RESUMO
Endometriosis is a multifactorial inflammatory disease with persistent activation of the nuclear factor-κB (NF-κB) signalling pathway. Aberrant adhesion of endometrium is the essential step in the progression of endometriosis, but the molecular mechanism of ectopic growth of endometrium is still unclear. Decoy receptor 3 (DcR3)/TNFRSF6B, a pleiotropic immunomodulator regulated by oestrogen, is able to activate focal adhesion kinase to promote cell adhesion. We found that DcR3 is upregulated in human ectopic endometrial cells via activation of the Akt-NF-κB signalling pathway, and its expression level correlates positively with that of the adhesion molecules intercellular adhesion molecule 1 (ICAM-1) and homing cell adhesion molecule (HCAM; CD44). In a multivariate regression model, DcR3 expression level was the most significant parameter associated with endometriosis severity. Knockdown of DcR3 not only downregulated the expression of ICAM-1 and HCAM, but also reduced cell adhesion and migration. In vivo investigation further showed that DcR3 promoted the growth and spread of endometrium, whereas knockdown of DcR3 by lentivirus-delivered short hairpin RNA inhibited ectopic adhesion of endometrium and abrogated endometriosis progression. These observations are in support of DcR3 playing a critical role in the pathogenesis of endometriosis, and the inhibition of DcR3 expression being a promising approach for the treatment of endometriosis. Copyright © 2017 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
Assuntos
Adesão Celular , Endometriose/metabolismo , Endométrio/metabolismo , Membro 6b de Receptores do Fator de Necrose Tumoral/metabolismo , Animais , Estudos de Casos e Controles , Moléculas de Adesão Celular/metabolismo , Linhagem Celular Tumoral , Movimento Celular , Modelos Animais de Doenças , Progressão da Doença , Endometriose/patologia , Endometriose/fisiopatologia , Endometriose/cirurgia , Endométrio/patologia , Endométrio/fisiopatologia , Endométrio/cirurgia , Feminino , Xenoenxertos , Humanos , Camundongos Endogâmicos C57BL , Camundongos Transgênicos , NF-kappa B/metabolismo , Proteínas Proto-Oncogênicas c-akt/metabolismo , Membro 6b de Receptores do Fator de Necrose Tumoral/genética , Transdução de SinaisRESUMO
According to the literature review, CO2 insufflation on parasitic myoma implantation is not well studied, and we concur that our study is related to "Morcellation-induced parasitic myomas." We did not compare CO2 insufflation to non-insufflation in our study. The reason is the efficacy of gasless laparoscopic myomectomy and morcellation is not well established and this modality is seldom performed. Moreover, the effects of pneumoperitoneum on mesothelial cells and the role of the entire peritoneal cavity as a cofactor in adhesion formation have become well established, the role of CO2 insufflation in the establishment of parasitic myomas has not yet been studied. As such, more in-depth and well-designed studies for the role of CO2 insufflation are needed.
Assuntos
Estrogênios/farmacologia , Mioma/cirurgia , Neovascularização Fisiológica/efeitos dos fármacos , Neoplasias Uterinas/cirurgia , Animais , Feminino , Humanos , Laparoscopia/efeitos adversos , Camundongos SCID , Morcelação/efeitos adversos , Mioma/parasitologia , Mioma/fisiopatologia , Neovascularização Fisiológica/fisiologia , Doenças Parasitárias/etiologia , Doenças Parasitárias/fisiopatologia , Transplante Heterólogo , Neoplasias Uterinas/parasitologia , Neoplasias Uterinas/fisiopatologiaRESUMO
BACKGROUND: According to 3 randomized trials, the levonorgestrel-releasing intrauterine system significantly reduced recurrent endometriosis-related pelvic pain at postoperative year 1. Only a few studies have evaluated the long-term effectiveness of the device for preventing endometrioma recurrence, and the effects of a levonorgestrel-releasing intrauterine system as a maintenance therapy remain unclear. OBJECTIVE: The objective of the study was to evaluate whether a maintenance levonorgestrel-releasing intrauterine system is effective for preventing postoperative endometrioma recurrence. STUDY DESIGN: From May 2011 through March 2012, a randomized controlled trial including 80 patients with endometriomas undergoing laparoscopic cystectomy followed by six cycles of gonadotropin-releasing hormone agonist treatment was conducted. After surgery, the patients were randomized to groups that did or did not receive a levonorgestrel-releasing intrauterine system (intervention group, n = 40, vs control group, n = 40). The primary outcome was endometrioma recurrence 30 months after surgery. The secondary outcomes included dysmenorrhea, CA125 levels, noncyclic pelvic pain, and side effects. RESULTS: Endometrioma recurrence at 30 months did not significantly differ between the 2 groups (the intervention group, 10 of 40, 25% vs the control group 15 of 40, 37.5%; hazard ratio, 0.60, 95% confidence interval, 0.27-1.33, P = .209). The intervention group exhibited a lower dysmenorrhea recurrence rate, with an estimated hazard ratio of 0.32 (95% confidence interval, 0.12-0.83, P = .019). Over a 30 month follow-up, the intervention group exhibited a greater reduction in dysmenorrhea as assessed with a visual analog scale score (mean ± SD, 60.8 ± 25.5 vs 38.7 ± 25.9, P < .001, 95% confidence interval, 10.7-33.5), noncyclic pelvic pain visual analog scale score (39.1 ± 10.9 vs 30.1 ± 14.7, P = .014, 95% confidence interval, 1.9-16.1), and CA125 (median [interquartile range], -32.1 [-59.1 to 14.9], vs -15.6 [-33.0 to 5.0], P = .001) compared with the control group. The number-needed-to-treat benefit for dysmenorrhea recurrence at 30 months was 5. The number of recurrent cases requiring further surgical or hormone treatment in the intervention group (1 of 40, 2.5%, 95% confidence interval, -2.3% to 7.3%) was significantly lower than that in the control group (8 of 40, 20%, 95% confidence interval, 7.6-32.4%; P = .031). CONCLUSION: Long-term maintenance therapy using a levonorgestrel-releasing intrauterine system is not effective for preventing endometrioma recurrence.
Assuntos
Endometriose/tratamento farmacológico , Dispositivos Intrauterinos Medicados , Levanogestrel/administração & dosagem , Recidiva Local de Neoplasia/prevenção & controle , Adulto , Antígeno Ca-125/sangue , Anticoncepcionais Orais Sintéticos , Dismenorreia/epidemiologia , Dismenorreia/prevenção & controle , Endometriose/prevenção & controle , Endometriose/cirurgia , Feminino , Humanos , Proteínas de Membrana/sangue , Recidiva Local de Neoplasia/epidemiologia , Dor Pélvica , Período Pós-Operatório , Estudos Prospectivos , Recidiva , Resultado do TratamentoRESUMO
Wound healing is a physiological process, involving three successive and overlapping phases-hemostasis/inflammation, proliferation, and remodeling-to maintain the integrity of skin after trauma, either by accident or by procedure. Any disruption or unbalanced distribution of these processes might result in abnormal wound healing. Many molecular and clinical data support the effects of estrogen on normal skin homeostasis and wound healing. Estrogen deficiency, for example in postmenopausal women, is detrimental to wound healing processes, notably inflammation and re-granulation, while exogenous estrogen treatment may reverse these effects. Understanding the role of estrogen on skin might provide further opportunities to develop estrogen-related therapy for assistance in wound healing.
Assuntos
Estrogênios/metabolismo , Transdução de Sinais , Cicatrização , Animais , Proliferação de Células/efeitos dos fármacos , Descoberta de Drogas , Estrogênios/farmacologia , Hemostasia/efeitos dos fármacos , Humanos , Inflamação/tratamento farmacológico , Inflamação/metabolismo , Receptores de Estrogênio/metabolismo , Transdução de Sinais/efeitos dos fármacos , Cicatrização/efeitos dos fármacosRESUMO
BACKGROUND: Iatrogenic parasitic myomas (PMs), caused by intra-corporeal power morcellation during laparoscopy is gradually increasing. However, the pathogenesis and medical treatment of PMs remain largely unelucidated. METHODS: Laparoscopically-induced PM xenografted mouse model was conducted by xenografting human uterine myoma fragments into the abdominal cavity of SCID mice and hormonal manipulation was performed using this mouse model to demonstrate the role of oestrogen in the development of implanted PMs. Immunohistochemistry of oestrogen receptor α (ERα), progesterone receptor (PR), vimentin, vascular endothelial growth factor (VEGF), microvessel density (MVD) and Ki-67 index was performed and compared. RESULTS: In the patient with PMs, ERα, PR, angiogenesis and proliferative property expression were upregulated in PM lesions compared to uterine myomas. In the laparoscopically-induced PM mouse model, implanted myomas had more steroid receptor expressions, angiogenesis and proliferative property compared with pre-xenografted or non-implanted myoma. Depletion of oestrogen in the ovariectomized (OVX) mice decreased laparoscopically-induced PM implantations. In comparison, the implantations of PMs were increased with additional E2 supplement. Hormonal manipulation in the PM mouse model, including AI, GnRHa and SERM groups, were compared and AI significantly decreased the implantations, steroid receptor, angiogenesis, cell density, and proliferative index of PMs compared with control group. Furthermore, GnRHa significantly decreased VEGF and MVD expressions compared with control group. CONCLUSIONS: These data highlight the crucial role of oestrogen in the development of laparoscopically-induced PMs and suggest that hormone manipulation may be a potential therapeutic agent. TRIAL REGISTRATION: This protocol was approved by the Human and Animal Institutional Review Board of Taipei Veterans General Hospital ( VGHIRB No 2014-10-002C on Nov. 17th, 2014; IACUC 2014-119 on Aug. 22nd, 2014).
Assuntos
Estrogênios/farmacologia , Laparoscopia/efeitos adversos , Leiomioma/diagnóstico , Morcelação/efeitos adversos , Neovascularização Fisiológica/efeitos dos fármacos , Doenças Parasitárias/diagnóstico , Neoplasias Uterinas/diagnóstico , Cavidade Abdominal/parasitologia , Adulto , Animais , Feminino , Humanos , Leiomioma/etiologia , Leiomioma/cirurgia , Camundongos , Camundongos SCID , Mioma/diagnóstico , Mioma/etiologia , Mioma/cirurgia , Neovascularização Fisiológica/fisiologia , Doenças Parasitárias/etiologia , Doenças Parasitárias/cirurgia , Transplante Heterólogo/métodos , Neoplasias Uterinas/etiologia , Neoplasias Uterinas/cirurgiaRESUMO
This study was conducted to determine the risk of chronic kidney disease (CKD) among women with endometriosis in Taiwan. We conducted a retrospective cohort study using the National Health Insurance Research Database of Taiwan. A total of 27,973 women with a diagnosis of endometriosis and 27,973 multivariable-matched controls (1:1) from 2000 to 2010 were selected. Cox regression and computed hazard ratios (HR) with 95% confidence intervals (95% CI) were used to determine the risk of CKD among women with endometriosis. The incidence rates (IR, per 10,000 person-years) of CKD among women with and without endometriosis were 4.64 and 7.01, respectively, with a significantly decreased risk of CKD (crude HR 0.65, 95% CI 0.53-0.81; adjusted HR 0.69, 95% CI 0.56-0.86) among women with endometriosis. The IR of CKD progressively increased with age, but the trend of lower CKD risk among women with endometriosis was consistent. However, the lower risk of CKD in women with endometriosis was no longer statistically significant after adjusting for menopausal status (adjusted HR 0.85, 95% CI 0.65-1.10). The results suggest that endometriosis is inversely associated with CKD, but this effect was mediated by menopause. The possible mechanism of this association is worthy of further evaluation.
Assuntos
Endometriose/diagnóstico , Insuficiência Renal Crônica/diagnóstico , Adulto , Idoso , Estudos de Casos e Controles , Estudos de Coortes , Bases de Dados Factuais , Endometriose/complicações , Feminino , Humanos , Menopausa , Pessoa de Meia-Idade , Prevalência , Modelos de Riscos Proporcionais , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/etiologia , Estudos Retrospectivos , Fatores de Risco , Taiwan/epidemiologiaRESUMO
Adenomyosis is an oestrogen-dependent disease characterized by the invasion of endometrial epithelial cells into the myometrium of uterus, and angiogenesis is thought to be required for the implantation of endometrial glandular tissues during the adenomyotic pathogenesis. In this study, we demonstrate that compared with eutopic endometria, adenomyotic lesions exhibited increased vascularity as detected by sonography. Microscopically, the lesions also exhibited an oestrogen-associated elevation of microvascular density and VEGF expression in endometrial epithelial cells. We previously reported that oestrogen-induced Slug expression was critical for endometrial epithelial-mesenchymal transition and development of adenomyosis. Our present studies demonstrated that estradiol (E2) elicited a Slug-VEGF axis in endometrial epithelial cells, and also induced pro-angiogenic activity in vascular endothelial cells. The antagonizing agents against E2 or VEGF suppressed endothelial cells migration and tubal formation. Animal experiments furthermore confirmed that blockage of E2 or VEGF was efficient to attenuate the implantation of adenomyotic lesions. These results highlight the importance of oestrogen-induced angiogenesis in adenomyosis development and provide a potential strategy for treating adenomyosis through intercepting the E2-Slug-VEGF pathway.
Assuntos
Adenomiose/patologia , Células Epiteliais/patologia , Estrogênios/efeitos adversos , Neovascularização Patológica/patologia , Fatores de Transcrição/metabolismo , Fator A de Crescimento do Endotélio Vascular/metabolismo , Adenomiose/tratamento farmacológico , Adenomiose/etiologia , Animais , Western Blotting , Células Cultivadas , Endometriose/tratamento farmacológico , Endometriose/metabolismo , Endometriose/patologia , Endométrio/efeitos dos fármacos , Endométrio/metabolismo , Endométrio/patologia , Células Epiteliais/efeitos dos fármacos , Células Epiteliais/metabolismo , Feminino , Humanos , Técnicas Imunoenzimáticas , Camundongos , Camundongos Endogâmicos NOD , Camundongos SCID , Miométrio/efeitos dos fármacos , Miométrio/metabolismo , Miométrio/patologia , Neovascularização Patológica/induzido quimicamente , Neovascularização Patológica/metabolismo , Fatores de Transcrição da Família SnailRESUMO
BACKGROUND: Premenstrual syndrome (PMS) occurs in women during their reproductive age with a quite negative impact on their daily lives. Women with PMS experience a wide range of physical or psychological symptoms and seek treatment for them. Chinese herb medicine (CHM) is commonly used for PMS and the goal of this study is to investigate the prescription patterns of CHM for PMS by using a nationwide database. METHODS: Prescriptions of CHM were obtained from two million beneficiaries randomly sampled from the National Health Insurance Research Database, a nationwide database in Taiwan. The ICD-9 code 625.4 was used to identify patients with PMS. Association rule mining and social network analysis were used to explore both the combinations and the core treatments for PMS. RESULTS: During 1998-2011, a total of 14,312 CHM prescriptions for PMS were provided. Jia-Wei-Xiao-Yao-San (JWXYS) was the CHM which had the highest prevalence (37.5% of all prescriptions) and also the core of prescription network for PMS. For combination of two CHM, JWXYS with Cyperus rotundus L. was prescribed most frequently, 7.7% of all prescriptions, followed by JWXYS with Leonurus heterophyllus Sweet, 5.9%, and Cyperus rotundus L. with Leonurus heterophyllus Sweet, 5.6%. CONCLUSIONS: JWXYS-centered CHM combinations were most commonly prescribed for PMS. To the best of our knowledge, this is the first pharmaco-epidemiological study to review CHM treatments for PMS. However, the efficacy and safety of these commonly used CHM were still lacking. The results of this study provide valuable references for further clinical trials and bench studies.
Assuntos
Prescrições de Medicamentos/estatística & dados numéricos , Medicamentos de Ervas Chinesas/uso terapêutico , Fitoterapia/estatística & dados numéricos , Síndrome Pré-Menstrual/tratamento farmacológico , Bases de Dados Factuais , Feminino , Humanos , Masculino , TaiwanRESUMO
Rupture of a pregnant uterus in early pregnancy and an unscarred uterus are extremely rare, and some non-specific symptoms might appear before this occurrence. We report the case of a multiparous woman (gravida 3, para 2) with uterine fundal rupture in her early second trimester (17+ weeks of gestational age), who presented upper abdominal discomfort and vomiting for 3 days, and progressed into sudden acute abdomen and shock. During emergent laparotomy, the entire amniotic sac was found in the peritoneal cavity with a rupture of the uterine fundus. Although we could not confirm that the appearance of upper gastrointestinal symptoms and severe vomiting was associated with uterine rupture in this pregnant woman, abdominal symptoms or signs might be a hint or cause of severe catastrophic pregnancy-related complications.
Assuntos
Complicações na Gravidez/etiologia , Ruptura Uterina/etiologia , Adulto , Feminino , Humanos , Gravidez , Segundo Trimestre da GravidezRESUMO
BACKGROUND: Despite the availability of current therapies, including oral antidiabetic drugs and insulin, for controlling the symptoms caused by high blood glucose, it is difficult to cure diabetes mellitus, especially type 1 diabetes mellitus. AIM: Cell therapies using mesenchymal stem cells (MSCs) may be a promising option. However, the therapeutic mechanisms by which MSCs exert their effects, such as whether they can differentiate into insulin-producing cells (IPCs) before transplantation, are uncertain. METHODS: In this study, we used three types of differentiation media over 10 d to generate IPCs from human Wharton's jelly MSCs (hWJ-MSCs). We further transplanted the undifferentiated hWJ-MSCs and differentiated IPCs derived from them into the portal vein of rats with streptozotocin-induced diabetes, and recorded the physiological and pathological changes. RESULTS: Using fluorescent staining and C-peptide enzyme-linked immunoassay, we were able to successfully induce the differentiation of hWJ-MSCs into IPCs. Transplantation of both IPCs derived from hWJ-MSCs and undifferentiated hWJ-MSCs had the therapeutic effect of ameliorating blood glucose levels and improving intraperitoneal glucose tolerance tests. The transplanted IPCs homed to the pancreas and functionally survived for at least 8 wk after transplantation, whereas the undifferentiated hWJ-MSCs were able to improve the insulitis and ameliorate the serum inflammatory cytokine in streptozotocin-induced diabetic rats. CONCLUSION: Differentiated IPCs can significantly improve blood glucose levels in diabetic rats due to the continuous secretion of insulin by transplanted cells that survive in the islets of diabetic rats. Transplantation of undifferentiated hWJ-MSCs can significantly improve insulitis and re-balance the inflammatory condition in diabetic rats with only a slight improvement in blood glucose levels.
RESUMO
Currently, there is no meta-analysis comparing intravaginal misoprostol plus intracervical Foley catheter versus intravaginal misoprostol alone for term pregnancy without identifying risk factors. Therefore, the purpose of this study is to conduct a systematic review and meta-analysis of randomized control trials (RCTs) comparing concurrent intravaginal misoprostol and intracervical Foley catheter versus intravaginal misoprostol alone for cervical ripening. We systematically searched Embase, Pubmed, and Cochrane Collaboration databases for randomized controlled trials (RCTs) comparing intracervical Foley catheter plus intravaginal misoprostol and intravaginal misoprostol alone using the search terms "Foley", "misoprostol", "cervical ripening", and "induction" up to 29 January 2019. Data were extracted and analyzed by two independent reviewers including study characteristics, induction time, cesarean section (C/S), clinical suspicion of chorioamnionitis, uterine tachysystole, meconium stain, and neonatal intensive care unit (NICU) admissions. Data was pooled using random effects modeling and calculated with risk ratio (RR) and 95% confidence interval (CI). Pooled analysis from eight studies, including 1110 women, showed that labor induction using a combination of intracervical Foley catheter and intravaginal misoprostol decreased induction time by 2.71 h (95% CI -4.33 to -1.08, p = 0.001), as well as the risk of uterine tachysystole and meconium staining (RR 0.54, 95% CI 0.30-0.99 and RR 0.48, 95% CI 0.32-0.73, respectively) significantly compared to those using intravaginal misoprostol alone. However, there was no difference in C/S rate (RR 0.93, 95% CI 0.78-1.11) or clinical suspicion of chorioamnionitis rate (RR 1.22, CI 0.58-2.57) between the two groups. Labor induction with a combination of intracervical Foley catheter and intravaginal misoprostol may be a better choice based on advantages in shortening induction time and reducing the risk of uterine tachysystole and meconium staining compared to intravaginal misoprostol alone.
Assuntos
Cateterismo , Maturidade Cervical , Misoprostol/administração & dosagem , Ocitócicos/administração & dosagem , Administração Intravaginal , Cesárea , Feminino , Humanos , Trabalho de Parto Induzido , Gravidez , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
A large hematoma resulting from hemorrhagic cystitis after uncomplicated pelvic reconstruction surgery with a transvaginal mesh is rare. A 66-year-old female who underwent pelvic reconstruction with transvaginal mesh presented with acute urinary retention and hematuria on postoperative day 10. Leukocytosis, pyuria, and hematuria were noted in the emergency room. After using cystoscopy to irrigate the coagulum, there was no mesh erosion or bladder perforation on inspection. A large bladder hematoma resulting from infectious hemorrhagic cystitis was confirmed, and uropathogenic Escherichia coli was isolated. The clinical condition improved after a 1-week treatment with an indwelling Foley catheter and oral antibiotics. Careful aseptic techniques and antibiotic prophylaxis reduce bacterial contamination only for brief periods of time, and patients may still be at risk for delayed infections. The possible modalities to prevent postoperative urinary tract infection after pelvic reconstruction surgery with transvaginal mesh include shortening the indwelling Foley catheter period and administration of an additional antibiotic during catheter removal. However, the antibiotic policies for pelvic reconstruction with transvaginal mesh demand further cost analyses.
RESUMO
INTRODUCTION: Depression might affect women with cervical cancer and can deteriorate their quality of life or even their compliance with cancer treatments. The aim of this study was to investigate the incidence of depression and risk factors for developing depression among women with cervical cancer in Taiwan. PATIENTS AND METHODS: This study enrolled patients with newly diagnosed cervical cancer from the National Health Insurance Research Database in Taiwan. From a population of 21,400,826 residents, each cervical cancer patient was matched with one subject without cervical cancer according to sex, age, and comorbidities with the same diagnostic index. The International Classification of Diseases, Ninth Revision, code 180.9 was used to identify patients with cervical cancer, and 296.0X-296.1X, 296.4X-296.8X, 296.2X-296.3X, 300.4, and 311.X codes were used to identify those with depressive disorders. RESULTS: In total, 19,316 newly diagnosed cervical cancer patients were enrolled from January 2000 to December 2005, and the median follow-up period was 5.23 years (1.75-8.48 years). The prevalence of depressive disorder was 4.21% (813 of 19,316) in the cervical cancer cohort, and it was 3.85% (744 of 19,316) in the control cohort. The incidence risk ratio of depressive disorders was 1.35 (95% CI =1.22-1.49, P<0.001) among these cervical cancer patients. Cervical cancer, as an independent risk factor, was associated with developing subsequent depressive disorder. In addition, being older (≥65 years old) and the comorbidities of diabetes mellitus, ischemic heart disease, and cerebrovascular disease were also risk factors for predicting depressive disorder in cervical cancer patients. DISCUSSION: Cervical cancer is a prominent risk factor for the development of depression in women with cervical cancer in Taiwan. The patients with comorbidities, including diabetes mellitus, ischemic heart disease, and cerebrovascular disease, have higher risks of developing depression. However, there were no significant differences among the cervical cancer treatment modalities. In conclusion, these patients require early psychological support and intervention.
RESUMO
Wound healing is an important physiological process to maintain the integrity of skin after trauma, either by accident or by intent procedure. The normal wound healing involves three successive but overlapping phases, including hemostasis/inflammatory phase, proliferative phase, and remodeling phase. Aberration of wound healing, such as excessive wound healing (hypertrophic scar and keloid) or chronic wound (ulcer) impairs the normal physical function. A large number of sophisticated experimental studies have provided insights into wound healing. This article highlights the information after 2010, and the main text includes (i) wound healing; (ii) wound healing in fetus and adult; (iii) prostaglandins and wound healing; (iv) the pathogenesis of excessive wound healing; (v) the epidemiology of excessive wound healing; (vi) in vitro and in vivo studies for excessive wound healing; (vii) stem cell therapy for excessive wound healing; and (viii) the prevention strategy for excessive wound healing.
Assuntos
Cicatrização , Adulto , Animais , Humanos , MicroRNAs/fisiologia , Antagonistas de Prostaglandina/farmacologia , Prostaglandinas/farmacologia , Transplante de Células-Tronco , Fator de Crescimento Transformador beta/fisiologia , Cicatrização/efeitos dos fármacos , Cicatrização/fisiologiaRESUMO
Pregnancy weight gain may be associated with adverse pregnancy outcomes. The article aims to explore the relationship between weight change and pregnancy outcome in the Taiwanese pregnant women.The retrospective cohort study enrolled women with vertex singleton pregnancy at University-associated Hospital between 2011 and 2014. Pregnancy weight change was separated into 3 groups, based on the Institute of Medicine (IOM) guidelines: below (nâ=â221); within (nâ=â544); and above (nâ=â382). Analysis of variance, χ tests, generalized linear models, and logistic regression models were used for statistical comparisons.Pregnant women with weight change above IOM guidelines had a significant increase in both maternal and perinatal complications compared with normal controls (odds ratio [OR] 1.65, 95% confidence interval [CI] 1.03-1.98; Pâ=â.043; OR 1.45, 95% CI 1.01-1.87; Pâ=â.049, respectively). This finding was not found in pregnant women with weight gain below IOM guidelines. Moreover, age (OR 1.08, 95% CI 1.02-1.15; Pâ=â.0011), pre-pregnancy weight (OR 1.04, 95% CI 1.01-1.09; Pâ=â.0008), pre-pregnancy body mass index (BMI; OR 1.15, 95% CI 1.06-1.30; Pâ<â.0001), weight at the time of delivery (OR 1.05, 95% CI 1.02-1.13; Pâ<â.0001) and BMI at the time of delivery (OR 1.15, 95% CI 1.06-1.39; Pâ<â.0001), all contributed to increased maternal complications but not perinatal complications, whereas parity (OR 0.23, 95% CI 0.12-0.41; Pâ<â.0001) and gestational age (OR 0.50, 95% CI 0.35-0.62; Pâ<â.001) were associated with fewer maternal complications.Our study reconfirmed that for Taiwanese pregnant women, the approximate pregnancy weight gain recommended by IOM in 2009 was associated with the fewest maternal and perinatal complications. If approximate pregnancy weight gain cannot be attained, even less weight gain during pregnancy is still reasonable without significantly and adversely affecting maternal and perinatal outcomes in Taiwan.
Assuntos
Complicações na Gravidez/fisiopatologia , Resultado da Gravidez , Aumento de Peso , Adulto , Análise de Variância , Índice de Massa Corporal , Distribuição de Qui-Quadrado , Feminino , Humanos , Modelos Lineares , Idade Materna , Paridade , Gravidez , Estudos Retrospectivos , TaiwanRESUMO
OBJECTIVE: To evaluate whether a maintenance levonorgestrel-releasing intrauterine system is effective for preventing the recurrence of postoperative adenomyosis-related symptoms. MATERIALS AND METHODS: From January 2005 through December 2014, a retrospective study including 133 patients with symptomatic adenomyosis undergoing conservative uterine-sparing surgery followed by gonadotropin-releasing hormone agonist treatment was conducted. We excluded the 18 patients who did not meet the inclusion criteria. The patients of intervention group (n = 54) received a levonorgestrel-releasing intrauterine system (LNG-IUS), which was inserted after surgery. The patients without LNG-IUS insertion were enrolled in the control group (n = 61). The primary outcome was improvement of adenomyosis-related dysmenorrhea, which was evaluated by the visual analog scale (VAS) and by hemoglobin (Hgb) and CA-125 levels. RESULTS: Over a 12-month follow-up, the intervention group exhibited a greater reduction in dysmenorrhea as assessed with a VAS score (mean ± SD: 6.5 ± 2.5 vs 4.1 ± 3.6, p = 0.001) and a greater elevation in the Hgb level (2.1 ± 1.9 vs 1.0 ± 1.7, p = 0.008) than the control group. At the end of the 24-month follow-up period, the intervention group also exhibited a greater reduction in dysmenorrhea as assessed with a VAS score (mean ± SD 6.1 ± 2.7 vs 3.7 ± 3.7, p = 0.002) and a greater elevation in the Hgb level (1.9 ± 2.1 vs 0.7 ± 1.8, p = 0.022) than the control group. The CA-125 level was significantly lower in the intervention group during the postoperative follow up (12th month follow-up, intervention vs control, 24.5 ± 28.8 vs 50.1 ± 44.0, p = 0.005; 24th month follow-up, 28.6 ± 26.2 vs 75.4 ± 68.5, p = 0.002). CONCLUSION: The maintenance therapy of LNG-IUS is effective and well accepted for long-term therapy after conservative surgery for patients with adenomyosis.
Assuntos
Adenomioma/tratamento farmacológico , Dispositivos Intrauterinos Medicados/efeitos adversos , Levanogestrel/administração & dosagem , Neoplasias Uterinas/tratamento farmacológico , Adenomioma/cirurgia , Adulto , Antígeno Ca-125/sangue , Dismenorreia/tratamento farmacológico , Feminino , Seguimentos , Hormônio Liberador de Gonadotropina/agonistas , Hemoglobinas/análise , Humanos , Pessoa de Meia-Idade , Tratamentos com Preservação do Órgão/efeitos adversos , Tratamentos com Preservação do Órgão/métodos , Medição da Dor , Período Pós-Operatório , Estudos Retrospectivos , Resultado do Tratamento , Neoplasias Uterinas/cirurgiaRESUMO
OBJECTIVE: Low-dose add-back therapy during postoperative GnRH agonist treatment could lower the risk of add-back-induced endometriosis recurrence and reduce treatment dropout compared with a regular dose. However, the effect of low-dose add-back therapy is still unknown. The aim of this study was to determine whether low-dose add-back therapy can also effectively relieve the hypoestrogenic side effects and simultaneously maintain a therapeutic response of GnRH agonist treatment. MATERIALS AND METHODS: This analysis was a prospective cohort study. During postoperative GnRH agonist treatment, a total of 107 women were prescribed add-back therapy [oral combination tablet; estradiol valerate (1 mg) and medroxyprogesterone acetate (2.5 mg)] (Indivina; Orion, Espoo, Finland) for 20 weeks. Patients in the low dose add-back therapy group were prescribed the tablet once a day, and patients in the regular dose group were given the tablet twice a day. Hypoestrogenic side effects, such as hot flashes and insomnia, were recorded. Patients were also questioned regarding their pelvic symptoms and pain to evaluate the possibility of endometriosis recurrence. Lumbar spine (L2-L4) bone mineral density was measured using dual X-ray absorptiometry. The dropout rates in both groups were also evaluated. RESULTS: The incidence of hypoestrogenic side effects was lower in the low dose group compared with the regular dose group, including hot flashes (19.2% vs. 21.8%, p = 0.741) and insomnia (15.4% vs. 18.2%, p = 0.699), although there were no significant difference between the groups. In addition, a higher number of patients in the regular dose group dropped out of treatment compared to the low dose group (14.5% and 9.6%, respectively, p = 0.435). The patients in both groups had a significant loss of mean bone mineral density during therapy (p < 0.001 and p = 0.018 for the low dose and regular dose groups, respectively). CONCLUSION: Low dose add-back therapy could effectively ameliorate hypoestrogenic side effects and simultaneously maintain the therapeutic response of GnRH agonist treatment. The treatment dropout was lower compared with a regular dose. Therefore, low dose add-back therapy can be considered a treatment choice during postoperative GnRH agonist treatment.
Assuntos
Endometriose/tratamento farmacológico , Estradiol/análogos & derivados , Hormônio Liberador de Gonadotropina/agonistas , Leuprolida/efeitos adversos , Acetato de Medroxiprogesterona/administração & dosagem , Adulto , Densidade Óssea/efeitos dos fármacos , Combinação de Medicamentos , Endometriose/cirurgia , Estradiol/administração & dosagem , Feminino , Terapia de Reposição Hormonal , Fogachos/induzido quimicamente , Fogachos/prevenção & controle , Humanos , Pacientes Desistentes do Tratamento , Estudos Prospectivos , Distúrbios do Início e da Manutenção do Sono/induzido quimicamente , Distúrbios do Início e da Manutenção do Sono/prevenção & controleRESUMO
Heavy menstrual bleeding, or menorrhagia, is subjectively defined as a "complaint of a large amount of bleeding during menstrual cycles that occurs over several consecutive cycles" and is objectively defined as menstrual blood loss of more than 80 mL per cycle that is associated with an anemia status (defined as a hemoglobin level of <10 g/dL). During their reproductive age, more than 30% of women will complain of or experience a heavy amount of bleeding, which leads to a debilitating health outcome, including significantly reduced health-related quality of life, and a considerable economic burden on the health care system. Although surgical treatment might be the most important definite treatment, especially hysterectomy for those women who have finished bearing children, the uterus is still regarded as the regulator and controller of important physiological functions, a sexual organ, a source of energy and vitality, and a maintainer of youth and attractiveness. This has resulted in a modern trend in which women may reconsider the possibility of organ preservation. For women who wish to retain the uterus, medical treatment may be one of the best alternatives. In this review, recent trends in the management of women with heavy menstrual bleeding are discussed.
Assuntos
Antifibrinolíticos/uso terapêutico , Técnicas Hemostáticas , Histerectomia/métodos , Menorragia/diagnóstico , Menorragia/terapia , Feminino , Humanos , Gravidez , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
OBJECTIVE: To investigate the effect of dehydroepiandrosterone (DHEA) supplementation on women with poor ovarian response (POR). MATERIALS AND METHODS: Women with POR treated with flexible daily gonadotropin-releasing hormone antagonist in vitro fertilization (IVF) cycles at The Reproductive Center in Kaohsiung Veterans General Hospital between January 2013 and October 2013, were enrolled for this prospective study. When patients failed to become pregnant during the first IVF cycle, they were treated with DHEA supplementation (30 mg, 3 times a day, orally) for 3 months (mean 12.2 weeks) before the next IVF cycle. Parameters of biochemical, ultrasound and treatment outcomes were compared before and after DHEA supplementation. RESULTS: Ten patients with a mean age of 36.6 ± 4.2 years were identified. After DHEA treatment, there was a significant increase in antral follicle count, from 2.8 ± 1.0 to 4.1 ± 1.2 (p < 0.05), and anti-Müllerian hormone, from 0.4 ± 0.2 ng/mL to 0.84 ± 0.2 ng/mL (p < 0.001). A significant decrease of Day 3 follicle-stimulating hormone and estradiol, from 14.4 ± 1.7 mIU/mL to 10.1 ± 0.7 mIU/mL and from 51.2 ± 6.3 pg/mL to 35.2 ± 4.2 pg/mL, respectively (both p < 0.001), was noted. Increased numbers of retrieved oocytes (from 2.4 ± 1.1 to 4.2 ± 1.2; p < 0.01), fertilized oocytes (from 1.7 ± 0.5 to 3.8 ± 1.1; p < 0.001), Day 3 embryos (from 1.7 ± 0.5 to 3.7 ± 1.1; p < 0.001) and transferred embryos (from 1.7 ± 0.8 to 2.8 ± 0.8; p < 0.01) were also seen in these women with POR after DHEA treatment. Three women became pregnant after DHEA treatment. CONCLUSION: The potential benefits of DHEA supplementation in women with POR were suggested by the biochemical parameters and IVF outcomes.