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Forty two resident general practitioners (GPs) attending obstetrics and gynecology course in Beijing Hospital were divided into trial group and control group with 21 in each group. The 2-hour study content uterine fibroids was taught by the same teacher. For control group the traditional classroom teaching mode was used, while for the trial group the WeChat-based flipped classroom model was used. The teaching effectiveness was evaluated by means of paper examination, critical examination and questionnaire survey. The average scores and the clinical reasoning scores of trial were significantly higher than those of control group [(90.5±3.4) vs. (82.5±4.2) points and (94.5±1.5) vs. (84.5±2.0) points; t=4.28, P<0.05 and t=5.01, P<0.05, respectively]. Compared with the control group, the trial group presented more learning interest, higher learning efficiency and self-learning ability; and also the ability of expression and communication was improved, the ability of teamwork and the ability of analyzing and solving problems was enhanced more markedly in trial group (all P<0.05). The result indicates that WeChat-based flipped classroom teaching model can improve the learning efficiency in general practice residency training.
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Objective:To explore the therapeutic effects of biofeedback therapy of perineal surface on stress urinary incontinence(SUI) in elderly women.Methods:A total of 87 elderly women with SUI treated at the outpatient clinics of Beijing Hospital and Yunnan First People's Hospital between January 2018 and December 2019 were recruited in this prospective cohort study.All participants were therapeutically divided into the perineal BF group(n=53)and the intravaginal BF group(n=34), based on the voluntary selection.In the intravaginal BF group, 3/34 cases dropped out of the study, and finally in 31 cases the treatment was completed.All patients were treated with biofeedback for 8 weeks with twice treatment per week.The quality of life was assessed by the incontinence impact questionnaire scores.Patients underwent the 1-hour pad-weighing test, pelvic floor muscle assessment and quality of life assessment by incontinence impact questionnaire(ⅡQ-7)scores before and after treatment.The effective rate of treatment, adverse reactions and treatment satisfaction scores were compared between the two groups.Results:The urine leakage and scores of ⅡQ-7 questionnaire were significantly improved after versus before 8 weeks of treatment in the perineal BF group[(4.65±2.33) g vs.(11.02±4.85) g, (7.96±5.11) scores vs.(4.34±2.66) scores, t=8.62 and 4.58, P<0.001], and in the intravaginal BF group[(3.85±1.89) g vs.(12.43±3.96) g, (3.81±1.23) scores vs.(8.29±5.01) scores, t=10.89 and 4.84, P<0.001]. Compared with before treatment, the grading of pelvic floor muscle strength was improved after treatment, but had no significant difference in the perineal BF group(3.93±2.77 vs.2.98±2.10, t=1.99, P=0.056)and in the intravaginal BF group(4.51±3.38 vs.3.07±2.02, t=2.04, P=0.051). There was no significant difference in the urine leakage, grading of pelvic floor muscle strength and scores of ⅡQ-7 questionnaire between two groups( P>0.05). The effective rate of treatment had no significant difference between the perineal and intravaginal BF groups(81.13% or 43/53 vs.83.87% or 26/31, χ2=0.10, P=0.750). The incidences of adverse effects were higher(20.59% or 7/34 vs.1.89% or 1/53, χ2=8.68, P=0.003)and the comfort levels during treatment assessed by visual analog scale(VAS)scores were lower in the intravaginal BF group than in the perineal BF group[(8.11±2.93) scores vs.(9.88±3.84) scores, t=2.95, P=0.004]. The main adverse effects included pain or discomfort, vaginal bleeding and increased vaginal discharge in the intrasvaginal BF treatment group. Conclusions:The perineal BF method is as effective as intravaginal BF in female stress urinary incontinencetreatmentin elderly women, and has fewer adverse effects.
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Objective:To explore the clinical application value of vector flow mapping (VFM) in assessment of early cardiac dysfunction in aortic stenosis (AS) patients with normal left ventricular ejection fraction (LVEF).Methods:The clinical study consisted of 37 patients with various degrees of AS (LVEF>50%) from October 2015 to February 2017 in Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, including 16 mild to moderate ones (AS1 group ) and 21 severe ones ( AS2 group ). A group of 35 age- and gender-matched healthy volunteers were selected as control group. Using Hitachi Aloka Prosound F75 color Doppler ultrasound diagnostic system, general two-dimensional parameters of left ventricular structure and function were measured. Furthermore, standard dynamic apical long axis view color Doppler flow images during 3 completed cardiac cycles were acquired for DAS-RS1 off-line workstation.Based on time-flow curve(T-F curve) of left ventricle, ECG, and the open-close of valves, the diastole period of left ventricle was divided into the isovolumic relaxation phase(P1), rapid filling phase(P2), slow filling phase(P3), atria contract phase (P4), and total diastolic phase(P0); the systole period was divided into isovolumetric contraction phase (P5), rapid ejecting phase(P6), slow ejecting phase(P7), and total systolic phase(P8). The left ventricular energy loss (EL) of three groups were acquired in all phases.Results:Left ventricular EL: ①Three peaks of EL appeared in P2, P4 and P6 respectively and total diastolic EL was almost equal to systolic. ②Compared with control group, the EL values of AS1 group increased in all phases, but only in P4, P7 and P0 with significant differences ( P<0.05). ③Compared with the other two groups, the EL values in AS2 group increased significantly in all phases of AS2 group ( P<0.01). Correlation analysis: ①For control group and AS group, there were both significant positive correlations between P0-EL, P8-EL and LVMI ( r=0.561, 0.585; 0.635, 0.652 respectively; P<0.01). ②There were both significant positive correlations between P2-EL and E, e′( r=0.623, 0.537; 0.576, 0.502 respectively; P<0.01), while P4-EL and A( r=0.482, 0.555, P<0.01). ③There were both significant positive correlations between P0-EL, P8-EL and E/e′( r=0.480, 0.459; 0.673, 0.590 respectively; P<0.01) and negative correlations between P0-EL, P8-EL and LVEF ( r=-0.537, -0.596; -0.569, -0.625 respectively; P<0.01). Conclusions:Quantitative evaluation of left ventricular EL by VFM technique is expected to provide a sensitive indicator for evaluating the cardiac structure and functional status in AS patients with normal LVEF.
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Objective To investigate the efficacy and safety of modified anterior vaginal wall repair in the treatment of anterior vaginal prolapse and cystocele in elderly women.Methods We retrospectively analyzed the clinical value of modified anterior vaginal wall repair in 58 elderly women with stage Ⅱ-Ⅳ anterior vaginal prolapse and cystocele,which were evaluated by pelvic organ prolapse quantitation (POP-Q) system.The modified anterior vaginal wall repair was based on the paravaginal repair as an add-on to a reverse bridge repair and cross stitching of bilateral sutures stemmed from vaginal repair.According to the condition of each patient,other pelvic floor repair,perineal laceration repair,and paraurethral fascia reinforcement might be performed at the same time.The curative effectiveness was subjectively and objectively evaluated in the postoperative follow-up.Results A total of 58 operations were successfully finished.The follow-up time was 6-24 months with an average of (14±8) months.The subjective cure rate was 100％ and the rate of objective cure defined as the top of the vagina above the level of ischial spine was 100％ at 3 months follow-up (n=58).The subjective and objective cure rate was 100％ and 96.6％ (56/58) at 6 months follow-up (n=58),100％ and 94.1％ (32/34) at 12 months follow-up (n=34),91.7％ (11/12) and 91.7％ (11/12) at 24 months follow-up (n=12),respectively.Conclusions The modified anterior vaginal wall repair is safe and effective for anterior vaginal prolapse and cystocele in elderly women.
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Objective To analyze the characteristics and the related risk factors of the contractility of pelvic floor muscles in old women with pelvic floor dysfunction(PFD).Methods A cohort of 125 elderly patients with symptoms of pelvic floor dysfunction,including 60 of postpartum urinary incontinence(SUI)and 65 of pelvic organ prolapse(POP),were recruited.60 women volunteers with normal pelvic floor function were recruited as a control group.A questionnaire survey was conducted to record the general situation of the subjects.The pelvic floor muscle strength was determined by the methods of electromyography and pressure feedback recording.Results The body mass index,the average number of delivery,newborn baby's body weight were significantly higher in the SUI and POP group than in control group,with statistically significant difference(F=5.29,6.27,5.26,P=0.007,0.003,0.008),but without statistically significant difference between SUI and POP groups (P =0.674,0.554,0.578).The rapid contractility value was significant lower in SUI group than in POP and control groups(all P＜0.01),and the sustained contractility value was significant lower in POP group than in SUI and control groups(all P＜0.01).Conclusions The postpartum pelvic floor dysfunction may be correlated with BMI,vaginal delivery rate,the average number of delivery,newborn baby's body weight and a history of increased abdominal pressure.The postpartum pelvic floor dysfunction may be associated with the declined contractility of pelvic floor muscle,among which the POP may be associated with class Ⅰ muscle and the SUI with class Ⅱ muscle.
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Spontaneous miscarriage is the most common complication of the first trimester,among which 90% are early miscarriage that occurs prior to the 12th week of the gestation.Low progesterone level may be the main cause of the early miscarriage.This article discusses the incidence,pathogenesis,progesterone treatment,and prediction marker of early miscarriage to provide clues for the clinical work.
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OBJECTIVE:To study the effects of volatile oil of Pogostemon cablin on the expression of tight junction proteins ZO-1 and Occludin in colonic mucosal epithelial cells of rats with post-infectious irritable bowel syndrome(PI-IBS). METHODS:Rats were randomly divided into normal control group(distilled water),model group(distilled water),Trimebutine maleate tablet group(TMT,0.1 g/kg)and volatile oil of P. cablin low-dose,medium-dose and high-dose groups [2,3,4 g(crude drug)/kg] with 8 rats in each group. Except for normal control group,those groups were given colon perfusion of acetic acid to induce PI-IBS mod-el. After modeling,they were given relevant medicine intragastrically once a day for consecutive 5 days. The expression of ZO-1 and Occludin [by IOD] and their distribution were detected by immunohistochemistry. RESULTS:In normal control group,ZO-1 and Occludin evenly distributed on the top of enterocyte,manifesting as alveolate and punctiform;in model group,ZO-1 and Oc-cludin scattered on the top of enterocyte,showing uneven dyeing or fade;the distribution of ZO-1 and Occludin in volatile oil of P. cablin groups was similar to normal control group,and its dyeing was lighter than that of normal control group. IOD value of ZO-1 and Occludin in model group were lower than in normal control group(P<0.01);those of volatile oil of P. cablin high-dose group and the IOD value of ZO-1 of P. cablin medium-dose group and TMT group were higher than those of model group (P<0.05 or P<0.01). CONCLUSIONS:The volatile oil of P. cablin can up-regulate the expression of tight junction proteins ZO-1 and Occlu-din in colonic mucosal epithelial cells of rats with PI-IBS.
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To assess the effect of cystocele (anterior pelvic organ prolapse,AOP)or stress urinary incontinence (SUI) on sex life quality in postmenopausal women under 65 years and observe the change of sex life quality after individualized surgical repair and tension-free vaginal tape-obturator (TVT-O).The postmenopausal patients aged 48 to 65 years at Beijing Hospital were observed from June 2008 to December 2010.They were divided into 3 groups of AOP (n =52),SUI (n =30) and control without gynecological and urinary system diseases on routine examinations (n =25).Their sexual life qualities were evaluated by pelvic organ prolapse/urinary incontinence sexual questionnaire (PISQ-31)with 31 items before treatment and at 3,6 months after surgical treatment in AOP and SUI groups.The sexual life quality scores were significantly lower in SUI group than those in control and AOP groups(P ＜ 0.01).It significantly increased after TVT-O treatment(P ＜0.01).There was no significant difference after treatment when compared with that before treatment in POP group.
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Objective To evaluate the safety and efficacy of Prolift pelvic reconstructive surgery for advanced pelvic organ prolapse in elderly patients,and to investigate its impact on pelvic floor function and sexual function.Methods Totally 42 patients aged 60-79 years with advanced pelvic organ prolapse [Pelvic Organ Prolapse Quantification (POP-Q) stage Ⅲ,n=30; POP-Q Ⅳ,n=12)were selected in this study.All patients underwent total Prolift procedure,and were followed up at month 1 and 6 after operation.Operation time,bleeding volume and postoperative complications were recorded.The impact of total Prolift procedure on pelvic floor function in patients were assessed by pelvic floor distress inventory short form 20 (PFDI-20),the pelvic floor incontinence questionnaire 7 (PFIQ-7) and the pelvic organ prolapsed and incontinence sexual quality questionnaire 31 (PISQ-31).Results The operative time was (35-78) minutes[mean time:(42±25) minutes].Bleeding volume was (50 300) ml [mean volume:(137±58) ml].No bladder injury,rectum injury and postoperative complications were observed.All patients were cured,and no one recurred.The scores of PFDI-20 and PFIQ-7 were decreased in patients after sugery at 1 and 6-month follow-up as compared with beforesugery (4.5±1.4,0 vs.47.9±12.2; 7.8±4.3,0 vs.76.3±17.9,respectively,all P＜0.01).There were no significant differences in scores of PFIQ-7 between before and after sugery at 1-and 6-months follow-up (52.3±4.3 vs.49.8±6.3,51.1±6.5,P＞0.05).Conclusions Prolift pelvic reconstructive surgery is an safe and effective treatment for advanced pelvic organ prolapse,which can significantly improve quality of life in elderly patients.
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Objective To investigate effects of hormone replacement therapy with conjugated equine estrogen (CEE) in different doses combined with medroxyprogesterone acetate ( MPA) on mammographic density among postmenopausal women and its clinical significance. Methods Ninety eligible postmenopausal women were randomized into three groups with varied treatment continuously for one year, Croup A receiving 0.3 mg CEE with 2 mg MPA and caltrate 600 mg and vitamin D 125 U daily; Group B receiving 0. 625 mg CEE combined with 2 mg MPA and caltrate 600 mg with vitamin D 125 U daily; and Group C receiving caltrate 600 mg and vitamin D 125 U daily. Mammographic density was analyzed using Wolfe and semi-quantitative methods for all of them and compared each other one year after treatment, as well as mammographic density before and after treatment in Groups A and B. Results One year after treatment, mammogrphic density reached the highest in postmenopausal woman of Group B and the lowest in those of Group C, with significant difference among the three groups (P ＜ 0. 01) and between Groups A and C (P ＜ 0. 01) and between Groups B and C ( P ＜ 0. 05 ). Mammogrphic density with semi-quantitative method increased significantly in Group A ( P ＜ 0. 05 ) and Group B ( P ＜ 0. 01 ), respectively, after treatment as compared with that before it. Change in mammografic density before and after treatment was greater in Group B than that in Group A, but not reaching statistically significant level (P ＞ 0. 05). Conclusions Hormone replacement therapy can cause the increase of mammographic density in postmenopausal women, possibly in a dose-dependent pattern, which suggest that HRT has side effect on breast tissue and the lowest effective dose of estrogen should be selected in HRT. Mammographic density can be used as an indicator to monitor side effect of HRT on breast.
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<p><b>OBJECTIVE</b>To determine the effects of raloxifene hydrochloride (RLX) on bone mineral density (BMD), bone metabolism markers and serum lipids in healthy postmenopausal women in Beijing.</p><p><b>METHODS</b>A multicenter, randomized, double-blind, placebo-controlled study was conducted in a total of 204 healthy postmenopausal women (age 59.5 +/- 5.0 years and weight 62.8 +/- 8.7 kg) treated with either RLX 60 mg (n = 102) or placebo (n = 102) daily for 12 months. BMD, serum lipids, and bone markers were measured before and after drug administration.</p><p><b>RESULTS</b>Compared with placebo, RLX produced a significant increase in both total lumbar spine and total hip BMD. For the lumbar spine, percentage increase in total BMD was 2.3% with RLX compared with a decrease of 0.1% with placebo (P < 0.001). Corresponding values for total hip BMD were a 2.5% increase for RLX and a 1.1% increase for placebo (P = 0.011). For biochemical markers of bone metabolism, serum osteocalcin and C-telopeptide, percentage decreases were 27.65% and 24.02% in RLX-treated subjects. Corresponding values in placebo were a 10.64% decrease and a 15.75% increase (RLX compared with placebo, both P < 0.001). For total cholesterol and low-density lipoprotein cholesterol levels, percentage decreases were 6.44% and 34.58% in the RLX-treated group. Corresponding values in placebo-treated patients were a 1.44% increase and a 19.07% decrease (RLX compared with placebo, both P < 0.001). No differences were found for high-density lipoprotein cholesterol or triglyceride levels between the two groups. Only 5 subjects discontinued early owing to an adverse event (3 in the RLX group and 2 in the placebo group).</p><p><b>CONCLUSIONS</b>This study confirms that RLX exerts positive effects on the skeleton, increasing BMD and decreasing biochemical markers of bone metabolism, and has a positive effect on the overall serum lipid profile in postmenopausal women in China.</p>