Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 226
Filtrar
1.
Medicine (Baltimore) ; 102(31): e34496, 2023 Aug 04.
Artigo em Inglês | MEDLINE | ID: mdl-37543781

RESUMO

BACKGROUND: Endometriosis (EMT) is a benign and common estrogen-dependent disease. Hormonal therapy improves pain symptoms in most women with EMT. However, in many cases, laparoscopic fertility preservation surgery is considered a common treatment for EMT. The present study aimed to evaluate the efficacy and safety of dienogest, leuprolide, danazol, gestrinone, mifepristone and levonorgestrel intrauterine system (LNG-IUS) in relieving symptoms and delaying the recurrence of EMT cysts after fertility protection surgery. METHODS: We searched PubMed, the Cochrane Library, Web of Science, EMBase, China National Knowledge Infrastructure, VIP Database, China Biology Medicine disc, WanFang Data databases to collect randomized controlled trials (RCT) related to dienogest, leuprolide, danazol, gestrinone, mifepristone and LNG-IUS as a follow-up treatment after fertility preserving surgery for EMT. After literature screening, data extraction and quality evaluation, effective rate, recurrence rate, pregnancy rate and adverse reaction rate were used as outcome indicators to evaluate the efficacy and safety of drugs. Evidence networks included in the study were drawn and publication bias was assessed. The drugs most likely to be the best postoperative treatment were explored through mixed comparison of different drugs and efficacy ranking. RESULT: Effective rate: dienogest, leprerelin, gestrinone and LNG-IUS were better than placebo after EMT fertility preservation surgery; dienogest was superior to mifepristone and danazol. LNG-IUS is superior to danazol. LNG-IUS has the highest potential for improving the effectiveness of EMT symptoms. Recurrence rate: the application of dienogest, leuprolide, gestrinone, mifepristone and LNG-IUS after EMT fertility preservation surgery was lower than that of placebo; dienogest and LNG-IUS were lower than danazol. The recurrence rate of dinorgestrel was the last place with the highest performance. Pregnancy rate: in the cases with fertility requirements, dienogest and,leuprolide were better than placebo after EMT fertility preservation surgery; dienogest was superior to danazol, gestrinone and mifepristone. Leuprolide is superior to danazol and gestrinone. The first rank of dienogest pregnancy rate was the highest. Adverse reaction rate: the application of dienogest, leuprolide, danazol, gestrinone, mifepristone and LNG-IUS after EMT fertility preservation surgery was higher than that of placebo. After placebo, LNG-IUS had the highest adverse reaction rate. CONCLUSION: For patients after fertility preserving surgery for EMT, the recurrence rate of dienogest was the last place with highest preference. The first rank of dienogest pregnancy was the highest.


Assuntos
Endometriose , Feminino , Humanos , Endometriose/tratamento farmacológico , Endometriose/cirurgia , Danazol/uso terapêutico , Gestrinone/uso terapêutico , Leuprolida/uso terapêutico , Mifepristona/uso terapêutico , Metanálise em Rede , Levanogestrel/uso terapêutico
2.
Cochrane Database Syst Rev ; 6: CD014788, 2023 06 21.
Artigo em Inglês | MEDLINE | ID: mdl-37341141

RESUMO

BACKGROUND: Endometriosis is a common gynaecological condition affecting 6 to 11% of reproductive-age women and may cause dyspareunia, dysmenorrhoea, and infertility. One treatment strategy is medical therapy with gonadotrophin-releasing hormone analogues (GnRHas) to reduce pain due to endometriosis. One of the adverse effects of GnRHas is a decreased bone mineral density. In addition to assessing the effect on pain, quality of life, most troublesome symptom and patients' satisfaction, the current review also evaluated the effect on bone mineral density and risk of adverse effects in women with endometriosis who use GnRHas versus other treatment options. OBJECTIVES: To assess the effectiveness and safety of GnRH analogues (GnRHas) in the treatment of painful symptoms associated with endometriosis and to determine the effects of GnRHas on bone mineral density of women with endometriosis. SEARCH METHODS: We searched the Cochrane Gynaecology and Fertility (CGF) Group trials register, CENTRAL, MEDLINE, Embase, PsycINFO and the trial registries in May 2022 together with reference checking and contact with study authors and experts in the field to identify additional studies. SELECTION CRITERIA: We included randomised controlled trials (RCTs) which compared GnRHas with other hormonal treatment options, including analgesics, danazol, intra-uterine progestogens, oral or injectable progestogens, gestrinone and also GnRHas compared with no treatment or placebo. Trials comparing GnRHas versus GnRHas in conjunction with add-back therapy (hormonal or non-hormonal) or calcium-regulation agents were also included in this review.  DATA COLLECTION AND ANALYSIS: We used standard methodology as recommended by Cochrane. Primary outcomes are relief of overall pain and the objective measurement of bone mineral density. Secondary outcomes include adverse effects, quality of life, improvement in the most troublesome symptoms and patient satisfaction.  Due to high risk of bias associated with some of the studies, primary analyses of all review outcomes were restricted to studies at low risk of selection bias. Sensitivity analysis including all studies was then performed. MAIN RESULTS: Seventy-two studies involving 7355 patients were included. The evidence was very low to low quality: the main limitations of all studies were serious risk of bias due to poor reporting of study methods, and serious imprecision.  Trials comparing GnRHas versus no treatment  We did not identify any studies. Trials comparing GnRHas versus placebo There may be a decrease in overall pain, reported as pelvic pain scores (RR 2.14; 95% CI 1.41 to 3.24, 1 RCT, n = 87, low-certainty evidence), dysmenorrhoea scores (RR 2.25; 95% CI 1.59 to 3.16, 1 RCT, n = 85, low-certainty evidence), dyspareunia scores (RR 2.21; 95% CI 1.39 to 3.54, 1 RCT, n = 59, low-certainty evidence), and pelvic tenderness scores (RR 2.28; 95% CI 1.48 to 3.50, 1 RCT, n = 85, low-certainty evidence) after three months of treatment. We are uncertain of the effect for pelvic induration, based on the results found after three months of treatment (RR 1.07; 95% CI 0.64 to 1.79, 1 RCT, n = 81, low-certainty evidence). Besides, treatment with GnRHas may be associated with a greater incidence of hot flushes at three months of treatment (RR 3.08; 95% CI 1.89 to 5.01, 1 RCT, n = 100, low-certainty evidence). Trials comparing GnRHas versus danazol For overall pain, for women treated with either GnRHas or danazol, a subdivision was made between pelvic tenderness, partly resolved and completely resolved. We are uncertain about the effect on relief of overall pain, when a subdivision was made for overall pain (MD -0.30; 95% CI -1.66 to 1.06, 1 RCT, n = 41, very low-certainty evidence), pelvic pain (MD 0.20; 95% CI -0.26 to 0.66, 1 RCT, n = 41, very low-certainty evidence), dysmenorrhoea (MD 0.10; 95% CI -0.49 to 0.69, 1 RCT, n = 41, very low-certainty evidence), dyspareunia (MD -0.20; 95% CI -0.77 to 0.37, 1 RCT, n = 41, very low-certainty evidence), pelvic induration (MD -0.10; 95% CI -0.59 to 0.39, 1 RCT, n = 41, very low-certainty evidence), and pelvic tenderness (MD -0.20; 95% CI -0.78 to 0.38, 1 RCT, n = 41, very low-certainty evidence) after three months of treatment. For pelvic pain (MD 0.50; 95% CI 0.10 to 0.90, 1 RCT, n = 41, very low-certainty evidence) and pelvic induration (MD 0.70; 95% CI 0.21 to 1.19, 1 RCT, n = 41, very low-certainty evidence), the complaints may decrease slightly after treatment with GnRHas, compared to danazol, for six months of treatment. Trials comparing GnRHas versus analgesics  We did not identify any studies. Trials comparing GnRHas versus intra-uterine progestogens We did not identify any low risk of bias studies. Trials comparing GnRHas versus GnRHas in conjunction with calcium-regulating agents There may be a slight decrease in bone mineral density (BMD) after 12 months treatment with GnRHas, compared to GnRHas in conjunction with calcium-regulating agents for anterior-posterior spine (MD -7.00; 95% CI -7.53 to -6.47, 1 RCT, n = 41, very low-certainty evidence) and lateral spine (MD -12.40; 95% CI -13.31 to -11.49, 1 RCT, n = 41, very low-certainty evidence).  AUTHORS' CONCLUSIONS: For relief of overall pain, there may be a slight decrease in favour of treatment with GnRHas compared to placebo or oral or injectable progestogens. We are uncertain about the effect when comparing GnRHas with danazol, intra-uterine progestogens or gestrinone. For BMD, there may be a slight decrease when women are treated with GnRHas, compared to gestrinone. There was a bigger decrease of BMD in favour of GnRHas, compared to GnRHas in conjunction with calcium-regulating agents. However, there may be a slight increase in adverse effects when women are treated with GnRHas, compared to placebo or gestrinone. Due to a very low to low certainty of the evidence, a wide range of outcome measures and a wide range of outcome measurement instruments, the results should be interpreted with caution.


Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Dispareunia , Endometriose , Feminino , Humanos , Endometriose/complicações , Endometriose/tratamento farmacológico , Danazol/uso terapêutico , Progestinas/uso terapêutico , Gestrinone , Dismenorreia , Cálcio , Dispareunia/tratamento farmacológico , Dispareunia/etiologia , Dor Pélvica/tratamento farmacológico , Dor Pélvica/etiologia , Cálcio da Dieta , Hormônio Liberador de Gonadotropina
3.
Arch Gynecol Obstet ; 307(1): 21-37, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-36434439

RESUMO

PURPOSE: Endometriosis is a common chronic gynecological disease defined as the presence of endometrial glands and stroma tissue outside the uterus. Gestrinone is an effective antiestrogen that induces endometrial atrophy and/or amenorrhea. The purpose of this systematic review is to provide an evaluation of safety and effectiveness of gestrinone for the treatment of endometriosis. METHODS: We performed a search in six electronic databases: PubMed, MEDLINE (ovid), Embase, Cochrane CENTRAL (clinical trials), Web of Science and Scopus. Our selected primary outcomes were the changes in dysmenorrhea, pain relief including pelvic pain and dyspareunia. The secondary outcomes embrace hormones parameters, pregnancy rate and adverse events. RESULTS: Of 3269 references screened, 16 studies were included involving 1286 women. All studies compared gestrinone with other drugs treatments (placebo, Danazol, Mifepristone tablets, Leuprolide acetate, Quyu Jiedu Recipe) during 6 months. When compared with other drugs treatments, gestrinone relieved dysmenorrhea, pelvic pain, and morphologic response in the ovary. There was an increase on the pregnancy rate. Regarding the side effects observed, gestrinone showed the same adverse events and increased the risk of acne and seborrhea when compared to other treatments. Even if there was any difference in efficacy between gestrinone, danazol, leuprolide acetate, or Quyu Jiedu Recipe Chinese Medicine, it remains unclear due to insufficient data. CONCLUSION: Based limited evidence available suggests that gestrinone appeared to be safe and may have some efficacy advantages over danazol, as well as other therapeutic interventions for treating endometriosis. However, this conclusion should be interpreted with caution, due the quality of the evidence provided is generally very low or unclear. TRIAL REGISTRATION: CRD42021284148.


Assuntos
Endometriose , Gravidez , Feminino , Humanos , Endometriose/tratamento farmacológico , Endometriose/complicações , Gestrinone/efeitos adversos , Danazol/uso terapêutico , Leuprolida/efeitos adversos , Dismenorreia/tratamento farmacológico , Dismenorreia/complicações , Dor Pélvica/tratamento farmacológico , Dor Pélvica/etiologia
4.
Zhongguo Zhong Yao Za Zhi ; 47(17): 4674-4681, 2022 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-36164874

RESUMO

This study aims to decipher the mechanism underlying the effect of Shaofu Zhuyu Decoction on endometriosis(EMT)-associated dysmenorrhea in rats with the syndrome of cold coagulation and blood stasis based on mitogen-and stress-activated protein kinase 1/2(MSK1/2).We employed a random number table to randomly assign SPF female non-pregnant rats into the sham group, and treated the rest rats with autologous transplantation+refrigerator freezing for the modeling of the syndrome of cold coagulation and blood stasis.The modeled rats were then randomly assigned into the control group and high-, medium-and low-dose Shaofu Zhuyu Decoction groups.The rats in the low-, medium-, and high-dose decoction groups were respectively administrated with 9, 4.5, and 2.3 g·kg~(-1) decoction through gavage once a day for 2 consecutive weeks, and those in the control group were administrated with 0.24 mg·kg~(-1) gestrinone through gavage once every 3 days for 2 weeks.After that, the size of ectopic focus in each rat was measured via laparotomy.Enzyme-linked immunosorbent assay(ELISA) was adopted to determine the expression of interleukin(IL)-6, IL-10, prostaglandin E2(PGE2), tumor necrosis factor-α(TNF-α).Western blot was employed to determine the protein levels of MSK1/2 and dual-specificity phosphatase 1(DUSP1) and real-time quantitative polymerase chain reaction(RT-PCR) to determine the mRNA levels of the two genes in rat eutopic endometrial tissue.Compared with the sham group, the model group showed increased levels of IL-6, PGE2, and TNF-α while decrease level of IL-10 in the serum(P<0.01).Compared with the model group, the high-and medium-dose decoction groups and the gestrinone group had declined levels of IL-6, PGE2, and TNF-α while risen level of IL-10 in the serum(P<0.01).The model group had lower protein levels and mRNA levels of MSK1/2 and DUSP1 in the eutopic endometrial tissue than the sham group(P<0.01). The high-and medium-dose decoction groups and the gestrinone group had higher protein and mRNA levels of MSK1/2 and DUSP1 in the eutopic endometrial tissue than the model group(P<0.01).The results indicated that Shaofu Zhuyu Decoction can regulate the abnormal expression of pro-inflammatory cytokines TNF-α, IL-6, and PGE2 and anti-inflammatory cytokines IL-10 and DUSP1 via MSK1/2 to alleviate EMT-associated dysmenorrhea in rats with the syndrome of cold coagulation and blood stasis.


Assuntos
Medicamentos de Ervas Chinesas , Endometriose , Animais , Feminino , Ratos , Anti-Inflamatórios/uso terapêutico , Citocinas , Dinoprostona , Medicamentos de Ervas Chinesas/uso terapêutico , Fosfatases de Especificidade Dupla , Dismenorreia/tratamento farmacológico , Dismenorreia/genética , Endometriose/complicações , Endometriose/tratamento farmacológico , Endometriose/genética , Gestrinone/uso terapêutico , Interleucina-10 , Interleucina-6 , Proteína Quinase 8 Ativada por Mitógeno/uso terapêutico , Mitógenos/uso terapêutico , RNA Mensageiro , Fator de Necrose Tumoral alfa/metabolismo
5.
Taiwan J Obstet Gynecol ; 61(1): 70-74, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35181049

RESUMO

OBJECTIVE: Endometriosis, defined as the growth of endometrial glands and stromal cells in a heterotopic location under the cyclic influence of ovarian hormones, is a common gynecological disorder manifested by chronic pelvic pain and infertility. In traditional Chinese medicine, endometriosis is characterized by stagnation of vital energy (qi) and blood stasis. Guizhi Fuling Wan (GFW) was first described in Chinese canonical medicine to treat disorders associated with stagnation of qi and blood stasis, including endometriosis. Therefore, the current study aimed to test the effects of combining GFW with western medicine on the suppression of endometriosis. MATERIALS AND METHODS: Endometriosis was generated by suturing endometrial tissue on the peritoneal wall of C57BL/6JNarl mice. The mice were subsequently treated with either GFW or current hormonal therapies or in combination for 28 days. RESULTS: Endometriosis development was inhibited by GFW, Gestrinone, Visanne, GFW + Gestrinone or GFW + medroxyprogesterone acetate (MPA). The expression of intercellular adhesion molecule 1 (ICAM-1) was inhibited by GFW, Gestrinone, MPA, Visanne, GFW + Gestrinone, GFW + MPA and GFW + Visanne. Vascular endothelial growth factor (VEGF) expression was inhibited by GFW, Gestrinone, Visanne, GFW + Gestrinone and GFW + MPA. Both ICAM-1- and VEGF-reducing effects of GFW were attenuated by western medicines. Administration of GFW, MPA, Visanne, GFW + MPA and GFW + Visanne also correspondingly reduced macrophage population in peritoneal fluid. GFW, MPA, Visanne, GFW + MPA and GFW + Visanne enhanced B-cell population in peritoneal fluid. CONCLUSION: The current study reveals the therapeutic effects of GFW on endometriosis. However, the combination of GFW and current hormonal therapies potentially impedes the efficacy of each individual agent in treating endometriosis.


Assuntos
Medicamentos de Ervas Chinesas/uso terapêutico , Endometriose/tratamento farmacológico , Gestrinone/uso terapêutico , Molécula 1 de Adesão Intercelular/efeitos dos fármacos , Acetato de Medroxiprogesterona/uso terapêutico , Fator A de Crescimento do Endotélio Vascular/efeitos dos fármacos , Animais , Feminino , Camundongos , Camundongos Endogâmicos C57BL
6.
Transl Res ; 243: 21-32, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-34921996

RESUMO

Endometriosis has been shown to increase the risk of gynecological cancers. However, the effect of gestrinone, a clinical endometriosis drug, on gynecological cancers remains unclear. This study aimed to understand the effect of gestrinone on gynecological cancers. A retrospective study was conducted using the Longitudinal Health Insurance Database 2000 of the Taiwan National Health Insurance Research Database (NHIRD) to observe the risk of gynecological cancers. Medication records from the Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital CSMUH and cancer records from the Taiwan Cancer Registry were collected to analyze the correlation between gestrinone use and gynecological cancers. Subsequently, human cell lines were used to investigate the effect of gestrinone on gynecological cancers. A total of 8330 endometriosis patients were enrolled, and analyses revealed that endometriosis patients had a higher risk of developing ovarian and endometrial cancer. However, the rate of cervical cancer was not statistically different (P = 0.249). Analyses of both the NHIRD and CSMUH databases revealed that gestrinone may reduce the risk of gynecological cancer. Cellular experiments verified the anticancer effects of gestrinone, which effectively and specifically inhibited the growth of HeLa cervical cancer cells, decreased P21 expression via JNK phosphorylation, and induced apoptosis. Combining the results of clinical database analysis and cell experiments, our findings prove that gestrinone has the potential to protect against cancer through regulation of the JNK-P21 axis. Repurposing the anticancer efficacy of gestrinone may be a strategy for targeted therapy in the future.


Assuntos
Endometriose , Ginecologia , Neoplasias , Reposicionamento de Medicamentos , Feminino , Gestrinone/uso terapêutico , Humanos , Neoplasias/tratamento farmacológico , Gravidez , Estudos Retrospectivos
8.
Int J Pharm Compd ; 25(5): 422-426, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34623968

RESUMO

Transdermal products are intended to be applied topically but to promote the biological effects systemically, while transmucosal products have the same final effect but are to be applied on mucosa (for example, vaginal mucosa). The extension and velocity in which absorption occurs vary depending on the vehicle used, the active pharmaceutical ingredient and a broad range of other factors related to the formulation, patient, and environmental characteristics. Ready-to-use vehicles, such as Pentravan, with proven penetration efficacy for various active pharmaceutical ingredients, are paramount. Pentravan, specially developed for compounding pharmacies, has been extensively studied. To date, most studies have focused on endocrinology (e.g., sexual hormones), anti-aging strategies, and gynecology (endometriosis and related conditions). In this work, we have determined the compatibility of Pentravan and three active pharmaceutical ingredients: gestrinone, a steroidal substance for vaginal use (endometriosis), and nimesulide and piroxicam, two nonsteroidal anti-inflammatory drugs used both for topical and vaginal application. This article shows an excellent beyond-use date of 180 days when stored at room temperature, which renders it suitable for daily practice.


Assuntos
Gestrinone , Piroxicam , Administração Cutânea , Feminino , Humanos , Sulfonamidas
10.
Pak J Pharm Sci ; 31(5(Special)): 2197-2201, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30463812

RESUMO

Endometriosis is a common disease among women of childbearing age, and it is the main cause of dysmenorrhea and infertility. This article analyzes the efficacy of mifepristone and gestrinone in the treatment of endometriosis. The results showed that the recurrence rate of mifepristone group and gestrinone group were 8.33% and 5%, respectively, which was significantly lower than 23.33% of the control group. Before and after treatment, LH, endocrine test results FSH PRL had no obvious change in mifepristone group and gestrinone group, while E2 decreased, as mifepristone group (141.7±31.2) pmol/L, gestrinone group (64.2±11.7) pmol/L. The incidence of adverse reactions and liver dysfunction in the mifepristone group were significantly lower than those the gestrinone group (P<0.05). Mifepristone and gestrinone can be used for endometriosis postoperative adjuvant treatment, is safe and effective, but using mifepristone has the lower rate of adverse reaction. In conclusion, mifepristone is a current research focus, its mechanism of action in the process of exploration, has broad prospects in the treatment of endometriosis, its long-term application security is paid more and more attention.


Assuntos
Endometriose/tratamento farmacológico , Gestrinone/uso terapêutico , Mifepristona/uso terapêutico , Adulto , Feminino , Humanos , Laparoscopia/métodos , Recidiva , Adulto Jovem
11.
Artigo em Inglês | WPRIM (Pacífico Ocidental) | ID: wpr-727862

RESUMO

Endometriosis (EM) is one of the most common gynaecological disorder affecting women in their reproductive age. Mechanisms involved in the pathogenesis of EM remains poorly understood, however inflammatory responses have been reported to be significantly involved. The efficacy of 6-shogaol on proliferation of endometriotic lesions and inflammatory pathways in experimentally-induced EM model was explored in this study. EM was stimulated in Sprague-Dawley rats by implantation of autologous endometrium onto the peritoneum abdominal wall. Separate groups were treated with 6-shogaol (50, 100 or 150 mg/kg b.wt/day) via oral gavage for one month period. Gestrinone (GTN) group received GTN (0.5 mg/kg/day) as positive control. Five weeks after implantation, the spherical volume of ecto-uterine tissues was determined. Treatment with 6-shogaol significantly reduced the implant size. Histological analysis reported atrophy and regression of the lesions. 6-shogaol administration effectively down-regulated NF-κB signaling, VEGF and VEGFR-2 (Flk-1) expression in the endometriotic lesions. Excess production of IL-1β and IL-6 (pro-inflammatory cytokines), PGE2 and nitric oxide (NO) were reduced. Overall, the results of the study reveal the efficacy of 6-shogaol against endometriosis via effectively suppressing proliferation of the lesions and modulating angiogenesis and COX-2/NF-κB-mediated inflammatory cascades.


Assuntos
Feminino , Humanos , Parede Abdominal , Atrofia , Dinoprostona , Endometriose , Endométrio , Gestrinone , Técnicas In Vitro , Interleucina-6 , Óxido Nítrico , Peritônio , Ratos Sprague-Dawley , Fator A de Crescimento do Endotélio Vascular , Receptor 2 de Fatores de Crescimento do Endotélio Vascular
12.
Cochrane Database Syst Rev ; 7: CD009881, 2017 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-28742263

RESUMO

BACKGROUND: Endometriosis is defined as the presence of endometrial tissue (glands and stroma) outside the uterine cavity. This condition is oestrogen-dependent and thus is seen primarily during the reproductive years. Owing to their antiproliferative effects in the endometrium, progesterone receptor modulators (PRMs) have been advocated for treatment of endometriosis. OBJECTIVES: To assess the effectiveness and safety of PRMs primarily in terms of pain relief as compared with other treatments or placebo or no treatment in women of reproductive age with endometriosis. SEARCH METHODS: We searched the following electronic databases, trial registers, and websites: the Cochrane Gynaecology and Fertility Group (CGFG) Specialised Register of Controlled Trials, the Central Register of Studies Online (CRSO), MEDLINE, Embase, PsycINFO, clinicaltrials.gov, and the World Health Organization (WHO) platform, from inception to 28 November 2016. We handsearched reference lists of articles retrieved by the search. SELECTION CRITERIA: We included randomised controlled trials (RCTs) published in all languages that examined effects of PRMs for treatment of symptomatic endometriosis. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures as expected by the Cochrane Collaboration. Primary outcomes included measures of pain and side effects. MAIN RESULTS: We included 10 randomised controlled trials (RCTs) with 960 women. Two RCTs compared mifepristone versus placebo or versus a different dose of mifepristone, one RCT compared asoprisnil versus placebo, one compared ulipristal versus leuprolide acetate, and four compared gestrinone versus danazol, gonadotropin-releasing hormone (GnRH) analogues, or a different dose of gestrinone. The quality of evidence ranged from high to very low. The main limitations were serious risk of bias (associated with poor reporting of methods and high or unclear rates of attrition in most studies), very serious imprecision (associated with low event rates and wide confidence intervals), and indirectness (outcome assessed in a select subgroup of participants). Mifepristone versus placebo One study made this comparison and reported rates of painful symptoms among women who reported symptoms at baseline.At three months, the mifepristone group had lower rates of dysmenorrhoea (odds ratio (OR) 0.08, 95% confidence interval (CI) 0.04 to 0.17; one RCT, n =352; moderate-quality evidence), suggesting that if 40% of women taking placebo experience dysmenorrhoea, then between 3% and 10% of women taking mifepristone will do so. The mifepristone group also had lower rates of dyspareunia (OR 0.23, 95% CI 0.11 to 0.51; one RCT, n = 223; low-quality evidence). However, the mifepristone group had higher rates of side effects: Nearly 90% had amenorrhoea and 24% had hot flushes, although the placebo group reported only one event of each (1%) (high-quality evidence). Evidence was insufficient to show differences in rates of nausea, vomiting, or fatigue, if present. Mifepristone dose comparisons Two studies compared doses of mifepristone and found insufficient evidence to show differences between different doses in terms of effectiveness or safety, if present. However, subgroup analysis of comparisons between mifepristone and placebo suggest that the 2.5 mg dose may be less effective than 5 mg or 10 mg for treating dysmenorrhoea or dyspareunia. Gestrinone comparisons Ons study compared gestrinone with danazol, and another study compared gestrinone with leuprolin.Evidence was insufficient to show differences, if present, between gestrinone and danazol in rate of pain relief (those reporting no or mild pelvic pain) (OR 0.71, 95% CI 0.33 to 1.56; two RCTs, n = 230; very low-quality evidence), dysmenorrhoea (OR 0.72, 95% CI 0.39 to 1.33; two RCTs, n = 214; very low-quality evidence), or dyspareunia (OR 0.83, 95% CI 0.37 to 1.86; two RCTs, n = 222; very low-quality evidence). The gestrinone group had a higher rate of hirsutism (OR 2.63, 95% CI 1.60 to 4.32; two RCTs, n = 302; very low-quality evidence) and a lower rate of decreased breast size (OR 0.62, 95% CI 0.38 to 0.98; two RCTs, n = 302; low-quality evidence). Evidence was insufficient to show differences between groups, if present, in rate of hot flushes (OR 0.79, 95% CI 0.50 to 1.26; two RCTs, n = 302; very low-quality evidence) or acne (OR 1.45, 95% CI 0.90 to 2.33; two RCTs, n = 302; low-quality evidence).When researchers compared gestrinone versus leuprolin through measurements on the 1 to 3 verbal rating scale (lower score denotes benefit), the mean dysmenorrhoea score was higher in the gestrinone group (MD 0.35 points, 95% CI 0.12 to 0.58; one RCT, n = 55; low-quality evidence), but the mean dyspareunia score was lower in this group (MD 0.33 points, 95% CI 0.62 to 0.04; low-quality evidence). The gestrinone group had lower rates of amenorrhoea (OR 0.04, 95% CI 0.01 to 0.38; one RCT, n = 49; low-quality evidence) and hot flushes (OR 0.20, 95% CI 0.06 to 0.63; one study, n = 55; low quality evidence) but higher rates of spotting or bleeding (OR 22.92, 95% CI 2.64 to 198.66; one RCT, n = 49; low-quality evidence).Evidence was insufficient to show differences in effectiveness or safety between different doses of gestrinone, if present. Asoprisnil versus placebo One study (n = 130) made this comparison but did not report data suitable for analysis. Ulipristal versus leuprolide acetate One study (n = 38) made this comparison but did not report data suitable for analysis. AUTHORS' CONCLUSIONS: Among women with endometriosis, moderate-quality evidence shows that mifepristone relieves dysmenorrhoea, and low-quality evidence suggests that this agent relieves dyspareunia, although amenorrhoea and hot flushes are common side effects. Data on dosage were inconclusive, although they suggest that the 2.5 mg dose of mifepristone may be less effective than higher doses. We found insufficient evidence to permit firm conclusions about the safety and effectiveness of other progesterone receptor modulators.


Assuntos
Endometriose/tratamento farmacológico , Antagonistas de Hormônios/uso terapêutico , Mifepristona/uso terapêutico , Receptores de Progesterona/antagonistas & inibidores , Danazol/uso terapêutico , Dismenorreia/tratamento farmacológico , Dismenorreia/epidemiologia , Dispareunia/tratamento farmacológico , Dispareunia/epidemiologia , Estrenos/uso terapêutico , Feminino , Gestrinone/efeitos adversos , Gestrinone/uso terapêutico , Hormônio Liberador de Gonadotropina/análogos & derivados , Antagonistas de Hormônios/administração & dosagem , Antagonistas de Hormônios/efeitos adversos , Humanos , Leuprolida/efeitos adversos , Leuprolida/uso terapêutico , Mifepristona/administração & dosagem , Mifepristona/efeitos adversos , Norpregnadienos/uso terapêutico , Oximas/uso terapêutico , Prevalência , Ensaios Clínicos Controlados Aleatórios como Assunto
13.
Clin Exp Obstet Gynecol ; 43(3): 350-3, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27328489

RESUMO

OBJECTIVE: To observe the effect of small-dose mifepristone conservative treatment and laparoscopic combined with mifepristone in the treatment of endometriosis. MATERIALS AND METHODS: Sixty-five endometriosis cases were given small-dose mifepristone conservative treatment and were assessed for the effect of this treatment; 92 cases were randomly divided into control group (taking gestrinone) and observation group (mifepristone), FSH, P, PRL and E2 levels were compared before and after treatment, and pregnancy investigation and each sex hormone level monitoring were followed-up at one year after drug withdrawal. RESULTS: Using mifepristone, FSH, P, E2, and LH levels all significantly changed six months after treatment and recovered 12 months after drug withdrawal; when comparing the pelvic symptoms, endometrial thickness showed that mifepristone was significantly effective (p < 0.01), and the pregnancy rate was 27.69%. Comparing the two groups, none of the total effective rate, pregnancy rate one year of follow-up, and recurrence rates were significantly different; hormone levels in the both groups were significantly decreased or increased (p < 0.05) after treatment. The two groups had no significant difference (p > 0.05), but 12 months after drug withdrawal, in the control group (not in the observation group), LH level was still significantly different (p < 0.05) compared pre-treatment. CONCLUSIONS: In the conservative treatment, mifepristone can safely improve the hormone levels, reduce the thickness of the endometrium, alleviate symptoms. With laparoscopic minimally invasive combined drug therapy, mifepristone has a significant effect, with a more followed-up pregnancy rate, less recurrence, and no drug accumulation side-effects, hence it is worthy of clinical application.


Assuntos
Endometriose/terapia , Antagonistas de Hormônios/uso terapêutico , Mifepristona/uso terapêutico , Adulto , Terapia Combinada , Dismenorreia/etiologia , Dispareunia/etiologia , Endometriose/sangue , Endometriose/complicações , Estradiol/sangue , Feminino , Hormônio Foliculoestimulante/sangue , Gestrinone/uso terapêutico , Procedimentos Cirúrgicos em Ginecologia , Humanos , Laparoscopia , Hormônio Luteinizante/sangue , Dor Pélvica/etiologia , Gravidez , Progesterona/sangue , Progestinas/uso terapêutico , Estudos Retrospectivos , Adulto Jovem
14.
Sci Rep ; 6: 27897, 2016 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-27302286

RESUMO

High-throughput in vitro screening experiments can be used to generate concentration-response data for large chemical libraries. It is often desirable to estimate the concentration needed to achieve a particular effect, or potency, for each chemical tested in an assay. Potency estimates can be used to directly compare chemical profiles and prioritize compounds for confirmation studies, or employed as input data for prediction modeling and association mapping. The concentration for half-maximal activity derived from the Hill equation model (i.e., AC50) is the most common potency measure applied in pharmacological research and toxicity testing. However, the AC50 parameter is subject to large uncertainty for many concentration-response relationships. In this study we introduce a new measure of potency based on a weighted Shannon entropy measure termed the weighted entropy score (WES). Our potency estimator (Point of Departure, PODWES) is defined as the concentration producing the maximum rate of change in weighted entropy along a concentration-response profile. This approach provides a new tool for potency estimation that does not depend on the assumption of monotonicity or any other pre-specified concentration-response relationship. PODWES estimates potency with greater precision and less bias compared to the conventional AC50 assessed across a range of simulated conditions.


Assuntos
Entropia , Ensaios de Triagem em Larga Escala/métodos , Modelos Teóricos , Bibliotecas de Moléculas Pequenas/farmacologia , Linhagem Celular , Simulação por Computador , Relação Dose-Resposta a Droga , Avaliação Pré-Clínica de Medicamentos/métodos , Estradiol/análogos & derivados , Estradiol/farmacologia , Gestrinone/farmacologia , Humanos , Fenóis/farmacologia , Receptores de Estrogênio/metabolismo , Reprodutibilidade dos Testes
15.
Zhonghua Fu Chan Ke Za Zhi ; 51(2): 98-102, 2016 Feb.
Artigo em Chinês | MEDLINE | ID: mdl-26917477

RESUMO

OBJECTIVE: To investigate the incidence, influencing factors and intervention of gestrinone-related abnormal uterine bleeding at different dosage of gestrinone in the clinical treatment. METHODS: This was a multicenter, randomized, control study of 195 Chinese women with endometriosis or adenomyosis from June 2011 to November 2013. The subjects were randomized into three groups with oral administration of gestrinone, 2.5 mg dose at one time; twice a week group: 67 cases with oral administration twice a week last three months; double dose first month group: 67 cases with oral administration triple times a week at first month, then twice a week for two months; three times a week group: 61 cases with oral administration three times a week last three months. The improvement of the abnormal uterine bleeding, the changes in estrogen, liver function and blood coagulation were evaluated. At the same time, B-ultrasound examination evaluation were performed. RESULTS: (1) Three months later, the incidence of abnormal uterine bleeding in twice a week group was 30% (20/67), in double dose first month group and three times a week group were 7%(5/67) and 16% (10/61) respectively, there were significant difference between three groups (P<0.05). The incidence in double dose first month group was the most lower. (2) Univariate analysis showed that the dosage and ovarian size were the significant factors for abnormal uterine bleeding (OR=0.461,P= 0.003;OR=0.303,P=0.016); logistic regression analysis demonstrated that the risk of abnormal uterine bleeding in double dose first month group was the lowest when compared with twice a week group and three times a week group, the risk in twice a week group was 5-fold higher than that in double dose first month group (OR=0.211,P=0.011). The incidence of abnormal uterine bleeding in participants with abnormal ovarian volume results from ovarian cyst or ovarian surgery was significantly lower than those with normal ovarian volume (OR=0.304,P=0.018). (3) After the treatment of three months, there were no significant difference in alanine transaminase level between the groups (P>0.05). The body mass index significantly increased in three group (P<0.05), but there were no significant differences between the groups (P>0.05). As for blood coagulation, there were also no significant differences between the groups (P>0.05). CONCLUSIONS: Double dose of gestrinone in the first month could significantly decrease the incidence of gestrinone-related abnormal uterine bleeding. It is a more optimied dosage of gestrinone and without severe side effects. CLINICAL TRIAL REGISTRATION: Chinese Clinical Trial Registry, registration number: ChiCTR-TRC-12002327.


Assuntos
Anticoncepcionais Orais/efeitos adversos , Gestrinone/efeitos adversos , Hemorragia Uterina/induzido quimicamente , Adenomiose , China/epidemiologia , Anticoncepcionais Orais/administração & dosagem , Relação Dose-Resposta a Droga , Feminino , Gestrinone/administração & dosagem , Humanos , Incidência , Cistos Ovarianos , Hemorragia Uterina/epidemiologia
16.
Artigo em Inglês | MEDLINE | ID: mdl-26796059

RESUMO

Uterine leiomyomas, or fibroids, are the most common benign tumor in reproductive aged women. Affected women may remain asymptomatic or may report symptoms related to abnormal uterine bleeding, infertility, or pelvic pain and pressure. Depending on a patient's symptomatology and reproductive plans, treatment options include expectant management, medical management (hormonal and non-hormonal), or surgical management (myomectomy or hysterectomy). In those wishing to defer surgical management, non-hormonal therapies such as non-steroidal anti-inflammatory drugs and tranexamic acid have been shown to decrease menstrual blood loss. In patients with more symptomatic leiomyomas, hormonal therapies such as gonadotropin-releasing hormone agonists and selective progesterone receptor modulators are effective at reducing leiomyoma volume, uterine size, and menstrual blood loss. This manuscript will detail the available and emerging hormonal and non-hormonal treatments for symptomatic uterine leiomyomas.


Assuntos
Anticoncepcionais Femininos/uso terapêutico , Hormônio Liberador de Gonadotropina/agonistas , Leiomioma/tratamento farmacológico , Neoplasias Uterinas/tratamento farmacológico , Antifibrinolíticos/uso terapêutico , Inibidores da Aromatase/uso terapêutico , Cabergolina , Colecalciferol/uso terapêutico , Anticoncepcionais Femininos/administração & dosagem , Anticoncepcionais Orais Hormonais/uso terapêutico , Anticoncepcionais Orais Sintéticos/uso terapêutico , Danazol/uso terapêutico , Agonistas de Dopamina/uso terapêutico , Ergolinas/uso terapêutico , Estrenos/uso terapêutico , Antagonistas de Estrogênios/uso terapêutico , Feminino , Gestrinone/uso terapêutico , Hormônio Liberador de Gonadotropina/antagonistas & inibidores , Humanos , Dispositivos Intrauterinos Medicados , Levanogestrel/administração & dosagem , Mifepristona/uso terapêutico , Norpregnadienos/uso terapêutico , Oximas/uso terapêutico , Planejamento de Assistência ao Paciente , Moduladores Seletivos de Receptor Estrogênico/uso terapêutico , Somatostatina/análogos & derivados , Ácido Tranexâmico/uso terapêutico , Vitaminas/uso terapêutico
17.
Zhongguo Zhong Yao Za Zhi ; 41(18): 3478-3482, 2016 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-28925135

RESUMO

To study the effect of Tripterygium wilfordii glycosides and gestrinone on endometriosis and serum cytokine expression, 135 cases of endometriosis patients were divided into treatment group(n=69) and control group(n=68). The observation group was orally given with T. wilfordii glycosides, 20 mg, tid, for 4 weeks. Then, the dose decreased to 10 mg/time, tid. T. wilfordii glycosides combined with gestrinone capsule(2.5 mg) were given in the 1st and 4th day of a menstrual cycle. Later, the administration was fixed at two times every week. The course of treatment lasted for 3 months. The control group was treated with gestrinone capsule(according to the same intake method). The serum-related cytokine levels before and after treatment were determined, and the clinical efficacy was observed. The results showed the total effective rate of the observation group was 89.71%, which was obviously higher than that of the control group(74.63%), with statistically significant differences(P<0.05). After treatment, TDS showed varying degrees of decreases, with a better effect in the observation group (P<0.01). Before treatment, serum TGF-ß, IL-10 and IL-4 level had no significant difference. After treatment, all of these cytokines decreased, particularly for the observation decreased(P<0.01). Before and after treatment, serum IL-17 had no obvious difference between the two groups. This study suggested that the integrated traditional Chinese medicine and western medicine has an obvious clinical efficiency in endometriosis. Its mechanism may be related to the effective regulation of cytokines.


Assuntos
Medicamentos de Ervas Chinesas/uso terapêutico , Endometriose/tratamento farmacológico , Gestrinone/uso terapêutico , Glicosídeos/uso terapêutico , Tripterygium/química , Citocinas/sangue , Feminino , Humanos
18.
Laterality ; 21(2): 100-17, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26292019

RESUMO

Non-human primates represent models to understand the evolution of handedness in humans. Despite several researches have been investigating non-human primates handedness, few studies examined the relationship between target position, hand preference and task complexity. This study aimed at investigating macaque handedness in relation to target laterality and tastiness, as well as task complexity. Seven pig-tailed macaques (Macaca nemestrina) were involved in three different "two alternative choice" tests: one low-level task and two high-level tasks (HLTs). During the first and the third tests macaques could select a preferred food and a non-preferred food, whereas by modifying the design of the second test, macaques were presented with no-difference alternative per trial. Furthermore, a simple-reaching test was administered to assess hand preference in a social context. Macaques showed hand preference at individual level both in simple and complex tasks, but not in the simple-reaching test. Moreover, target position seemed to affect hand preference in retrieving an object in the low-level task, but not in the HLT. Additionally, individual hand preference seemed to be affected from the tastiness of the item to be retrieved. The results suggest that both target laterality and individual motivation might influence hand preference of macaques, especially in simple tasks.


Assuntos
Comportamento de Escolha/fisiologia , Lateralidade Funcional/fisiologia , Desempenho Psicomotor/fisiologia , Animais , Comportamento Animal , Comportamento Alimentar , Feminino , Gestrinone , Masculino
19.
J Obstet Gynaecol Res ; 41(5): 712-6, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25420776

RESUMO

AIM: The aim of this study was to determine clinical performance of gestrinone combined with ultrasound-guided aspiration and ethanol injection in treating chocolate cyst of ovary. METHODS: Sixty-eight patients enrolled in this study were randomly divided into two groups: control group and combination treatment group. In the control group, 34 patients were treated with ultrasound-guided aspiration and ethanol injection. In the combination treatment group, 34 patients received gestrinone p.o. following ultrasound-guided aspiration and ethanol injection. RESULTS: The recurrence rate of chocolate cyst was 10-fold lower in the combination treatment group (2.94%, 1/34) than in the control group (29.4%, 10/34) at 12 months. The effective rate for reduction of chocolate cyst was significantly higher in the combination treatment group (94.12%, 32/34) than in the control group (64.71%, 22/34) (P = 0.009). CONCLUSION: Gestrinone combined with ultrasound-guided aspiration and ethanol injection therapy is an effective treatment for ovarian chocolate cyst with low recurrence rate.


Assuntos
Etanol/uso terapêutico , Gestrinone/uso terapêutico , Cistos Ovarianos/terapia , Paracentese , Progestinas/uso terapêutico , Adulto , Terapia Combinada , Feminino , Humanos , Pessoa de Meia-Idade , Cistos Ovarianos/tratamento farmacológico , Cistos Ovarianos/cirurgia , Recidiva , Resultado do Tratamento , Ultrassonografia de Intervenção , Adulto Jovem
20.
Zhonghua Fu Chan Ke Za Zhi ; 48(2): 113-7, 2013 Feb.
Artigo em Chinês | MEDLINE | ID: mdl-23544492

RESUMO

OBJECTIVE: To investigate clinicopathological features of abdominal wall endometriosis (AWE). METHODS: A retrospective study was conducted on 151 consecutive AWE patients undergoing treatment in Affiliated Obstetrics and Gynecology Hospital, Fudan University from January 2003 to December 2010. The period of following up was at range of 16 to 97 months. RESULTS: (1) The incidence of AWE was 1.96% (166/8469). All 151 AWE cases followed up had previous cesarean sections. The period between the previous cesarean section (CS) and the onset of symptoms of AWE was 24 months (3 - 192 months). However, the latency was not associated with the age at CS, incision site, gestational week at CS, duration of lactation, postpartum menstruation recovery, the choice of contraceptives and size of AWE (P > 0.05). The duration of disease, defined to be the time interval between the onset of symptoms and surgery, was 26 months (2 - 168 months), which was negatively correlated with the latent period (r = -0.267, P < 0.05) and was positively with size of AWE (patients with large-scar endometrioma with diameter of lesions ≥ 3 cm had longer disease duration than those with small-scar endometriomas < 3 cm, r = 0.326, P < 0.05). (2) The rate of pre-operational ultrasonography detection was 97.4% (147/151). The lesion size detected by pre-operative ultrasonography was significantly smaller than that measured intraoperatively by palpation (20 mm versus 35 mm, P < 0.05). Moreover, only 26.5% (40/151) of AWE patients were found to have deep infiltration by pre-operative ultrasonography. (3) All patients were managed by surgical treatment to completely excise lesions on the abdominal wall. Of all 34 patients (22.5%, 34/151) took medicine pre-operatively while 57 patients (37.7%, 57/151) taking medicine post-operatively. The rate of recurrence was 3.1% (3/96) of cases with lesions ≥ 3 cm, which was significantly lower than 17.8% (8/45) in cases with lesion < 3 cm (P < 0.05). (4) After surgery, the symptoms were found to be relieved in 93.4% (141/151) of patients. The recurrence rate was 7.8% (11/141) while the average recurrent time was (20 ± 16) months. CONCLUSION: Surgery is the main management on AWE. The risk factors associated with recurrence were size of lesion and postoperative medication.


Assuntos
Parede Abdominal/patologia , Endometriose/patologia , Endometriose/cirurgia , Dor Abdominal/etiologia , Parede Abdominal/cirurgia , Adulto , Cesárea , Endometriose/diagnóstico , Endometriose/tratamento farmacológico , Feminino , Gestrinone/uso terapêutico , Gosserrelina/uso terapêutico , Humanos , Histerectomia , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...