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Titolo:
Unexplained sporadic and recurrent miscarrage in the new millennium: a critical analysis of immune mechanisms and treatments
Autore:
Clark, DA; Coulam, CB; Daya, S; Chaouat, G;
Indirizzi:
McMaster Univ, Dept Med, Hamilton, ON L8N 3Z5, Canada McMaster Univ Hamilton ON Canada L8N 3Z5 ed, Hamilton, ON L8N 3Z5, Canada McMaster Univ, Dept Mol Med & Pathol, Hamilton, ON L8N 3Z5, Canada McMaster Univ Hamilton ON Canada L8N 3Z5 ol, Hamilton, ON L8N 3Z5, Canada McMaster Univ, Dept Obstet & Gynecol, Hamilton, ON L8N 3Z5, Canada McMaster Univ Hamilton ON Canada L8N 3Z5 ol, Hamilton, ON L8N 3Z5, Canada Sher Ctr Reprod Med, Chicago, IL USA Sher Ctr Reprod Med Chicago IL USASher Ctr Reprod Med, Chicago, IL USA McMaster Univ, Dept Clin Epidemiol & Biostat, RMITG Study Grp, Hamilton, ON, Canada McMaster Univ Hamilton ON Canada , RMITG Study Grp, Hamilton, ON, Canada Hop Antoine Beclere, INSERM, U131, Clamart, France Hop Antoine Beclere Clamart France clere, INSERM, U131, Clamart, France
Titolo Testata:
HUMAN REPRODUCTION UPDATE
fascicolo: 5, volume: 7, anno: 2001,
pagine: 501 - 511
SICI:
1355-4786(200109/10)7:5<501:USARMI>2.0.ZU;2-P
Fonte:
ISI
Lingua:
ENG
Soggetto:
KILLER-CELL ACTIVITY; T-HELPER CYTOKINES; V-LEIDEN MUTATION; SPONTANEOUS-ABORTION; INTRAVENOUS IMMUNOGLOBULIN; CONTROLLED TRIAL; PREGNANCY LOSS; BLOOD-TRANSFUSION; REPRODUCTIVE IMMUNOLOGY; COLORECTAL SURGERY;
Keywords:
cytokines; immunotherapy; IVIg; meta-analysis; miscarriage;
Tipo documento:
Review
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
101
Recensione:
Indirizzi per estratti:
Indirizzo: Clark, DA McMaster Univ, Dept Med, Rm 3V39, Hamilton, ON L8N 3Z5, Canada McMaster Univ Rm 3V39 Hamilton ON Canada L8N 3Z5 L8N 3Z5, Canada
Citazione:
D.A. Clark et al., "Unexplained sporadic and recurrent miscarrage in the new millennium: a critical analysis of immune mechanisms and treatments", HUM REP UPD, 7(5), 2001, pp. 501-511

Abstract

There have been important advances in basic science investigation of mechanisms underlying spontaneous miscarriages which lend support to empirical treatments such as intravenous immunoglobulin G and allogeneic leukocyte immunotherapy. The results from clinical trials of these and other proposed treatments have been problematic. There is only one published meta-analysis of sufficient power and appropriate stratification to qualify as Level 1 evidence, and that deals only with leukocyte immunotherapy. Here we criticallyreview current trials and their flaws, update the meta-analysis, and comment on potential new approaches. Inadequate sample size, better definition of heterogeneity, and proper stratification to minimize the effects of heterogeneity remain as problems. Verification that the experimental or test treatment was active in producing the expected alteration in immunophysiology in the recipient is lacking in most trials; use of stored rather than freshallogeneic leukocytes appears problematic. Hidden biases that affect trialsignificance emerge with critical analysis, and the focus on apparent 'high quality' of design in published reports may be misleading. We conclude that there seem to be enough patients to conduct clinical trials of sufficient size to achieve adequate power to test therapies showing promise in pilotstudies, but at present, the only Level 1 evidence concerns leukocyte immunotherapy which appears to increase the chance of a live birth if given to appropriate patients.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 04/04/20 alle ore 21:54:14