1.
Daratumumab plus Bortezomib, Melphalan, and Prednisone for Untreated Myeloma
Mateos, María-Victoria; Dimopoulos, Meletios A; Cavo, Michele ...
The New England journal of medicine,
02/2018, Letnik:
378, Številka:
6
Journal Article
In patients with newly diagnosed multiple myeloma who were ineligible for stem-cell transplantation, the addition of daratumumab to bortezomib, melphalan, and prednisone increased progression-free ...
survival and the response rate at the cost of an increase in infections.
več
Dostopno za:
CMK, UL
2.
Influence of prenatal diagnosis of abnormally invasive placenta on maternal outcome: systematic review and meta‐analysis
Buca, D.; Liberati, M.; Calì, G. ...
Ultrasound in obstetrics & gynecology,
September 2018, Letnik:
52, Številka:
3
Journal Article
ABSTRACT
Objective
To ascertain the impact of prenatal diagnosis on surgical outcome of women affected by abnormally invasive placenta (AIP).
Methods
MEDLINE, EMBASE, CINAHL and Cochrane databases ...
were searched. Observed outcomes included: gestational age at birth (weeks), amount of blood loss (L), units of red blood cells (RBC), platelets (PLT) and fresh frozen plasma (FFP) transfused, length of stay in hospital and the intensive care unit (ICU) (days), urinary tract injury and infection. Only studies reporting the occurrence of any of the explored outcomes in women with a prenatal compared with an intrapartum diagnosis of AIP were considered eligible for inclusion. Random‐effect head‐to‐head meta‐analyses were used to analyze the data.
Results
Thirteen studies were included. Women with a prenatal diagnosis of AIP had less blood loss during surgery (mean difference (MD), −0.87; 95% CI, −1.5 to −0.23), had fewer units of RBC (MD, −1.45; 95% CI, −2.9 to −0.04) and FFP (MD, −1.73; 95% CI, −3.3 to −0.2) transfused, and delivered earlier (MD, 1.33 weeks; 95% CI, −2.23 to −0.43) compared with those with an intrapartum diagnosis. The risk of admission to an ICU and length of in‐hospital and in‐ICU stay were not different between the groups. Prenatal diagnosis of AIP was associated with a higher risk of urinary‐tract injury (odds ratio, 2.5; 95% CI, 1.3–4.6), mainly due to the higher prevalence of placenta percreta in the group with AIP diagnosed prenatally.
Conclusion
Prenatal diagnosis of AIP is associated with reduced hemorrhagic morbidity compared with cases in which such anomalies are detected at delivery. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
RESUMEN
Influencia del diagnóstico prenatal de placenta invasiva en el desenlace materno: revisión sistemática y metaanálisis
Objetivo
Determinar el impacto del diagnóstico prenatal en el desenlace quirúrgico de las mujeres afectadas por placenta invasiva (PI).
Métodos
Se buscó en las bases de datos MEDLINE, EMBASE, CINAHL y Cochrane. Los resultados observados incluyeron: edad gestacional al nacer (semanas), volumen de pérdida de sangre (L), unidades de glóbulos rojos (GR), plaquetas (PLT) y plasma fresco congelado (PFC) transfundido, tiempo de hospitalización y tiempo en la unidad de cuidados intensivos (UCI) (días), y lesión e infección del tracto urinario. Sólo se consideraron aptos para esta revisión los estudios que mencionaron la aparición de cualquiera de los resultados estudiados en mujeres con un diagnóstico prenatal, en comparación con las que la PI se les diagnosticó durante el parto. Para analizar los datos se utilizaron metaanálisis directos de efectos aleatorios.
Resultados
Se incluyeron 13 estudios. Las mujeres con un diagnóstico prenatal de PI tuvieron menos pérdida de sangre durante la cirugía (diferencia de medias DM, –0,87; IC 95%: –1,5 a –0,23), tuvieron menos unidades de GR (DM, –1,45; IC 95%: –2,9 a –0,04) y de PFC (DM, –1,73; IC 95%: –3,3 a –0,2) transfundido, y dieron a luz antes (DM, 1,33 semanas; IC 95%: –2,23 a –0,43), en comparación con aquellas a las que se les diagnosticó durante el parto. El riesgo de ingreso en la UCI y el tiempo de hospitalización y en la UCI no fueron diferentes entre los grupos. El diagnóstico prenatal de PI se asoció con un mayor riesgo de lesión del tracto urinario (razón de momios, 2,5; IC 95%: 1,3 a 4,6), debido principalmente a la mayor prevalencia de placenta percreta en el grupo con PI diagnosticada prenatalmente.
Conclusiones
El diagnóstico prenatal de la PI se asocia con una reducción de la morbilidad hemorrágica, en comparación con los casos en los que estas anomalías se detectan durante el parto.
摘要
异常植入性胎盘产前诊断对母亲结局的影响:系统评价和meta分析
目的
确定产前诊断对异常植入性胎盘(abnormally invasive placenta,AIP)孕妇手术结局的影响。
方法
检索MEDLINE、EMBASE、CINAHL和Cochrane数据库。观察的结局包括:分娩孕周(周),失血量(L),输注的红细胞(red blood cells,RBC)、血小板(platelets,PLT)和新鲜冰冻血浆(fresh frozen plasma,FFP)单位,住院时间和重症监护室(intensive care unit,ICU)治疗时间(天),尿道损伤和感染。仅纳入报道对出现上述任一结局的产前和产时诊断为AIP的孕妇进行比较的研究。采用随机效应头对头比较meta分析对数据进行分析。
结果
纳入13项研究。与产时诊断为AIP的孕妇相比,产前诊断为AIP的孕妇术中出血量较少(均数差mean difference,MD −0.87;95% CI,−1.5 ~ −0.23),输注RBC(MD,−1.45;95% CI,−2.9 ~ −0.04)和FFP(MD,−1.73;95% CI,−3.3 ~ −0.2)单位较少,分娩时间较早(MD,1.33周;95% CI,−2.23 ~ −0.43)。组间比较,进入ICU治疗的风险以及住院时间、ICU治疗时间无差异。产前诊断为AIP的孕妇发生尿道损伤的风险较高(比值比,2.5;95% CI,1.3~4.6),主要是由于产前诊断为AIP的孕妇胎盘植入的患病率较高。
结论
与分娩时发现AIP相比,产前诊断为AIP能够降低出血发生率。
This article's has been translated into Spanish and Chinese. Follow the links from the to view the translations.
več
Dostopno za:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
3.
Role of interventional radiology in pregnancy complicated by placenta accreta spectrum disorder: systematic review and meta‐analysis
D'Antonio, F.; Iacovelli, A.; Liberati, M. ...
Ultrasound in obstetrics & gynecology,
June 2019, 2019-Jun, 2019-06-00, 20190601, Letnik:
53, Številka:
6
Journal Article
ABSTRACT
Objective
To evaluate the potential benefit of interventional radiology (IR) in improving the outcome of women undergoing surgery for a placenta accreta spectrum (PAS) disorder.
Methods
...
MEDLINE, EMBASE and CINAHL databases were searched for studies comparing outcomes of women with a prenatal diagnosis of PAS who underwent an IR procedure before surgery vs those who did not, using a robust collection of terms relating to PAS. The primary outcome was intraoperative estimated blood loss (EBL). Secondary outcomes were the number of transfused units of packed red blood cells (PRBC), fresh frozen plasma (FFP), platelets and cryoprecipitate, operation time, length of hospital stay, EBL ≥ 2.5 L, PRBC transfused ≥ 5 units, surgical complications, bladder or ureteral injury, relaparotomy, infection, disseminated intravascular coagulation, and complications related to endovascular catheter placement. Only studies reporting on the incidence of, or the mean difference in, the observed outcomes in women affected by a PAS disorder who had vs those who did not have an IR procedure before surgery were considered for inclusion. All outcomes were explored in the overall population of women with a prenatally diagnosed PAS disorder and in those undergoing hysterectomy. Quality assessment of each included study was performed using the Risk Of Bias In Non‐randomized Studies of Interventions (ROBINS‐I) tool. The GRADE methodology was used to assess the quality of the body of retrieved evidence.
Results
Fifteen studies (958 women with PAS) were included. In women who underwent IR before surgery, compared with those who did not, mean EBL (mean difference (MD), −1.02 L; 95% CI, −1.60 to −0.43 L; P < 0.001) and the risk of EBL ≥ 2.5 L (odds ratio (OR), 0.18; 95% CI, 0.04–0.78; P = 0.02) were significantly lower. There was no significant difference between the two groups in the other outcomes explored. On subgroup analysis of pregnancies complicated by PAS undergoing hysterectomy, EBL (MD, −0.68 L; 95% CI, −1.24 to −0.12 L; P = 0.02) and the number of transfused FFP units (MD, −1.66; 95% CI, −2.71 to −0.61; P = 0.02) were significantly lower in women who had an endovascular IR procedure compared with controls. Furthermore, women undergoing IR had a significantly lower risk of EBL ≥ 2.5 L (OR, 0.10; 95% CI, 0.02–0.47; P = 0.004). Overall, complications related to the placement of an endovascular catheter occurred in 5.3% (95% CI, 2.6–8.9; I2, 65.3%) of pregnancies undergoing IR. Overall quality of evidence, as assessed by GRADE, was very low.
Conclusions
The current available data provide encouraging evidence that IR procedures may be associated with lower EBL and need for transfusion in pregnancies undergoing surgery for a PAS disorder. However, given the overall very low quality of the evidence, further large studies are needed in order to confirm the beneficial role of IR in improving the outcome of these women. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
več
Dostopno za:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
4.
Cardiovascular events following pregnancy complicated by pre‐eclampsia with emphasis on comparison between early‐ and late‐onset forms: systematic review and meta‐analysis
Dall'Asta, A.; D'Antonio, F.; Saccone, G. ...
Ultrasound in obstetrics & gynecology,
20/May , Letnik:
57, Številka:
5
Journal Article
ABSTRACT
Objective
To elucidate whether pre‐eclampsia (PE) and the gestational age at onset of the disease (early‐ vs late‐onset PE) have an impact on the risk of long‐term maternal cardiovascular ...
complications.
Methods
MEDLINE, EMBASE and Scopus databases were searched until 15 April 2020 for studies evaluating the incidence of cardiovascular events in women with a history of PE, utilizing combinations of the relevant MeSH terms, keywords and word variants for ‘pre‐eclampsia’, ‘cardiovascular disease’ and ‘outcome’. Inclusion criteria were cohort or case–control design, inclusion of women with a diagnosis of PE at the time of the first pregnancy, and sufficient data to compare each outcome in women with a history of PE vs women with previous normal pregnancy and/or in women with a history of early‐ vs late‐onset PE. The primary outcome was a composite score of maternal cardiovascular morbidity and mortality, including cardiovascular death, major cardiovascular and cerebrovascular events, hypertension, need for antihypertensive therapy, Type‐2 diabetes mellitus, dyslipidemia and metabolic syndrome. Secondary outcomes were the individual components of the primary outcome analyzed separately. Data were combined using a random‐effects generic inverse variance approach. MOOSE guidelines and the PRISMA statement were followed.
Results
Seventy‐three studies were included. Women with a history of PE, compared to those with previous normotensive pregnancy, had a higher risk of composite adverse cardiovascular outcome (odds ratio (OR), 2.05 (95% CI, 1.9–2.3)), cardiovascular death (OR, 2.18 (95% CI, 1.8–2.7)), major cardiovascular events (OR, 1.80 (95% CI, 1.6–2.0)), hypertension (OR, 3.93 (95% CI, 3.1–5.0)), need for antihypertensive medication (OR, 4.44 (95% CI, 2.4–8.2)), dyslipidemia (OR, 1.32 (95% CI, 1.3–1.4)), Type‐2 diabetes (OR, 2.14 (95% CI, 1.5–3.0)), abnormal renal function (OR, 3.37 (95% CI, 2.3–5.0)) and metabolic syndrome (OR, 4.30 (95% CI, 2.6–7.1)). Importantly, the strength of the associations persisted when considering the interval (< 1, 1–10 or > 10 years) from PE to the occurrence of these outcomes. When stratifying the analysis according to gestational age at onset of PE, women with previous early‐onset PE, compared to those with previous late‐onset PE, were at higher risk of composite adverse cardiovascular outcome (OR, 1.75 (95% CI, 1.0–3.0)), major cardiovascular events (OR, 5.63 (95% CI, 1.5–21.4)), hypertension (OR, 1.48 (95% CI, 1.3–1.7)), dyslipidemia (OR, 1.51 (95% CI, 1.3–1.8)), abnormal renal function (OR, 1.52 (95% CI, 1.1–2.2)) and metabolic syndrome (OR, 1.66 (95% CI, 1.1–2.5).
Conclusions
Both early‐ and late‐onset PE represent risk factors for maternal adverse cardiovascular events later in life. Early‐onset PE is associated with a higher burden of cardiovascular morbidity and mortality compared to late‐onset PE. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
več
Dostopno za:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
5.
First‐trimester detection of abnormally invasive placenta in high‐risk women: systematic review and meta‐analysis
D'Antonio, F.; Timor‐Tritsch, I. E.; Palacios‐Jaraquemada, J. ...
Ultrasound in obstetrics & gynecology,
February 2018, Letnik:
51, Številka:
2
Journal Article
ABSTRACT
Objectives
The primary aim of this systematic review was to ascertain whether ultrasound signs suggestive of abnormally invasive placenta (AIP) are present in the first trimester of ...
pregnancy. Secondary aims were to ascertain the strength of association and the predictive accuracy of such signs in detecting AIP in the first trimester.
Methods
An electronic search of MEDLINE, EMBASE, CINAHL and Cochrane databases (2000–2016) was performed. Only studies reporting on first‐trimester diagnosis of AIP that was subsequently confirmed in the third trimester either during operative delivery or by pathological examination were included. Meta‐analysis of proportions, random‐effects meta‐analysis and hierarchical summary receiver–operating characteristics curve analysis were used to analyze the data.
Results
Seven studies, involving 551 pregnancies at high risk of AIP, were included. At least one ultrasound sign suggestive of AIP was detected in 91.4% (95% CI, 85.8–95.7%) of cases with confirmed AIP. The most common ultrasound feature in the first trimester of pregnancy was low implantation of the gestational sac close to a previous uterine scar, which was observed in 82.4% (95% CI, 46.6–99.8%) of cases. Anechoic spaces within the placental mass (lacunae) were observed in 46.0% (95% CI, 10.9–83.7%) and a reduced myometrial thickness in 66.8% (95% CI, 45.2–85.2%) of cases affected by AIP. Pregnancies with a low implantation of the gestational sac had a significantly higher risk of AIP (odds ratio, 19.6 (95% CI, 6.7–57.3)), with a sensitivity and specificity of 44.4% (95% CI, 21.5–69.2%) and 93.4% (95% CI, 90.5–95.7%), respectively.
Conclusions
Ultrasound signs of AIP can be present during the first trimester of pregnancy, even before 11 weeks' gestation. Low anterior implantation of the placenta/gestational sac close to or within the scar was the most commonly seen early ultrasound sign suggestive of AIP, although its individual predictive accuracy was not high. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
več
Dostopno za:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
6.
Outcome of fetal ovarian cysts diagnosed on prenatal ultrasound examination: systematic review and meta‐analysis
Bascietto, F.; Liberati, M.; Marrone, L. ...
Ultrasound in obstetrics & gynecology,
July 2017, Letnik:
50, Številka:
1
Journal Article
ABSTRACT
Objective
To explore the outcome of fetuses with a prenatal diagnosis of ovarian cyst.
Methods
The electronic databases MEDLINE and EMBASE were searched using keywords and word variants for ...
‘ovarian cysts’, ‘ultrasound’ and ‘outcome’. The following outcomes in fetuses with a prenatal diagnosis of ovarian cyst were explored: resolution of the cyst, change of ultrasound pattern of the cyst, occurrence of ovarian torsion and intracystic hemorrhage, need for postnatal surgery, need for oophorectomy, accuracy of prenatal ultrasound examination in correctly identifying ovarian cyst, type of ovarian cyst at histopathological analysis and intrauterine treatment. Meta‐analyses using individual data random‐effects logistic regression and meta‐analyses of proportions were performed. Quality assessment of the included studies was performed using the Newcastle–Ottawa Scale.
Results
Thirty‐four studies (954 fetuses) were included. In 53.8% (95% CI, 46.0–61.5%) of cases for which resolution of the cyst was evaluated (784 fetuses), the cyst regressed either during pregnancy or after birth. The likelihood of resolution was significantly lower in complex vs simple cysts (odds ratio (OR), 0.15 (95% CI, 0.10–0.23)) and in cysts measuring ≥ 40 mm vs < 40 mm (OR, 0.03 (95% CI, 0.01–0.06)). Change in ultrasound pattern of the cyst was associated with an increased risk of ovarian loss (surgical removal or autoamputation) (pooled proportion, 57.7% (95% CI, 42.9–71.8%)). The risk of ovarian torsion was significantly higher for cysts measuring ≥ 40 mm compared with < 40 mm (OR, 30.8 (95% CI, 8.6–110.0)). The likelihood of having postnatal surgery was higher in patients with cysts ≥ 40 mm compared with < 40 mm (OR, 64.4 (95% CI, 23.6–175.0)) and in complex compared with simple cysts, irrespective of cyst size (OR, 14.6 (95% CI, 8.5–24.8)). In cases undergoing prenatal aspiration of the cyst, rate of recurrence was 37.9% (95% CI, 14.8–64.3%), ovarian torsion and intracystic hemorrhage were diagnosed after birth in 10.8% (95% CI, 4.4–19.7%) and 12.8% (95% CI, 3.8–26.0%), respectively, and 21.8% (95% CI, 0.9–40.0%) had surgery after birth.
Conclusion
Size and ultrasound appearance are the major determinants of perinatal outcome in fetuses with ovarian cysts. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
več
Dostopno za:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
7.
The temporal response and mechanism of action of tranexamic acid in endothelial glycocalyx degradation
Diebel, Mark E; Martin, Jonathan V; Liberati, David M ...
The journal of trauma and acute care surgery,
01/2018, Letnik:
84, Številka:
1
Journal Article
The endothelial glycocalyx (GCX) plays an important role in vascular barrier function. Damage to the GCX occurs due to a variety of causes including hypoxia, ischemia-reperfusion, stress-related ...
sympathoadrenal activation, and inflammation. Tranexamic acid (TXA) may prevent GCX degradation. The therapeutic window for TXA administration and the mechanism of action has been under review. Membrane-anchored proteases (sheddases) are key components in endothelial cell biology including the regulation of vascular permeability. The effect of TXA administration on stress-related GCX damage, and the role of sheddases in this process was studied in a cell-based model.
Confluent human umbilical vein endothelial cells (HUVEC) were exposed to hydrogen peroxide and/or epinephrine (EPI) to stimulate postshock reperfusion. TXA was added at various times after hydrogen peroxide (H2O2) and/or EPI exposure. GCX degradation was indexed by syndecan-1 and hyaluronic acid release. Activation of endothelial sheddases was indexed by A Disintegrin and Metalloproteinase-17 and matrix metalloproteinase-9 activity in culture supernatants.
Exposure of HUVEC to either/both EPI and H2O2 resulted in a cellular stress and GCX disruption demonstrated by increased levels of syndecan-1 shedding, hyaluronic acid release, tumor necrosis factor-α release. Shedding of these GCX components was associated with increased activity of both A Disintegrin and Metalloproteinase-17 and matrix metalloproteinase. Disruption of the GCX was further demonstrated via fluorescent imaging, which demonstrated disruption after exposure to either/both H2O2 and EPI. Early administration of either TXA or doxycycline resulted in preservation of the GCX. Late administration of TXA had no effect, whereas doxycycline had some residual protective effect.
Tranexamic acid as a serine protease inhibitor prevented GCX degradation via inhibition of endothelial sheddase activation. This effect was not apparent when TXA was administered greater than 60 minutes after "simulated" reperfusion. Our study supports the clinical practice of early TXA administration in the severely injured patient.
več
Dostopno za:
UL
8.
Dostopno za:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
9.
Outcome of twin–twin transfusion syndrome according to Quintero stage of disease: systematic review and meta‐analysis
Di Mascio, D.; Khalil, A.; D'Amico, A. ...
Ultrasound in obstetrics & gynecology,
December 2020, Letnik:
56, Številka:
6
Journal Article
ABSTRACT
Objectives
To report the outcome of pregnancies complicated by twin–twin transfusion syndrome (TTTS) according to Quintero stage.
Methods
MEDLINE, EMBASE and CINAHL databases were searched ...
for studies reporting the outcome of pregnancies complicated by TTTS stratified according to Quintero stage (I–V). The primary outcome was fetal survival rate according to Quintero stage. Secondary outcomes were gestational age at birth, preterm birth (PTB) before 34, 32 and 28 weeks' gestation and neonatal morbidity. Outcomes are reported according to the different management options (expectant management, laser therapy or amnioreduction) for pregnancies with Stage‐I TTTS. Only cases treated with laser therapy were considered for those with Stages‐II–IV TTTS and only cases managed expectantly were considered for those with Stage‐V TTTS. Random‐effects head‐to‐head meta‐analysis was used to analyze the extracted data.
Results
Twenty‐six studies (2699 twin pregnancies) were included. Overall, 610 (22.6%) pregnancies were diagnosed with Quintero stage‐I TTTS, 692 (25.6%) were Stage II, 1146 (42.5%) were Stage III, 247 (9.2%) were Stage IV and four (0.1%) were Stage V. Survival of at least one twin occurred in 86.9% (95% CI, 84.0–89.7%) (456/552) of pregnancies with Stage‐I, in 85% (95% CI, 79.1–90.1%) (514/590) of those with Stage‐II, in 81.5% (95% CI, 76.6–86.0%) (875/1040) of those with Stage‐III, in 82.8% (95% CI, 73.6–90.4%) (172/205) of those with Stage‐IV and in 54.6% (95% CI, 24.8–82.6%) (5/9) of those with Stage‐V TTTS. The rate of a pregnancy with no survivor was 11.8% (95% CI, 8.4–15.8%) (69/564) in those with Stage‐I, 15.0% (95% CI, 9.9–20.9%) (76/590) in those with Stage‐II, 18.6% (95% CI, 14.2–23.4%) (165/1040) in those with Stage‐III, 17.2% (95% CI, 9.6–26.4%) (33/205) in those with Stage‐IV and in 45.4% (95% CI, 17.4–75.2%) (4/9) in those with Stage‐V TTTS. Gestational age at birth was similar in pregnancies with Stages‐I–III TTTS, and gradually decreased in those with Stages‐IV and ‐V TTTS. Overall, the incidence of PTB and neonatal morbidity increased as the severity of TTTS increased, but data on these two outcomes were limited by the small sample size of the included studies. When stratifying the analysis of pregnancies with Stage‐I TTTS according to the type of intervention, the rate of fetal survival of at least one twin was 84.9% (95% CI, 70.4–95.1%) (94/112) in cases managed expectantly, 86.7% (95% CI, 82.6–90.4%) (249/285) in those undergoing laser therapy and 92.2% (95% CI, 84.2–97.6%) (56/60) in those after amnioreduction, while the rate of double survival was 67.9% (95% CI, 57.0–77.9%) (73/108), 69.7% (95% CI, 61.6–77.1%) (203/285) and 80.8% (95% CI, 62.0–94.2%) (49/60), respectively.
Conclusions
Overall survival in monochorionic diamniotic pregnancies affected by TTTS is higher for earlier Quintero stages (I and II), but fetal survival rates are moderately high even in those with Stage‐III or ‐IV TTTS when treated with laser therapy. Gestational age at birth was similar in pregnancies with Stages‐I–III TTTS, and gradually decreased in those with Stages‐IV and ‐V TTTS treated with laser and expectant management, respectively. In pregnancies affected by Stage‐I TTTS, amnioreduction was associated with slightly higher survival compared with laser therapy and expectant management, although these findings may be confirmed only by future head‐to‐head randomized trials. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.
RESUMEN
Resultado del síndrome de transfusión feto‐fetal según el estadio de Quintero de la enfermedad: revisión sistemática y metaanálisis
Objetivos
Informar sobre el resultado de los embarazos complicados por el síndrome de transfusión feto‐fetal (TTTS, por sus siglas en inglés) según el estadio de Quintero.
Métodos
Se hicieron búsquedas en las bases de datos de MEDLINE, EMBASE y CINAHL de estudios que hubieran informado sobre el resultado de embarazos complicados por TTTS, estratificados según el estadio de Quintero (I–V). El resultado primario fue la tasa de supervivencia fetal según el estadio de Quintero. Los resultados secundarios fueron la edad gestacional al nacer, el parto pretérmino (PPT) antes de las 34, 32 y 28 semanas de gestación y la morbilidad neonatal. Los resultados se reportan de acuerdo con las diferentes opciones de tratamiento (expectante, terapia de láser o amniorreducción) para los embarazos con TTTS en Estadio I. Sólo se consideraron los casos tratados con terapia de láser para aquellos con TTTS de las Etapas II‐IV y sólo se consideraron los casos tratados de manera expectante para aquellos con TTTS de la Etapa V. Para analizar los datos extraídos se utilizó un metaanálisis directo de efectos aleatorios.
Resultados
Se incluyeron veintiséis estudios (2699 embarazos de gemelos). En total, 610 (22,6%) embarazos fueron diagnosticados con TTTS de Estadio I de Quintero, 692 (25,6%) de Estadio II, 1146 (42,5%) de Estadio III, 247 (9,2%) de Estadio IV y cuatro (0,1%) de Estadio V. La supervivencia de al menos un gemelo se produjo en el 86,9% (IC 95%, 84,0–89,7%) (456/552) de los embarazos en Estadio I, en el 85% (IC 95%, 79,1–90,1%) (514/590) de aquellos en Estadio II, en el 81,5% (IC 95%, 76,6–86,0%) (875/1040) de aquellos en Estadio‐III, en el 82,8% (IC 95%, 73,6–90,4%) (172/205) de aquellos en Estadio‐IV y en el 54,6% (IC 95%, 24,8–82,6%) (5/9) de aquellos en Estadio‐V de TTTS. La tasa de embarazos sin supervivientes fue del 11,8% (IC 95%, 8,4–15,8%) (69/564) de aquellos en Estadio‐I, 15,0% (IC 95%, 9,9–20,9%) (76/590) de aquellos en Estadio‐II, 18,6% (IC 95%, 14,2–23,4%) (165/1040) de aquellos en Estadio‐III, 17,2% (IC 95%, 9,6–26,4%) (33/205) de aquellos en Estadio‐IV y en el 45,4% (IC 95%, 17,4–75,2%) (4/9) de aquellos en Estadio‐V de TTTS. La edad gestacional al nacer fue similar en los embarazos con TTTS en los Estadios I‐III, y disminuyó gradualmente en aquellos con TTTS en los Estadios IV y V. En general, la incidencia de PPT y la morbilidad neonatal aumentaron a medida que se incrementó la gravedad del TTTS, pero los datos sobre estos dos resultados se vieron limitados por el pequeño tamaño de la muestra de los estudios incluidos. Al estratificar el análisis de los embarazos con TTTS en Estadio I según el tipo de tratamiento, la tasa de supervivencia fetal de al menos un gemelo fue del 84,9% (IC 95%, 70,4–95,1%) (94/112) en los casos tratados de forma expectante, del 86,7% (IC 95%, 82,6–90.4%) (249/285) en los sometidos a terapia láser y del 92,2% (IC 95%, 84,2–97,6%) (56/60) en los sometidos a amniorreducción, mientras que la tasa de supervivencia doble fue del 67,9% (IC 95%, 57,0–77,9%) (73/108), del 69,7% (IC 95%, 61,6–77,1%) (203/285) y del 80,8% (IC 95%, 62,0–94,2%) (49/60), respectivamente.
Conclusiones
La supervivencia en general en los embarazos biamnióticos monocoriónicos afectados por TTTS es mayor en los estadios tempranos de Quintero (I y II), pero las tasas de supervivencia fetal son moderadamente altas incluso en aquellos con TTTS en estadios III o IV cuando se tratan con terapia láser. La edad gestacional al nacer fue similar en los embarazos con TTTS en los Estadios I‐III, y disminuyó gradualmente en aquellos con TTTS en los Estadios IV y V tratados con láser y tratamiento expectante, respectivamente. En los embarazos afectados por TTTS en Estadio I, la amniorreducción estuvo asociada con una supervivencia ligeramente mayor en comparación con la terapia de láser y el tratamiento expectante, aunque estos hallazgos solo pueden confirmarse mediante futuros estudios aleatorizados directos. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.
摘要
根据Quintero分级的双胎输血综合征预后:系统评价与meta分析
目的
根据Quintero分级，报告双胎输血综合征(TTTS)患者的预后。
方法
根据Quintero分级(1‐5级)，在MEDLINE(美国医学文献联机数据库)、EMBASE(荷兰医学文摘数据库)和CINAHL(护理学数据库)中进行检索，找出报告双胎输血综合征(TTTS)患者预后的研究。根据Quintero分级，主要预后指标是胎儿的存活率。其次是出生时胎龄、孕期在34周、32周和28周之前的早产(PTB)，以及新生儿发病率。针对1级TTTS患者，根据不同的治疗方案(期待治疗、激光治疗或羊水减量术)来报告预后。对2‐4级TTTS患者仅考虑使用激光治疗，而对5级TTTS患者则仅考虑期待治疗。对提取数据进行了随机效应头对头meta分析。
结果
包含26项研究(2699个双胎妊娠)。总的说来，610个妊娠(占22.6%)被诊断为Quintero分级1级TTTS，692个妊娠(占25.6%)被诊断为Quintero分级2级TTTS，1146个妊娠(占42.5%)被诊断为Quintero分级3级TTTS，247个妊娠(占9.2%)被诊断为Quintero分级4级TTTS，以及四个妊娠(占0.1%)被诊断为Quintero分级5级TTTS。1级患者双胎中至少有一胎存活的占86.9%(95% CI，84.0–89.7%)(456/552)，2级患者双胎中至少有一胎存活的占 85%(95% Ci，79.1–90.1%)(514/590)，3级患者双胎中至少有一胎存活的占81.5% (95% CI，76.6–86.0%)(875/1040)，4级患者双胎中至少有一胎存活的占82.8% (95% CI, 73.6–90.4%)(172/205)，以及5级患者双胎中至少有一胎存活的占54.6% (95% CI, 24.8–82.6%)(5/9)。无胎儿存活的概率在1级患者中占11.8%(95% CI，8.4–15.8%)(69/564)，在2级患者中占15.0%(95% CI，9.9–20.9%)(76/590)，在3级患者中占18.6%(95% CI，14.2–23.4%)(165/1040)，在4级患者中占17.2%(95% CI，9.6–26.4%)(33/205)，以及在5级患者中占45.4%(95% CI，17.4–75.2%)(4/9)。出生时胎龄在1‐3级患者中均类似，而在4‐5级TTTS患者中逐渐降低。总体来看，PTB发生率和新生儿发病率随着TTTS严重程度的增加而增加，但这两种结果的相关数据受到所包含研究的小样本限制。当根据医疗干预类型来分层分析1级TTTS患者时，在采取期待治疗的病例中，双胎中至少有一胎存活的占84.9%(95% CI，70.4–95.1%)(94/112)；在采取激光治疗的病例中， 双胎中至少有一胎存活的占86.7%(95% CI，82.6–90.4%)(249/285)，而在进行了羊水减量术的病例中，双胎中至少有一胎存活的占92.2%(95% CI，84.2–97.6%)(56/60)。对于这三种医疗干预类型，双胎存活率分别为67.9%(95% CI，57.0–77.9%)(73/108)，69.7%(95% CI，61.6–77.1%)(203/285)和80.8%(95% CI，62.0–94.2%)(49/60)。
结论
在患有TTTS的单绒毛膜囊双羊膜囊妊娠中，Quintero分级越早期(1级和2级)，总体存活率越高，但在采取了激光治疗的3级或4级患者中均有较高的胎儿存活率。出生时胎龄在1‐3级患者中均类似，而在4级和5级(分别采取激光和期待治疗的)TTTS患者中逐渐降低。在1级TTTS患者中，与激光治疗和期待治疗相比，羊水减量术有略高的存活率，然而，这些研究结果也许只有通过将来的头对头随机试验来进行确认。版权 © 2020 ISUOG。由威利父子公司(John Wiley & Sons Ltd)出版。
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več
Dostopno za:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
10.
Disparate effects of catecholamines under stress conditions on endothelial glycocalyx injury: An in vitro model
Martin, Jonathan V.; Liberati, David M.; Diebel, Lawrence N.
The American journal of surgery,
December 2017, 2017-Dec, 2017-12-00, 20171201, Letnik:
214, Številka:
6
Journal Article
Geriatric trauma patients have high circulating norepinephrine (NE) levels but attenuated release of epinephrine (Epi) in response to increasing severity of injury. We hypothesized that NE and Epi ...
have different effects on the endothelial and glycocalyx components of the vascular barrier following shock.
Human umbilical vein endothelial cells (HUVEC) were treated with varying concentrations of NE or Epi and exposed to simulated shock conditions (HR). Relevant biomarkers were sampled to index glycocalyx injury and endothelial cell activation.
NE was associated with significantly greater glycocalyx damage and endothelial activation/injury vs. Epi treatment groups. There were minimal changes in PAI-1 with either NE or Epi ± H/R. However NE ± H/R was associated with significantly higher tPA levels.
NE favors a profibrinolytic state. Our study supports investigating liberal use of the anti-fibrinolytic agent tranexamic acid in the severely injured geriatric trauma patient.
več
Dostopno za:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
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