Effect of DMPA on IL-1 Alpha in Serum of Women with Endometrioma

Objective: To study the effect of DMPA on serum IL-1α in women with endometrioma undergoing the conservative surgery.Materials and methods:A randomized clinical trial was performed in thirty-five women with endometrioma who underwent conservative surgery in Reproductive Endocrinology and Laparoscopy clinic in Department of Obstetrics and Gynecology, Faculty of Medicine Ramathibodi Hospital. These patients were randomly assigned to one of the following treatments: group A surgery and postoperative treatment with DMPA 150 mg intramuscular or group B surgery alone. Serum IL-1α level was measured by enzyme-linked immunosorbent assay (ELISA) in both groups. Pain scores were evaluated using a visual analog scale (VAS) at 2 and 12 weeks after the operation.Results: There was no significant difference in IL-1α serum levels between both groups at 2 weeks and 12 weeks after the surgery (p = 0.06 and 0.86 respectively). There was no significant difference in pre and postoperative IL-1α level between both group (p = 0.23 and 1.00 respectively). Pain scores of both groups were significantly decreased at 2 weeks and 12 weeks after the surgery (p < 0.001). The patients in DMPA group had significantly less pain scores at 12 weeks after the surgery (p = 0.01). Conclusion: The current study demonstrated that no significant change of IL-1α serum level in women with endometrioma before and after the surgery, with or without postoperative treatment with DMPA. We found decreasing of pain score in both group after surgery and less pain score in DMPA group

Die Modellierung von Kovariatinformationen in multizentrischen Studien mit binärer Zielgröße mit Hilfe des Profil-likelihood

Title 1\. Introduction 1 2\. The Classical Methods 9 3\. The Basic Model 15 4\. Modelling Covariate Information 19 5\. Example of Multicenter Studies 27 6\. Discussion 55 Bibliography 61 Acknowledgements 65Heterogeneity of treatment effects commonly occurs in multicentre studies. The estimation of an average treatment effect from a multicentre study may not be appropriate when heterogeneity is present. Simply combining the results from a multicentre study into an overall estimate potentially is misleading. In recent years several methods have been suggested to investigate the possible sources of heterogeneity between studies. These methods allow the inclusion of covariates that may explain some heterogeneity of the treatment effects. However, there has been discussion on the choice of appropriate statistical methods to address this issue. This study propose a novel model for incorporating covariate information which is the modelling of covariate information using the profile likelihood approach. This study focused on the comparison of two treatments with a binary outcome. A generalized linear model has been applied to explain the variation of treatment effects by covariate information. The canonical link has been applied to link the linear predictor to the relative risk parameter. Additionally, this study illustrates the applications of this model to four examples of multicentre studies. For the reasons given in this study, the modelling of covariate information using the profile likelihood approach becomes attractive in the analysis of multicentre studies. First, the model which has been developed in this study is based upon the Poisson distribution which is appropriate for the structure of binary data. Second, the canonical link has been applied to link the linear predictor to the relative risk parameter which guarantees that the relative risk estimate is positive which is an essential requirement. Third, the nuisance parameter, that is the baseline parameter in the control group, has been eliminated before dealing with the inference for the parameter of interest, and thereby, keeping the dimensionality of the approach low. This will lead to more precision in the estimator for the parameter of interest. Fourth, the software tool which has been developed in this study, is available to compute and deal with this approach. Only patient data on the study level have been considered. Therefore, the modelling of covariate information using the profile likelihood is validly applicable in multicentre studies as well as meta-analysis.Heterogenität von Behandlungseffekten wird oft in multizentrischen Studien beobachtet. Die Schätzung eines durchschnittlichen Behandlungseffektes aus multizentrischen Studien ist nicht adäquat, falls Heterogenität im Effekt vorliegt. In den letzten Jahren wurden verschiedene Methoden vorgeschlagen, um die möglichen Quellen der Heterogenität zwischen den Studien zu untersuchen. Diese Methoden erlauben die Berücksichtigung der Information aus Kovariaten, die zumindest Aneile der Heterogenität im Behandlungseffekt erklären könnten. Allerdings gibt es eine Diskussion um die geeignete Wahl der statistischen Methoden für dieses Vorhaben. In der vorliegenden Arbeit wird ein neues Model zur Einarbeitung von Kovariatinformationen vorgeschlagen, das auf dem Profil- likelihood basiert. Die Arbeit zielt auf den Vergleich zweier Behandlungen mit binärer Zielgröße. Ein verallgemeinertes lineares Model wird modifiziert angewendet, um die Variation des Behandlungseffektes durch Kovariate zu erklären. Die kanonische Linkfunktion wird verwendet, um den linearen Prädiktor mit dem Parameter des relativen Risikos zu verbinden. Darüber hinaus wird das Modell an vier Beispielen von multizentrischen Studien illustriert. Es wird eine Reihe von Gründen angegeben, durch die die Anwendung des Profil- likelihoods auf die Analyse multizentrischer Studien attraktiv wird. Zunächst benutzt das Modell, das in dieser Arbeit entwickelt wird, die Poissonverteilung, die eine geeignete Verteilung für die Anzahl binärer Ereignisse darstellt. Zum anderen wird die kanonische Linkfunktion verwendet, um den linearen Prädiktor mit dem Parameter des Relativen Risikos zu verbinden. Dies garantiert, dass die Schätzung des relativen Risikos immer positiv ausfällt, was eine wesentliche Bedingung zur Interpretierbarkeit der Schätzung darstellt. Zum dritten wird mit dem Ansatz des Profil-likelihoods der Störparameter, der durch den Baseline-parameter der Vergleichsgruppe gegeben ist, zunächst eliminiert und anschließend die Inferenz für den interessierenden Parameter betrachtet mit dem Vorteil, dass die Dimension des Ansatzes niedrig bleibt. Dies führt zu einer größeren Präzision für die Schätzung im interessierenden Parameter. Zum vierten wird eine Software in dieser Arbeit bereit gestellt, die speziell die neue Methodik des Profil- likelihoods realisiert und Vergleiche mit anderen Ansätzen zulässt. Da nur Patientendaten auf der Studienebene benutzt werden, ist der Ansatz des Profil- likelihood nicht nur für multizentrische Studien sondern auch für meta- analytische Studien geeignet

Improving quality of colonoscopy by adding simethicone to sodium phosphate bowel preparation

AIM: To evaluate the effectiveness of simethicone in enhancing visibility and efficacy during colonoscopy

Comparison of Radial Echoendoscopy and Predictive Factors in the Evaluation of Patients with Suspected Choledocholithiasis

Objective: The aim of this study was to compare predictive factors and Radial Echoendoscopy (EUS) in the diagnosis of choledocholithiasis. Materials and Methods: Patients with suspected choledocholithiasis were recruited from April 2011 to January 2018. All patient characteristics, findings of EUS and findings of ERCP were recorded and analyzed. Results: Eighty patients were enrolled in this study. Clinical symptoms, blood chemistry and liver function test were similar in patients with and without choledocholithiasis. Using the findings of ERCP as the gold standard, Radial EUS had sensitivity and specificity for the detection of choledocholithiasis at 90.2% and 97.4%, and for choledocholithiasis and/or common bile duct sludge at 92.7% and 100%, respectively. For patients with intermediate likelihood and high likelihood from predictive factors (33 and 45), Radial EUS was positive for choledocholithiasis in 51.5% (17/33) and 46.7% (21/45), and  ERCP was positive for choledocholithiasis in 54.5% (18/33) and 48.9% (22/45), respectively. Conclusion: Predictive factors, for both intermediate and high likelihood groups, were not accurate to diagnose these patients. Radial EUS is a good diagnostic tool and should done in both groups of patients to avoid unnecessary ERCP

Predicting factors and prediction model for discriminating between fungal infection and bacterial infection in severe microbial keratitis.

A retrospective medical record review including 344 patients who were admitted with severe microbial keratitis at Ramathibodi Hospital, Bangkok, Thailand, from January 2010 to December 2016 was conducted. Causative organisms were identified in 136 patients based on positive culture results, pathological reports and confocal microscopy findings. Eighty-six eyes (63.24%) were bacterial keratitis, while 50 eyes (36.76%) were fungal keratitis. Demographics, clinical history, and clinical findings from slit-lamp examinations were collected. We found statistically significant differences between fungal and bacterial infections in terms of age, occupation, contact lens use, underlying ocular surface diseases, previous ocular surgery, referral status, and duration since onset (p < 0.05). For clinical features, depth of lesions, feathery edge, satellite lesions and presence of endothelial plaque were significantly higher in fungal infection compared to bacterial infection with odds ratios of 2.97 (95%CI 1.43-6.15), 3.92 (95%CI 1.62-9.45), 6.27 (95%CI 2.26-17.41) and 8.00 (95%CI 3.45-18.59), respectively. After multivariate analysis of all factors, there were 7 factors including occupation, history of trauma, duration since onset, depth of lesion, satellite lesions, endothelial plaque and stromal melting that showed statistical significance at p < 0.05. We constructed the prediction model based on these 7 identified factors. The model demonstrated a favorable receiver operating characteristic curve (ROC = 0.79, 95%CI 0.72-0.86) with correct classification, sensitivity and specificity of 81.48%, 70% and 88.24%, respectively at the optimal cut-off point. In conclusion, we propose potential prediction factors and prediction model as an adjunctive tool for clinicians to rapidly differentiate fungal infection from bacterial infection in severe microbial keratitis patients

Effect of simvastatin on monocyte chemoattractant protein-1 expression in endometriosis patients: a randomized controlled trial

Abstract Background Simvastatin is a promising new drug for the treatment of endometriosis. It is a cholesterol-lowering drug that acts by inhibiting HMG-CoA reductase, resulting in a decrease in mevalonate, a precursor of cholesterol and monocyte chemoattractant protein-1 (MCP-1). This study investigated the effect of pre-operative oral simvastatin administration on MCP-1 gene expression and serum MCP-1 protein levels in patients with endometriosis. Methods A prospective, randomized, controlled study was conducted at the Reproductive Endocrinology Unit of the Department of Obstetrics and Gynecology at the Faculty of Medicine Ramathibodi Hospital. Forty women (mean age: 18–45 years) scheduled for laparoscopic surgery who had been diagnosed with endometriosis were recruited and randomly assigned to either a treatment group (20 mg/d of orally administered simvastatin for 2 weeks before surgery) or an untreated control group. Serum was collected before and after treatment and protein levels of MCP-1 were determined. MCP-1 and CD68 transcript levels were also quantified using real-time PCR on endometriotic cyst tissues. Results MCP-1 gene expression on endometriotic cyst was not significantly different between the simvastatin-treated and untreated groups (P = 0.99). CD68 expression was higher in the treatment group compared to the control group, but this was not statistically significant (P = 0.055). Serum MCP-1 levels following simvastatin treatment were higher than in samples obtained before treatment (297.89 ± 70.77 and 255.51 ± 63.79 pg/ml, respectively) (P = 0.01). Conclusions Treatment with 20 mg/d of simvastatin for 2 weeks did not reduce the expression of either the chemokine MCP-1 gene or macrophage-specific genes. Cumulatively, this suggests that simvastatin is not ideal for treating endometriosis because a higher dose of simvastatin (40–100 mg/d) would be needed to achieve the target outcome, which would significantly increase the risk of myopathy in patients. Trial registration Thai Clinical Trials Registry TCTR20130627003 Registered: June 27, 2013

ASSOCIATION AMONG STATIN, TELOMERE LENGTH AND CARDIOVASCULAR DISEASES

Background: Recent evidence has shown associations between cardiovascular diseases (CVDs) and telomere length (TL). Many factors affect telomerase activity (TA) and TL, and statin was recently found to be associated with TA and TL. This systematic review and meta-analysis was conducted to summarize the evidence on the effect of statin on TA and TL, and update the knowledge of association between TL and CVDs. Primary objective is to determine the effect of statin on TA and TL; Secondary objective, to assess the associations between TL and CVDs. Methods: The MEDLINE and Scopus databases were searched to identify eligible studies and extracted data. Meta-analysis was done to see effects of statin on TA/TL [i.e., standardized/unstandardized mean difference (SMD/USMD)] and TL on CVDs using random-effects and fixed-effects model according to heterogeneity assessed by Q test and I2. Results: Five and 18 studies were selected for the primary and secondary objectives, respectively. Pooled TA showed effect of statin on TA with SMD [95% confidence interval (CI)] of 1.90 (1.16, 2.64) TA. However, no significant effect on TL was seen. Increased risk of CHD among participants with shorter TL was estimated by a pooled risk ratio of 1.58 (1.19, 2.09). However, pooled hazard ratios (HRs) for CHD and stroke were non-significant; but shorter TL was significantly increased risk for unspecified CVDs with pooled HR of 1.33 (1.04, 1.70). Conclusions: Our study showed association between statin and TA, but not for TL. In addition, shorter TL is more likely to be higher risk for CHD and unspecified CVDs. However, results were still inconclusive based on different pooled parameters. More studies are required to confirm the association of statin with TL, possibly to elucidate its protective effect on CVDs. Keywords: Telomere, Telomerase, Statin, Cardiovascular disease

The inverse effect of meal intake on controlled attenuation parameter and liver stiffness as assessed by transient elastography

Abstract Background Controlled attenuation parameter (CAP) and liver stiffness (LS) measured by transient elastography (TE, Fibroscan®) have been used for steatosis and fibrosis assessment. We evaluated the effect of meal intake on CAP and LS values. Methods Forty patients who had had a liver biopsy within the previous month were recruited. The biopsy was graded for fibrosis (F) and steatosis (S) stagings. TE was performed after overnight fasting (baseline values) and 15, 30, 45, 60, 90, and 120 min following the intake of a standard commercial formula meal, and every 30 min until LS and CAP values returned to baseline. The effect of meal intake on CAP and LS values was analyzed with a multilevel mixed model approach. Results The mean age was 53.1 ± 11.2 years old. The mean (SD) BMI was 25.6 ± 4.5 kg/m2. F0, F1, F2, F3 and F4 fibrosis stages were found in 17 (42.5%), 9 (22.5%), 4 (10.0%), 8 (20.0%) and 2 (5.0%), respectively. S0, S1, S2 and S3 steatosis stages were seen in 22 (55.0%), 11 (27.5%), 4 (10.0%) and 3 (7.5%), respectively. The mean (SD) CAP and median (IQR) LS values at baseline were 249.7 ± 58.1 dB/m and 11.9 (6–18.1) kPa. A significant decrease in CAP values was observed in all patients 15 to 120 min after meals, with the CAP peak value at 60 min and the mean post-meal delta reduction of 18.1 dB/min. CAP values declined after meals at early fibrosis stages and across all stages of steatosis. A significant increase in LS values after meal intake was observed within 15 to 120 min, with the LS peak value at 15 min and the mean post-meal delta increase of 2.4 kPa. Post-meal CAP and LS values returned to baseline within 150 min following meals. Conclusion Following a meal, patients’ CAP values declined with the peak value at 60 min, contrasting with the rising of LS values with the peak value at 15 min. The post-meal CAP and LS values returned to baseline by 150 min. A fasting period of more than 150 min after a meal is recommended for patients undergoing TE