Postendoscopic retrograde cholangiopancreatography pancreatitis (PEP) is the most common complication of endoscopic retrograde cholangiopancreatography pancreatitis (ERCP). No randomized controlled trial (RCT) has compared the efficacy of the American Society of Gastrointestinal Endoscopy and European Society of Gastrointestinal Endoscopy recommended interventions for PEP prevention. We assessed the effectiveness of these interventions using network meta-Analysis. PubMed, EMBASE, and Cochrane databases were searched to identify RCTs investigating guideline-recommended interventions and their combinations [rectal nonsteroidal anti-inflammatory drugs (NSAIDs): indomethacin or diclofenac, pancreatic stent (PS), aggressive hydration (AH), sublingual nitrate) for PEP prevention. We performed direct and Bayesian network meta-Analysis, and the surface under the cumulative ranking curve to rank interventions. Subgroup network meta-Analysis for high-risk populations was also performed. We identified a total of 38 RCTs with 10 different interventions. Each intervention was protective against PEP on direct and network meta-Analysis compared with controls. Except AH+diclofenac and NSAIDs+ sublingual nitrate, AH+indomethacin was associated with a significant reduction in risk of PEP compared with PS [odds ratio (OR), 0.09; credible interval (CrI), 0.003-0.71], indomethcin+PS (OR, 0.09; CrI, 0.003-0.85), diclofenac (OR, 0.09; CrI, 0.003-0.65), AH (OR, 0.09; CrI, 0.003-0.65), sublingual nitrate (OR, 0.07; CrI, 0.002-0.63), and indomethacin (OR, 0.06; CrI, 0.002-0.43). AH with either rectal NSAIDs or sublingual nitrate had similar efficacy. AH+indomethacin was the best intervention for preventing PEP with 95.3% probability of being ranked first. For high-risk patients, although the efficacy of PS and indomethacin were comparable, PS had an 80.8% probability of being ranked first. AH+indomethacin seems the best intervention for preventing PEP. For high-risk patients, PS seems the most effective strategy. The potential of combination of interventions need to be explored further.

Made available in DSpace on 2015-03-26T13:54:57Z (GMT). No. of bitstreams: 1 texto completo.pdf: 289860 bytes, checksum: d97d6956fc0d5d33352d2b0b1f1b87c8 (MD5) Previous issue date: 2010-07-16 / Conselho Nacional de Desenvolvimento Científico e Tecnológico / The experiment was performed at the Caprinocutura Department of Animal Science, Federal University of Viçosa, in Viçosa-MG. The goal was to add in the thawing of goat semen, solutions of Ringer's lactate, sodium citrate and 2.92% and TRIS solution to verify the stability and persistence of sperm motility and strength as well as changes in the plasma membrane. Semen was collected from adult male goats were healthy with history of normal fertility, during the natural breeding season (March-April 2010). We evaluated the physical characteristics of semen at collection and the thawing of straws, which have undergone a process of cooling medium. Even after thawing were performed three additional tests: test of heat resistance (TTR), supravital and bonding sperm in egg yolk. All average values for fresh semen as the volume (mL), motility (%), strength (0-5), sperm concentration (x10 9 total) and morphology (% normal) were consistent with that recommended by the Brazilian College of Animal Reproduction (CBRA), being 1.0 ± 0.04, 83.1 ± 0.54 3.9 ± 0.08, 3.3 ± 0.2 and 90.8 ± 0.85, respectively. The parameters motility (33.1 ± 1.8%) and strength (3.0 ± 0.1) semen analysis in the post-thawing (5 minutes) also attended what is established by CBRA the beginning of the TTR, but the period of survival of semen did not exceed 90 minutes after thawing, decreasing sharply over time. The treatment control was the with highest motility after thawing (42.2 ± 2.0) and the treatment received the TRIS solution showed greater persistence (90 minutes) and less abrupt decline in motility parameters and force in relation to other treatments. In all treatments, after 30 minutes of TTR, the parameters were lower than those recommended by the CBRA. One possible explanation for the TRIS solution have allowed persistence and less abrupt decline in motility and strength parameters may bedue to the increase in volume and dilution of the elements that could be being toxic to sperm (free radicals) and also the addition of fructose ( substratro energy), TRIS and citric acid (buffering agent).Additional tests (test of binding of sperm in egg yolk and supravital test) performed in this study showed no difference between treatments (P> 0.05). A positive correlation between motility and supravital test, the test can be considered a ratification of motility assessed subjectively by the researcher. No significant difference was found between the morphologic alterations observed after cryopreservation compared to fresh semen. It was concluded therefore that the addition of Ringer lactate, sodium citrate 2.92% and TRIS solution did not allow greater persistence of motility and vigor after thawing. We suggest the in vivo tests to verify whether the survival time after addition of diluents presented is sufficient to achieve fertilization, since it can count on the assistance of the female external factors (nutrition and aid in movement of sperm). It is further recommended the use of fluorescent probes to assess sperm to better verify the membrane integrity of sperm, since sperm motility in this study had motility after thawing, but their membranes could be altered to the point of not supporting the challenge of temperature (37 °C) for long periods. / O experimento foi realizado no Setor de Caprinocutura do Departamento de Zootecnia da Universidade Federal de Viçosa, no município de Viçosa-MG. O objetivo foi adicionar, no descongelamento de sêmen caprino, as soluções de Ringer com lactato, citrato de sódio 2,92% e solução TRIS, para verificar a estabilidade e persistência da motilidade e vigor dos espermatozóides, assim como alterações da membrana plasmática. O sêmen foi coletado de machos caprinos adultos, sadios, com histórico de fertilidade normal, durante a estação de monta natural (março a abril de 2010). Foram avaliadas as características físicas do sêmen no momento da coleta e no descongelamento das palhetas, as quais passaram por um processo de resfriamento médio. Ainda após o descongelamento, foram realizados três testes complementares: teste de termorresistência (TTR), supravital e de ligação do espermatozóide na gema de ovo. Todos os valores médios obtidos para o sêmen fresco quanto a volume (mL), motilidade (%), vigor (0-5), concentração espermática (x109 totais), e morfologia (% normais) foram condizentes ao preconizado pelo Colégio Brasileiro de Reprodução Animal (CBRA), sendo de 1,0±0,04; 83,1±0,54; 3,9±0,08; 3,3±0,2 e 90,8±0,85, respectivamente. Os parâmetros motilidade (33,1±1,8%) e vigor (3,0±0,1) do sêmen analisado no pós-descongelamento (5 minutos) também atenderam o que é estabelecido pelo CBRA no início do TTR; porém, o período de sobrevivência do sêmen não ultrapassou os 90 minutos após o descongelamento, diminuindo bruscamente com o passar do tempo. O tratamento controle foi o que obteve maior motilidade no descongelamento (42,2±2,0) e o tratamento que recebeu a solução TRIS apresentou maior persistência (90 minutos) e diminuição menos abrupta dos parâmetros motilidade e vigor, em relação aos outros tratamentos. Em todos os tratamentos, após 30 minutos de TTR, os parâmetros estavam aquém do preconizado pelo CBRA. Uma possível explicação para a solução TRIS ter permitido persistência e diminuição menos abrupta dos parâmetros motilidade e vigor pode ser devido o aumento de volume e diluição dos elementos que poderiam estar sendo tóxicos aos espermatozóides (radicais livres) e, também, a adição de frutose (substratro energético), TRIS e ácido cítrico (agentes tamponantes). Os testes complementares (teste de ligação do espermatozóide na gema de ovo e teste supravital) realizados neste trabalho não apresentaram diferença entre tratamentos (P>0,05). Foi encontrada correlação positiva entre a motilidade e o exame supravital, podendo o teste ser considerado uma ratificação dos valores de motilidade aferidos subjetivamente pelo pesquisador. Não foi encontrada diferença significativa entre as alterações morfológicas observadas após a criopreservação em relação ao sêmen fresco. Concluiu-se, assim, que a adição das soluções Ringer lactato, citrato de sódio 2,92% e solução TRIS não permitiu maior persistência da motilidade e vigor após o descongelamento. Sugere-se a realização de testes in vivo a fim de verificar se o tempo de sobrevivência apresentado após adição dos diluentes é suficiente para se realizar a fertilização, uma vez que se pode contar com o auxílio de fatores inerentes a fêmea (nutrição e auxílio na movimentação do espermatozóide). Recomenda-se ainda, o uso de sondas fluorescentes naavaliação espermática para se verificar melhor a integridade da membrana dosespermatozóides, pois os espermatozóides neste trabalho possuíam motilidade após o descongelamento, mas as suas membranas poderiam estar alteradas a ponto de não suportarem o desafio da temperatura (37 ºC) por longo período.