Aim: Recent studies suggest that misoprostol may be more effective than dinoprostone in pregnant women with unfavorable cervix. The objective here is to investigate and compare the efficacy and safety of intravaginal misoprostol and intracervical dinoprostone for labor induction, including incidence of cesarean section, vaginal delivery rate within 24 h, uterine hyperstimulation, tachysystole, oxytocin augmentation, neonatal intensive care unit (NICU) admissions, and Apgar score of less than 7 at 1 and 5 min. Methods: Databases searched were MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials, up to July 2013. Randomized controlled trials comparing intravaginal misoprostol with intracervical dinoprostone in women with singleton pregnancy, intact membranes and unfavorable cervix (Bishop's <6) were included. Pooled relative risk, mean difference and 95% confidence intervals were calculated. Results: The use of misoprostol was significantly effective in increasing the rate of vaginal delivery within 24 h and less oxytocin augmentation when compared with dinoprostone. However, the incidents of uterine hyperstimulation and tachysystole were significantly higher under the misoprostol protocol than dinoprostone protocol. Furthermore, we found similar efficiency in the rate of cesarean delivery, NICU admission and Apgar score at 1 and 5 min among the study groups. Conclusion: Intravaginal misoprostol appears to be more efficient for labor induction than intracervical dinoprostone; however, dinoprostone has been demonstrated to be safer because of the lower incidence of uterine hyperstimulation and tachysystole. Further high-quality studies assessing the possible effectiveness of misoprostol and dinoprostone in selected groups of patients are warranted.
Background The gut microbiota (GM)–bone axis has emerged as a crucial mediator of bone homeostasis. Estrogen deficiency–induced bone loss is closely associated with an altered GM. However, the underlying mechanisms remain unclear. Objectives We sought to explore the putative effects of GM on estrogen deficiency–induced bone loss and determine a potential mechanism. Methods Fecal samples collected from postmenopausal women with osteoporosis (PMO) and with normal bone mass (PMN) were examined by 16S ribosomal RNA (rRNA) gene sequencing and analysis. Prevotella histicola, a typical species of Prevotella, was orally given to female C57BL6/J mice after ovariectomy [ovariectomized (OVX)]. The primary outcomes were changes in bone microstructures as measured by micro–computed tomography scanning and bone histomorphometry analysis. Secondary outcomes included changes in osteoclast activity, the expression of osteoclastogenic cytokines, and gut permeability, which were measured by ELISA, qRT-PCR, western blot, and immunofluorescence. Results As demonstrated through 16S rRNA gene sequencing and analysis, the GM in the PMO group featured a significantly decreased proportion of the genus Prevotella in comparison with that in the PMN group (∼60%, P < 0.05). In animal experiments, P. histicola–treated OVX mice maintained a relatively higher bone volume than OVX controls. Mechanistically, the protective effects of P. histicola on bone mass were found to be associated with its modulation of gut permeability as well as its inhibitory effects on osteoclast activity which function by attenuating osteoclastogenic cytokine expression. Conclusions The GM diversity and composition between the PMN and PMO groups were significantly different. In particular, the proportion of the genus Prevotella was notably higher in the PMN group, demonstrating its potential bone-protective effects on osteoporosis. Further animal study using osteoporotic mice showed P. histicola could prevent estrogen deficiency–induced bone loss through the GM–bone axis. Thus, P. histicola may serve as a therapeutic agent or target for osteoporosis treatment.
Aim: To explore the intervention with erythropoietin (EPO) in sarcopenic patients with femoral intertrochanteric fractures, and its potential effects on postoperative rehabilitation.Methods: A total of 141 patients with femoral intertrochanteric fracture were selected from January 2018 to January 2019. Patients (aged ≥60 years) with indications for EPO use, but without significant medical history, were selected in the present study. All patients were screened for sarcopenia, and divided into the intervention group and control group according to whether they took EPO. The intervention groups received EPO postoperatively every day for 10 days, whereas the control groups received an equal dose of normal saline. Patients' handgrip strength, appendicular skeletal muscle, duration of hospitalization and postoperative infection rate were assessed by analysis.Results: Among sarcopenic women, the handgrip strength was higher in the intervention group than in the control group after a week (P < 0.05). However, no significant effect was found in men (P > 0.05). The appendicular skeletal muscle increment of the intervention group with sarcopenia was markedly increased regardless of sex (P < 0.001). In addition, the postoperative infection rate was lower in the intervention group than the control group (P < 0.05), accompanied by a shorter hospital stay due to EPO administration (P < 0.05).Conclusions: EPO can improve the muscle strength of female patients with sarcopenia during the perioperative period, and increase muscle mass both of women and men. It can improve the symptoms of sarcopenia, but cannot reverse sarcopenia. Additionally, it can reduce the postoperative complications of patients with hip fracture and shorten the length of hospital stay. Therefore, postoperative administration of EPO might potentially promote rapid postoperative rehabilitation. Geriatr Gerontol Int 2020; 20: 150-155.
MicroRNA-451 has been proven down-regulated in many human malignancies and correlated with tumor progression. However, its expression and clinical significance in osteosarcoma is still unclear. Thus, the aim of this study was to explore the effects of miR-451 in osteosarcoma tumorigenesis and development. The expression level of miR-451 was quantified by quantitative real-time reverse-transcriptase-polymerase chain reaction in primary osteosarcoma tissues and osteosarcoma cell lines. MTT, flow cytometric, and scratch migration assay were used to test the proliferation, apoptosis, and migration of miR-451 transfection osteosarcoma cells, and a mouse model was used to investigate tumorigenesis. The expression levels of miR-451 in osteosarcoma tissues were significantly lower than those in corresponding noncancerous bone tissues (P < 0.001). In addition, miR-451 down-regulation more frequently occurred in osteosarcoma specimens with advanced clinical stage (P < 0.001), positive distant metastasis (P = 0.015), and poor response to neoadjuvant chemotherapy (P < 0.001). Univariate and multivariate analysis identified low miR-451 expression as an unfavorable prognostic factor for both overall and disease-free survival. After miR-451 transfection, cell proliferation, migration, and tumorigenesis in the osteosarcoma cells were significantly inhibited and cell apoptosis was increased. These findings indicate that miR-451 may act not only as a novel diagnostic and prognostic marker, but also as a potential target for molecular therapy of osteosarcoma.
The objective of this study is to investigate and compare the effectiveness of letrozole and clomiphene citrate for improving fertility outcomes, including pregnancy rate, miscarriage rate, multiple pregnancy rate, and incidence rate of adverse events, number of dominant follicles, endometrial thickness at hCG day and serum E2 on hCG day. MEDLINE, EMBASE, CENTRAL, CNKI and CBMdisc databases were searched up to March 2013. Randomized controlled trials comparing letrozole with clomiphene in women with unexplained infertility were included. Pooled relative risk, mean difference and 95% confidence intervals were calculated. We found that there are no differences in pregnancy, miscarriage and multiple pregnancy rates, incidence rate of adverse events, number of dominant follicles (>18 mm) and endometrial thickness at hCG day in women with unexplained infertility between letrozole and clomiphene regimens. The mean (±standard deviation) concentration of serum E2 on hCG day was lower in those treated with letrozole than those with clomiphene. The subgroup of 2.5 mg letrozole displayed a statistically significant higher rate of clinical pregnancy as compared with 100 mg of clomiphene. The results of this study conclude that letrozole is as effective as clomiphene in women with unexplained infertility. Letrozole at a dose of 2.5 mg seems more effective. Further high-quality studies assessing the possible effectiveness of letrozole in selected groups of patients are warranted.
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