Analysis on constructing a risk prediction model for premature ovarian function failure in patients with uterine fibroids complicated with hypertension after surgery based on decision tree method / 中华内分泌外科杂志

Objective:The decision tree Chi-square automatic interactive detection (CHAID) algorithm and binary Logistic regression analysis were used to construct the risk prediction model of premature ovarian failure (POF) in patients with uterine fibroids complicated with hypertension after surgery, and the results of the risk prediction model were compared and analyzed.Methods:Patients with uterine fibroids complicated with hypertension admitted to Taizhou Hospital of Zhejiang Province from Jan. 2019 to Sep. 2022 were retrospectively analyzed as the research objects. CHAID algorithm and Logistic regression analysis were used to establish risk prediction models, respectively. The area under the curve (AUC) of receiver operating characteristic curve (ROC) was used to compare and evaluate the prediction effects of the two models.Results:A total of 860 patients were collected, including 56 patients with premature ovarian function failure after operation, and the incidence of premature ovarian function failure was 6.51%. CHAID method and Logistic regression analysis showed that uterine myoma surgery, hypertension, smoking or passive smoking, family history of premature ovarian failure, sleep status, physical exercise and history of induced curettage were important influencing factors of premature ovarian failure. The accuracy of risk prediction of decision tree model was 88.2%, and the fitting effect of the model was good. The Logistic regression model Hosmer-Leme-show goodness of fit test showed that the model fit was good. The AUC of Logistic regression model was 0.893 (95% CI: 0.862-0.899), and the AUC of decision tree model was 0.882 (95% CI: 0.856-0.899). The predictive value of the two models was moderate, and there was no significant difference between them ( Z=0.254, P>0.05) . Conclusions:The combination of decision tree and Logistic regression model can find the influencing factors of premature ovarian function failure in patients with uterine fibroids complicated with hypertension after operation from different levels, and the relationship between the factors can be more fully understood. The establishment of a risk model for premature ovarian function failure in patients with uterine fibroids complicated with hypertension after surgery can provide a reference for postoperative intervention in patients with uterine fibroids complicated with hypertension, and more effectively help patients actively prevent and slow down the occurrence and development of POF.

Analysis of the efficacy of differential diagnosis of atypical adenomyosis and uterine fibroids through contrast-enhanced ultrasound by decision tree model / 中华超声影像学杂志

Objective:To evaluate the effectiveness of contrast-enhanced ultrasound in the differential diagnosis of atypical adenomyosis and fibroids using a decision tree model.Methods:The data of cases with difficulty in differentiating atypical adenomyosis from fibroids on conventional ultrasound examination at Shengjing Hospital of China Medical University from April 2021 to April 2022 were selected and analyzed. Ninety-five patients with contrast-enhanced ultrasound examination were finally selected, including 64 patients in the pathologically confirmed adenomyosis group and 31 patients in the fibroids group. The data from the qualitative analysis and the quantitative analysis of the time-intensity curve (TIC) curve were collected separately, including the temporal variability of contrast entry into the lesion, i.e.the difference between the time when the contrast agent started to enter the lesion and the time when the contrast agent finally filled the lesion completely. Indicators were first screened for inclusion in the decision tree model by univariate and multifactorial analyses, and decision tree models based on qualitative analysis indicators, and qualitative and TIC-based analyses were developed to further assess the diagnostic efficacy of both models.Results:Through the univariate analysis, it showed that the qualitative analysis indicators of lesion onset enhancement pattern, enhancement intensity, intra-lesion contrast distribution, and post-contrast lesion border were of statistical significance (all P<0.05) between the two groups. The differences in contrast arrive time (AT), contrast time to peak (TTP), |ΔAT|, and |ΔTTP| in the TIC curve analysis indexes were statistically significant between the two groups (all P<0.05). The difference in lesion temporal phase variability was statistically significant between the two groups ( P<0.05). After further screening by multifactorial analysis, the accuracy and misdiagnosis rates were 87.40% and (17.90±3.90)% in the qualitative analysis-based decision tree model respectively, and 90.50% and (21.10±4.20) % in the qualitative and TIC curve-based analysis decision tree model respectively. The ROC curves were plotted according to the two groups of models, and the areas under the curves were 0.915 and 0.931 respectively. Conclusions:A decision tree model based on ultrasonographic image analysis has diagnostic value for the differential diagnosis of atypical adenomyosis and uterine fibroids.

A preliminary study of transversus abdominis plane combined with paracervical block in percutaneous microwave ablation of uterine fibroids / 中华超声影像学杂志

Objective:To investigate the safety and efficacy of ultrasound-guided transversus abdominis plane (TAP) combined with paracervical block in percutaneous microwave ablation(PMWA) of uterine fibroids.Methods:Twenty-four patients with uterine fibroids who underwent PMWA after ultrasound-guided TAP combined with paracervical block in Sichuan Cancer Hospital from October 2021 to January 2022 were retrospectively analyzed. The success rate and adverse reactions of TAP combined with paracervical block were recorded, and the types and doses of rescue analgesics used during and after operation were recorded. The pain degree of patients was recorded by NRS(numeric rating scales) during and 30 minutes, 1 hour, 2 hours, 4 hours, 6 hours, 12 hours and 24 hours after operation, and the satisfaction of patients was recorded.Results:The success rate of TAP combined with paracervical block was 100%, and there were no adverse reactions during and after operation. During the operation, 5 patients(20.83%) had mild pain, which was tolerable and did not need intervention, 4 patients(16.67%) presented with moderate pain, and the NRS scores were 4, 4, 5 and 6 respectively, the symptoms were relieved after rescue analgesia. All patients completed one ablation, no ablation failure or secondary ablation. Some patients had mild pain after operation, which could be tolerated without intervention, and all were relieved naturally within 6 hours. All patients returned home on the day of ablation and were 100% satisfied with the analgesic effect.Conclusions:Ultrasound-guided TAP combined with paracervical block in PMWA of uterine fibroids is safe and effective, which is worthy of clinical promotion.

The role of contrast-enhanced ultrasound imaging in preoperative screening of patients with uterine fibroids treated by magnetic resonance guided focused ultrasound / 中华超声影像学杂志

Objective:To investigate the role of contrast-enhanced ultrasound (CEUS) features in preoperative screening of patients with uterine fibroids treated by magnetic resonance imaging guided focused ultrasound (MRgFUS).Methods:The preoperative CEUS features of 28 patients (32 lesions) with uterine fibroids treated by MRgFUS in Xijing Hospital of Air Force Military Medical University from January 2018 to March 2021 were analyzed. The relationships between the imaging features of lesions and the necrosis range were evaluated, which included echo intensity in gray-scale ultrasound, the patterns of the perfusion intensity, perfusion distribution, the contrast agent into the model, lesions with entangled branch vessels, ring-like enhancement, and perfusion regression.Results:The gray-scale ultrasound showed that 68.75%(22/32) lesions were hypoechoic. The CEUS showed that 81.25%(26/32) lesions were iso/hypo-enhancement, 65.63%(21/32) lesions were heterogeneous enhancement, 68.75%(22/32) lesions with entangled branch vessels, 71.88%(23/32) lesions with ring-like enhancement, and 75%(24/32) lesions with fast-out enhancement. The 6 indicators above-mentioned had effects on the non-perfusion volume ratio≥50%, the differences were statistically significant (all P<0.05). Conclusions:CEUS can evaluate the blood flow characteristics in uterine fibroids, providing important information for preoperative screening of uterine fibroids for MRgFUS ablation.

Endometrial Injury and Preservation after Magnetic Resonance-guided Focused Ultrasound Ablation of Uterine Fibroids / 中国医学科学院学报

Objective To explore the risk factors for incident endometrial injury and 3-month endometrial injury after magnetic resonance-guided focused ultrasound(MRgFUS)ablation of uterine fibroids(UF). Methods UF patients who were diagnosed in Peking Union Medical College Hospital and underwent MRgFUS ablation in Amcare Women's and Children's Hospital from August 2016 to October 2020 were retrospectively enrolled in this study.Clinical data of 66 UF patients were collected and compared between endometrial injury group and non-injury group.Stepwise regression was employed to determine the risk factors for the incident endometrial injury and 3-month endometrial injury.Multivariate logistic regression analysis was performed to explore the relationship of endometrial injury with age,pre-ablation tumor size,multiple UF,International Federation of Gynecology and Obstetrics(FIGO)classification,T2WI signal intensity,and treatment time.Results In terms of incident endometrial injury,the 66 patients included 41(62.1%)cases with no injury,4 cases(6.1%) with grade 1 injury,5 cases(7.6%)with grade 2 injury,and 16 cases(24.2%)with grade 3 injury.In terms of 3-month endometrial injury,the 66 patients included 49 cases(74.2%)with no injury,5 cases(7.6%)with grade 1 injury,2 cases(3.0%)with grade 2 injury,and 10 cases(15.2%)with grade 3 injury.Stepwise regression analysis indicated that FIGO classification was significantly associated with incident endometrial injury(

Molecular Mechanism of Modified Guizhi Fulingwan Intervention on Uterine Fibroids in Rats Based on micRNA Expression Profiling / 中国实验方剂学杂志

Objective:To explore the molecular mechanism of modified Guizhi Fulingwan in rats with uterine fibroids. Method:Seventy-two female adult SD rats of SPF grade were randomly divided into a model group， a normal group， and a preventive administration group. The model group and preventive administration group were established by estrogen and progestin loading method. After successful modeling， the rats in the model group were randomly divided into a western medicine group （mifepristone）， the high-dose traditional Chinese medicine（TCM） group， and a low-dose TCM group. All the rats were dosing as required once a day for 28 consecutive days. Hematoxylin-eosin（HE）staining was used to observe the morphological changes of the uterus. The micRNA gene chip was used to detect the expression profile of uterine micRNA gene. Differential expressions of micRNA were screened by bioinformatics methods. Gene function enrichment was used to predict the possible signaling pathways in rats with uterine fibroids by modified Guizhi Fulingwan. Result:Compared with the normal group， microRNA of the model group was 1 up-regulated and 9 down-regulated. Compared with the model group， microRNA of the high-dose group of TCM group was 2 up-regulated and 1 down-regulated， in the preventive administration group， 9 was up-regulated and 2 was down-regulated. Gene function enrichment analysis indicated that four signaling pathways were closely related to uterine fibroids. They were mitogen-activated protein kinase （MAPK） signaling pathway， Wnt signaling pathway， mammalian rapamycin target protein （mTOR） signaling pathway and vascular endothelial cell growth factor （VEGF） signaling pathway. Conclusion:Modified Guizhi Fulingwan affected the expression profile of micRNA in rat model of uterine fibroids induced by estrogen and progesterone， suggesting that modified Guizhi Fulingwan may involve in a variety of biological processes such as signal transduction and gene regulation in the treatment of uterine fibroids.

T2WI female pelvic MRI using the MultiVane XD technique at 3.0 T in uterine adenomyosis and fibroids: a preliminary study / 中华放射学杂志

Objective@#To explore the application value of 3.0 T MultiVane XD (MVXD) technique in female patients with uterine adenomyosis and fibroids.@*Methods@#Patients diagnosed with uterine fibroids with ultrasound and suspected of adenomyosis were involved prospectively from March to May 2018, 3.0 T pelvic MRI examinations were performed during peri-ovulatory period. Axialconventional turbo spin echo (TSE) T2WI, axial MVXD T2WI, sagittal conventional TSE T2WI and MVXD sagittal T2WI were acquired. Two observers rated those 4 series in the aspects of sharpness of uterine border, motion artifacts, identification capability of lesions, confidence of diagnosis and overall image quality. Cohen Kappa analysis was used to evaluate the consistency of scores between 2 observers. Scores of TSE T2WI and MVXD T2WI qualities were compared using Wilcoxon matched-pairs signed-ranks test.@*Results@#Twenty patients were enrolled. Axial conventional TSE T2WI, axial MVXD T2WI were aquired on all of them. Sagittal conventional TSE T2WI, sagittal MVXD T2WI were aquired on 19 among them. Nine patients had only obvious adenomyosis, 6 had only uterinefibroids, and 5 had adenomyosis and uterine fibroids. Compared to conventional TSE technique, scores of two observers in the sharpness of uterine border, motion artifacts, and overall image quality is higher by MVXD with significant difference (P<0.05). The Kappa values for image quality scores of two observers ranged from 0.615 to 0.971, the agreement was good or very good.@*Conclusion@#Applying MVXD T2WI technique to patients with uterine fibroids and adenomyosiscould improve image quality, without sacrificing the ability to recognize and diagnose lesions, compared to conventional TSE T2WI technique.

Leiomioma como simulador de neoplasia maligna uterina: reporte de un caso / Leiomyoma as a simulator of uterine malignant neoplasms: a case report

RESUMEN El cáncer de mama puede originar de forma muy excepcional metástasis en órganos genitales. Estas suelen presentarse de forma asintomática siendo su diagnóstico generalmente tardío. En el estudio de la enfermedad diseminada la tomografía de emisión de positrones con fluordeoxiglucosa asociada a la tomografía computada (FDG PET/CT) juega un rol importante, sin embargo presenta limitantes al momento de diferenciar entre lesiones secundarias, primarias y neoplasias benignas que pueden tener elevada captación de fluordeoxiglucosa (1). Por lo expuesto anteriormente el diagnóstico de certeza solo puede realizarse mediante el estudio anatomopatológico. El caso presentado a continuación abarca uno de los posibles diagnósticos diferenciales con FDG PET/CT que evidencia un incremento en la captación de fluordeoxiglucosa.

ABSTRACT Breast cancer rarely metastasize on pelvic organs and its diagnosis is often delayed due to the asymptomatic nature of this disease. Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (FDG PET/CT) is a useful method for early diagnosis. However, may present a false positive diagnosis from benign lesions that have an increased uptake of glucose. We present a case in which a patient who had breast cancer had an increase glucose uptake in FDG PET/CT from a benign lesion.

Analysis of pregnancy outcomes in patients with uterine fibroids after high intensity focused ultrasound treatment / 中国实用妇科与产科杂志

OBJECTIVE: To investigate the effect of high intensity focused ultrasound(HIFU)on pregnancy outcomes inpatients with uterine fibroids.METHODS:From October 2010 to October 2017,241 patients with uterine fibroids whowere pregnant after HIFU treatment in Suining Central Hospital and Chongqing Haifu Hospital were retrospectivelyanalyzed.The efficacy of HIFU ablation and the patient′s pregnancy outcomes were investigated.RESULTS:Among thesepatients,9 of them were conceived within 2 month after HIFU,24 were conceived between 2 and 4 months after HIFU,33 patients were conceived between 4 and 6 months,and 175 patients were conceived after 6 months of HIFU treatment.The median conception time was 9 months after HIFU(range:1 to 26 months).Among them,152 patients had deliveredbabies successfully,12 patients are still in pregnancy,3 patients had ectopic pregnancy,2 patients had incisionalpregnancy,72 patients had abortions,including 66 cases of induced abortion and 6 cases of spontaneous abortion.Causesof induced abortion included:embryonic development stopping(8 cases),increased vaginal bleeding(5 cases),hypothyroidism(1 case),use of drugs during pregnancy and being fear of fetal malformation(6 cases),and unplannedpregnancy(52 cases).Of the 152 patients who had delivered,147 had 148 full-term deliveries(1 had full-term deliverytwice)and 5 had preterm birth.No uterine rupture occured during pregnancy or childbirth,and the newborn is healthy.Before HIFU treatment,136 of 241 patients had a history of abnormal pregnancy,and only 17 of these patients hadabnormal pregnancy after HIFU treatment.The incidence of spontaneous abortion in patients after HIFU treatment wassignificantly lower than before treatment(P<0.05).CONCLUSION:HIFU is a safe and effective treatment for patients whowish to have children.It can also improve the fertility of patients with a history of abnormal pregnancy,with no additionalobstetric risks.

Clinical study of radical laparoscopic myomectomy in 31 cases / 中国实用妇科与产科杂志

OBJECTIVE: To study the characteristics and clinical application of radical laparoscopic myomectomy.METHODS: Retrospectively analyze the clinical data of 31 patients with uterine leiomyomas undergoing laparoscopic radical myomectomy at the Department of Obstetrics and Gynecology,the First Affiliated Hospital of Soochow University,from January 2016 to December 2018.The surgical indications,operation time,intraoperative blood loss,postoperative menstrual recovery,postoperative uterine fibroid recurrence rate and postoperative sexual and life quality change indicators were analyzed.RESULTS: All patients were with multiple uterine fibroids(averaged 42.6±3.5 years),and all of them received successful operation.There were no patients who underwent laparotomy or hysterectomy.The postoperative fibroids residual rate among the 31 patients was 3.23%(1 case).The recurrence rate of postoperative uterine fibroids half a year later was 9.68%(3 cases).Five patients has no significant change in postoperative menstruation volume while the other 25 patients had volume reduction(t=8.614,P0.05).Only one patient suffered from hot flashes,night sweating and other menopausal symptoms.WHOQOL-BREF scale was used for patients to assess preoperative and postoperative quality of life,and there were obviously improved psychological and physiological score in patients after operation(P<0.05).CONCLUSION: For women with multiple uterine fibroids who have surgical indications and a strong desire to retain the uterine but have no fertility requirements,radical laparoscopic myomectomy may be the most effective surgical therapy,which can achieve the purpose of surgical treatment,improving the resection rate,and maintaining low postoperative recurrence rate,preserving menstruation and the function of uterus and ovary,and increasing the sexual life quality.

Application of transvaginal natural orifice transluminal endoscopic surgery in gynecological benign diseases / 中国实用妇科与产科杂志

vNOTES is an endoscopic surgery through vaginal access.At present,vNOTES is mainly applied to benign gynecological diseases,and great attention was paid to it because of its advantage of fast recovery,cosmetic results and mild incision pain.This study was the discussion about surgical indication,methods,advantages,problems and surgical techniques in benign gynecological diseases by vNOTES,and the clinical application value and feasibility of vNOTES were also analyzed.

Detection of occult fibroids in myomectomy / 中国实用妇科与产科杂志

Uterine fibroids(leiomyomas or myomas)are extremely common benign neoplasms of the uterus.Myomectomy is a conservative surgical method,including laparotomy,laparoscopy and vaginal surgery and so on.The uterine-sparing intervention may lead to recurrence after surgery.The purpose of this manuscript is to discuss how to detect occult fibroids in myomectomy so as to improve the treatment effect of myomectomy and reduce the risk of recurrence.

Classification of uterine fibroids and strategy of clinical treatment / 中国实用妇科与产科杂志

Uterine fibroid is a common gynecological disease,patients with which would present no symptoms or severe symptoms based on the location and size of focus.According to their relationship with uterine cavity and serosa,uterine fibroids can be classified into several types.In clinical practice,different measures should be taken depending on the type and size of fibroids as well as the age,fertility desire,reproductive function and symptoms of patients.This paper elaborates the classification of uterine fibroids and corresponding strategy of clinical treatments.

Disease burden on uterine fibroids in China, 1990 and 2016 / 中华流行病学杂志

Objective To assess the disease burden on uterine fibroids in China in 1990 and 2016.Methods Data were extracted from the Global Burden of Disease Study 2016.Burdens of uterine fibrosis among different age groups and provinces were measured in 1990 and 2016,with key indicators including number of cases,prevalence rates,disability-adjusted life year (DALY) and the rates of DALY.The WHO world standard population,2010-2035 was used to calculate the agestandardized rates.Results In 1990 and 2016,there were 13 695 567 and 27 169 312 women aged 15 years and older,suffered from uterine fibrosis respectively,with prevalence rate as 2.48％ and 4.10％,DALY as 146 045.05 life years and 281 976.67 life years,and the DALY rate as 26.40/100 000 and 42.50/100 000,in 1990 and 2016 respectively.Both the prevalence rate and the DALY rate increased with age,reaching the peak on the 45-49 years-old,in both 1990 and 2016.Women aged 40-54 years accounted for 55.60％ (1990) and 66.74％ (2016) of the total cases while 48.37％ (1990) and 60.65％ (2016) of the total DALY.The first three provinces with highest DALYs were Shandong (1990:12 574.67 life year;2016:22 728.12 life year),Henan (1990:10 849.29 life year;2016:18 454.32 life year) and Jiangsu (1990:10 501.55 life year;2016:18 274.10 life year),while the three provinces with leading standardized DALY rates were Heilongjiang (1990:48.20/100 000;2016:47.00/100 000),Shanxi (1990:44.50/100 000;2016:47.70/100 000) and Tianjin (1990:43.80/100 000;2016:46.40/100 000) in both 1990 and 2016.Compared with 1990,the number of cases with uterine fibroids increased by 13 473 745 (with rate of change as:98.38％),standardized prevalence rate increased by 1.88％,DALY value increased by 135 931.62 life years (with the rate of change as 93.08％) and standardized DALY rate increased by 5.92％ among Chinese women,in 2016.Conclusion Menopausal women were the ones hard hit by uterine fibrosis.Compared with data from 1990,the disease burden of uterine fibrosis increased rapidly in China,in 2016.

Disease burden on uterine fibroids in China, 1990 and 2016 / 中华流行病学杂志

Objective To assess the disease burden on uterine fibroids in China in 1990 and 2016.Methods Data were extracted from the Global Burden of Disease Study 2016.Burdens of uterine fibrosis among different age groups and provinces were measured in 1990 and 2016,with key indicators including number of cases,prevalence rates,disability-adjusted life year (DALY) and the rates of DALY.The WHO world standard population,2010-2035 was used to calculate the agestandardized rates.Results In 1990 and 2016,there were 13 695 567 and 27 169 312 women aged 15 years and older,suffered from uterine fibrosis respectively,with prevalence rate as 2.48％ and 4.10％,DALY as 146 045.05 life years and 281 976.67 life years,and the DALY rate as 26.40/100 000 and 42.50/100 000,in 1990 and 2016 respectively.Both the prevalence rate and the DALY rate increased with age,reaching the peak on the 45-49 years-old,in both 1990 and 2016.Women aged 40-54 years accounted for 55.60％ (1990) and 66.74％ (2016) of the total cases while 48.37％ (1990) and 60.65％ (2016) of the total DALY.The first three provinces with highest DALYs were Shandong (1990:12 574.67 life year;2016:22 728.12 life year),Henan (1990:10 849.29 life year;2016:18 454.32 life year) and Jiangsu (1990:10 501.55 life year;2016:18 274.10 life year),while the three provinces with leading standardized DALY rates were Heilongjiang (1990:48.20/100 000;2016:47.00/100 000),Shanxi (1990:44.50/100 000;2016:47.70/100 000) and Tianjin (1990:43.80/100 000;2016:46.40/100 000) in both 1990 and 2016.Compared with 1990,the number of cases with uterine fibroids increased by 13 473 745 (with rate of change as:98.38％),standardized prevalence rate increased by 1.88％,DALY value increased by 135 931.62 life years (with the rate of change as 93.08％) and standardized DALY rate increased by 5.92％ among Chinese women,in 2016.Conclusion Menopausal women were the ones hard hit by uterine fibrosis.Compared with data from 1990,the disease burden of uterine fibrosis increased rapidly in China,in 2016.

Quality information about uterine fibroids on the internet / Qualidade da informação presente na Internet sobre Leiomioma uterino

Abstract Objective There are no published studies analyzing the quality of the information for lay women on the Internet regarding uterine fibroids. The accuracy of the provided material is also unknown. Thus, we have performed a cross-sectional study with 381 websites in the English and Brazilian Portuguese languages between May and December 2017. Methods Two investigators performed the analysis, and the Cohen kappa coefficient was calculated to analyze the agreement between them. Search terms (uterine fibroids and derivatives) in the English and Brazilian Portuguese languages were used. The accuracywas analyzed by a 10-itemchecklist created based on the American Society for Reproductive Medicine (ASRM), National Institutes of Health (NIH) and European Menopause and Andropause Society (EMAS) consensuses about uterine fibroids. The item-test correlation and the intraclass coefficient were performed in the 16 questions from the DISCERN instrument, which was designed to measure the quality of health information on the Internet. Analysis of variance (ANOVA) measurements were performed for the independent variables and the DISCERN/accuracy scores. Results Google was the most used search engine, and uterine fibroid was the search term that generatedmost of the analyzed material. The median score for accuracy in all websites was 5 out of 10, and the median score of the DISCERN instrument was 38 out of 80. The top-scoring sites in the English language were derived from scientific organizations and federal governments, and they regarded the DISCERN score (The American College of Obstetricians and Gynecologists [ACOG], the Food and Drug Administration [FDA]) and the accuracy criteria (NIH, and FDA). On the other hand, in the Brazilian Portuguese language, the highest scores in both instruments were from magazines or physician's blogs. The Cronbach α test showed a higher correlation (0.77-0.79) between the sites and DISCERN; however, the item-test correlation varied from 0.39 to 0.56. Conclusion There is a need to improve the quality of the information regarding uterine fibroids for lay women.

Resumo Objetivos Não existem estudos publicados analisando a qualidade de informação para mulheres leigas na internet sobre o leiomioma uterino. A acurácia do material existente também não é conhecida. Portanto, realizamos um estudo transversal envolvendo 381 sites em língua inglesa e portuguesa de maio a dezembro de 2017. Métodos Dois pesquisadores fizeram a análise, e o coeficiente kappa de Cohen foi calculado para analisar a concordância entreambos. Termos de pesquisa (leiomioma uterino e derivados)eminglês e português foramusados. A acurácia foi analisada por meio de uma lista de 10 itens criados após a fusão de consensos da Sociedade Americana de Medicina da Reprodução (ASRM, na siglaeminglês), dos InstitutosNacionais de Saúde (NIH, na siglaem inglês) e da Sociedade Europeia de Menopausa e Andropausa (EMAS, na sigla em inglês) sobre leiomioma uterino. A correlação item-teste e o coeficiente intraclasse foram realizados nas 16 questões do questionário DISCERN, um instrumento desenvolvido para medir a qualidade da informação de saúde disponível na internet. O método de análise de variância (ANOVA, na sigla em inglês) foi utilizado para as variáveis independentes e as pontuações de acurácia e do DISCERN. Resultados O Google foi a ferramenta mais utilizada, e o leiomioma uterino foi o termo de busca que gerou a maior parte do material analisado. A pontuação média para a acurácia dos websites foi 5/10, e do questionário DISCERN, 38/80. Os sites de língua inglesa commaior pontuação foram os de organizações científicas e de governos federais, tanto no questionário DISCERN (Faculdade Americana de Obstetrícia e Ginecologia [ACOG, na sigla em inglês], Administração de Alimentos e Medicamentos [FDA, na sigla em inglês]) quanto na acurácia (NIH e FDA). Entretanto, em língua portuguesa, os sites com as maiores pontuações em ambos os instrumentos foram de revistas ou blogs médicos. O teste α de Cronbach evidenciou maior correlação entre os sites e o DISCERN (0,77-0,79); contudo, a correlação item-teste variou de 0,39 a 0,56. Conclusão Há necessidade demelhorar a qualidade da informação sobre o leiomioma uterino para mulheres leigas.

Efficacy, Efficiency, and Safety of Magnetic Resonance-Guided High-Intensity Focused Ultrasound for Ablation of Uterine Fibroids: Comparison with Ultrasound-Guided Method

OBJECTIVE: The purpose of this study was to compare efficacy, sonication energy efficiency, treatment time and safety of magnetic resonance-guided high-intensity focused ultrasound (MRgHIFU) and those of ultrasound-guided high-intensity focused ultrasound (USgHIFU) for ablation of uterine fibroids. MATERIALS AND METHODS: This study included 43 patients with 44 symptomatic uterine fibroids treated with MRgHIFU and 51 patients with 68 symptomatic uterine fibroids treated with USgHIFU. After therapy, contrast-enhanced MRI was conducted and complete ablation was defined as 100% non-perfused volume (NPV) of fibroids. Patients with completely ablated fibroids were selected for the comparison of the treatment data and sonication parameters between MRgHIFU and USgHIFU treated groups. RESULTS: Thirteen completely ablated fibroids in 10 patients (23.3%, 10/43) were achieved with MRgHIFU and 28 completely ablated fibroids in 22 patients (43.1%, 22/51) were achieved with USgHIFU. In completely ablated fibroids, the energy-efficiency factor (EEF) was 5.1 ± 3.0 J/mm3 and 4.7 ± 2.5 J/mm3 in the MRgHIFU and USgHIFU, respectively (p = 0.165). There was a negative linear correlation between EEF and the NPV of fibroids for MRgHIFU (p = 0.016) and USgHIFU (p = 0.001). The mean treatment time was 174.5 ± 42.2 minutes and 114.4 ± 39.2 minutes in the MRgHIFU and USgHIFU procedures, respectively (p = 0.021). There were no severe adverse events and major complications after treatment. CONCLUSION: MRgHIFU and USgHIFU are safe and effective with the equivalent energy efficiency for complete ablation of fibroids. USgHIFU has shorter treatment time than MRgHIFU.

The application of superb micro-vascular imaging in evaluating the therapeutic efficacy of uterine fibroids treated with high intensity focused ultrasound / 中华超声影像学杂志

Objective To evaluate the value of superb micro-vascular imaging( SMI) in evaluating the efficacy of uterine fibroids treated with high intensity focused ultrasound( HIFU) . Methods Forty patients with single fibroid were selected before and after HIFU treatment ,color Doppler flow imaging(CDFI) ,SMI and contrast-enhanced ultrasound ( CEUS ) pattern were used to detect the lesions . CEUS was used as standard . The correlation of different blood flow levels in the fibroids with SMI and the efficacy of HIFU were evaluated . Results Before HIFU treatment ,the blood flow signals of different degrees were found in the uterine fibroids . SMI showed that 4 fibroids( 10 .0％ ) were in the first degree ,21 fibroids( 52 .5％ ) were in the second degree and 15 fibroids ( 37 .5％ ) were in the third degree . CEUS showed that 8 fibroids ( 20 .0％ ) were hypo-enhanced ,19 fibroids( 47 .5％ ) were iso-enhanced and 13 fobroids(32 .5％ ) were hyper-enhanced . The correlation analysis showed that there was close relationship between the results of SMI and CEUS( Kappa = 0 .754 , P = 0 .00) . After HIFU treatment ,SMI and CEUS had no statistical difference in evaluating the efficacy of HIFU( P > 0 .05) . The ratio of non-perfused volume and the ratio of the volume reduction at 6 months after HIFU in the third degree of SMI were lower than those in the first and second degrees( P < 0 .05) . Conclusions There are some relationships between SMI and CEUS in evaluating the blood flow signal of uterine fibroids . SMI can prompt therapeutic efficacy of uterine fibroids ablated by HIFU and provide some clinical reference values .

Clinical effect of MR-guided high intensity focused ultrasound and gonadotropin releasing hormone agonist combined with levonorgestrel-releasing intrauterine system in the treatment of recurrent uterine fibroids / 中国综合临床

Objective To explore the clinical effects of magnetic resonance guided high intensity focused ultrasound ( MRgHIFU ) and gonadotropin releasing hormone agonist ( GnRH-a ) combined with levonorgestrel-releasing intrauterine system (LNG-IUS) in the treatment of recurrent uterine fibroids. Methods Eighty patients of recurrent uterine fibroids from April 2015 to June2017 in the First Hospital of Harbin were collected and randomly divided into the observation group and control group. MRgHIFU was used in the observation group were employed,and patients in the control group were treated with ING-IUS after first injecting GnRH-a. The tumor volume,hemoglobin level,menstrual quantity and adverse reactions were compared before and at 3 months,6 months after treatment. Results After 6 months,the size of the uterine myoma in the observation group was ((80. 23 ± 4. 35) cm3 ),significantly lower than that of the control group (( 135. 46 ±9. 25) cm3 ),and the difference was statistically significant ( t = 6. 01,P < 0. 05) . At 3 and 6 months after treatment,the amount of menstruation in the observation group was significantly lower than that of the control group( (66. 37 ± 12. 12) points vs. (40. 46 ± 10. 15) points; (98. 42 ± 14. 12) points vs. ( 68. 26 ± 11. 38) points). The difference was statistically significant (t at 3 months after treatment= 4. 52,P<0. 05,t at 6 months after treatment= 3. 53,P<0. 05). After 6 months of treatment,the hemoglobin value of the observation group was significantly higher than that of the control group (( 142. 12 ± 4. 24) g/ L vs. ( 108. 27 ± 3. 09) g/ L), the difference was statistically significant (t= 5. 02,P<0. 05),while the adverse reactions such as vaginal bleeding, hot flashes and night sweats were lower than those of the control group (2. 5% (1/ 40) vs. 7. 5% (3/ 40)) (χ2= 3. 99,P<0. 05). Conclusion Magnetic resonance guided high intensity focused ultrasound was considered as safe and effective in treating uterine fibroids,which is a new and noninvasive therapeutic methed,

The preliminary study of ESWAN in diagnosis of uterine fibroids / 实用放射学杂志

Objective To explore the diagnostic value of ESWAN in uterine fibroids by analyzing the ESWAN signal of uterine fibroid. Methods Conventional MRI and ESWAN were carried out in thirty-seven patients with uterine fibroids.The differences of ESWAN indexes between uterine fibroids and myometrium were analyzed by paired t-test.The value of ESWAN on diagnosing uterine fibroids was analyzed by receiver operating characteristic curve(ROC curve).Results The magnitude value,phase value,R2* value and T2*value of uterine fibroids were 1 661.69 ± 45.24,(0.006 7 ± 0.007 7)Hz,(26.69 ± 1.04)Hz and(34.68 ± 1.73)ms,respectively.The magnitude value,phase value,R2* value and T2* value of myometrium were 1 790.95 ± 49.04,(0.013 1 ± 0.011 8)Hz,(22.35 ± 0.84)Hz and(42.53 ± 2.16)ms.The magnitude value,phase value and T2* value of uterine fibroids were lower than those of myometrium (P=0.008,P=0.659 and P=0.002).While the R2* value of of uterine fibroids was higher than that of myometrium(P=0.001). The area under curve(AUC)of magnitude value,phase value,R2* value and T2* value were 0.604,0.553,0.666 and 0.662.Conclusion ESWAN can show the differences between uterine fibroids and myometrium ，while the ability to independently diagnose uterine fibroids was modest.