Association of gestational hepatitis B virus infection and antiviral therapy with pregnancy outcomes: A retrospective study.

OBJECTIVE: To explore the relationships between gestational hepatitis B virus (HBV) infection, antiviral therapy, and pregnancy outcomes. METHODS: We retrospectively selected hepatitis B surface antigen (HBsAg)-positive pregnant women hospitalized for delivery at Fujian Medical University Affiliated Hospital from October 1, 2016 to October 1, 2020. The control group included randomly selected healthy pregnant women hospitalized for delivery during the same time. RESULTS: Overall, 1115 participants were enrolled and grouped into control (n = 380) and HBsAg-positive groups (n = 735), which were further divided into groups I (n = 407; low viral load), II (n = 207; high viral load without antiviral therapy), and III (n = 121; high viral load with antiviral therapy). Pregnant women with HBV were positively correlated with the incidence of intrahepatic cholestasis of pregnancy (ICP) (adjusted odds ratio [aOR] 5.1, 95% confidence interval [CI] 2.62-9.92, P < 0.001), neonatal jaundice (aOR 10.56, 95% CI 4.49-24.83, P < 0.001), and neonatal asphyxia (aOR 5.03, 95% CI 1.46-17.27, P = 0.01). Aspartate aminotransferase (AST) greater than the upper limit of normal (ULN) was an independent risk factor for increased ICP incidence (aOR 3.49, 95% CI 1.26-9.67, P = 0.019). Antiviral therapy considerably reduced HBV DNA and improved liver function. High viral load and antiviral therapy did not correlate significantly with adverse pregnancy outcomes (P < 0.05). CONCLUSION: Pregnant women with HBV have significantly elevated incidence of ICP, neonatal jaundice, and neonatal asphyxia not significantly correlated with viral load. AST greater than ULN independently increases the risk of ICP. Antiviral therapy effectively reduces viral replication and improves liver function without increasing the risk of adverse outcomes.

Case Report: Intravesical and extravesical urachal cyst in children with lower abdominal pain and hematuria.

Bladder urachal cysts in children are a rare form of urachal abnormality. In this paper, we present a case of atypical imaging that presented with lower abdominal pain accompanied by hematuria, resulting in the formation of both internal and external urachal cysts in a child. A 6-year-old male child presented with repeated abdominal pain over a span of 4 days. Color ultrasound and pelvic CT scans revealed a soft tissue lesion on the right anterior wall of the bladder with an unclear boundary from the bladder wall. Voiding Cystourethrography (VCUG) showed no significant abnormalities in the bladder, while routine urine testing was positive for hematuria. A cystoscopy was simultaneously performed with a laparoscopic resection of the urachal cyst. Intraoperative cystoscopy identified the intravesical lesion, which was precisely removed using a cystoscope-assisted laparoscopy. Postoperative pathology confirmed that both extravesical and intravesical lesions were consistent with a urachal cyst. No complications were observed after the operation, and no recurrence was noted during a six-month follow-up. Therefore, for urachal cysts at the bladder's end, the possibility of intravesical urachal cysts should not be excluded, especially in patients with microscopic hematuria. We recommend performing cystoscopy simultaneously with laparoscopic urachal cyst removal to avoid missing intravesical lesions.

Development and Validation of a Nomogram for Predicting the Severity of the First Episode of Hyperlipidemic Acute Pancreatitis.

Purpose: Early detection of hyperlipidemic acute pancreatitis (HLAP) with exacerbation tendency is crucial for clinical decision-making and improving prognosis. The aim of this study was to establish a reliable model for the early prediction of HLAP severity. Patients and Methods: A total of 225 patients with first-episode HLAP who were admitted to Fujian Medical University Union Hospital from June 2012 to June 2023 were included. Patients were divided into mild acute pancreatitis (MAP) or moderate-severe acute pancreatitis and severe acute pancreatitis (MSAP+SAP) groups. Independent predictors for progression to MSAP or SAP were identified through univariate analysis and least absolute shrinkage and selection operator regression. A nomogram was established through multivariate logistic regression analysis to predict this progression. The calibration, receiver operating characteristic(ROC), and clinical decision curves were employed to evaluate the model's consistency, differentiation, and clinical applicability. Clinical data of 93 patients with first-episode HLAP who were admitted to the First Affiliated Hospital of Fujian Medical University from October 2015 to October 2022 were collected for external validation. Results: White blood cell count, lactate dehydrogenase, albumin, serum creatinine, serum calcium, D-Dimer were identified as independent predictors for progression to MSAP or SAP in patients with HLAP and used to establish a predictive nomogram. The internally verified Harrell consistency index (C-index) was 0.908 (95% CI 0.867-0.948) and the externally verified C-index was 0.950 (95% CI 0.910-0.990). The calibration, ROC, and clinical decision curves showed this nomogram's good predictive ability. Conclusion: We have established a nomogram that can help identify HLAP patients who are likely to develop MSAP or SAP at an early stage, with high discrimination and accuracy.

Association between hepatitis B virus replication during pregnancy and perinatal outcomes: a retrospective cohort study.

BACKGROUND: The effect of hepatitis B virus (HBV) replication during pregnancy on the outcomes of pregnancies remains to be elucidated. OBJECTIVES: This study aimed to investigate the association between HBV replication and adverse maternal and infant outcomes. METHODS: We retrospectively analysed the clinical data of 836 pregnant inpatients with hepatitis B surface antigen positivity who delivered at two provincial tertiary grade A hospitals in the Fujian province between June 2016 and October 2020. RESULTS: The incidence of intrahepatic cholestasis of pregnancy, hypertensive syndrome complicating pregnancy, gestational diabetes mellitus, preterm birth, macrosomia, growth restriction, and vaginal infections did not differ in the HBV replication and non-replication groups (p > 0.05); however, the rates of caesarean section (p = 0.017; OR, 1.423; 95% CI, 1.065-1.902) and neonatal jaundice (p < 0.001; OR, 2.361; 95% CI, 1.498-3.721) were higher in the replication group than that in the non-replication group. After using propensity score analysis to adjust for alanine transaminase and aspartate aminotransferase levels in both groups, the replication group was still found to have an increased risk for caesarean section (p < 0.001; OR, 2.367; 95% CI, 1.668-3.359) and their infants had higher rates of neonatal jaundice (p < 0.001; OR, 12.605; 95% CI, 4.456-35.656). CONCLUSIONS: Our findings contribute to a better understanding of the association between maternal HBV replication status and perinatal outcomes. Pregnant women with HBV replication face an increased risk of caesarean section, and their infants appear to have a higher risk for neonatal jaundice.

Application of clitoris exposure + episioplasty + dermabrasion + platelet-rich plasma injection + chemexfoliation in vulvar lichen sclerosus.

Introduction: To investigate the therapeutic effect of clitoris exposure + episioplasty + dermabrasion + platelet-rich plasma (PRP) injection + chemexfoliation on vulvar lichen sclerosus (VLS). Methods: Twenty children with VLS (under 14 years old) at our hospital from July 2020 to November 2022 were enrolled and treated with clitoris exposure + episioplasty + dermabrasion + PRP injection + chemexfoliation. Additionally, symptomatic changes and improvements in signs were recorded. Results: Significant therapeutic effects were achieved in all children enrolled in this study. The Cattanco score was 8.02 ± 1.22 points before surgery, 2.21 ± 0.70 points 3 months after surgery, and 2.61 ± 0.59 points 6 months after surgery, demonstrating that the score after surgery was significantly lower than that before surgery (p < 0.05). Mild complications (one case of mild vulvar swelling, one case of minor bleeding, and one case of superficial ulcer) were observed in three children after surgery, with an overall complication incidence of 15%; all complications were improved after the intervention, and no severe adverse reactions were observed. Recurrence was observed in one child (5%) 6 months after surgery. Conclusion: Clitoris exposure + episioplasty + dermabrasion + PRP injection + chemexfoliation is an effective approach for the treatment of VLS. Systematic Review Registration: https://www.chictr.org.cn/searchproj.html, identifier: ChiCTR2100054787.

Comparative study of different surgical approaches for treatment of UPJ obstruction according to the degree/severity of hydronephrosis factor.

Objective: To compare the efficacy of two different surgical approaches during and after pyeloplasty according to the degree/severity of hydronephrosis factor. Materials and methods: Sixty child patients with UPJ obstruction admitted to our hospital from August 2019 to October 2021 were collected. Patients who underwent retroperitoneal laparoscopic pyeloplasty (RPLP) were enrolled into Group A (n = 20), while those who received transperitoneal laparoscopic pyeloplasty (TLP) were selected as Group B (n = 40). Clinical parameters, including gender, age, laterality of UPJ obstruction, degree/severity of hydronephrosis, body weight, operation time, drainage tube indwelling time, complete oral feeding time, and length of hospital stay, were compared between the two groups. Results: All 60 child patients were operated upon successfully without conversion to open surgery. There were no statistically significant differences in gender, age, laterality of UPJ obstruction, and body weight between the two groups, while the operation time of TLP was shorter than that of RPLP, indicating a statistically significant difference (P < 0.001). The differences in complete oral feeding time, drainage tube indwelling time, and length of hospital stay were statistically significant between the two groups, and RPLP was superior to TLP in terms of postoperative recovery time (P < 0.001). A stratified comparison showed that there were no statistically significant differences in anteroposterior diameter ≤ 20 mm, while there were statistically significant differences in anteroposterior diameter >20 mm. Hydronephrosis is reviewed after 3 months of the operation, degree/severity of hydronephrosis have been reduced. Conclusion: Both RPLP and TLP are safe and feasible in the treatment of UPJ obstruction, and their overall surgical effects are equivalent. For child patients with anteroposterior diameter ≤ 20 mm, RPLP is available, while patients with anteroposterior diameter >20 mm, TLP is recommended.

Effects of unilateral/bilateral amputation of the ischiocavernosus muscle in male rats on erectile function and conception.

BACKGROUND: The ischiocavernosus muscle (ICM) encompasses a pair of short pinnate muscles attached to the pelvic ring. The ICM begins at the ischial tuberosity and ends at the crus of the penis while covering the surface of the crus. According to the traditional view, the contraction of the ICM plays an auxiliary role in penile erection. However, we have previously shown that the ICM plays an important role in penile erection through an indirect method of diagnosing erectile dysfunction (ED) caused by ICM injury by observing the infertility of paired female rats. Since intracavernosal pressure (ICP) is the current gold standard for diagnosing ED, this study aimed to amputate unilaterally/bilaterally the ICM to establish an ED model by detecting the ICP, recording the infertility of matching female rats, and comparing the two methods. RESULTS: Forty sexually mature adult male rats were selected and randomly divided into the following groups: the control group (n = 10), sham operation group (n = 10), unilateral ischiocavernosus muscle (Uni-ICM) amputation group (n = 10), and bilateral ischiocavernosus muscle (Bi-ICM) amputation group (n = 10). Eighty female reproductive rats were randomly assigned to the above groups at a ratio of 2:1. We evaluated the time to conception for the paired female rats and the effects of unilateral/bilateral severing of the ICM on erectile function. The results showed that the baseline and maximum intracavernosal pressure (ICP) in the control group, sham operation group, Uni-ICM amputation group, and Bi-ICM amputation group were 17.44±2.50 mmHg and 93.51±10.78 mmHg, 17.81±2.81 mmHg and 95.07±10.40 mmHg, 16.73±2.11 mmHg and 83.49±12.38 mmHg, and 14.78±2.78 mmHg and 33.57±6.72 mmHg, respectively, immediately postsurgery. The max ICP in the Bi-ICM amputation group was lower than that in the remaining three groups (all P<0.05). The pregnancy rates were 100, 100, 90, and 0% in the control group, sham operation group, Uni-ICM amputation group, and the Bi-ICM amputation group, respectively. The pregnancy rate in the Bi-ICM amputation group was significantly lower than that in the remaining groups (all P<0.05). The time to conception was approximately 7-10 days later in the Uni-ICM amputation group than in the control and sham groups (all P<0.05). CONCLUSIONS: Male rats undergoing Bi-ICM amputation may develop permanent ED, which affects their fertility. In contrast, rats undergoing Uni-ICM amputation may experience transient ED.

RéSUMé: INTRODUCTION: Le muscle Ischiocavernosus (MIC) est une paire de muscles courts attachés à l'anneau pelvien. Elle commence à la tubérosité ischiale et se termine au crus du pénis tout en couvrant la surface de ce dernier. Selon la vision traditionnelle, la contraction du MIC joue un rôle auxiliaire dans l'érection pénienne. Cependant, nos travaux précédents ont montré qu'il joue un rôle important dans l'érection pénienne par une méthode indirecte de diagnostic de la dysfonction érectile (DE) induite par une blessure du MIC en observant l'infertilité des rats femelles appariés. Comme la pression intracaverneuse (PIC) est actuellement l'étalon de référence pour le diagnostic, cette étude visait à amputer unilatéralement/bilatéralement l'ICM pour établir un modèle de DE par détection de l'ICP, par détection de l'infertilité de rats femelles appariés, et par comparaison des deux méthodes. RéSULTATS: Quarante rats mâles adultes sexuellement matures ont été sélectionnés et répartis aléatoirement dansquatre groupes groupe témoin (n = 10), groupe d'opération simulée (n = 10), groupe d'amputation unilatérale du MIC (Uni-MIC) (n = 10), et groupe d'amputation bilatérale du MIC (Bi-MIC) (n = 10). Quatre-vingts rats femelles en période de reproduction ont été réparties de façon aléatoire dans chacun des groupes mentionnés ci-dessus, selon un rapport de 2:1. Nous avons évalué le temps avant la conception des rats femelles appariés et les effets de l'amputation Uni /Bi-MIC sur la fonction érectile. Les résultats ont montré que la pression de base et la PIC maximale dans le groupe témoin, le groupe d'opération simulée, le groupe Uni-MIC et le groupe Bi-MIC étaient respectivement de 17.44 ± 2.50 mmHg et 93.51 ± 10.78 mmHg, 17.81 ± 2.81 mmHg et 95.07 ± 10.40 mmHg, 16.73 ± 2.11 mmHg et 83.49 ± 12.38 mmHg, et 14.78 ± 2.78 mmHg et 33.57 ± 6.72 mmHg, immédiatement après l'opération. La PIC maximale dans le groupe Bi-MIC était inférieure à celles des trois autres groupes (tous P < 0.05). Les taux de grossesse étaient de 90% dans le groupe Uni-MIC et de 0% dans le groupe Bi-MIC. Le taux de grossesse dans le groupe Bi-MIC était significativement plus faible que dans les autres groupes (tous P < 0.05). Le temps de conception a été d'environ 7 à 10 jours plus tard dans le groupe Uni-MIC que dans le groupe témoin et le groupe d'opération simulée (tous P < 0.05). CONCLUSIONS: Les rats mâles subissant une amputation Bi-MIC peuvent développer une DE permanente qui affecte leur fertilité. En revanche, ceux qui subissent une amputation Uni-MIC peuvent connaître des troubles érectiles transitoires.

Clinical Efficacy of Prodom-Assisted Urokinase in the Treatment of Male Infertility Caused by Impaired Semen Liquefaction.

PURPOSE: To evaluate the clinical efficacy of prodom in the administration of urokinase in the vagina in couples with impaired semen liquefaction. MATERIALS AND METHODS: Overall, 261 patients with impaired semen liquefaction were randomly divided into prodom-assisted urokinase treatment (PAUT) group (n = 91), syringe-assisted urokinase treatment (SAUT) group (n = 86), and traditional treatment (TT) group (n = 84) in the first stage. If the first stage of treatment failed, other treatment methods were initiated instead and the patients were grouped according to the newer treatment method in the second stage. The pregnancy rate, time-to-conception, and treatment costs were evaluated in each group. RESULTS: In the first stage, the pregnancy rate in the PAUT, SAUT, and TT groups was 69.23%, 29.07%, and 22.62%, respectively; the time-to-conception was 2.66 ± 1.44, 3.69 ± 2.61, and 3.86 ± 3.00 months, respectively; the treatment costs were 658.18 ± 398.40, 666.67 ± 507.50, and 680.56 ± 480.94 $, respectively. The pregnancy rate and time-to-conception were different in the PAUT group compared with those in SAUT and TT groups (all P < 0.05). However, the difference in treatment costs was not significant (P = 0.717). In the second stage, 154 nonpregnant patients were divided into nine treatment groups, and the effects of changing TT to PAUT on the pregnancy rate, time-to-conception, and treatment costs were observed to be different from those of other treatments (all P < 0.05). CONCLUSION: Prodom-assisted urokinase can effectively treat male infertility secondary to impaired semen liquefaction.

A correlation study of ischiocavernosus muscle injury with different types of pelvic fractures and erectile dysfunction after pelvic fracture.

OBJECTIVE: To explore the correlation between ischiocavernosus muscle injury (ICMI) with different types of pelvic fractures and erectile dysfunction (ED) after pelvic fracture. DESIGN: Retrospective analysis of a prospective database. SETTING: The study was carried out at the affiliated hospital of Zunyi Medical University. PATIENTS/PARTICIPANTS: A total of 776 male patients with pelvic fracture, aged 18 to 67 years, were recruited for this study by retrospective analysis, and based on the diagnosis of ED and the presence of ICMI, the participants were divided into ED and non-ED groups as well as ICMI and non-ICMI groups. INTERVENTION: No. MAIN OUTCOME MEASUREMENTS: ICMI, the type of pelvic fracture, International Index of Erectile Function-5 scores. Computed tomography/magnetic resonance imaging scans, electromyography (motor unit potential) was used to diagnose ICMI. RESULTS: The International Index of Erectile Function-5 score was 19.7 ±â€Š5.9. The incidence of ED was 27.3%, the duration time of ED was 30 ±â€Š23 months, and the incidence of reversible ED was 39.6% and of irreversible ED was 60.4%. The incidence of ICMI was 29.4%, among which the incidence of unilateral injury was 57.9%, and the incidence of bilateral injury was 42.1%. Among all pelvic fractures, the incidence of pubic ramus fracture was 88.1%. Bilateral pubic ramus fractures, bilateral fractures of the ischial ramus, and ICMI were independent risk factors for ED after pelvic fracture. Bilateral pubic ramus fractures and pubic symphysis separation were independent risk factors for ICMI. Unilateral ICMI was an independent risk factor for reversible ED, while bilateral ICMI was an independent risk factor for irreversible ED. CONCLUSIONS: ICMI is associated with ED and may be a cause for ED, while pubic ramus fracture, ischial ramus fracture, and pubic symphysis separation may be the main causes of ICMI. Unilateral ICMI may be the main risk factor for transient ED, and bilateral ICMI may be the main risk factor for permanent ED.