Transvaginal natural orifice transluminal endoscopic surgery for myomectomy: A more suitable surgical approach for enhanced recovery after surgery.

OBJECTIVE: Vaginal natural orifice transluminal endoscopic surgery (vNOTES) is widely recognized for its potential benefits, including reducing post-surgical pain and leaving no discernible scarring. However, the anatomical specificity of the vNOTES approach may elevate the risk of nearby organ damage, such as the rectum and bladder. Thus, this study aims to demonstrate the safety and relative merits of vNOTES over transumbilical laparoendoscopic single-site surgery (LESS). METHODS: The Longitudinal Vaginal Natural Orifice Transluminal Endoscopic Surgery Study (LovNOTESS), which was conducted in Chengdu, China. A total of 110 patients who underwent myomectomy in vNOTES or LESS from January 2021 to December 2022. This study prospectively collected and compared perioperative and follow-up data of the two groups. RESULTS: In the vNOTES group, patients had shorter postoperative anal exhaust time, lower pain medications use rate, shorter hospital stay but higher intraoperative conversion rate, and higher postoperative fever rate. vNOTES decreased the anal exhaust time by approximately 8.7 h (95 %CI: -16.182, -1.262, p = 0.007). Moreover, vNOTES reduces pain medication use risk by 73.1 % (OR: 0.269, 95 %CI: 0.172, 0.318, p = 0.016). CONCLUSION: Relative to LESS, vNOTES can make patients mitigate postoperative discomfort, accelerate the recovery of gastrointestinal function, curtail hospitalization duration, and enable a more rapid return to daily activities in myomectomy. However, vNOTES has a higher risk of surgical conversion and adjacent organ injury. Therefore, larger scale prospective studies are needed to prove its security and promote the widespread application of vNOTES in myomectomy.

Low-dose aspirin might alleviate the symptoms of preeclampsia by increasing the expression of antioxidative enzymes.

Preeclampsia (PE) is a pregnancy-related syndrome that is characterized by new onset of hypertension combined with proteinuria or end-organ dysfunction occurring after 20 weeks of pregnancy. Endothelial dysfunction is also commonly observed in patients with PE. PE remains a leading cause of maternal morbidity and mortality, resulting in ~76,000 maternal and 500,000 fetus and newborn deaths worldwide annually. The present study aimed to investigate the protective effect of aspirin in patients with PE. A PE model was established in C57/BL mice, followed by the detection of expression levels of antioxidative enzymes, including superoxide dismutase 1, catalase, periaxin and thioredoxin and AKT/mTOR signaling pathway-related proteins by performing western blotting. The concentration of these enzymes in serum samples from PE model mice was also assessed. Compared with the negative control group, the expression of these antioxidative enzymes was decreased in PE model mice (P<0.05). High-dose aspirin treatment enhanced PE-induced effects, whereas low-dose aspirin treatment partially reversed PE-induced effects (P<0.05). Moreover, the results indicated that the effects of aspirin treatment on PE might be mediated via the AKT/mTOR signaling pathway. Therefore, low-dose aspirin administration may serve as a therapeutic strategy for PE.

The effectiveness of prophylactic internal iliac artery balloon occlusion in the treatment of patients with pernicious placenta previa coexisting with placenta accreta.

Aim: This study aimed to explore the therapeutic effectiveness of prophylactic internal iliac artery balloon occlusion (IIABO) during cesarean delivery in the management of patients with pernicious placenta previa (PPP) coexisting with placenta accreta (PA).Methods: This retrospectively study enrolled 83 patients diagnosed with PPP coexisting with PA in our hospital between January 2014 and December 2017. The patients were divided into the study group (n = 58, receiving routine cesarean section followed prophylactic IIABO) and control group (n = 25, receiving routine cesarean section alone). The general situation, intraoperative conditions, maternal and neonatal outcomes, and postoperative complications between the two groups were compared.Results: The two groups were comparable due to no significant difference in the general situation of patients. The intraoperative conditions, such as intraoperative and postoperative blood loss, transfusion volume and the incidence rate of transfusion in the study group were significantly lower than those in the control group, but the incidence rate of disseminated intravascular coagulation and hysterectomy did not exhibit significant differences. Moreover, maternal and neonatal outcomes were not significantly different. Besides, in the study group, a patient with left foot numbness appeared left popliteal artery thrombosis and four patients experienced fever of <38.5 °C and lower abdominal pain. In the control group, a patient underwent hysterectomy.Conclusions: Prophylactic IIABO is an alternative method to control postpartum hemorrhage in the treatment of PPP coexisting with PA. However, it may not decrease the incidence of hysterectomy.

Predictors of adverse perinatal outcomes in intrahepatic cholestasis of pregnancy with dichorionic diamniotic twin pregnancies.

OBJECTIVE: The aim of our study was to investigate the predictors of adverse perinatal outcomes in intrahepatic cholestasis of pregnancy (ICP) with dichorionic diamniotic (DCDA) twin pregnancies. METHODS: This study was a retrospective study of women diagnosed with ICP and DCDA twin pregnancies in Chengdu's women and children's central hospital. These patients were subdivided into mild and severe ICP groups according to total bile acid (TBA) level. The clinical characteristics and perinatal outcomes were collected and compared between the two groups. Logistic regression analysis was developed to evaluate predictors of adverse perinatal outcomes. RESULTS: About 134 cases were included in the study. Eighty-four cases were in the mild ICP group, and the other 50 cases were in the severe ICP group. Level of alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), total bilirubin (TBIL), and direct bilirubin (DBIL) in the severe ICP group were significant higher than those in the mild ICP group. The rate of delivery before 34 gestational weeks, meconium-stained amniotic fluid, and composite adverse neonatal outcome were higher in the severe ICP group than those in the mild ICP group. After adjusting for confounders, ICP onset gestational age (GA) <30 weeks and AST >200U/l were associated with GA at delivery <34 weeks. ALP >400U/l was an independent risk factor of meconium-stained amniotic fluid. ICP onset GA <30 weeks was an independent risk factor of composite adverse neonatal outcome. CONCLUSION: ICP onset GA <30 weeks, TBA >40 µmol/l, AST >200U/l, and ALP >400U/l were associated with composite adverse perinatal outcomes in ICP with DCDA twin pregnancies. For those patients with these characteristics, fetal surveillance and treatment should be enhanced.

Antibacterial mechanism of high-mobility group nucleosomal-binding domain 2 on the Gram-negative bacteria Escherichia coli.

OBJECTIVE: To investigate the antibacterial mechanism of high-mobility group nucleosomal-binding domain 2 (HMGN2) on Escherichia coli K12, focusing on the antibacterial and antibiofilm formation effects. Its chemotactic activity on human neutrophils was also investigated. METHODS: Human tissue-derived HMGN2 (tHMGN2) was extracted from fresh uterus fiber cystadenoma and purified by HP1100 reversed-phase high-performance liquid chromatography (RP-HPLC). Recombinant human HMGN2 (rHMGN2) was generated in E. coli DE3 carrying PET-32a-c(+)-HMGN2. Antibacterial activity of HMGN2 was determined using an agarose diffusion assay and minimum inhibitory concentration (MIC) of HMGN2 was determined by the microdilution broth method. Bacterial membrane permeability assay and DNA binding assay were performed. The antibiofilm effect of HMGN2 was investigated using a crystal violet assay and electron microscopy scanning. The activating effect and chemotactic activity of HMGN2 on neutrophils were determined using a nitroblue tetrazolium (NBT) reduction assay and Transwell chamber cell migration assay, respectively. RESULTS: HMGN2 showed a relatively high potency against Gram-negative bacteria E. coli and the MIC of HMGN2 was 16.25 µg/ml. Elevated bacterial membrane permeability was observed in HMGN2-treated E. coli K12. HMGN2 could also bind the bacterial plasmid and genomic DNA in a dose-dependent manner. The antibiofilm effect of HMGN2 on E. coli K12 was confirmed by crystal violet staining and scanning electron microscopy. However, the activating effects and chemotactic effects of HMGN2 on human neutrophils were not observed. CONCLUSIONS: As an antimicrobial peptide (AMP), HMGN2 possessed a good capacity for antibacterial and antibiofilm activities on E. coli K12. This capacity might be associated with disruption of the bacterial membrane and combination of DNA, which might affect the growth and viability of E. coli.

[Study on antimicrobial activity of human hemoglobin and its fragments both in vitro and in vivo].

OBJECTIVE: To isolate human hemoglobin and its fragrments, compare their antimicrobial activity in vitro and pilot study of their antimicrobial activity in vivo. METHODS: The alpha and beta chains of hemoglobin were separated by cation exchange chromatography and gel chromatography; The alpha and beta chains were cleaved by cyanogens bromide respectively. The cleaved fragments were purified by reverse phase high performance liquid chromatography. Antimicrobial activity of hemoglobin and its fragments was determined by agrose radial diffusion assay. After establishment of E. coli vaginal infection model, the rats were randomized into the experimental group (hemoglobin group) and the control group. The histologically pathological section was observed. RESULTS: Hemoglobin, alpha/beta chain and their fragments had similar antibacterial activities in vitro, which were mainly against Gram-negative bacteria E. coli; except alpha1-32 had a comparatively lower activity. Antimicrobial activity in vivo: a comparison of the hemoglobin group with the matrix control group (no treatment after infection), the surface layer of vaginal stratified squamous epithelium was smoother, inflammatory cells were significantly reduced in the lamina propria and congestion was obviously decreased. CONCLUSION: Human hemoglobin and its fragments had antibacterial activity in vitro, hemoglobin might relieve the inflammation of E. coil vaginal infection in rats moreover.