recommendations was high for objective cure, bladder injury, hematoma, lower urinary tract symptoms, and tape erosion and moderate for subjective cure, pain, and urinary tract infection. CONCLUSIONS: TVT-O is associated with a reduced risk of bladder injury and hematoma and an elevated risk of postoperative pain. Other complications, including tape erosion, urinary tract infection, lower urinary tract symptoms, and recatheterization, are similar to those of TVT.