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[PMID]:27778641
[Au] Autor:Joshi NR; Miyadahira EH; Afshar Y; Jeong JW; Young SL; Lessey BA; Serafini PC; Fazleabas AT
[Ad] Endereço:Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University, Grand Rapids, Michigan 49503.
[Ti] Título:Progesterone Resistance in Endometriosis Is Modulated by the Altered Expression of MicroRNA-29c and FKBP4.
[So] Source:J Clin Endocrinol Metab;102(1):141-149, 2017 Jan 01.
[Is] ISSN:1945-7197
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Context: Endometriosis results in aberrant gene expression in the eutopic endometrium (EuE) and subsequent progesterone resistance. MicroRNA (miR) microarray data in a baboon model of endometriosis showed an increased expression of miR-29c. Objectives: To explore the role of miR-29c in progesterone resistance in a subset of women with endometriosis. Design: MiR-29c expression was analyzed in the endometrium of baboons and women with or without endometriosis. The role in progesterone resistance and decidualization was analyzed by transfecting human uterine fibroblast cells with miR-29c. Patients: Subjects diagnosed with deep infiltrative endometriosis (DIE) by transvaginal ultrasound with bowel preparation underwent surgical excision of endometriosis. Eutopic secretory endometrium was collected pre- and postoperatively. Women with normal EuE and without DIE served as controls. Results: Quantitative reverse transcription polymerase chain reaction demonstrated that miR-29c expression increased, while the transcript levels of its target, FK506-binding protein 4 (FKBP4), decreased in the EuE of baboons following the induction of endometriosis. FKBP4 messenger RNA and decidual markers were statistically significantly decreased in decidualized human uterine fibroblast cells transfected with a miR-29c mimic compared with controls. Human data corroborated our baboon data and demonstrated higher expression of miR-29c in endometriosis EuE compared with normal EuE. MiR-29c was significantly decreased in endometriosis EuE postoperatively compared with preoperative tissues, and FKBP4 showed an inverse trend following radical laparoscopic resection surgery. Conclusions: We demonstrate that miR-29c expression is increased in EuE of baboons and women with endometriosis, which might contribute to a compromised progesterone response by diminishing the levels of FKBP4. Resection of DIE is likely to reverse the progesterone resistance associated with endometriosis in women.
[Mh] Termos MeSH primário: Biomarcadores/análise
Endometriose/genética
Endométrio/anormalidades
MicroRNAs/genética
Progesterona/farmacologia
Proteínas de Ligação a Tacrolimo/metabolismo
Doenças Uterinas/genética
[Mh] Termos MeSH secundário: Animais
Estudos de Casos e Controles
Modelos Animais de Doenças
Endometriose/tratamento farmacológico
Endometriose/patologia
Feminino
Seres Humanos
Papio
Prognóstico
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Biomarkers); 0 (MIRN29 microRNA, human); 0 (MicroRNAs); 4G7DS2Q64Y (Progesterone); EC 5.2.1.- (Tacrolimus Binding Proteins); EC 5.2.1.- (tacrolimus binding protein 4)
[Em] Mês de entrada:1706
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:161026
[St] Status:MEDLINE
[do] DOI:10.1210/jc.2016-2076


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[PMID]:29178172
[Au] Autor:Bosteels J; Weyers S; D'Hooghe TM; Torrance H; Broekmans FJ; Chua SJ; Mol BWJ
[Ad] Endereço:Academic Centre for General Practice, Cochrane Belgium, Kapucijnenvoer 33, blok J bus 7001, Leuven, Belgium, 3000.
[Ti] Título:Anti-adhesion therapy following operative hysteroscopy for treatment of female subfertility.
[So] Source:Cochrane Database Syst Rev;11:CD011110, 2017 11 27.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Observational evidence suggests a potential benefit with several anti-adhesion therapies in women undergoing operative hysteroscopy (e.g. insertion of an intrauterine device or balloon, hormonal treatment, barrier gels or human amniotic membrane grafting) for decreasing intrauterine adhesions (IUAs). OBJECTIVES: To assess the effectiveness of anti-adhesion therapies versus placebo, no treatment or any other anti-adhesion therapy, following operative hysteroscopy for treatment of female subfertility. SEARCH METHODS: We searched the following databases from inception to June 2017: the Cochrane Gynaecology and Fertility Group Specialised Register; the Cochrane Central Register of Studies (CRSO); MEDLINE; Embase; CINAHL and other electronic sources of trials, including trial registers, sources of unpublished literature and reference lists. We handsearched the Journal of Minimally Invasive Gynecology, and we contacted experts in the field. We also searched reference lists of appropriate papers. SELECTION CRITERIA: Randomised controlled trials (RCTs) of anti-adhesion therapies versus placebo, no treatment or any other anti-adhesion therapy following operative hysteroscopy in subfertile women. The primary outcome was live birth. Secondary outcomes were clinical pregnancy, miscarriage and IUAs present at second-look hysteroscopy, along with mean adhesion scores and severity of IUAs. DATA COLLECTION AND ANALYSIS: Two review authors independently selected studies, assessed risk of bias, extracted data and evaluated quality of evidence using the GRADE method. MAIN RESULTS: The overall quality of the evidence was low to very low. The main limitations were serious risk of bias related to blinding of participants and personnel, indirectness and imprecision. We identified 16 RCTs comparing a device versus no treatment (two studies; 90 women), hormonal treatment versus no treatment or placebo (two studies; 136 women), device combined with hormonal treatment versus no treatment (one study; 20 women), barrier gel versus no treatment (five studies; 464 women), device with graft versus device without graft (three studies; 190 women), one type of device versus another device (one study; 201 women), gel combined with hormonal treatment and antibiotics versus hormonal treatment with antibiotics (one study; 52 women) and device combined with gel versus device (one study; 120 women). The total number of participants was 1273, but data on 1133 women were available for analysis. Only two of 16 studies included 100% infertile women; in all other studies, the proportion was variable or unknown.No study reported live birth, but some (five studies) reported outcomes that were used as surrogate outcomes for live birth (term delivery or ongoing pregnancy). Anti-adhesion therapy versus placebo or no treatment following operative hysteroscopy.There was insufficient evidence to determine whether there was a difference between the use of a device or hormonal treatment compared to no treatment or placebo with respect to term delivery or ongoing pregnancy rates (odds ratio (OR) 0.94, 95% confidence interval (CI) 0.42 to 2.12; 107 women; 2 studies; I² = 0%; very-low-quality evidence).There were fewer IUAs at second-look hysteroscopy using a device with or without hormonal treatment or hormonal treatment or barrier gels compared with no treatment or placebo (OR 0.35, 95% CI 0.21 to 0.60; 560 women; 8 studies; I² = 0%; low-quality evidence). The number needed to treat for an additional beneficial outcome (NNTB) was 9 (95% CI 5 to 17). Comparisons of different anti-adhesion therapies following operative hysteroscopyIt was unclear whether there was a difference between the use of a device combined with graft versus device only for the outcome of ongoing pregnancy (OR 1.48, 95% CI 0.57 to 3.83; 180 women; 3 studies; I² = 0%; low-quality evidence). There were fewer IUAs at second-look hysteroscopy using a device with or without graft/gel or gel combined with hormonal treatment and antibiotics compared with using a device only or hormonal treatment combined with antibiotics, but the findings of this meta-analysis were affected by evidence quality (OR 0.55, 95% CI 0.36 to 0.83; 451 women; 5 studies; I² = 0%; low-quality evidence). AUTHORS' CONCLUSIONS: Implications for clinical practiceThe quality of the evidence ranged from very low to low. The effectiveness of anti-adhesion treatment for improving key reproductive outcomes or for decreasing IUAs following operative hysteroscopy in subfertile women remains uncertain. Implications for researchMore research is needed to assess the comparative safety and (cost-)effectiveness of different anti-adhesion treatments compared to no treatment or other interventions for improving key reproductive outcomes in subfertile women.
[Mh] Termos MeSH primário: Histeroscopia/efeitos adversos
Infertilidade Feminina/cirurgia
Doenças Uterinas/terapia
[Mh] Termos MeSH secundário: Âmnio/transplante
Estrogênios/uso terapêutico
Feminino
Géis/uso terapêutico
Seres Humanos
Dispositivos Intrauterinos
Nascimento Vivo/epidemiologia
Gravidez
Ensaios Clínicos Controlados Aleatórios como Assunto
Cirurgia de Second-Look/estatística & dados numéricos
Aderências Teciduais/epidemiologia
Aderências Teciduais/etiologia
Aderências Teciduais/terapia
Doenças Uterinas/epidemiologia
Doenças Uterinas/etiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW
[Nm] Nome de substância:
0 (Estrogens); 0 (Gels)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180111
[Lr] Data última revisão:
180111
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171128
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD011110.pub3


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Vega, Jorge
Texto completo SciELO Chile
[PMID]:29182206
[Au] Autor:Kral A; Vega J
[Ad] Endereço:Hospital Carlos Van Buren, Valparaíso, Chile.
[Ti] Título:[McKrittick-Wheelock syndrome. Report of one case].
[Ti] Título:Síndrome de McKittrick-Wheelock. Una causa infrecuente de hipokalemia e injuria renal aguda. Caso clínico..
[So] Source:Rev Med Chil;145(7):950-953, 2017 Jul.
[Is] ISSN:0717-6163
[Cp] País de publicação:Chile
[La] Idioma:spa
[Ab] Resumo:McKittrick-Wheelock syndrome is caused by chronic water and electrolyte hypersecretion from an intestinal tumor, usually a villous adenoma, located in the rectum or sigmoid. Patients often have dehydration, hypovolemic shock and kidney failure associated with hypokalemia, hyponatremia, hypochloremia and metabolic acidosis. We report a 62-year-old male, suffering chronic diarrhea for eight years who was admitted after a syncope. He had severe hypokalemia, hyponatremia, metabolic acidosis, hypovolemia and acute renal failure. After his metabolic disorders were corrected, a colonoscopy showed a large rectosigmoid tumor with the characteristics of a villous adenoma. During the follow up after the complete tumor resection, the patient has remained asymptomatic.
[Mh] Termos MeSH primário: Anormalidades Múltiplas/diagnóstico
Doença das Coronárias/diagnóstico
Cardiopatias Congênitas/diagnóstico
Hidrocolpos/diagnóstico
Polidactilia/diagnóstico
Doenças Uterinas/diagnóstico
[Mh] Termos MeSH secundário: Anormalidades Múltiplas/cirurgia
Diagnóstico Diferencial
Cardiopatias Congênitas/cirurgia
Seres Humanos
Hidrocolpos/cirurgia
Masculino
Meia-Idade
Polidactilia/cirurgia
Doenças Uterinas/cirurgia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171214
[Lr] Data última revisão:
171214
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171129
[St] Status:MEDLINE


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[PMID]:29095305
[Au] Autor:Fan D; Wu S; Ye S; Wang W; Guo X; Liu Z
[Ad] Endereço:aFoshan Institute of Fetal Medicine bDepartment of Obstetrics, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, Foshan, Guangdong cDepartment of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China.
[Ti] Título:Umbilical cord mesenchyme stem cell local intramuscular injection for treatment of uterine niche: Protocol for a prospective, randomized, double-blinded, placebo-controlled clinical trial.
[So] Source:Medicine (Baltimore);96(44):e8480, 2017 Nov.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Uterine niche is defined as a triangular anechoic structure at the site of the scar or a gap in the myometrium at the site of a previous caesarean section. The main clinical manifestations are postmenstrual spotting and intrauterine infection, which may seriously affect the daily life of nonpregnant women. Trials have shown an excellent safety and efficacy for the potential of mesenchymal stem cells (MSCs) as a therapeutic option for scar reconstruction. Therefore, this study is designed to investigate the safety and efficacy of using MSCs in the treatment for the uterine niche. METHODS/DESIGN: This phase II clinical trial is a single-center, prospective, randomized, double-blind, placebo-controlled with 2 arms. One hundred twenty primiparous participants will be randomly (1:1 ratio) assigned to receive direct intramuscular injection of MSCs (a dose of 1*10 cells in 1 mL of 0.9% saline) (MSCs group) or an identical-appearing 1 mL of 0.9% saline (placebo-controlled group) near the uterine incision. The primary outcome of this trial is to evaluate the proportion of participants at 6 months who is found uterine niche in the uterus by transvaginal utrasonography. Adverse events will be documented in a case report form. The study will be conducted at the Department of Obstetric of Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan. DISCUSSION: This trial is the first investigation of the potential for therapeutic use of MSCs for the management of uterine niche after cesarean delivery. CONCLUSION: This protocol will help to determine the efficacy and safety of MSCs treatment in uterine niche and bridge the gap with regards to the current preclinical and clinical evidence. TRIAL REGISTRATION NUMBER: NCT02968459 (Clinical Trials.gov: http://clinicaltrials.gov/).
[Mh] Termos MeSH primário: Cesárea/efeitos adversos
Transplante de Células-Tronco de Sangue do Cordão Umbilical/métodos
Transplante de Células-Tronco Mesenquimais/métodos
Complicações Pós-Operatórias/terapia
Doenças Uterinas/terapia
[Mh] Termos MeSH secundário: Adulto
Cicatriz/complicações
Protocolos Clínicos
Método Duplo-Cego
Feminino
Seres Humanos
Injeções Intramusculares
Complicações Pós-Operatórias/etiologia
Gravidez
Estudos Prospectivos
Resultado do Tratamento
Doenças Uterinas/etiologia
Útero
[Pt] Tipo de publicação:CLINICAL TRIAL, PHASE II; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171109
[Lr] Data última revisão:
171109
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171103
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008480


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[PMID]:28753627
[Au] Autor:Scott CA; Marsden AN; Rebagliati MR; Zhang Q; Chamling X; Searby CC; Baye LM; Sheffield VC; Slusarski DC
[Ad] Endereço:Department of Biology, University of Iowa, Iowa City, Iowa, United States of America.
[Ti] Título:Nuclear/cytoplasmic transport defects in BBS6 underlie congenital heart disease through perturbation of a chromatin remodeling protein.
[So] Source:PLoS Genet;13(7):e1006936, 2017 Jul.
[Is] ISSN:1553-7404
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Mutations in BBS6 cause two clinically distinct syndromes, Bardet-Biedl syndrome (BBS), a syndrome caused by defects in cilia transport and function, as well as McKusick-Kaufman syndrome, a genetic disorder characterized by congenital heart defects. Congenital heart defects are rare in BBS, and McKusick-Kaufman syndrome patients do not develop retinitis pigmentosa. Therefore, the McKusick-Kaufman syndrome allele may highlight cellular functions of BBS6 distinct from the presently understood functions in the cilia. In support, we find that the McKusick-Kaufman syndrome disease-associated allele, BBS6H84Y; A242S, maintains cilia function. We demonstrate that BBS6 is actively transported between the cytoplasm and nucleus, and that BBS6H84Y; A242S, is defective in this transport. We developed a transgenic zebrafish with inducible bbs6 to identify novel binding partners of BBS6, and we find interaction with the SWI/SNF chromatin remodeling protein Smarcc1a (SMARCC1 in humans). We demonstrate that through this interaction, BBS6 modulates the sub-cellular localization of SMARCC1 and find, by transcriptional profiling, similar transcriptional changes following smarcc1a and bbs6 manipulation. Our work identifies a new function for BBS6 in nuclear-cytoplasmic transport, and provides insight into the disease mechanism underlying the congenital heart defects in McKusick-Kaufman syndrome patients.
[Mh] Termos MeSH primário: Anormalidades Múltiplas/genética
Síndrome de Bardet-Biedl/genética
Chaperoninas do Grupo II/genética
Cardiopatias Congênitas/genética
Hidrocolpos/genética
Polidactilia/genética
Fatores de Transcrição/genética
Doenças Uterinas/genética
[Mh] Termos MeSH secundário: Anormalidades Múltiplas/metabolismo
Anormalidades Múltiplas/patologia
Transporte Ativo do Núcleo Celular/genética
Animais
Animais Geneticamente Modificados/genética
Síndrome de Bardet-Biedl/metabolismo
Síndrome de Bardet-Biedl/patologia
Cromatina/genética
Montagem e Desmontagem da Cromatina/genética
Cílios/metabolismo
Cílios/patologia
Citoplasma/metabolismo
Modelos Animais de Doenças
Cardiopatias Congênitas/metabolismo
Cardiopatias Congênitas/patologia
Seres Humanos
Hidrocolpos/metabolismo
Hidrocolpos/patologia
Camundongos
Mutação
Polidactilia/metabolismo
Polidactilia/patologia
Transporte Proteico/genética
Fatores de Transcrição/biossíntese
Doenças Uterinas/metabolismo
Doenças Uterinas/patologia
Peixe-Zebra/genética
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Chromatin); 0 (MKKS protein, human); 0 (SMARCC1 protein, human); 0 (Transcription Factors); EC 3.6.1.- (Group II Chaperonins)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170816
[Lr] Data última revisão:
170816
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170729
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pgen.1006936


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[PMID]:28711899
[Au] Autor:Smiianov VA; Vygovskaya LA
[Ad] Endereço:Sumy State University, Sumy, Ukraine.
[Ti] Título:Intrauterine infections - challenges in the perinatal period (literature review).
[So] Source:Wiad Lek;70(3 pt 1):512-515, 2017.
[Is] ISSN:0043-5147
[Cp] País de publicação:Poland
[La] Idioma:eng
[Ab] Resumo:The purpose of the study is to summarize the literature data on the state of intrauterine infections that cause antenatal fetal abnormalities. MATERIALS AND METHODS: This article presents the assessment of 25 world literature sources from 2000 to 2016, which discuss the etiology of infectious agents acting on the fetus and causing a variety of pathological conditions. RESULTS: During gestation many researchers refer to the infection as one of the causes of antenatal fetal abnormalities. The etiology of intrauterine infection is diverse and differs between countries with different economic conditions. Detection of an infectious agent makes it possible to promptly carry out preventive measures, to improve hygiene standards in order to reduce the rate of infection transmission from mother to fetus. CONCLUSION: Timely detection of the etiology of intrauterine infections promotes the identification of high-risk groups giving a possibility to provide treatment in order to prevent the transmission of an infectious agent having direct economic benefits, especially in resource-poor countries with low and middle income.
[Mh] Termos MeSH primário: Complicações Infecciosas na Gravidez/etiologia
Infecções do Sistema Genital/etiologia
Doenças Uterinas/microbiologia
[Mh] Termos MeSH secundário: Feminino
Feto/anormalidades
Seres Humanos
Gravidez
Complicações Infecciosas na Gravidez/microbiologia
Complicações Infecciosas na Gravidez/virologia
Complicações Parasitárias na Gravidez/etiologia
Infecções do Sistema Genital/complicações
Infecções do Sistema Genital/microbiologia
Infecções do Sistema Genital/virologia
Natimorto
Doenças Uterinas/parasitologia
Doenças Uterinas/virologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170922
[Lr] Data última revisão:
170922
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170717
[St] Status:MEDLINE


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[PMID]:28697116
[Au] Autor:Mahnert N; Kamdar N; Lim CS; Skinner B; Hassett A; Kocher KE; Morgan DM; As-Sanie S
[Ad] Endereço:Department of Obstetrics and Gynecology, Banner University Medical Center, University of Arizona, Phoenix, Arizona; and the Departments of Obstetrics and Gynecology, Anesthesiology, and Emergency Medicine and the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.
[Ti] Título:Risk Factors for Emergency Department Visits After Hysterectomy for Benign Disease.
[So] Source:Obstet Gynecol;130(2):296-304, 2017 Aug.
[Is] ISSN:1873-233X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To identify the incidence, indications, and risk factors for emergency department visits that do not result in readmission within 30 days of hysterectomy for benign disease. METHODS: We conducted a secondary data analysis of hysterectomies for benign disease using the Michigan Surgical Quality Collaborative, a statewide group of hospitals that voluntarily reports perioperative outcomes. Hysterectomies for benign disease were abstracted from January 1, 2013, to July 2, 2014. We examined the incidence of emergency department visits within 30 days after hysterectomy for benign disease and constructed a multivariable logistic regression model to identify risk factors for these visits. We focused on emergency department visits that did not result in readmission because they are more likely to represent avoidable encounters. RESULTS: Among the 10,274 women who underwent hysterectomy for benign disease during the study period, 932 (9.1%) presented to the emergency department and were not readmitted to the hospital. Based on a multivariable regression model, risk factors for emergency department visits after hysterectomy for benign disease were younger age, higher parity, Medicaid or self-pay insurance, prior venous thromboembolism, chronic obstructive pulmonary disease, preoperative surgical indication of chronic pelvic pain, and postoperative day 1 pain scores greater than 4 on a 0-10 numeric rating scale. The most common primary emergency department International Classification of Diseases, 9th Revision diagnoses were for pain (29.5% [n=275]), gastrointestinal (12.8% [n=118]), and genitourinary (10.7% [n=99]) complaints. CONCLUSION: Approximately 1 in 11 women present to the emergency department, but do not result in readmission within 30 days of hysterectomy for benign disease. Emergency department visits might be avoided with expanded perioperative education and improved communication pathways for high-risk patients.
[Mh] Termos MeSH primário: Serviço Hospitalar de Emergência/estatística & dados numéricos
Histerectomia/efeitos adversos
Complicações Pós-Operatórias/terapia
Doenças Uterinas/cirurgia
[Mh] Termos MeSH secundário: Adulto
Fatores Etários
Feminino
Doenças Urogenitais Femininas
Gastroenteropatias
Seres Humanos
Meia-Idade
Medição da Dor
Educação de Pacientes como Assunto
Readmissão do Paciente/estatística & dados numéricos
Dor Pélvica
Fatores de Risco
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170821
[Lr] Data última revisão:
170821
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170712
[St] Status:MEDLINE
[do] DOI:10.1097/AOG.0000000000002146


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[PMID]:28577884
[Au] Autor:Dilley SE; Havrilesky LJ; Bakkum-Gamez J; Cohn DE; Michael Straughn J; Caughey AB; Rodriguez MI
[Ad] Endereço:Department of Obstetrics and Gynecology, Oregon Health and Science University, Mail Code L-466, 3181 SW Sam Jackson Park Rd., Portland, OR 97239, United States. Electronic address: sedilley@uabmc.edu.
[Ti] Título:Cost-effectiveness of opportunistic salpingectomy for ovarian cancer prevention.
[So] Source:Gynecol Oncol;146(2):373-379, 2017 Aug.
[Is] ISSN:1095-6859
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: Data suggesting a link between the fallopian tube and ovarian cancer have led to an increase in rates of salpingectomy at the time of pelvic surgery, a practice known as opportunistic salpingectomy (OS). However, the potential benefits, risks and costs for this new practice are not well established. Our objective was to assess the cost-effectiveness of opportunistic salpingectomy at the time of laparoscopic permanent contraception or hysterectomy for benign indications. METHODS: We created two models to compare the cost-effectiveness of salpingectomy versus usual care. The hypothetical study population is 50,000 women aged 45 undergoing laparoscopic hysterectomy with ovarian preservation for benign indications, and 300,000 women aged 35 undergoing laparoscopic permanent contraception. SEER data were used for probabilities of ovarian cancer cases and deaths. The ovarian cancer risk reduction, complication rates, utilities and associated costs were obtained from published literature. Sensitivity analyses and Monte Carlo simulation were performed, and incremental cost-effectiveness ratios (ICERs) were calculated to determine the cost per quality adjusted life year (QALY) gained. RESULTS: In the laparoscopic hysterectomy cohort, OS is cost saving and would yield $23.9 million in health care dollars saved. In the laparoscopic permanent contraception cohort, OS is cost-effective with an ICER of $31,432/QALY compared to tubal ligation, and remains cost-effective as long as it reduces ovarian cancer risk by 54%. Monte Carlo simulation demonstrated cost-effectiveness with hysterectomy and permanent contraception in 62.3% and 55% of trials, respectively. CONCLUSIONS: Opportunistic salpingectomy for low-risk women undergoing pelvic surgery may be a cost-effective strategy for decreasing ovarian cancer risk at time of hysterectomy or permanent contraception. In our model, salpingectomy was cost-effective with both procedures, but the advantage greater at time of hysterectomy.
[Mh] Termos MeSH primário: Histerectomia/métodos
Neoplasias Ovarianas/prevenção & controle
Procedimentos Cirúrgicos Profiláticos/métodos
Salpingectomia/métodos
Esterilização Tubária/métodos
[Mh] Termos MeSH secundário: Adulto
Análise Custo-Benefício
Feminino
Seres Humanos
Histerectomia/economia
Laparoscopia/economia
Laparoscopia/métodos
Meia-Idade
Modelos Econômicos
Método de Monte Carlo
Neoplasias Ovarianas/economia
Complicações Pós-Operatórias/economia
Complicações Pós-Operatórias/epidemiologia
Procedimentos Cirúrgicos Profiláticos/economia
Anos de Vida Ajustados por Qualidade de Vida
Programa de SEER
Salpingectomia/economia
Esterilização Tubária/economia
Doenças Uterinas/cirurgia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170724
[Lr] Data última revisão:
170724
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170605
[St] Status:MEDLINE


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[PMID]:28542500
[Au] Autor:Cheong SH; Sá Filho OG; Absalon-Medina VA; Schneider A; Butler WR; Gilbert RO
[Ad] Endereço:Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, United States of America.
[Ti] Título:Uterine and systemic inflammation influences ovarian follicular function in postpartum dairy cows.
[So] Source:PLoS One;12(5):e0177356, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The objective of this study was to determine the effects of uterine and systemic inflammatory responses to uterine bacterial contamination at calving in dairy cows on the growth and ovulatory outcomes of the first dominant follicle postpartum. Ovulatory capability of the first dominant follicle postpartum was predicted in 53 multiparous cows by using a combination of follicle growth characteristics and circulating estradiol concentrations. Endotoxin levels were assayed in follicular fluid samples that were aspirated the day after ovulatory outcome prediction. Plasma levels of haptoglobin, a proinflammatory acute phase protein, and paraoxonase, a negative acute phase protein were determined. Uterine bacteria and inflammation were evaluated in three uterine fluid samples from each cow collected on the day of calving, the day after follicle aspiration, and at 35 days postpartum. Cows that had a strong initial uterine inflammatory response (robust recruitment of polymorphonuclear leukocytes of ≥ 35% and cows with uterine pH < 8.5 on the day of calving) were more likely to have an ovulatory first dominant follicle. Follicular fluid endotoxin levels were higher in non-ovulatory cows compared with ovulatory cows. Endotoxin levels in circulation were not different between ovulatory groups but were higher prepartum than on day 7 and 14 postpartum. Systemic inflammation characterized by elevated haptoglobin concentrations was higher in non-ovulatory cows despite similar bacterial contamination and circulating endotoxin levels. Paraoxonase activity in follicular fluid was significantly associated with the paraoxonase activity in plasma, however, plasma paraoxonase concentrations were not different between non-ovulatory and ovulatory cows. Cows with a higher uterine bacterial load on the day of calving had slower ovarian follicle growth. In summary, a robust uterine inflammatory response on the day of calving was positively associated with ovarian function while elevated systemic inflammation during the early postpartum period was negatively associated with the ovulatory status of the first dominant follicle postpartum.
[Mh] Termos MeSH primário: Indústria de Laticínios
Folículo Ovariano/fisiopatologia
Período Pós-Parto/fisiologia
Doenças Uterinas/veterinária
[Mh] Termos MeSH secundário: Animais
Bovinos
Feminino
Inflamação/fisiopatologia
Inflamação/veterinária
Ovulação
Doenças Uterinas/fisiopatologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170919
[Lr] Data última revisão:
170919
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170526
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0177356


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[PMID]:28538495
[Au] Autor:Committee on Gynecologic Practice
[Ti] Título:Committee Opinion No 701: Choosing the Route of Hysterectomy for Benign Disease.
[So] Source:Obstet Gynecol;129(6):e155-e159, 2017 Jun.
[Is] ISSN:1873-233X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Hysterectomy is one of the most frequently performed surgical procedures in the United States. Selection of the route of hysterectomy for benign causes can be influenced by the size and shape of the vagina and uterus; accessibility to the uterus; extent of extrauterine disease; the need for concurrent procedures; surgeon training and experience; average case volume; available hospital technology, devices, and support; whether the case is emergent or scheduled; and preference of the informed patient. Vaginal and laparoscopic procedures are considered "minimally invasive" surgical approaches because they do not require a large abdominal incision and, thus, typically are associated with shortened hospitalization and postoperative recovery times compared with open abdominal hysterectomy. Minimally invasive approaches to hysterectomy should be performed, whenever feasible, based on their well-documented advantages over abdominal hysterectomy. The vaginal approach is preferred among the minimally invasive approaches. Laparoscopic hysterectomy is a preferable alternative to open abdominal hysterectomy for those patients in whom a vaginal hysterectomy is not indicated or feasible. Although minimally invasive approaches to hysterectomy are the preferred route, open abdominal hysterectomy remains an important surgical option for some patients. The obstetrician-gynecologist should discuss the options with patients and make clear recommendations on which route of hysterectomy will maximize benefits and minimize risks given the specific clinical situation. The relative advantages and disadvantages of the approaches to hysterectomy should be discussed in the context of the patient's values and preferences, and the patient and health care provider should together determine the best course of action after this discussion.
[Mh] Termos MeSH primário: Técnicas de Apoio para a Decisão
Histerectomia/métodos
Doenças Uterinas/cirurgia
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
Histerectomia Vaginal
Laparoscopia
Sociedades Médicas
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE; PRACTICE GUIDELINE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170714
[Lr] Data última revisão:
170714
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170525
[St] Status:MEDLINE
[do] DOI:10.1097/AOG.0000000000002112



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