| 1. |
|
|
| 2. |
- Ovadia, C., et al.
(författare)
-
Ursodeoxycholic acid in intrahepatic cholestasis of pregnancy: a systematic review and individual participant data meta-analysis
- 2021
-
Ingår i: Lancet Gastroenterology & Hepatology. - : Elsevier BV. - 2468-1253. ; 6:7, s. S47-S58
-
Tidskriftsartikel (refereegranskat)abstract
- Background Ursodeoxycholic acid is commonly used to treat intrahepatic cholestasis of pregnancy, yet its largest trial detected minimal benefit for a composite outcome (stillbirth, preterm birth, and neonatal unit admission). We aimed to examine whether ursodeoxycholic acid affects specific adverse perinatal outcomes. Methods In this systematic review and individual participant data meta-analysis, we searched PubMed, Web of Science, Embase, MEDLINE, CINAHL, Global Health, MIDIRS, and Cochrane without language restrictions for relevant articles published between database inception, and Jan 1, 2020, using search terms referencing intrahepatic cholestasis of pregnancy, ursodeoxycholic acid, and perinatal outcomes. Eligible studies had 30 or more study participants and reported on at least one individual with intrahepatic cholestasis of pregnancy and bile acid concentrations of 40 mu mol/L or more. We also included two unpublished cohort studies. Individual participant data were collected from the authors of selected studies. The primary outcome was the prevalence of stillbirth, for which we anticipated there would be insufficient data to achieve statistical power. Therefore, we included a composite of stillbirth and preterm birth as a main secondary outcome. A mixed-effects meta-analysis was done using multi-level modelling and adjusting for bile acid concentration, parity, and multifetal pregnancy. Individual participant data analyses were done for all studies and in different subgroups, which were produced by limiting analyses to randomised controlled trials only, singleton pregnancies only, or two-arm studies only. This study is registered with PROSPERO, CRD42019131495. Findings The authors of the 85 studies fulfilling our inclusion criteria were contacted. Individual participant data from 6974 women in 34 studies were included in the meta-analysis, of whom 4726 (67.8%) took ursodeoxycholic acid. Stillbirth occurred in 35 (0.7%) of 5097 fetuses among women with intrahepatic cholestasis of pregnancy treated with ursodeoxycholic acid and in 12 (0.6%) of 2038 fetuses among women with intrahepatic cholestasis of pregnancy not treated with ursodeoxycholic acid (adjusted odds ratio [aOR] 1.04, 95% CI 0.35-3.07; p=0.95). Ursodeoxycholic acid treatment also had no effect on the prevalence of stillbirth when considering only randomised controlled trials (aOR 0.29, 95% CI 0.04-2.42; p=0.25). Ursodeoxycholic acid treatment had no effect on the prevalence of the composite outcome in all studies (aOR 1.28, 95% CI 0.86-1.91; p=0.22), but was associated with a reduced composite outcome when considering only randomised controlled trials (0.60, 0.39-0.91; p=0.016). Interpretation Ursodeoxycholic acid treatment had no significant effect on the prevalence of stillbirth in women with intrahepatic cholestasis of pregnancy, but our analysis was probably limited by the low overall event rate. However, when considering only randomised controlled trials, ursodeoxycholic acid was associated with a reduction in stillbirth in combination with preterm birth, providing evidence for the clinical benefit of antenatal ursodeoxycholic acid treatment. Copyright (C) 2021 The Authors(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.
|
|
| 3. |
- Galan, C., et al.
(författare)
-
International observational campaigns of the last two eclipses in EE Cephei : 2003 and 2008/9
- 2012
-
Ingår i: Astronomy and Astrophysics. - : EDP Sciences. - 0004-6361 .- 1432-0746. ; 544, s. A53-
-
Tidskriftsartikel (refereegranskat)abstract
- Context. EECep is an unusual long-period (5.6 yr) eclipsing binary discovered during the mid-twentieth century. It undergoes almost-grey eclipses that vary in terms of both depth and duration at different epochs. The system consists of a Be type star and a dark dusty disk around an invisible companion. EECep together with the widely studied epsilon Aur are the only two known cases of long-period eclipsing binaries with a dark, dusty disk component responsible for periodic obscurations.Aims. Two observational campaigns were carried out during the eclipses of EECep in 2003 and 2008/9 to verify whether the eclipsing body in the system is indeed a dark disk and to understand the observed changes in the depths and durations of the eclipses.Methods. Multicolour photometric data and spectroscopic observations performed at both low and high resolutions were collected with several dozen instruments located in Europe and North America. We numerically modelled the variations in brightness and colour during the eclipses. We tested models with different disk structure, taking into consideration the inhomogeneous surface brightness of the Be star. We considered the possibility of disk precession.Results. The complete set of observational data collected during the last three eclipses are made available to the astronomical community. The 2003 and 2008/9 eclipses of EECep were very shallow. The latter is the shallowest among all observed. The very high quality photometric data illustrate in detail the colour evolution during the eclipses for the first time. Two blue maxima in the colour indices were detected during these two eclipses, one before and one after the photometric minimum. The first (stronger) blue maximum is simultaneous with a "bump" that is very clear in all the UBV(RI)(C) light curves. A temporary increase in the I-band brightness at the orbital phase similar to 0.2 was observed after each of the last three eclipses. Variations in the spectral line profiles seem to be recurrent during each cycle. The Na I lines always show at least three absorption components during the eclipse minimum and strong absorption is superimposed on the H alpha emission.Conclusions. These observations confirm that the eclipsing object in EECep system is indeed a dark, dusty disk around a low luminosity object. The primary appears to be a rapidly rotating Be star that is strongly darkened at the equator and brightened at the poles. Some of the conclusions of this work require verification in future studies: (i) a complex, possibly multi-ring structure of the disk in EECep; (ii) our explanation of the "bump" observed during the last two eclipses in terms of the different times of obscuration of the hot polar regions of the Be star by the disk; and (iii) our suggested period of the disk precession (similar to 11-12 P-orb) and predicted depth of about 2(m) for the forthcoming eclipse in 2014.
|
|
| 4. |
|
|
| 5. |
|
|
| 6. |
|
|
