Cesarean delivery after non-medically indicated induction of labor: A population-based study using different definitions of expectant management.
- 作者列表："Zenzmaier C","Pfeifer B","Leitner H","König-Bachmann M
INTRODUCTION:Most observational studies found that non-medically indicated induction of labor (IOL) is not associated with an increased risk of cesarean delivery compared with expectant management, defined as all births at a later gestation. However, given the higher rate of cesarean delivery at late term, this definition of the expectant management group might bias the results of observational studies in favor of IOL at early or full term when estimating the risk of short-term (eg up to 1 week) expectant management. MATERIAL AND METHODS:We conducted a retrospective cohort study including 447 066 singleton term and post-term hospital births that occurred in Austria between 2008 and 2016. Multivariate logistic regression was used to test the association of IOL and cesarean delivery at each week of gestation from 37-41. Expectant management was either defined as all births at "next week or beyond" or "at next week". RESULTS:Non-medically indicated IOL was associated with increased odds for cesarean delivery at 37 and 38 weeks, and reduced odds at 40 and 41 weeks. At 39 weeks, IOL resulted in comparable cesarean rates compared with expectant management defined as "next week or beyond" (17.2% vs 16.2%; adjusted odds ratio [OR] 0.93; 95% confidence interval [CI] 0.86-1.00; P = .059). However, when defined as births "at the next week", expectant management was associated with significantly reduced odds for cesarean delivery (13.6%; adjusted OR 0.76; 95% CI 0.70-0.82; P < .001). Comparison of the cesarean delivery rates for the two definitions of expectant management showed that the "next week and beyond" model underestimates the benefit of short-term expectant management by up to 1 week, particularly for IOL at weeks 38 and 39. CONCLUSIONS:Our findings demonstrate that the definition of the expectant management group has a significant impact when analyzing the outcome of IOL in retrospective cohort studies. Non-medically indicated IOL is not an all-or-none choice between "elective" induction and indefinite expectant management. Thus, to define the control group as all births at the next week could be useful for clinical decision-making, as it allows to estimate the risks of expectant management until the next appointment compared with immediate IOL.
引言: 大多数观察性研究发现，与期待治疗相比，非医学指征引产 (IOL) 与剖宫产风险增加无关，期待治疗定义为妊娠后期的所有分娩。然而，鉴于晚期剖宫产率较高，当评估短期 (如长达1周) 期待治疗的风险时，期待治疗组的这一定义可能会偏向于观察性研究的结果，有利于早期或足月人工晶体。 材料和方法: 我们进行了一项回顾性队列研究，包括2008年至447年间在奥地利发生的2016例单胎足月和足月后住院分娩。使用多变量logistic回归来测试IOL与37-41妊娠每周剖宫产的相关性。期待管理被定义为 “下周或以后” 或 “下周” 的所有出生。 结果: 非医学指征IOL与37周和38周剖宫产几率增加相关，40周和41周几率降低相关。39周时，与定义为 “下周或以后” 的期待治疗相比，IOL导致的剖宫产率相当 (17.2% vs 16.2%; 校正比值比 [or] 0.93; 95% 置信区间 [CI] 0.86-1.00; P = .059)。然而，当定义为 “下周” 分娩时，期待治疗与剖宫产分娩几率显著降低相关 (13.6%; 调整后的OR 0.76; 95% CI 0.70-0.82; P <.001)。两种期待治疗定义的剖宫产率比较显示，“下周及以后” 模型低估了短期期待治疗1周的益处，特别是38周和39周的人工晶体。 结论: 我们的研究结果表明，在回顾性队列研究中分析IOL的结局时，期待治疗组的定义具有显著影响。非医学指征IOL不是 “选择性” 诱导和无限期期待治疗之间的全有或无选择。因此，将对照组定义为下周的所有分娩可能有助于临床决策，因为与即时人工晶体相比，它允许估计期待治疗直到下一次预约的风险。
METHODS::The ATP binding-cassette superfamily corresponds the mostly transmembrane transporters family found in humans. These proteins actively transport endogenous and exogenous substrates through biological membranes in body tissues, so they have an important role in the regulation of many physiological functions necessary for human homeostasis, as well as in response regulation to several pharmacological substrates. The development of multidrug resistance has become one of the main troubles in conventional chemotherapy in different illnesses including cancer, being the increased efflux of antineoplastic drugs the main reason for this multidrug resistance, with a key role of the ABC superfamily. Likely, the interindividual variability in the pharmacological response among patients is well known, and may be due to intrinsically factors of the disease, genetic and environmental ones. Thus, the understanding of this variability, especially the genetic variability associated with the efficacy and toxicity of drugs, can provide a safer and more effective pharmacological treatment, so ABC genes are considered as important regulators due to their relationship with the reduction in pharmacological response. In this review, updated information about transporters belonging to this superfamily was collected, the possible role of these transporters in cancer, the role of genetic variability in their genes, as well as some therapeutic tools that have been tried to raise against main transporters associated with chemoresistance in cancer.
METHODS:BACKGROUND:Cholinergic neurotransmission regulates neuroinflammation in Parkinson disease (PD). RESEARCH DESIGN AND METHODS:The authors conducted a delayed-start study of donepezil for cognitive decline in non-demented PD patients. The study consisted of a 96-week randomized placebo-controlled double-blind phase 1, followed by a 24-week donepezil extension phase 2. The primary outcome measure was a change in the Mini-Mental State Examination (MMSE) at week 120. RESULTS:A total of 98 patients were randomly allocated to the early-start (donepezil-to-donepezil) and delayed-start (placebo-to-donepezil) groups. Mean (SD) of the baseline MMSE was 27.6 (2.0) and 28.0 (2.1), respectively. MMSE change at week 120 was better in the early-start group than in the delayed-start group, but the difference was not significant. The MMSE declined in apolipoprotein ε4 carriers, but not in non-carriers, and the factor interaction (intervention × ε4 genotype) was highly significant (P < 0.001). Analyzed with the interaction, the difference was significant (group difference 1.95 [0.33 to 3.57], P = 0.018). The MMSE decline slope in phase 1 was significantly better in the early-start group than in the delayed-start group (P = 0.048). CONCLUSIONS:Cognitive function deteriorated in ε4 carriers, but not in non-carriers, and early-start donepezil may postpone cognitive decline in the former.
METHODS::Since the discovery of dental pulp stem cells, a lot of teams have expressed an interest in dental pulp regeneration. Many approaches, experimental models and biological explorations have been developed, each including the use of stem cells and scaffolds with the final goal being clinical application in humans. In this review, the authors' objective was to compare the experimental models and strategies used for the development of biomaterials for tissue engineering of dental pulp with stem cells. Electronic queries were conducted on PubMed using the following terms: pulp regeneration, scaffold, stem cells, tissue engineering and biomaterial. The extracted data included the following information: the strategy envisaged, the type of stem cells, the experimental models, the exploration or analysis methods, the cytotoxicity or viability or proliferation cellular tests, the tests of scaffold antibacterial properties and take into account the vascularization of the regenerated dental pulp. From the 71 selected articles, 59% focused on the "cell-transplantation" strategy, 82% used in vitro experimentation, 58% in vivo animal models and only one described an in vivo in situ human clinical study. 87% used dental pulp stem cells. A majority of the studies reported histology (75%) and immunohistochemistry explorations (66%). 73% mentioned the use of cytotoxicity, proliferation or viability tests. 48% took vascularization into account but only 6% studied the antibacterial properties of the scaffolds. This article gives an overview of the methods used to regenerate dental pulp from stem cells and should help researchers create the best development strategies for research in this field.