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Objective:To study the long-term clinical effect of transvaginal mesh (TVM) and pelvic floor reconstruction with native tissue repair (NTR) in the treatment of advanced pelvic organ prolapse (POP).Methods:Totally 207 patients with advanced POP who were treated in Hunan Provincial Maternal and Child Health Care Hospital from Jan. 2016 to Sep. 2019 were enrolled. The patient′s pelvic organ prolapse quantification were all at degree Ⅲ or above, and they all complained for different degree of symptoms. They were divided into two groups according to the different surgical methods, TVM group and NTR group. In TVM group, the mesh was implanted through the vagina for pelvic floor reconstruction, while in NTR group, the traditional transvaginal hysterectomy combined with uterosacral ligament suspension and anterior and posterior wall repair, as well as perineal body repair were performed. The median follow-up time was 60 months, during the follow up time, 164 cases (79.2%, 164/207) had completed follow-up, including 76 cases in TVM group and 88 cases in NTR group. The perioperative data and complication rates of the two groups were compared, and the subjective and objective outcomes of the two groups at 1, 3 and 5 years were observed, respectively. The objective efficacy was evaluated by three composite criteria, namely: (1) the distance from the farthest end of the prolapse of the anterior and posterior wall of the vagina to the hymen is ≤0 cm, and the descending distance of the top is ≤1/2 of the total length of the vagina; (2) determine the disappearance of relevant POP symptoms according to “Do you often see or feel vaginal mass prolapse？”; (3) no further operation or pessary treatment was performed due to prolapse. If the above three criteria were met at the same time, the operation is successful; otherwise, it was recurrence. The subjective efficacy was evaluated by the pelvic floor distress inventory-short form 20 (PFDI-20) and pelvic floor impact questionnaire-short form 7 (PFIQ-7).Results:The median follow-up time of the two groups was 60 months (range: 41-82 months). Five years after the operation, the subjective and objective cure rates of TVM group were 89.5% (68/76) and 94.7% (72/76), respectively. The subjective and objective cure rates in NTR group were 80.7% (71/88) and 85.2% (75/88), respectively. There were significant differences in the subjective and objective cure rates between the two groups ( χ2=9.869, P=0.002; χ2=3.969, P=0.046). The recurrence rate of TVM group was 5.3% (4/76), and that of NTR group was 14.8% (13/88). There was a significant difference between the two groups ( P=0.046). The postoperative PFDI-20 and PFIQ-7 scores of the two groups were significantly lower than those before surgery, and there were significant differences of the two groups before and after surgery (all P<0.05). Postoperative mesh exposure in TVM group was 1.3% (1/76). Conclusions:The long-term outcomes between the two groups show that the subjective and objective outcomes of pelvic floor reconstruction in TVM group are significantly higher than those in NTR group, and the recurrence rate is significantly lower than that in NTR group. TVM has certain advantages in the treatment of advanced POP.
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AIM: To observe the clinical effect of 3% diquafosol sodium eye drops in treatment of meibomian gland dysfunction-related dry eye.METHODS: The study involved 280 patients totally with meibomian gland dysfunction-related dry eye in the ophthalmology department, Hangzhou Hospital of Traditional Chinese Medicine from May 2020 to May 2021. Patients were divided into the treatment group(160 cases with 320 eyes)and the control group(120 cases with 240 eyes)according to the randomized number table method. The control group was treated with YangXueRunMu formula combined with 0.3% sodium hyaluronate eye drops, the treatment group was treated with YangXueRunMu formula combined with 3% diquafosol sodium eye drops. Both groups were administered for 4wk. The following indicators were measured before and after treatment at 2 and 4wk, respectively: the ocular surface disease index(OSDI)score, Schirmer I test( SⅠt), comprehensive analysis of tear meniscus height(TMH), non-invasive tear film break-up time(NITBUT), meibomian gland lipid secretion of smooth degree scoring and meibomian gland loss rate score, the determination of interleukin-6(IL-6)in tears and the level of tumor necrosis factor-alpha(TNF-α). The efficacy of these tests results was evaluated among these indicators.RESULTS: The overall effective rates of the treatment group and the control group were 95.6% and 81.7% respectively(P<0.05). After 2, 4wk of treatment, the ocular surface disease index(OSDI), NITBUT, meibomian gland lipid secretion scoring, meibomian gland loss rate score and the levels of IL-6 and TNF-α in tears of two groups were significantly different than before treatment(P<0.05). and the treatment group was better than the control group; there was no difference between the SⅠt and TMH groups before and after treatment in the two groups(P>0.05).CONCLUSION: The 3% diquafosol sodium eye drops can promote the normal secretion of meibomian gland by prolonging the homeostasis of the tear membrane, and it can also inhibit the release of inflammatory factors in tears in the treatment of blebomian gland dysfunction-related dry eye.
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@#AIM: To investigate the effects of fluorometholone combined with sodium hyaluronate eye drops in the treatment of xerophthalmia and the influence on inflammatory factors in tears. <p>METHODS: A prospective randomized controlled study was conducted in 116 patients(232 eyes)with xerophthalmia who were treated between February 2017 and December 2019. They were randomly divided into observation group and control group, 58 cases(116 eyes)in each group. The control group was treated with sodium hyaluronate eye drops, while the observation group was treated with 0.1% fluorometholone eye drops based on the treatment for the control group. Ocular Surface Disease Index(OSDI)scoring was carried out before treatment and after 2wk and 4wk of treatment. The tear film break-up time(BUT), Schirmer I test(SⅠt)and corneal fluorescent staining(FL)scores were measured. The tear meniscus height(TMH)and noninvasive keratograph tear breakup time(NIKBUT)were determined by eye surface comprehensive analyzer. Conjunctival impression cytology was performed to determine epithelial cell grading score and goblet cell density. Levels of interleukin 1β(IL-1β), interleukin -6(IL-6)and transforming growth factor β1(TGF-β1)in tears were determined. Meanwhile, efficacy and safety were evaluated.<p>RESULTS: The overall response rates of the observation group and the control group were 94.8% and 82.8%(<i>P</i><0.05). The observation group had higher SⅠt, BUT and NIKBUT, lower FL scores and OSDI scores than the control group at 4wk(<i>P</i><0.05). The goblet cell density was higher in the observation group than in the control group at 4wk(<i>P</i><0.05). IL-6 and IL-1β in the observation group were significantly lower than those in the control group at 2wk and 4wk, and TGF-β1 was significantly higher than that in the control group at 4wk(<i>P</i><0.05). The incidences of adverse reactions in the two groups were 3.4% and 1.7%(<i>P</i>>0.05).<p>CONCLUSION: Fluorometholone combined with sodium hyaluronate can significantly improve clinical symptoms as well as tear film stability in patients with xerophthalmia, which may be related to regulating effect on ocular surface inflammatory factors.
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Objective To investigate the effects of human umbilical mesenchymal stem cells (hUCMSCs) on Wistar rat models of stress urinary incontinence and its possible mechanism.Methods hUCMSCs cells were separated and extracted from human umbilical cord of cesarean delivery of full-term pregnancy women.The models of stress urinary incontinence (SUI) of Wistar rats were established by imitating delivery damage and ovary removing surgery,and then randomly divided into three groups:model group,transforming growth factor-β1 (TGF-β31) group,hUCMSCs group,and normal rats as normal group;and every group included ten rats.Maximal bladder capacity (MBC),leak point pressure (LPP),abdominal leak point pressure (ALPP),and sneezing experiment of rats including normal rats,model rats and model rats accepted TGF-β1 or hUCMSCs treatment were examined.When the treatment accomplished,the rats were killed and urethral sphincter were separated and examined by hematoxylin eosin (HE) staining and the proteins of troponin Ⅰ (TnI),troponin C (TnC),troponin T (TnT),tropomyosin (Tm),actin (AT),myosin heavy chain (MHC) and myosin light chain (MLC) of urethral sphincter was detected with Western blot method.Results The cells of hUCMSCs were extracted and authenticated,SUI models of Wistar rats were successfully established and authenticated.Compared to model group and TGF-β1 group,the MBC,LPP and ALPP of hUCMSCs group dramatically improved (P ＜ 0.05),while the positive rate of sneezing experiment significantly dropped (P ＜ 0.05).HE staining showed urethral sphincter became attenuation,fracture,sparse and disorder,simultaneously the proteins of TnI,TnC,TnT,Tm,MHC and MLC of urethral sphincter reduced (P ＜ 0.05).While the damaged urethral sphincter basically restored the normal structure and the proteins of TnI,TnC,TnT,Tm,MHC and MLC of urethral sphincter up-regulated through hUCMSCs treatment (P ＜ 0.05).Conclusions The treatment of hUCMSCs translation could observably improve the clinic symptoms of SUI Wistar rat models,and its mechanism may be related to enhancement of the protein expression of TnI,TnC,TnT,Tm,MHC and MLC of urethral sphincter,and were involved in the rehabilitation and reconstruction of urethral sphincter.
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<p><b>BACKGROUND</b>Old pelvis fractures are among the most challenging fractures to treat because of their complex anatomy, difficult-to-access surgical sites, and the relatively low incidence of such cases. Proper evaluation and surgical planning are necessary to achieve the pelvic ring symmetry and stable fixation of the fracture. The goal of this study was to assess the use of three-dimensional (3D) printing techniques for surgical management of old pelvic fractures.</p><p><b>METHODS</b>First, 16 dried human cadaveric pelvises were used to confirm the anatomical accuracy of the 3D models printed based on radiographic data. Next, nine clinical cases between January 2009 and April 2013 were used to evaluate the surgical reconstruction based on the 3D printed models. The pelvic injuries were all type C, and the average time from injury to reconstruction was 11 weeks (range: 8-17 weeks). The workflow consisted of: (1) Printing patient-specific bone models based on preoperative computed tomography (CT) scans, (2) virtual fracture reduction using the printed 3D anatomic template, (3) virtual fracture fixation using Kirschner wires, and (4) preoperatively measuring the osteotomy and implant position relative to landmarks using the virtually defined deformation. These models aided communication between surgical team members during the procedure. This technique was validated by comparing the preoperative planning to the intraoperative procedure.</p><p><b>RESULTS</b>The accuracy of the 3D printed models was within specification. Production of a model from standard CT DICOM data took 7 hours (range: 6-9 hours). Preoperative planning using the 3D printed models was feasible in all cases. Good correlation was found between the preoperative planning and postoperative follow-up X-ray in all nine cases. The patients were followed for 3-29 months (median: 5 months). The fracture healing time was 9-17 weeks (mean: 10 weeks). No delayed incision healing, wound infection, or nonunions occurred. The results were excellent in two cases, good in five, and poor in two based on the Majeed score.</p><p><b>CONCLUSIONS</b>The 3D printing planning technique for pelvic surgery was successfully integrated into a clinical workflow to improve patient-specific preoperative planning by providing a visual and haptic model of the injury and allowing patient-specific adaptation of each osteosynthesis implant to the virtually reduced pelvis.</p>
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Adolescent , Adult , Female , Humans , Male , Middle Aged , Young Adult , Fractures, Bone , Diagnosis , Pathology , Imaging, Three-Dimensional , Methods , Pelvic Bones , General Surgery , Plastic Surgery ProceduresABSTRACT
<p><b>OBJECTIVE</b>To analyze the status of overweight and obesity among preschool children in rural areas of ten provinces in China.</p><p><b>METHODS</b>Using data from "Physical development of rural children under the age of 7 from ten provinces of China in 2006", preschool children were selected as the object of study. Overweight, mild obesity, moderately obese, severe obesity were defined as:weight was over 10%, 20%, 30%, 50% than the same sex under height population reference mean. SPSS 13.0 software was used for statistical analysis. χ² test was used to compare rates.</p><p><b>RESULTS</b>A total number of 38 923 preschool children were included in the study. The overall prevalence of overweight was 4.18%, with boy's higher than girl's (χ² = 4.343 6, P = 0.037 1) and the highest rate of overweight (5.80%) was seen in the 3-year-old group. The overall prevalence of obesity was 1.21% , with majority as mild (0.78%). There was no significant difference between boys and girls (χ² = 0.389 0, P = 0.532 8). The 6 to 7 year old group had the highest rate of obesity (1.42%). In the ten provinces, the prevalence rates of overweight were 1.38%-7.62% and the obesity were 0.57%-3.08% . The prevalence rates of overweight and obesity showed the highest in Jilin and lowest in Guangxi.</p><p><b>CONCLUSION</b>The overall prevalence rates of overweight and obesity among preschool children in rural areas of China were low, with 3 to 4-year-olds appeared in the age of high incidence of overweight and obesity. The overall prevalence rates of overweight and obesity in northern area were higher than in other areas.</p>
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Child , Child, Preschool , Female , Humans , Male , China , Epidemiology , Overweight , Epidemiology , Pediatric Obesity , Epidemiology , Prevalence , Rural PopulationABSTRACT
<p><b>BACKGROUND</b>Surgical treatment of acetabular fracture has long been a challenging area in the field of orthopedic trauma. The aim of this research was to investigate the operative methods for delayed acetabular fractures and to assess the operation results.</p><p><b>METHODS</b>The operative approaches, procedures, results, and complications of the delayed acetabular fractures between 1995 and 2005 were retrospectively evaluated at Beijing Jishuitan Hospital. Quality of life was assessed for each patient with the Merle d'Aubingne and Postel fracture function rating scale and the radiological result was assessed using the Matta radiological score.</p><p><b>RESULTS</b>Sixty-eight cases (70 hips) were followed up with a minimal duration of five years (average of 5.8 years). Excellent functional results were observed in 10 hip joints, good results in 40, fair results in 11, and poor results in nine. The risks of poor prognosis include impact fracture or osteochondral fracture of femoral head, a time beyond 42 days from injury to operative management, and dislocation of femoral head during the injury. Some of the problems, which were observed included postoperative infection in two hips, iatrogenic sciatic nerve injury in eight hips, traumatic arthritis in 15 hips, heterotopic ossification in 17 hips, and necrosis of the femoral head in six hips.</p><p><b>CONCLUSION</b>A careful selection of operative indications for delayed acetabular fractures in combination with a proper operative approach and appropriate reduction and fixation could guarantee relatively good results.</p>
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Adolescent , Adult , Female , Humans , Male , Middle Aged , Acetabulum , Wounds and Injuries , General Surgery , Fractures, Bone , General Surgery , Prognosis , Retrospective Studies , Treatment OutcomeABSTRACT
Objective To understand the current status and relevant factors influencing the duration of breastfeeding in rural areas in China.Methods Children under two years old were selected as subjects from the study on "Physical growth among the under 7-years-old children from the rural areas of ten provinces in China in 2006".Kaplan-Meier method was used to estimate the survival curves and Cox multivariate stepwise regression was used to identify the relevant factors on the duration of breastfeeding.Results Median of the duration for breastfeeding was 12 months in rural areas of 10 provinces in China.Results of this study suggested that factors as sex,birth order,areas of residency,nationality,initiation of formula,parents' education levels,maternal services and famliy income were correlated with the duration of breastfeeding.Conclusion Duration of breastfeeding among rural children under 2-years of age was short in the 10 provinces of China.Factors as level of education,residential areas and family income of the parents as well as sex of the chilaren were correlated with the duration of breastfeeding.Intervention program should be implemented to improve the current status on breastfeeding.
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<p><b>BACKGROUND</b>The correlation between the plasma D-dimer level and deep vein thrombosis has not been conclusive in various studies. The aim of this research was to study the relationship between plasma D-dimer levels and the severity of orthopedic trauma by retrospective examination of orthopedic trauma cases.</p><p><b>METHODS</b>Clinically acute trauma and non-acute trauma patients were selected and their plasma D-dimer levels were measured. Plasma D-dimer levels in patients of these two groups were compared. The relationship between the plasma D-dimer level and the severity of the trauma was also studied.</p><p><b>RESULTS</b>There were 548 cases in the acute trauma group and 501 cases in the non-acute trauma group. The levels of plasma D-dimer were significantly higher in the acute trauma group than in the non-acute trauma group (P < 0.01). In the acute trauma group, the correlation between the D-dimer level and the number of fractures was a positive linear correlation (r = 0.9532).</p><p><b>CONCLUSIONS</b>Elevated plasma D-dimer is common in trauma patients. The D-dimer level and the number of fractures in the trauma patients are closely correlated. D-dimer is not only an indicator for the diagnosis of deep vein thrombosis and pulmonary embolus, but also an indicator of the severity of trauma in acute trauma patients.</p>
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Adult , Female , Humans , Male , Middle Aged , Acute Disease , Fibrin Fibrinogen Degradation Products , Pulmonary Embolism , Blood , Retrospective Studies , Severity of Illness Index , Venous Thrombosis , Blood , Wounds and Injuries , BloodABSTRACT
<p><b>OBJECTIVE</b>To study the risk factors for neonatal ventilator-associated pneumonia (VAP) and the changes of isolated pathogens in the last eight years.</p><p><b>METHODS</b>The clinical data of 230 neonates who were admitted into the neonatal intensive care unit (NICU) and received mechanical ventilation for equal to or longer than 48 hrs in 2008 were retrospectively reviewed. The isolated pathogens were compared with those of eight years ago.</p><p><b>RESULTS</b>The incidence of VAP (25.2%) in the year 2008 was lower than that of eight years ago (36.1%; P<0.05). The development of VAP was negatively correlated with the gestational age and the birth weight, but positively correlated with the duration of mechanical ventilation, intubation times, duration of hospitalization, presence of gastrointestinal bleeding and need for blood products transfusion. The main isolated pathogens were opportunistic antibiotics resistant bacteria, and the majority was gram negative bacilli (77%). The most frequently detected gram negative bacilli were Klebsiella (20%), Stenotrophomonas maltophilia (18%) and Acinetobacter (13%). Streptococcus mitis was the most frequently detected gram positive bacilli (14%). The distribution pattern of pathogens isolated in the same NICU eight years ago was somewhat different: Klebsiella (23%), Pseudomonas aeruginosa (17%), Acinetobacter (16%), Streptococcus mitis (11%), Fungi (1%) and Candida albicans (1%).</p><p><b>CONCLUSIONS</b>The incidence of VAP is correlated with gestational age, birth weight, duration of mechanical ventilation and hospitalization, intubation times, presence of gastrointestinal bleeding and need for blood products transfusion. The main isolated pathogens are usually antibiotic resistant opportunistic bacteria. The detection rate of Stenotrophomonas maltophilia increased and that of Pseudomonas aeruginosa decreased when compared with eight years ago.</p>
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Humans , Infant, Newborn , Anti-Bacterial Agents , Therapeutic Uses , Gram-Negative Bacteria , Incidence , Pneumonia, Ventilator-Associated , Risk FactorsABSTRACT
Aim To study the effect of Vitamin C on growth and apoptosis of human cervical cancer cell line HeLa and its mechanisms. Methods HeLa cell line was treated with VitC. Cell proliferation was evaluated with MTT assay. The distribution of cell cycle,the rate of apoptosis and the expression of HPV18 E6,p53,Bax and Bcl-2 protein of the heLa cells, were observed using flow cytometer respectively. TRAP-PCR-ELISA assay was used to evaluate telomerase activity. Results Vitamin C arrested the HeLa cell line in G_0/G_1 phase in a dose and time-dependent manner, and significantly inhibited HeLa cells growth and increased the rate of apoptosis.Expression of HPV18 E6 and Bcl-2 proteins, was down regulated expression of p53 and Bax proteins was upregulated, and the telomerase activity was reduced. Conclusion Vitamin C can significantly inhibit HeLa cells growth and proliferation,arrest them in G_0/G_1 phase and induce their apoptosis.The reason of these changes is the decrease of E6 gene′s expression, and the succedent changes of proteins′ expression in cancer cells,including the downregulated expression of HPV18 E6 and Bcl-2 proteins, upregulated expression of p53 and Bax proteins and reduced telomerae activity.
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To evaluate the significance of bone marrow (BM) and peripheral blood (PB) cells with clonal gene rearrangement of the third complementary determining region of immunoglobulin heavy chain (IgHCDR3) in the diagnosis, clinical staging, determination of treatment effects and prediction of relapse in B-NHL, clonal IgH gene rearrangement of BM from 46 and PB from 38 cases with B-NHL were tested by semi-nested polymerase chain reaction (SnPCR) and polyacrylamide gel electrophoresis before treatment, and ten of them were tested in complete remission after treatment. Results showed that this method was applicable to detecting one clonal IgHCDR3 gene rearrangement positive cell from up to 1 000 normal cells. Specificity of detection was 97%. Clonal IgHCDR3 rearrangement was shown in all 3 cases of BM and 2 of PB specimens with morphologic involvement. The clonal IgHCDR3 was detected in 65.1% of the BM and 44.4% of the PB without morphologic involvement in untreated patients with B-NHL, independent of Ann Arbor staging and systemic symptoms. In 10 cases of B-NHL with clonal IgHCDR3 rearrangement in diagnostic tissues, the molecular marker became negative in 7 patients who entered and remained in complete remission. Two cases relapsed in whom clonal IgHCDR3 rearrangements were detected in serial samples of BM or PB after autologous PBSCT. One patient in whom clonal IgHCDR3 rearrangement was detected at 10 months post-PBSCT remained in complete remission up to now. It was concluded that clonal IgHCDR3 gene rearrangements were found in BM and PB from B-NHL patients without morphologic abnormality. Persistence of molecular marker-positive may be associated with relapse for patients in complete remission, and the patients without clonal IgHCDR3 rearrangement will be in continuous complete remission. Little is known about a few patient who was a long-term disease-free survivor despite the presence of PCR-IgH rearrangement in the marrow.