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[PMID]:28796898
[Au] Autor:Louie M; Spencer J; Wheeler S; Ellis V; Toubia T; Schiff LD; Siedhoff MT; Moulder JK
[Ad] Endereço:Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
[Ti] Título:Comparison of the levonorgestrel-releasing intrauterine system, hysterectomy, and endometrial ablation for heavy menstrual bleeding in a decision analysis model.
[So] Source:Int J Gynaecol Obstet;139(2):121-129, 2017 Nov.
[Is] ISSN:1879-3479
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: A better understanding of the relative risks and benefits of common treatment options for abnormal uterine bleeding (AUB) can help providers and patients to make balanced, evidence-based decisions. OBJECTIVES: To provide comparative estimates of clinical outcomes after placement of levonorgestrel-releasing intrauterine system (LNG-IUS), ablation, or hysterectomy for AUB. SEARCH STRATEGY: A PubMED search was done using combinations of search terms related to abnormal uterine bleeding, LNG-IUS, hysterectomy, endometrial ablation, cost-benefit analysis, cost-effectiveness, and quality-adjusted life years. SELECTION CRITERIA: Full articles published in 2006-2016 available in English comparing at least two treatment modalities of interest among women of reproductive age with AUB were included. DATA COLLECTION AND ANALYSIS: A decision tree was generated to compare clinical outcomes in a hypothetical cohort of 100 000 premenopausal women with nonmalignant AUB. We evaluated complications, mortality, and treatment outcomes over a 5-year period, calculated cumulative quality-adjusted life years (QALYs), and conducted probabilistic sensitivity analysis. MAIN RESULTS: Levonorgestrel-releasing intrauterine system had the highest number of QALYs (406 920), followed by hysterectomy (403 466), non-resectoscopic ablation (399 244), and resectoscopic ablation (395 827). Ablation had more treatment failures and complications than LNG-IUS and hysterectomy. Findings were robust in probabilistic sensitivity analysis. CONCLUSIONS: Levonorgestrel-releasing intrauterine system and hysterectomy outperformed endometrial ablation for treatment of AUB.
[Mh] Termos MeSH primário: Técnicas de Apoio para a Decisão
Menorragia/terapia
Modelos Teóricos
[Mh] Termos MeSH secundário: Técnicas de Ablação Endometrial
Feminino
Seres Humanos
Histerectomia
Levanogestrel/administração & dosagem
Menorragia/cirurgia
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
5W7SIA7YZW (Levonorgestrel)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171030
[Lr] Data última revisão:
171030
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170811
[St] Status:MEDLINE
[do] DOI:10.1002/ijgo.12293


  2 / 3129 MEDLINE  
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[PMID]:28696501
[Au] Autor:Kalampokas E; McRobbie S; Payne F; Parkin DE
[Ad] Endereço:Department of Gynecologic Oncology, Aberdeen Royal Infirmary, Aberdeen, UK.
[Ti] Título:Long-term incidence of hysterectomy following endometrial resection or endometrial ablation for heavy menstrual bleeding.
[So] Source:Int J Gynaecol Obstet;139(1):61-64, 2017 Oct.
[Is] ISSN:1879-3479
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To estimate the incidence of hysterectomy following endometrial resection or endometrial ablation (ERA). METHODS: The present retrospective study enrolled women who underwent ERA for benign heavy menstrual bleeding (HMB) at Aberdeen Royal Infirmary, UK, between February 1, 1990, and December 31, 1997; follow-up data to the end of 2015 were included from the pathology laboratory report system from the single pathology laboratory in the region. Data were compared between patients who did or did not require a hysterectomy after ERA. RESULTS: There were 901 patients who underwent ERA for HMB during the study period. The mean age of patients was 42.3 ± 5.7 years; of the patients included, 206 (22.9%) women underwent hysterectomy and these patients had a mean age of 40.1 years. Of the patients who had hysterectomies, 155 (75.2%) did so in the first 5 years following ERA, 31 (15.0%) did within 6-10 years, 11 (5.3%) did within 11-15 years, and 9 (4.4%) did within 16-20 years. In total, 51 (24.8%) of these patients had hysterectomies within 6-25 years of ERA. CONCLUSIONS: A significant majority of women who underwent ERA for HMB did not require hysterectomy up to 25 years after the procedure.
[Mh] Termos MeSH primário: Técnicas de Ablação Endometrial/utilização
Endométrio/cirurgia
Histerectomia/estatística & dados numéricos
Menorragia/epidemiologia
[Mh] Termos MeSH secundário: Adulto
Estudos de Coortes
Feminino
Seres Humanos
Incidência
Menorragia/cirurgia
Estudos Retrospectivos
Escócia/epidemiologia
Serviços de Saúde da Mulher
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171006
[Lr] Data última revisão:
171006
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170712
[St] Status:MEDLINE
[do] DOI:10.1002/ijgo.12259


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[PMID]:28584042
[Au] Autor:Sholzberg M; Teitel J; Hicks LK
[Ad] Endereço:Department of Medicine (Sholzberg, Teitel, Hicks), Division of Hematology/Oncology; Department of Laboratory Medicine and Pathobiology (Sholzberg), St. Michael's Hospital, University of Toronto, Toronto, Ont. SholzbergM@smh.ca.
[Ti] Título:A 24-year-old woman with heavy menstrual bleeding.
[So] Source:CMAJ;189(22):E779-E780, 2017 06 05.
[Is] ISSN:1488-2329
[Cp] País de publicação:Canada
[La] Idioma:eng
[Mh] Termos MeSH primário: Menorragia/etiologia
Doença de von Willebrand Tipo 1/complicações
Doença de von Willebrand Tipo 1/diagnóstico
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
Adulto Jovem
Doença de von Willebrand Tipo 1/terapia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171108
[Lr] Data última revisão:
171108
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170607
[St] Status:MEDLINE
[do] DOI:10.1503/cmaj.161469


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[PMID]:28579415
[Au] Autor:Archer DF; Stewart EA; Jain RI; Feldman RA; Lukes AS; North JD; Soliman AM; Gao J; Ng JW; Chwalisz K
[Ad] Endereço:Eastern Virginia Medical School, Norfolk, Virginia. Electronic address: archerdf@evms.edu.
[Ti] Título:Elagolix for the management of heavy menstrual bleeding associated with uterine fibroids: results from a phase 2a proof-of-concept study.
[So] Source:Fertil Steril;108(1):152-160.e4, 2017 Jul.
[Is] ISSN:1556-5653
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To evaluate the safety and efficacy of elagolix vs. placebo and elagolix with low-dose E /progestogen add-back therapy. DESIGN: Proof-of-concept, dose-ranging, multiple-cohort study. SETTING: Clinics. PATIENT(S): Premenopausal women with fibroids and heavy menstrual bleeding (menstrual blood loss [MBL] >80 mL per cycle). INTERVENTION(S): Three months' treatment with elagolix alone: 100 mg twice daily (BID), 200 mg BID, 300 mg BID, 400 mg once daily (QD), or 600 mg QD (all but the 600 mg QD arm were placebo controlled); or elagolix plus add-back therapy: 200 mg BID plus continuous low-dose E 0.5 mg/norethindrone acetate 0.1 mg or elagolix 300 mg BID plus E 1 mg continuously and cyclical P 200 mg. MAIN OUTCOME MEASURE(S): Least-squares mean percentage change in MBL; adverse events (AEs). RESULT(S): Mean age was 41.8 years; 73.8% were black; mean baseline MBL was 267 mL. Of randomized women (elagolix alone, n = 160; placebo, n = 50; elagolix with add-back therapy, n = 61), 228 of 271 completed the 3-month treatment period. The MBL percentage change from baseline to last 28 days was significantly greater with elagolix alone (range, -72% to -98%; dose-dependent reduction was highest with 300 mg BID) vs. placebo (range, -8% to -41%); mean percentage changes with add-back regimens were -80% to -85%. Overall AEs were dose independent (elagolix alone, 70.0%-81.3%) but lower with placebo (56.0%) and add-back regimens (55.6%-70.6%). Hot flush was the most common AE (elagolix alone, 45.5%-62.5%; placebo, 12.0%; add-back regimens, 18.5%-26.5%). CONCLUSION(S): Elagolix significantly reduced heavy menstrual bleeding in women with fibroids. Low-dose add-back regimens substantially reduced flushing. CLINICAL TRIAL REGISTRATION NUMBER: NCT01441635.
[Mh] Termos MeSH primário: Terapia de Reposição Hormonal/métodos
Hidrocarbonetos Fluorados/administração & dosagem
Leiomioma/complicações
Menorragia/tratamento farmacológico
Menorragia/etiologia
Pirimidinas/administração & dosagem
Neoplasias Uterinas/complicações
[Mh] Termos MeSH secundário: Adulto
Terapia Combinada/métodos
Relação Dose-Resposta a Droga
Feminino
Hormônio Liberador de Gonadotropina/antagonistas & inibidores
Seres Humanos
Hidrocarbonetos Fluorados/efeitos adversos
Leiomioma/diagnóstico
Leiomioma/tratamento farmacológico
Menorragia/diagnóstico
Projetos Piloto
Pirimidinas/efeitos adversos
Resultado do Tratamento
Neoplasias Uterinas/diagnóstico
Neoplasias Uterinas/tratamento farmacológico
[Pt] Tipo de publicação:CLINICAL TRIAL, PHASE II; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Hydrocarbons, Fluorinated); 0 (Pyrimidines); 33515-09-2 (Gonadotropin-Releasing Hormone); 5B2546MB5Z (elagolix)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170818
[Lr] Data última revisão:
170818
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170606
[St] Status:MEDLINE


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[PMID]:28439193
[Au] Autor:Calzolari S; Cozzolino M; Castellacci E; Dubini V; Farruggia A; Sisti G
[Ad] Endereço:Regional Center of Excellence in Hysteroscopy, Palagi Hospital, Florence, Italy.
[Ti] Título:Hysteroscopic Management of Uterine Arteriovenous Malformation.
[So] Source:JSLS;21(2), 2017 Apr-Jun.
[Is] ISSN:1938-3797
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND AND OBJECTIVES: Uterine arteriovenous malformation (AVM) is characterized by shunts between the myometrial arteries and veins. Treatment is based on the severity of uterine bleeding and ranges from conservative medical approaches to embolization of affected arteries. The aim of study was to evaluate the feasibility and safety of hysteroscopy for management of uterine AVM. METHODS: This was a retrospective study of a cohort of 11 cases occurring between March 2012 and December 2015 in our Regional Center of Excellence in Hysteroscopy, University of Florence. The diagnosis of AVM was made by transvaginal ultrasonography with high-definition flow in patients with mild to moderate symptoms. In all cases, we used the hysteroscopic platform Gynecare VersaPoint II (Ethicon, Somerville, New Jersey, USA), equipped with a 4-mm electrosurgical loop and associated with the SPIES (Storz Professional Image Enhancement System) system (Karl Storz, Tuttlingen, Germany). RESULTS: All patients were successfully treated with operative hysteroscopy with no reported complications. No patient had residual disease detected by ultrasonography performed after a month. At this writing, of the 11 patients treated with operative hysteroscopy, 4 had achieved a pregnancy that carried to term, 1 was pregnant at 20 wk, and 1 had a miscarriage in the first trimester. CONCLUSIONS: Hysteroscopy is a feasible and safe alternative treatment modality for AVM. Patients treated with surgical hysteroscopy have high fertility outcomes, a 100% success rate after the first treatment, no complications related to the surgical procedure, and a short hospital stay.
[Mh] Termos MeSH primário: Malformações Arteriovenosas/cirurgia
Histeroscopia
Útero/cirurgia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Malformações Arteriovenosas/diagnóstico por imagem
Estudos de Coortes
Feminino
Seres Humanos
Menorragia/etiologia
Menorragia/cirurgia
Metrorragia/etiologia
Metrorragia/cirurgia
Gravidez
Resultado da Gravidez
Taxa de Gravidez
Estudos Retrospectivos
Ultrassonografia Doppler em Cores
Útero/anormalidades
Útero/diagnóstico por imagem
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170926
[Lr] Data última revisão:
170926
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170426
[St] Status:MEDLINE


  6 / 3129 MEDLINE  
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[PMID]:28437003
[Au] Autor:Zhang L; Rao F; Setzen R
[Ad] Endereço:State Key Laboratory of Ultrasound Engineering in Medicine, Chongqing Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China.
[Ti] Título:High intensity focused ultrasound for the treatment of adenomyosis: selection criteria, efficacy, safety and fertility.
[So] Source:Acta Obstet Gynecol Scand;96(6):707-714, 2017 Jun.
[Is] ISSN:1600-0412
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Adenomyosis is a disorder of uterus in which endometrial glands and stroma are present within the uterine musculature. The main clinical manifestations are dysmenorrhea and menorrhagia. Adenomyosis has a great impact on both the quality of life and fertility of women. The treatment of adenomyosis remains an immense challenge. Relevant articles were searched through MEDLINE and PubMed between 2000 and March 2017. The search terms of adenomyosis, magnetic resonance imaging (MRI) features of adenomyosis, high intensity focused ultrasound (HIFU), ultrasound-guided HIFU and MRgFUS were used. There were no language restrictions. HIFU is a non-invasive local thermal ablation technique which has been used in the treatment of both focal and diffuse adenomyosis. Several case studies have demonstrated that HIFU presents low rate of minor and/or major complications and, at the same time, a long symptom-relief period. Multiple factors such as the enhancement type of the adenomyotic lesion, volume of the adenomyotic lesions, number of hyperintense foci on T2WI, location of the uterus, location of adenomyotic lesions, thickness of the abdominal wall and distance from the skin to the adenomyotic lesions contribute to the efficacy of HIFU. Consequently, based on these contributing factors, specific and strict selection criteria have been used to achieve higher efficacy. Thus, patients with pelvic endometriosis, adhesions between the bowel and the uterus, or an abdominal surgical scar wider than 10 mm, are not suitable for HIFU treatment. Moreover, HIFU-treated patients with adenomyosis, who wished to conceive, showed high conception and live birth rates. HIFU is a new and promising treatment option for patients with adenomyosis, but its efficacy, safety, cost-effectiveness and fertility outcome must be evaluated by randomized controlled trials.
[Mh] Termos MeSH primário: Adenomiose/cirurgia
Dismenorreia/cirurgia
Ablação por Ultrassom Focalizado de Alta Intensidade/métodos
Infertilidade Feminina/prevenção & controle
Menorragia/cirurgia
Ultrassonografia de Intervenção/métodos
[Mh] Termos MeSH secundário: Adenomiose/complicações
Dismenorreia/etiologia
Feminino
Seres Humanos
Infertilidade Feminina/etiologia
Imagem por Ressonância Magnética/métodos
Menorragia/etiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170815
[Lr] Data última revisão:
170815
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170425
[St] Status:MEDLINE
[do] DOI:10.1111/aogs.13159


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[PMID]:28323982
[Au] Autor:Gueye NA; Mead TJ; Koch CD; Biscotti CV; Falcone T; Apte SS
[Ad] Endereço:Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio 44195.
[Ti] Título:Versican Proteolysis by ADAMTS Proteases and Its Influence on Sex Steroid Receptor Expression in Uterine Leiomyoma.
[So] Source:J Clin Endocrinol Metab;102(5):1631-1641, 2017 May 01.
[Is] ISSN:1945-7197
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Context: Leiomyomas have abundant extracellular matrix (ECM), with upregulation of versican, a large proteoglycan. Objective: We investigated ADAMTS (a disintegrin-like and metalloprotease with thrombospondin type 1 motifs) protease-mediated versican cleavage in myometrium and leiomyoma and the effect of versican knockdown in leiomyoma cells. Design: We used quantitative reverse transcription polymerase chain reaction (qRT-PCR), western blotting, immunohistochemistry, and RNA in situ hybridization for analysis of myometrium, leiomyoma and immortalized myometrium and leiomyoma cells. Short interfering RNA (siRNA) was used to knockdown versican in leiomyoma cells. Setting: This study was performed in an academic laboratory. Patients: Study subjects were women with symptomatic or asymptomatic leiomyoma. Main Outcome Measures: We quantified messenger RNAs (mRNAs) for versican splice variants. We identified ADAMTS-cleaved versican in myometrium and leiomyoma and ADAMTS messenger RNAs and examined the effect of VCAN siRNA on smooth muscle differentiation and expression of estrogen and progesterone receptors. Results: The women in the symptomatic group (n = 7) had larger leiomyoma (P = 0.01), heavy menstrual bleeding (P < 0.01), and lower hemoglobin levels (P = 0.02) compared with the asymptomatic group (n = 7), but were similar in age and menopausal status. Versican V0 and V1 isoforms were upregulated in the leiomyomas of symptomatic versus asymptomatic women (P = 0.03 and P = 0.04, respectively). Abundant cleaved versican was detected in leiomyoma and myometrium, as well as in myometrial and leiomyoma cell lines. ADAMTS4 (P = 0.03) and ADAMTS15 (P = 0.04) were upregulated in symptomatic leiomyomas. VCAN siRNA did not effect cell proliferation, apoptosis, or smooth muscle markers, but reduced ESR1 and PR-A expression (P = 0.001 and P = 0.002, respectively). Conclusions: Versican in myometrium, leiomyomas and in the corresponding immortalized cells is cleaved by ADAMTS proteases. VCAN siRNA suppresses production of estrogen receptor 1 and progesterone receptor-A. These findings have implications for leiomyoma growth.
[Mh] Termos MeSH primário: Proteínas ADAMTS/genética
Proteína ADAMTS4/genética
Receptor alfa de Estrogênio/genética
Leiomioma/metabolismo
RNA Mensageiro/metabolismo
Receptores de Progesterona/genética
Neoplasias Uterinas/metabolismo
Versicanas/metabolismo
[Mh] Termos MeSH secundário: Proteínas ADAMTS/metabolismo
Proteína ADAMTS4/metabolismo
Adulto
Apoptose/genética
Doenças Assintomáticas
Western Blotting
Linhagem Celular Tumoral
Proliferação Celular/genética
Receptor alfa de Estrogênio/metabolismo
Matriz Extracelular/metabolismo
Feminino
Técnicas de Silenciamento de Genes
Hemoglobinas/metabolismo
Seres Humanos
Imuno-Histoquímica
Hibridização In Situ
Leiomioma/patologia
Menorragia/etiologia
Meia-Idade
Miométrio/metabolismo
Isoformas de Proteínas/genética
Proteólise
RNA Interferente Pequeno
Receptores de Progesterona/metabolismo
Reação em Cadeia da Polimerase Via Transcriptase Reversa
Carga Tumoral
Regulação para Cima
Neoplasias Uterinas/patologia
Versicanas/genética
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Estrogen Receptor alpha); 0 (Hemoglobins); 0 (Protein Isoforms); 0 (RNA, Messenger); 0 (RNA, Small Interfering); 0 (Receptors, Progesterone); 0 (VCAN protein, human); 0 (estrogen receptor alpha, human); 0 (progesterone receptor A); 126968-45-4 (Versicans); EC 3.4.24.- (ADAMTS Proteins); EC 3.4.24.- (ADAMTS15 protein, human); EC 3.4.24.82 (ADAMTS4 Protein); EC 3.4.24.82 (ADAMTS4 protein, human)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170911
[Lr] Data última revisão:
170911
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170322
[St] Status:MEDLINE
[do] DOI:10.1210/jc.2016-3527


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[PMID]:28323919
[Au] Autor:Maybin JA; Thiruchelvam U; Madhra M; Saunders PTK; Critchley HOD
[Ad] Endereço:MRC Centre for Reproductive Health, The University of Edinburgh, Queen's Medical Research Institute, Edinburgh EH16 4TJ, United Kingdom.
[Ti] Título:Steroids Regulate CXCL4 in the Human Endometrium During Menstruation to Enable Efficient Endometrial Repair.
[So] Source:J Clin Endocrinol Metab;102(6):1851-1860, 2017 Jun 01.
[Is] ISSN:1945-7197
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Context: Repair of the endometrial surface at menstruation must be efficient to minimize blood loss and optimize reproductive function. The mechanism and regulation of endometrial repair remain undefined. Objective: To determine the presence/regulation of CXCL4 in the human endometrium as a putative repair factor at menses. Patients/Setting: Endometrial tissue was collected throughout the menstrual cycle from healthy women attending the gynecology department. Menstrual blood loss was objectively measured in a subset, and heavy menstrual bleeding (HMB) was defined as >80 mL per cycle. Monocytes were isolated from peripheral blood. Design: CXCL4 messenger RNA (mRNA) and protein were identified by quantitative reverse transcription polymerase chain reaction and immunohistochemistry. The function/regulation of endometrial CXCL4 was explored by in vitro cell culture. Results: CXCL4 mRNA concentrations were significantly increased during menstruation. Intense staining for CXCL4 was detected in late secretory and menstrual tissue, localized to stromal, epithelial and endothelial cells. Colocalization identified positive staining in CD68+ macrophages. Treatment of human endometrial stromal and endothelial cells (hESCs and HEECs, respectively) with steroids revealed differential regulation of CXCL4. Progesterone withdrawal resulted in significant increases in CXCL4 mRNA and protein in hESCs, whereas cortisol significantly increased CXCL4 in HEECs. In women with HMB, CXCL4 was reduced in endothelial cells during the menstrual phase compared with women with normal menstrual bleeding. Cortisol-exposed macrophages displayed increased chemotaxis toward CXCL4 compared with macrophages incubated with estrogen or progesterone. Conclusions: These data implicate CXCL4 in endometrial repair after menses. Reduced cortisol at the time of menses may contribute to delayed endometrial repair and HMB, in part by mechanisms involving aberrant expression of CXCL4.
[Mh] Termos MeSH primário: Endométrio/metabolismo
Menorragia/genética
Menstruação/genética
Fator Plaquetário 4/genética
[Mh] Termos MeSH secundário: Adulto
Endométrio/citologia
Células Epiteliais/efeitos dos fármacos
Estradiol/farmacologia
Feminino
Regulação da Expressão Gênica
Seres Humanos
Hidrocortisona/farmacologia
Imuno-Histoquímica
Técnicas In Vitro
Menorragia/metabolismo
Ciclo Menstrual/genética
Ciclo Menstrual/metabolismo
Menstruação/metabolismo
Meia-Idade
Monócitos
Fator Plaquetário 4/efeitos dos fármacos
Fator Plaquetário 4/metabolismo
Progesterona/farmacologia
RNA Mensageiro
Reação em Cadeia da Polimerase Via Transcriptase Reversa
Células Estromais/efeitos dos fármacos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (RNA, Messenger); 37270-94-3 (Platelet Factor 4); 4G7DS2Q64Y (Progesterone); 4TI98Z838E (Estradiol); WI4X0X7BPJ (Hydrocortisone)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170911
[Lr] Data última revisão:
170911
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170322
[St] Status:MEDLINE
[do] DOI:10.1210/jc.2016-3604


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[PMID]:28273646
[Au] Autor:Zandstra D; Busser JA; Aarts JW; Nieboer TE
[Ad] Endereço:Department of Obstetrics and Gynecology, Gelderse Vallei Hospital, Willy Brandtlaan 10, 6716 RP, Ede, The Netherlands. Electronic address: dorienzandstra@gmail.com.
[Ti] Título:Interventions to support shared decision-making for women with heavy menstrual bleeding: A systematic review.
[So] Source:Eur J Obstet Gynecol Reprod Biol;211:156-163, 2017 Apr.
[Is] ISSN:1872-7654
[Cp] País de publicação:Ireland
[La] Idioma:eng
[Ab] Resumo:This review studies women's preferences for shared decision-making about heavy menstrual bleeding treatment and evaluates interventions that support shared decision-making and their effectiveness. PubMed, Cochrane, Embase, Medline and ClinicalTrials.gov were searched. Three research questions were predefined: 1) What is the range of perspectives gathered in studies that examine women facing a decision related to heavy menstrual bleeding management?; 2) What types of interventions have been developed to support shared decision-making for women experiencing heavy menstrual bleeding?; and 3) In what way might women benefit from interventions that support shared decision-making? All original studies were included if the study population consisted of women experiencing heavy menstrual bleeding. We used the TIDieR (Template for Intervention: Description and Replication) checklist to assess the quality of description and the reproducibility of interventions. Interventions were categorized using Grande et al. guidelines and collated and summarized outcomes measures into three categories: 1) patient-reported outcomes; 2) observer-reported outcomes; and 3) doctor-reported outcomes. Fifteen studies were included. Overall, patients preferred to decide together with their doctor (74%). Women's previsit preference was the strongest predictor for treatment choice in two studies. Information packages did not have a statistically significant effect on treatment choice or satisfaction. However, adding a structured interview or decision aid to increase patient involvement did show a positive effect on treatment choice and results, patient satisfaction and shared decision-making related outcomes. In conclusion shared decision-making is becoming more important in the care of women with heavy menstrual bleeding. Structured interviews or well-designed (computerized) tools such as decision aids seem to facilitate this process, but there is room for improvement. A shared treatment choice is only possible after careful provision of information, elicitation of patients' preferences and integrating those preferences. Interventions should be designed accordingly.
[Mh] Termos MeSH primário: Tomada de Decisões
Menorragia/terapia
Participação do Paciente
Preferência do Paciente
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170926
[Lr] Data última revisão:
170926
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170309
[St] Status:MEDLINE


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[PMID]:28262240
[Au] Autor:Davies J; Kadir RA
[Ad] Endereço:The Haemophilia Centre and Thrombosis Unit and Department of Obstetrics and Gynaecology, The Royal Free Hospital, London, United Kingdom.
[Ti] Título:Heavy menstrual bleeding: An update on management.
[So] Source:Thromb Res;151 Suppl 1:S70-S77, 2017 Mar.
[Is] ISSN:1879-2472
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Heavy menstrual bleeding (HMB) is defined as excessive menstrual blood loss (MBL) >80 mL per cycle, that interferes with a woman's physical, emotional, social wellbeing and quality of life. Aetiology is due to underlying uterine pathologies, coagulopathy, ovulation dysfunction, or iatrogenic. Up to 20% of women with HMB will have an underlying inherited bleeding disorder (IBD). Assessment of HMB should entail a menstrual and gynaecological history and a bleeding score to distinguish those women who require additional haematological investigations. A pelvic examination and ultrasound scan help to rule out presence of any underlying pathology. Management depends on the underlying cause and the woman's preference and her fertility wishes. Medical therapies include hormonal treatments; levonorgestrel-releasing intrauterine system (LNG-IUS) and combined hormonal contraceptives are most commonly used. Ulipristal acetate is an approved preoperative treatment for uterine fibroids, and has demonstrated efficacy in reducing MBL. Haemostatic therapies include tranexamic acid and DDAVP (1-deamino-8-D-arginine). DDAVP is used for HMB associated with certain IBDs. These therapies can be used in isolation or in combination with hormonal treatments. HMB associated with certain severe IBDs may require factor concentrate administration during menses to alleviate symptoms. Endometrial ablation is a minor surgical procedure that is associated with low operative morbidity and can be performed as an outpatient. Hysterectomy remains the definitive treatment of choice when medical therapies have failed and endometrial ablation is not suitable.
[Mh] Termos MeSH primário: Menorragia/terapia
[Mh] Termos MeSH secundário: Adulto
Anticoncepcionais/administração & dosagem
Anticoncepcionais/uso terapêutico
Gerenciamento Clínico
Feminino
Hemostasia/efeitos dos fármacos
Hormônios/administração & dosagem
Hormônios/uso terapêutico
Seres Humanos
Dispositivos Intrauterinos Medicados
Levanogestrel/administração & dosagem
Levanogestrel/uso terapêutico
Menorragia/sangue
Menorragia/etiologia
Menorragia/cirurgia
Norpregnadienos/administração & dosagem
Norpregnadienos/uso terapêutico
Qualidade de Vida
Adulto Jovem
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Contraceptive Agents); 0 (Hormones); 0 (Norpregnadienes); 5W7SIA7YZW (Levonorgestrel); YF7V70N02B (ulipristal acetate)
[Em] Mês de entrada:1705
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170307
[St] Status:MEDLINE



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