Study Objective: To evaluate the imaging characteristics and healing following application of an absorbable biocompatible hydrogel into the excision cavity following breast conservation surgery. Design: Non-randomized...Study Objective: To evaluate the imaging characteristics and healing following application of an absorbable biocompatible hydrogel into the excision cavity following breast conservation surgery. Design: Non-randomized study evaluating hydrogel application feasibility, post-operative hydrogel imaging characteristics, cavity healing following hydrogel absorption and the resulting breast cosmesis. Setting: Teaching hospital University of Essen, Germany. Patients: Seven (7) patients underwent unilateral or bilateral breast conservation surgery to remove cancerous or benign tumors. Interventions: All patients received hydrogel application following primary tumor excision. Imaging performed in the first postoperative week included ultrasound, MRI and CT. Breast cosmesis scores were obtained at one and three months following surgery. Measurements and Main Results: While preliminary, a relationship between percent cavity filling and drainage was observed, with 30% or more cavity filling resulting in decreased drainage. Additionally, the hydrogel was readily visible under ultrasound, MRI and CT imaging modalities. Finally, patients were satisfied and surgeons felt that patient cosmesis was improved relative to their prior experience. Conclusion: Initial data suggest that hydrogel filling may reduce excision cavity drainage, which may reduce seroma or hematoma formation. Additionally, these gels may improve cavity visibility and stability, furthering the use of partial breast irradiation. Finally, while more studies are required, these materials may have a role in improving long term patient cosmesis.展开更多
Objective: To evaluate the associations of gestational diabetes (GDM) history with dietary intake, nutritional status, insulin resistance, demographic, and anthropometrical data. Materials & Methods: This cross-se...Objective: To evaluate the associations of gestational diabetes (GDM) history with dietary intake, nutritional status, insulin resistance, demographic, and anthropometrical data. Materials & Methods: This cross-sectional study used data from the National Health and Nutrition Examination Survey for the years 2000-2010. Data analysis was based on 290 women who reported a history of GDM compared to 4239 women who denied a GDM history. Insulin resistance [HOMA_IR = (fasting insulin in mU/mL × fasting glucose in mmol/L)/405] was calculated. Pearson correlation, Wilcoxon rank sum tests, Student’s t-tests, and chi-square analysis were used while linear regression assessed independent associations. Results: The median time-lapse from the diagnosis of GDM was 15 years. Women with a GDM history had significantly higher body mass index (BMI), other anthropometric measurements, diastolic blood pressures and insulin resistance. They were also more likely to be Hispanic, have delivered macrosomic infants, and delivered via cesarean. Previous GDM history compared to non-GDM subjects had significantly higher dietary intakes of energy calories, protein, total fat, saturated fatty acids, mono-saturated fatty acids, and cholesterol. Within the entire cohort, increasing insulin resistance was also associated with lower income, less college education, Hispanic or African American ethnicity, obesity, higher systolic and diastolic blood pressures, and with higher dietary cholesterol but lower intake of dietary fiber and micronutrients. Regression analyses showed that GDM history, Hispanic ethnicity, BMI, dietary intake of cholesterol and decreasing income were independently predictive of insulin resistance. Conclusion: The data confirm that even many years after a pregnancy associated with GDM, women with a history of GDM still report significantly higher dietary intakes of energy calories, protein, and fat with no corresponding increase in consumption of dietary fiber or minerals and vitamins. Consequently, the increased calorie and food consumption of women with previous GDM are associated with obesity, insulin resistance and higher blood pressures. These observations may suggest the need to target high-risk groups who may need more resources and awareness of the benefits of quality nutrition.展开更多
The Loeys-Dietz syndrome (LDS) is a connective tissue disorder that is associated with vascular abnormalities, including aggressive aortic aneurysms, as well as skeletal and craniofacial malformations. The molecular m...The Loeys-Dietz syndrome (LDS) is a connective tissue disorder that is associated with vascular abnormalities, including aggressive aortic aneurysms, as well as skeletal and craniofacial malformations. The molecular mechanism of this syndrome remains to be fully elucidated. In this case, we describe a 29-year-old woman, gravida 2 para 1, who was referred for consultation after urinary tract malformations were observed during her mid-gestation anatomic survey. Following referral to our unit, ultrasound examination of the 21-week fetus was repeated. The fetus was observed to have a dilated aortic root and a poorly ossified sternum with mild pectus deformity. After elective termination, single nucleotide polymorphism microarray testing identified a novel 204 kb microdeletion involving the short arm of chromosome 3. The deleted genetic material included 4 exons of the TGFBR2 gene. Although the phenotype of LDS may be caused by haploinsufficiency of the TGFBR1 or TGFBR2 gene, our experience suggests a more complex picture of LDS. The study of such cases might further elucidate its pathogenesis.展开更多
Objective This study identifies preoperative risk factors associated with blood transfusion in women undergoing surgery for ectopic pregnancy.A retrospective chart review of 252 cases was performed at a single academi...Objective This study identifies preoperative risk factors associated with blood transfusion in women undergoing surgery for ectopic pregnancy.A retrospective chart review of 252 cases was performed at a single academic-affiliated community hospital system between January 2014 and October 2017.Univariate analysis was performed using non-parametric testing where appropriate,and significant variables were incorporated in multivariate modelling.Methods In this cohort of 252women,the overall transfusion rate was 8.7%(n=22).Increasing age(OR 1.12,95%CI 1.03 to 1.22),lower systolic blood pressure(SBP)on presentation(OR 0.96,95%CI 0.93 to 1.00),lower minimum systolic and diastolic blood pressure(DBP)(OR 0.92,95%CI 0.89 to 1.95 and OR 0.9,95%CI 0.84 to 0.93)and lower preoperative haemoglobin(g/L)(OR 0.46,95%CI 0.33 to 0.62)were associated with higher rates of blood transfusion.Women who had prior care in their current pregnancy and women treated in a women’s specific emergency room(compared with a general emergency room)were less likely to be transfused(OR 0.16,95%CI 0.05 to 0.51 and OR 0.09,95%CI 0.03 to 0.30,respectively).Our study used a model in which variance in transfusion can reliably be explained by location of presentation to care,pain alone as a presenting complaint and haemoglobin level(Area under the curve(AUC)=0.87).Conclusion History of caesarean section and a presenting complaint of pain alone are newly identified indicators for women at higher risk of transfusion at the time of surgical management of ectopic pregnancy.Additionally,care provided in women’s specific emergency rooms may decrease the risk of blood transfusion in this population.展开更多
Background:Polycystic ovary syndrome(PCOS)is the leading cause of anovulatory infertility.Clomiphene citrate,insulin-sensitizing drugs,aromatase inhibitors,gonadotropins,or laparoscopic ovarian drilling are various me...Background:Polycystic ovary syndrome(PCOS)is the leading cause of anovulatory infertility.Clomiphene citrate,insulin-sensitizing drugs,aromatase inhibitors,gonadotropins,or laparoscopic ovarian drilling are various methods used for ovulation induction in women with PCOS.PCOS women with high levels of anti-mullerian hormone(AMH)and free androgen index(FAI)do not respond well to ovulation induction.This prospective observational study explores the relationship between FAI and AMH levels on ovarian response to clomiphene citrate in infertile women with PCOS.Methods:This prospective observational study included 40 infertile with PCOS who underwent ovulation induction with clomiphene citrate with dose ranging from 50 to 150 mg.Participants were classified into four phenotypes by NIH(National Institute of Health)consensus panel criteria.The clinical and endocrine parameters of participants who were sensitive to clomiphene were compared to those who were resistant.Results:The most common phenotype was A,with all three features of PCOS:hyperandrogenism,ovulatory dysfunction,and polycystic ovarian morphology.There was no significant difference in clinical and endocrine parameters among the different phenotypes of PCOS except AMH and FAI values.The mean FAI was 9.391.11 and AMH 7.260.48(ng/ml)in clomiphene resistant and 5.311.93 and 3.691.84(ng/ml)respectively in clomiphene-sensitive women.Women with FAI>7.5 and AMH>7 ng/ml might be resistant to clomiphene.Conclusion:FAI and AMH values were significantly higher in women resistant to clomiphene induction.AMH and FAI may help women with PCOS to tailor their ovulation induction protocol.展开更多
Bartter syndrome is a group of autosomal recessive renal tubular disorders;it has two types of presentation:antenatal and classic.The antenatal type presents as severe unexplained polyhydramnios in the second trimeste...Bartter syndrome is a group of autosomal recessive renal tubular disorders;it has two types of presentation:antenatal and classic.The antenatal type presents as severe unexplained polyhydramnios in the second trimester.This is due to fetal urinary losses of sodium,chloride,and potassium,leading to fetal polyuria.The classic type presents in the late neonatal or infancy stage,with dehydration,dyselectrolytemia,failure to thrive,and nephrocalcinosis.Antenatal scans are normal in such cases.Type I and II Bartter syndrome presents in the antenatal period,whereas type IV has a classic presentation.We describe an unusual case of type IVa Bartter syndrome presenting in the antenatal period,with severe polyhydramnios.The initial diagnosis was made based on amniotic fluid chloride levels and later confirmed by performing a genetic test.Genetic testing is important for confirming diagnosis and prognostication regarding the condition.展开更多
Urinary incontinence(UI)is a disease that quietly yet seriously impacts women's health and represents a global health burden that is often neglected.This study aims to systematically assess the prevalence and dyna...Urinary incontinence(UI)is a disease that quietly yet seriously impacts women's health and represents a global health burden that is often neglected.This study aims to systematically assess the prevalence and dynamics of female UI in China,and can inform further policies and have international implications.This study used three nationwide investigations:A national cross-sectional survey in 2021;another nationwide cross-sectional survey in 2006;and data regarding the institutions and physicians providing pelvic floor rehabilitation services from 2005 to 2019.The weighted prevalence of female UI and its subtypes,including stress UI(SUI),urgency UI(UUI),and mixed UI(MUI),were estimated as primary outcomes.Knowledge,attitude and care-seeking behaviors of UI were evaluated.It was found that the weighted prevalence of female UI was 16.0%(95%CI,13.3%–19.1%)with SUI remaining the predominant subtype(7.0%)in 2021,followed by MUI(6.5%)and UUI(1.9%).The estimated absolute number of Chinese adult women with UI was 85.8 million in 2021.52.7%(95%CI,45.9%–59.4%)of women were aware that UI was a medical condition,and only 10.1%of women with UI sought health care.After 15 years of development,there were 8400 pelvic floor rehabilitation institutions and nearly 10,000 relevant physicians in ChinaDthey were found to be associated with UI prevalence.The UI prevalence in China was significantly lower in 2021 compared to that in 2006.Despite the achievement,UI remains a public health problem,especially given China's fast aging and three-child policy.More innovations,especially those that can facilitate care seeking,are needed to address this prevalent yet treatable condition.展开更多
文摘Study Objective: To evaluate the imaging characteristics and healing following application of an absorbable biocompatible hydrogel into the excision cavity following breast conservation surgery. Design: Non-randomized study evaluating hydrogel application feasibility, post-operative hydrogel imaging characteristics, cavity healing following hydrogel absorption and the resulting breast cosmesis. Setting: Teaching hospital University of Essen, Germany. Patients: Seven (7) patients underwent unilateral or bilateral breast conservation surgery to remove cancerous or benign tumors. Interventions: All patients received hydrogel application following primary tumor excision. Imaging performed in the first postoperative week included ultrasound, MRI and CT. Breast cosmesis scores were obtained at one and three months following surgery. Measurements and Main Results: While preliminary, a relationship between percent cavity filling and drainage was observed, with 30% or more cavity filling resulting in decreased drainage. Additionally, the hydrogel was readily visible under ultrasound, MRI and CT imaging modalities. Finally, patients were satisfied and surgeons felt that patient cosmesis was improved relative to their prior experience. Conclusion: Initial data suggest that hydrogel filling may reduce excision cavity drainage, which may reduce seroma or hematoma formation. Additionally, these gels may improve cavity visibility and stability, furthering the use of partial breast irradiation. Finally, while more studies are required, these materials may have a role in improving long term patient cosmesis.
文摘Objective: To evaluate the associations of gestational diabetes (GDM) history with dietary intake, nutritional status, insulin resistance, demographic, and anthropometrical data. Materials & Methods: This cross-sectional study used data from the National Health and Nutrition Examination Survey for the years 2000-2010. Data analysis was based on 290 women who reported a history of GDM compared to 4239 women who denied a GDM history. Insulin resistance [HOMA_IR = (fasting insulin in mU/mL × fasting glucose in mmol/L)/405] was calculated. Pearson correlation, Wilcoxon rank sum tests, Student’s t-tests, and chi-square analysis were used while linear regression assessed independent associations. Results: The median time-lapse from the diagnosis of GDM was 15 years. Women with a GDM history had significantly higher body mass index (BMI), other anthropometric measurements, diastolic blood pressures and insulin resistance. They were also more likely to be Hispanic, have delivered macrosomic infants, and delivered via cesarean. Previous GDM history compared to non-GDM subjects had significantly higher dietary intakes of energy calories, protein, total fat, saturated fatty acids, mono-saturated fatty acids, and cholesterol. Within the entire cohort, increasing insulin resistance was also associated with lower income, less college education, Hispanic or African American ethnicity, obesity, higher systolic and diastolic blood pressures, and with higher dietary cholesterol but lower intake of dietary fiber and micronutrients. Regression analyses showed that GDM history, Hispanic ethnicity, BMI, dietary intake of cholesterol and decreasing income were independently predictive of insulin resistance. Conclusion: The data confirm that even many years after a pregnancy associated with GDM, women with a history of GDM still report significantly higher dietary intakes of energy calories, protein, and fat with no corresponding increase in consumption of dietary fiber or minerals and vitamins. Consequently, the increased calorie and food consumption of women with previous GDM are associated with obesity, insulin resistance and higher blood pressures. These observations may suggest the need to target high-risk groups who may need more resources and awareness of the benefits of quality nutrition.
文摘The Loeys-Dietz syndrome (LDS) is a connective tissue disorder that is associated with vascular abnormalities, including aggressive aortic aneurysms, as well as skeletal and craniofacial malformations. The molecular mechanism of this syndrome remains to be fully elucidated. In this case, we describe a 29-year-old woman, gravida 2 para 1, who was referred for consultation after urinary tract malformations were observed during her mid-gestation anatomic survey. Following referral to our unit, ultrasound examination of the 21-week fetus was repeated. The fetus was observed to have a dilated aortic root and a poorly ossified sternum with mild pectus deformity. After elective termination, single nucleotide polymorphism microarray testing identified a novel 204 kb microdeletion involving the short arm of chromosome 3. The deleted genetic material included 4 exons of the TGFBR2 gene. Although the phenotype of LDS may be caused by haploinsufficiency of the TGFBR1 or TGFBR2 gene, our experience suggests a more complex picture of LDS. The study of such cases might further elucidate its pathogenesis.
文摘Objective This study identifies preoperative risk factors associated with blood transfusion in women undergoing surgery for ectopic pregnancy.A retrospective chart review of 252 cases was performed at a single academic-affiliated community hospital system between January 2014 and October 2017.Univariate analysis was performed using non-parametric testing where appropriate,and significant variables were incorporated in multivariate modelling.Methods In this cohort of 252women,the overall transfusion rate was 8.7%(n=22).Increasing age(OR 1.12,95%CI 1.03 to 1.22),lower systolic blood pressure(SBP)on presentation(OR 0.96,95%CI 0.93 to 1.00),lower minimum systolic and diastolic blood pressure(DBP)(OR 0.92,95%CI 0.89 to 1.95 and OR 0.9,95%CI 0.84 to 0.93)and lower preoperative haemoglobin(g/L)(OR 0.46,95%CI 0.33 to 0.62)were associated with higher rates of blood transfusion.Women who had prior care in their current pregnancy and women treated in a women’s specific emergency room(compared with a general emergency room)were less likely to be transfused(OR 0.16,95%CI 0.05 to 0.51 and OR 0.09,95%CI 0.03 to 0.30,respectively).Our study used a model in which variance in transfusion can reliably be explained by location of presentation to care,pain alone as a presenting complaint and haemoglobin level(Area under the curve(AUC)=0.87).Conclusion History of caesarean section and a presenting complaint of pain alone are newly identified indicators for women at higher risk of transfusion at the time of surgical management of ectopic pregnancy.Additionally,care provided in women’s specific emergency rooms may decrease the risk of blood transfusion in this population.
文摘Background:Polycystic ovary syndrome(PCOS)is the leading cause of anovulatory infertility.Clomiphene citrate,insulin-sensitizing drugs,aromatase inhibitors,gonadotropins,or laparoscopic ovarian drilling are various methods used for ovulation induction in women with PCOS.PCOS women with high levels of anti-mullerian hormone(AMH)and free androgen index(FAI)do not respond well to ovulation induction.This prospective observational study explores the relationship between FAI and AMH levels on ovarian response to clomiphene citrate in infertile women with PCOS.Methods:This prospective observational study included 40 infertile with PCOS who underwent ovulation induction with clomiphene citrate with dose ranging from 50 to 150 mg.Participants were classified into four phenotypes by NIH(National Institute of Health)consensus panel criteria.The clinical and endocrine parameters of participants who were sensitive to clomiphene were compared to those who were resistant.Results:The most common phenotype was A,with all three features of PCOS:hyperandrogenism,ovulatory dysfunction,and polycystic ovarian morphology.There was no significant difference in clinical and endocrine parameters among the different phenotypes of PCOS except AMH and FAI values.The mean FAI was 9.391.11 and AMH 7.260.48(ng/ml)in clomiphene resistant and 5.311.93 and 3.691.84(ng/ml)respectively in clomiphene-sensitive women.Women with FAI>7.5 and AMH>7 ng/ml might be resistant to clomiphene.Conclusion:FAI and AMH values were significantly higher in women resistant to clomiphene induction.AMH and FAI may help women with PCOS to tailor their ovulation induction protocol.
文摘Bartter syndrome is a group of autosomal recessive renal tubular disorders;it has two types of presentation:antenatal and classic.The antenatal type presents as severe unexplained polyhydramnios in the second trimester.This is due to fetal urinary losses of sodium,chloride,and potassium,leading to fetal polyuria.The classic type presents in the late neonatal or infancy stage,with dehydration,dyselectrolytemia,failure to thrive,and nephrocalcinosis.Antenatal scans are normal in such cases.Type I and II Bartter syndrome presents in the antenatal period,whereas type IV has a classic presentation.We describe an unusual case of type IVa Bartter syndrome presenting in the antenatal period,with severe polyhydramnios.The initial diagnosis was made based on amniotic fluid chloride levels and later confirmed by performing a genetic test.Genetic testing is important for confirming diagnosis and prognostication regarding the condition.
基金supported by the National Key Research and Development Program of China(2021YFC2701300,2023YFC2706000 and 2018YFC2002201)the National Natural Science Foundation of China(72104247)the National High Level Hospital Clinical Research Funding(2022-PUMCH-B-087,2022-PUMCH-A-023)。
文摘Urinary incontinence(UI)is a disease that quietly yet seriously impacts women's health and represents a global health burden that is often neglected.This study aims to systematically assess the prevalence and dynamics of female UI in China,and can inform further policies and have international implications.This study used three nationwide investigations:A national cross-sectional survey in 2021;another nationwide cross-sectional survey in 2006;and data regarding the institutions and physicians providing pelvic floor rehabilitation services from 2005 to 2019.The weighted prevalence of female UI and its subtypes,including stress UI(SUI),urgency UI(UUI),and mixed UI(MUI),were estimated as primary outcomes.Knowledge,attitude and care-seeking behaviors of UI were evaluated.It was found that the weighted prevalence of female UI was 16.0%(95%CI,13.3%–19.1%)with SUI remaining the predominant subtype(7.0%)in 2021,followed by MUI(6.5%)and UUI(1.9%).The estimated absolute number of Chinese adult women with UI was 85.8 million in 2021.52.7%(95%CI,45.9%–59.4%)of women were aware that UI was a medical condition,and only 10.1%of women with UI sought health care.After 15 years of development,there were 8400 pelvic floor rehabilitation institutions and nearly 10,000 relevant physicians in ChinaDthey were found to be associated with UI prevalence.The UI prevalence in China was significantly lower in 2021 compared to that in 2006.Despite the achievement,UI remains a public health problem,especially given China's fast aging and three-child policy.More innovations,especially those that can facilitate care seeking,are needed to address this prevalent yet treatable condition.
