Objectives To systematically review the efficacy and safety of carbetocinversusoxytocin on the prevention of postpartum hemorrhage (PPH) for women undergoing vaginal delivery. Methods PubMed, The Cochrane Library, Web of Science, CBM, WanFang Data, CNKI and VIP databases were electronically searched to collect randomized controlled trials (RCTs) on carbetocinversusoxytocin on the prevention of PPH for women undergoing vaginal delivery from inception to January 2018. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 and Stata 12.0 software. Results A total of 16 RCTs including 2 537 patients were included. The results of meta-analysis showed that: compared to oxytocin, carbetocin could reduce the amount of blood loss within 24h (MD=–107.68, 95%CI–130.21 to –85.15, P<0.000 01) and 2h (MD=–85.98, 95%CI–93.37 to –78.59,P<0.000 01), hemoglobin (Hb) within 24h after delivery (MD=–5.63, 95%CI–6.82 to –4.43,P<0.000 01), the occurrence of PPH (RR=0.46, 95%CI 0.32 to 0.66,P<0.000 01) and the requirement for additional uterotonic agents (RR=0.63, 95%CI 0.48 to 0.84,P=0.002). There was no significant difference in the risk of adverse effects between two groups. Conclusions Current evidence shows that carbetocin is superior to oxytocin in the prevention of PPH for women undergoing vaginal delivery, without increasing the adverse effects. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above the conclusion.
With the development of molecular and cellar cardiology, gene therapy to cardiovascular disease has become the hot spot and the direction of study. Now, preclinical studies on ultrasound-mediated gene delivery (UMGD) in cardiovascular disease have achieved some success, but it is still hindered by a series of practical challenges for clinical translation. Even so, UMGD still holds the promise to cardiovascular disease in gene therapy for its non-invasiveness, accuracy, safety and ability to deliver multiple genes with repeated deliveries. In this review, we will focus on the basic principle, the current development, the future prospect and drawbacks of UMGD in the therapeutic applications of cardiovascular disease.
ObjectiveTo observe the safety of 2-port non-vitrectomized subretinal injection (SRI) for the treatment of Bietti crystalline dystrophy (BCD). MethodsA exploratory clinical study. From February to May 2023, 6 BCD patients with 6 eyes who were confirmed by examination in Xiamen Eye Center of Xiamen University and were treated with SRI adeno-associated virus vector transgenic drugs were included in the study. Among them, 2 males had 2 eyes and 4 females had 4 eyes. Age were 34-60 years old. The study eye underwent adeno associated virus gene therapy via 2-port non-vitrectomized SRI. Two scleral ports were created using 25G vitrectomy trocar to place the light pipe and injection cannula. Anterior chamber paracentesis was performed to lower intraocular pressure. Under the silicone oil infusion mode of the vitrectomy machine, a 38G injection cannula penetrated the retina to reach the subretinal space. The injection speed was controlled by the foot pedal of the vitrectomy machine, and the drug was slowly injected into the subretinal space to create a subretinal bleb. if intra-ocular pressure assessed by finger palpation was high at the end of injection, drainage of the aqueous humor can be made by compressing the cornea incision until the intraocular pressure was normal. Patients were followed for 9-12 months and be examined using the same equipment and methods as before. ResultsRetinal pigment epithelium and choroidal atrophy were observed in all 6 eyes of 6 patients were graded as stage Ⅲ by the fundus examination revealing atrophy of retinal pigmented epithelium and choroid, with or without yellow-white crystals and/or complex lipid. The range were operation time 9-14 minutes. No vitreous prolapse, retinal hemorrhage, or retinal tear was observed during surgery. After 24 hours, optical coherence tomogrophy examination showed absorption of subretinal fluid and retinal reattachment. None of the six patients showed corneal keratic precipitates, anterior chamber cells, vitreous cells, inflammation, high intraocular pressure, or retinal tear within the 9-month follow-up. ConclusionSubretinal injection without vitrectomy using two ports is a safe and feasible alternative for adult gene therapy, and it shortens the surgical time.
ObjectivesTo systematically review the association between pregnancy-induced hypertension (PIH) and preterm birth in mainland China.MethodsPubMed, The Cochrane Library, ScienceDirect, Web of Science, CBM, CNKI, WanFang Data and VIP databases were electronically searched to collect studies on the association between PIH and preterm birth in mainland China from January, 2007 to March, 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies; then, meta-analysis was performed by using Stata 12.0 software.ResultsA total of 48 studies were included, involving 43 276 cases of premature birth, 527 995 cases of full-term control group, in which there were 3 446 cases of PIH in premature delivery, with a prevalence rate of 7.96%. There were 14 099 cases of PIH in the full-term control group, with a prevalence rate of 2.67%. The results of meta-analysis showed that PIH was associated with preterm birth (OR=3.27, 95%CI 2.64 to 4.05, P<0.001). The overall population attributable risk was 13.0%. Subgroup analysis was conducted for different study types, and the results were unaltered.ConclusionsThe current evidence shows that PIH is associated with preterm birth. During pregnancy, the management and intervention of pregnant females with gestational hypertension should be strengthened, and active treatment should be supervised to prevent the occurrence of premature birth.
Objective To develop the plastic nano-hydroxyapatite (nano-HA)/poly (3-hydroxybutyrate-hydroxyvalerate) polyethylene glycol(PHBV-PEG) gentamicin (GM) drug delivery system(DDS)(nano-HA/PHBV-PEG-GM-DDS) for treating osteomyelitis and find its releasing character in vivo. Methods The plastic nano-HA/PHBV- PEG-GM-DDS was prepared using nanoHAas the core carrier of GM, nano-HA with PHBV and PEG as coating and plastic fibrin glue(FG) as microsphere scaffold. The morphological features of nano-HA,drug loaded nano-HA and drug loaded nano-HA/PHBVPEG microsphere were examined by electron microscope.The GM concentration in blood, cortex bone and cancellousbone was detected at 12 different time points by the method of K-B after the plastic nano-HA/PHBV-PEGGM-DDS was implanted into the femora of 36 rabbits. Its GM releasing character was assayed in vivo. Results Nano-HA was similar to a blackjack, and its length was less than 60 nm. Drug loaded nano-HA appeared natural crystal condensate, of which surface adsorbed massive GM. The average grain diameter was 200.5 nm. Drug loaded nanoHA/PHBV-PEG microsphere had a shrinkable porous structure, of which surface configuration was consistent. The average grain diameter was 34.5 μm. The GM concentration and the antibacterial annulus was in the linear correlation. The correlation coefficient was 0.998. In cortex and cancellous bone tissue, the GM concentration was about 95.50±16.50 μg/ml and 80.20±13.80 μg/ml from the plastic nano-HA/PHBV-PEG-GM-DDS on the 1st day, then decreased gradually. After 56 days of operation, the GM concentration still exceeded the minimum inhibitory concentrationfor the staphylococcus aureus, but the peak level of serum GM concentration wasunder the nephrotoxicity concentration. Conclusion Plastic nano-HA/PHBV-PEG-GM-DDS was a good drug delivery system with sustained antibiotic effect in vivo. It was an effective method for the treatment of osteomyelitis.
摘要:眼部的局部給藥方式影響著藥物作用的強度,速率及持續時間和不良反應。視網膜,脈絡膜,玻璃體及視神經的疾病則對眼后節的局部給藥治療提出了挑戰,以局部給藥的方式通過解剖學的膜屏障及淚液排泄,并達到在特定部位起治療作用的藥物濃度是其中的重要課題。全身給藥則難以在眼組織積蓄足夠的藥物濃度,且易引起全身性的不良反應。眼表局部應用滴眼劑在淚液循環及角膜,結膜的屏障作用下易發生流失,而有創的給藥方式包括玻璃體內注射,結膜下注射等變得越來越普遍的同時,除對病人造成疼痛不適外,甚至也可導致多種嚴重于疾病本身的并發癥。本文綜述了近幾年來隨著各種眼科疾病分子機制的研究和解明,眼部局部給藥方式及新劑型的藥代動力學及安全性的研究進展。Abstract: The ocular drug delivery system affects the drug’s efficacy,rate of speed,velocity and adverse reaction.How to deliver the drug with therapeutic local concentrations to the posterior segment remains a challenge. Many invasive methods such as intravitreal injection,subconjunctival injection are generally used,noninvasive method like eye drop can not pass through the barrier of the eye although it is convenient.The recent progress in safty and pharmacokinetic of ocular drug delivery system is reviewed in this article.
ObjectiveTo investigate the expression of amniotic fluid levels and blood serum levels of matrix metalloproteinases-8 (MMP-8) and interleukin-6 (IL-6) in women with preterm delivery. MethodsBetween January 2010 and December 2012, we collected the amniotic fluid of 102 preterm pregnant women and 98 full term pregnant women and analyzed the MMP-8 levels and IL-6 levels in amniotic fluid and blood serum. Meanwhile, we also collected the amniotic fluid to do bacterial culture. ResultsThe amniotic fluid levels of MMP-8 in preterm pregnant women were higher than those in full term pregnant women [(320.45±59.88) vs (153.72±29.12) ng/mL, P<0.05], but there was no obvious discrepancy in the blood serum levels of MMP-8 in the two groups [(9.56±2.11) vs (9.42±2.01) ng/mL, P>0.05]. Both amniotic fluid levels and blood serum levels of IL-6 in preterm pregnant women were significantly higher than the full term pregnant women [(90.5±16.3] vs (20.6±12.5) μg/L, P<0.05; (159.2±20.4) vs (22.3±11.8) μg/L, P<0.05]. The positive bacterial culture rate of preterm pregnant women was higher than the full term pregnant women (8.8% vs 1.0%, P<0.05). ConclusionInfection is the most important reason for preterm pregnancy. MMP-8 level increases in the amniotic fluid, and the level of IL-6 in amniotic fluid and blood serum is a valuable clinical index for identifying premature delivery.
Objective To investigate the physicochemicalproperties of the calcium phosphate cement (CPC) containing Danshen composite injection and its drug release rate. Methods This experiment included 4 groups and each group contained 6 specimens. CPC (2 g) was mixed with the setting solution that served as thecontrol group; 0.1,0.5 and 1.0 ml of Danshen composites injection (concentration, 1 000 mg/ml; pH, 7.35) were respectively added to CPC (2 g), which were used as the experimental groups 1, 2 and 3. The resulting specimens were investigated by the X-ray diffraction (XRD), the fourier transformed infrared spectroscopy(FTIR), and the scanning electron microscope (SEM).ResultsThe XRD analysis showed that the control group had a typical diffraction pattern of the hydroxypatite (HAP), which was consistent with the standard patternof HAP. When more Danshen was added in the experimental groups, the diffractionpeaks of HAP gradually decreased; when the diffraction angle 2θ was about 25.92°, the HAP peaks disappeared. Based on the FTIR analysis, with an increase of the drug concentration, the absorption peak of the hydroxy groups decreased. The SEM showed that the size of the CPC particle was related to the drug concentration; with an increase of the drug concentration, the CPC particle increased in number, resulting in an increasing trend of coacervation. The elution test showed that the drugrelease rate and capacity varied with the different concentrationsof Danshen. The initial release rate was relatively great, but after 96 hours the rate slowed down, lasting for a long time. Conclusion The physicochemical properties of CPC do not change when a proper dose (0.1 ml/2 g) of Danshen isadded to CPC. The Danshen composite can be effectively released from CPC, and so CPCcan be used as an ideal drugdelivery carrier for Danshen composite.
ObjectiveTo overview of systematic reviews of the efficacy and safety of antimicrobials in the prevention of postpartum infection after vaginal delivery, and to provide evidence for the rational use of antimicrobials. MethodsThe CNKI, WanFang Data, VIP, PubMed, Embase, and Cochrane Library databases were searched to collect systematic reviews/meta-analyses on antibiotic prophylaxis for transvaginal delivery from inception to June 25, 2023. The data of the included systematic reviews were extracted by 2 investigators independently, and the methodological quality, risk of bias, and report quality were evaluated by AMSTAR 2.0 scale, ROBIS tool, and PRISMA, respectively. And a pool of outcomes for assessing the effectiveness of antimicrobials in prevention of postpartum infection after transvaginal delivery was developed. ResultsA total of 7 systematic reviews were included. And the AMSTAR 2.0 indicated that most studies (5/7) were from very low quality to low quality. The ROBIS tool showed 3 studies with low risk of bias, 3 with high risk of bias, and 1 with unclear risk of bias. The results of the PRISMA statement showed that the included system evaluation reports were relatively complete. The present evidence showed that prophylactic use of antimicrobials may be beneficial and recommended in women with Ⅲ-Ⅳ perineal fissures, with no significant benefit in women with manual placenta removal, but prophylactic use of antimicrobials was recommended considering their invasive nature, but it was controversial whether antimicrobials should be used in the categories of vaginal assisted delivery, perineal lateralization, and spontaneous delivery (without complications). ConclusionAntimicrobial prophylaxis may not be recommended for all the pregnant women undergoing vaginal delivery to prevent the postpartum infection, but considering the low methodological quality of the included systematic review and the inconsistent outcomes in this field, the conclusion should be further verified by future research with high-quality.
ObjectiveTo summarize the research progress of tissue engineering technology to promote bone tissue revascularization in osteonecrosis of the femoral head (ONFH).MethodsThe relevant domestic and foreign literature in recent years was extensively reviewed. The mechanism of femoral head vascularization and the application progress of tissue engineering technology in the promotion of ONFH bone tissue revascularization were summarized.ResultsRebuilding or improving the blood supply of the femoral head is the key to the treatment of ONFH. Tissue engineering is a hot spot in current research. It mainly focuses on the three elements of seed cells, scaffold materials, and angiogenic growth factors, combined with three-dimensional printing technology and drug delivery systems to promote the revascularization of the femoral bone tissue.ConclusionThe strategy of revascularization of the femoral head can improve the local blood supply and delay or even reverse the progression of ONFH disease.