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Expulsion at home for early medical abortion: A systematic review with meta-analyses.

早期药物流产在家驱逐: 荟萃分析的系统综述。

  • 影响因子:2.21
  • DOI:10.1111/aogs.14025
  • 作者列表:"Schmidt-Hansen M","Pandey A","Lohr PA","Nevill M","Taylor P","Hasler E","Cameron S
  • 发表时间:2021-04-01

INTRODUCTION:The safety and acceptability of medical abortion using mifepristone and misoprostol at home at ≤9+0  weeks' gestation is well established. However, the upper gestational limit at which the procedure remains safe and acceptable at home is not known. To inform a national guideline on abortion care we conducted a systematic review to determine what gestational limit for expulsion at home offers the best balance of benefits and harms for women who are having medical abortion. MATERIAL AND METHODS:We searched Embase, MEDLINE, Cochrane Library, Cinahl Plus and Web-of-Science on 2 January 2020 for prospective and retrospective cohort studies with ≥50 women per gestational age group, published in English from 1995 onwards, that included women undergoing medical abortion and compared home expulsion of pregnancies of ≤9+0  weeks' gestational age with pregnancies of 9+1 -10+0  weeks or >10+1  weeks' gestational age, or compared the latter two gestational age groups. We assessed risk-of-bias using the Newcastle-Ottowa scale. All outcomes were meta-analyzed as risk ratios (RR) using the Mantel-Haenszel method. The certainty of the evidence was assessed using GRADE. RESULTS:Six studies (n = 3381) were included. The "need for emergency care/admission to hospital" (RR = 0.79, 95% confidence interval [CI] 0.45-1.4), "hemorrhage requiring transfusion/≥500 mL blood loss" (RR = 0.62, 95% CI 0.11-3.55), patient satisfaction (RR = 0.99, 95% CI 0.95-1.03), pain (RR = 0.91, 95% CI 0.82-1.02), and "complete abortion without the need for surgical intervention" (RR = 1.03, 95% CI 1-1.05) did not differ statistically significantly between the ≤9+0 and >9+0  weeks' gestation groups. The rates of vomiting (RR = 0.8, 95% CI 0.69-0.93) and diarrhea (RR = 0.85, 95% CI 0.73-0.99) were statistically significantly lower in the ≤9+0  weeks group but these differences were not considered clinically important. We found no studies comparing pregnancies of 9+1 -10+0  weeks' gestation with pregnancies of >10+0  weeks' gestation. The certainty of this evidence was predominantly low and mainly compromised by low event rates and loss to follow up. CONCLUSIONS:Women who are having a medical abortion and will be taking mifepristone up to and including 10+0  weeks' gestation should be offered the option of expulsion at home after they have taken the misoprostol. Further research needs to determine whether the gestational limit for home expulsion can be extended beyond 10+0  weeks.


引言: 在妊娠 ≤ 9 + 0周时,在家使用米非司酮和米索前列醇进行药物流产的安全性和可接受性已得到公认。然而,该手术在家庭中保持安全和可接受的妊娠上限尚不清楚。为了给国家堕胎护理指南提供信息,我们进行了一项系统回顾,以确定在家驱逐的妊娠限制为药物流产妇女提供了最佳的利益和伤害平衡。 材料和方法: 我们于2020年1月2日检索了Embase、MEDLINE、Cochrane Library、Cinahl Plus和Web-of-Science,检索了自1995年起以英文发表的每个胎龄组 ≥ 50名妇女的前瞻性和回顾性队列研究。这包括接受药物流产的妇女,并比较了 ≤ 9 + 0周妊娠与9 + 1 -10 + 0周妊娠或> 10 + 1周妊娠的家庭分娩,或比较了后两个孕龄组.我们使用纽卡斯尔-奥托瓦量表评估偏倚风险。使用Mantel-Haenszel方法以风险比 (RR) 对所有结局进行荟萃分析。使用GRADE评估证据的确定性。 结果: 共纳入6项研究 (n = 3381)。“需要急诊/入院” (RR = 0.79,95% 置信区间 [CI] 0.45-1.4) 、 “需要输血的出血/≥ 500 mL失血” (RR = 0.62,95% CI 0.11-3.55) 、患者满意度 (RR = 0.99,95% CI 0.95-1.03) 、疼痛 (RR = 0.91,95% CI 0.82-1.02) 、并且 “完全流产而不需要手术干预” (RR = 1.03,95% CI 1-1.05) 在 ≤ 9 + 0和> 9 + 0周妊娠组之间没有统计学显著差异。在 ≤ 9 + 0周组中,呕吐 (RR = 0.8,95% CI 0.69-0.93) 和腹泻 (RR = 0.85,95% CI 0.73-0.99) 的发生率在统计学上显著较低,但这些差异不被认为是临床上重要的。我们没有发现比较9 + 1 -10 + 0周妊娠与> 10 + 0周妊娠的研究。该证据的确定性主要较低,主要受到低事件发生率和失访的影响. 结论: 正在进行药物流产并将服用米非司酮直至妊娠10 + 0周的妇女应在服用米索前列醇后在家中选择驱逐。进一步的研究需要确定家庭驱逐的妊娠限制是否可以延长超过10 + 0周。



作者列表:["Juan-Carlos PM","Perla-Lidia PP","Stephanie-Talia MM","Mónica-Griselda AM","Luz-María TE"]

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.

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作者列表:["Sawada H","Oeda T","Kohsaka M","Tomita S","Umemura A","Park K","Yamamoto K","Kiyohara K"]

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.

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作者列表:["Louvrier A","Terranova L","Meyer C","Meyer F","Euvrard E","Kroemer M","Rolin G"]

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.

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