As a rare obstetric disease, fetomaternal hemorrhage (FMH) often causes severe fetal anemia, edema and even death, easily to be confused with severe neonatal asphyxia. Currently, there are several ways to detect or predict FMH, however, most of them are flawed and time-consuming, as well as unsuitable for rapid diagnosis and timely intervention of FMH. To explore the values of umbilical artery blood gas analysis in the rapid diagnosis of FMH, providing basis for rapid guidance of newborn rescue. Five cases of neonates with FMH from the First Affiliated Hospital of Army Military Medical University (Chongqing Southwest Hospital) from January 2013 to January 2016 were selected as the study group. Another 9 cases of severe asphyxia neonates were chosen into the control group. The difference in Apgar score and umbilical artery blood gas analysis between the 2 groups at birth was compared, and the treatments and clinical outcomes of the 2 groups were analyzed. The PH value of umbilical artery blood gas analysis in the study group was higher than that of the control group, but the difference was not statistically significant ( P > .05). In the study group, cases with pH value < 7.0 accounted for 0%, whereas the cases with pH < 7.0 accounted for 66.67% in the control group, and the difference between the 2 groups was statistically significant ( P < .05). Compared with the control group, the arterial oxygen partial pressure (PO 2 ), the absolute value of (PCO 2 ), lactic acid (lac) and alkali were not significantly different from those of the control group ( P > .05), while the total hemoglobin (tHb) and hematocrit (Hct) were significantly lower than the control group ( P < .0001). In the study group, tHb in the umbilical cord blood of 2 newborns with FMH death was significantly lower than 40 g/L. FMH should be highly suspected when there is an expression of severe asphyxia in neonates, indicated by significantly lower tHb levels in umbilical cord blood. It is helpful to improve the neonatal outcome by FMH neonatal resuscitation as soon as possible.
Abstract Objective: To establish a rat model of pharmacological ovariectomy by GnRH-a injection, and to preliminarily investigate the reproductive endocrine effects of Xiangshao granules on pharmacological ovariectomised rats. Methods: A rat model of pharmacological ovariectomy was established by injecting female rats with GnRH-a. The rats were randomly divided into four groups: GnRH-a injected saline group (GnRH-a + NS); GnRH-a injected oestradiol group (GnRH-a + E2); GnRH-a injected Xiang shao granule group (GnRH-a + Xiang shao), and the control group of saline injected rats (NS + NS). according to the observation of the vaginal smear of the rats to determine the success of the modelling, after the success of the modelling of the corresponding drug gavage intervention for 28 days, every other day to weigh the body weight of the rats and measure the anal temperature, according to the changes in body weight of the rats to adjust the amount of drug intervention. Plasma sex hormone levels (E2, FSH, LH), uterine weight, uterine index and endometrial histomorphological changes, and ovarian weight, ovarian index and ovarian histomorphological changes were measured in each group after gavage. Results: (1) Vaginal cell smears of rats in the control group (NS+NS) showed changes in the estrous cycle, whereas vaginal cell smears of rats in the GnRH-a+NS, GnRH-a+E2, and GnRH-a+Xiang shao groups showed no changes in the estrous cycle; (2) The body mass gain of rats in the GnRH-a+NS, GnRH-a+E2, and GnRH-a+Xiang shao groups was significantly higher than that of the NS+NS group, whereas intervention with estradiol (E2) and peony granules significantly slowed down the GnRH-a induced body mass gain. NS group, while the intervention of estradiol (E2) and Xiang shao granules could significantly delay the trend of GnRH-a-induced body mass gain in rats; (3) The anal temperature of rats after GnRH-a injection showed an overall increasing trend, and compared with GnRH-a+NS, the body temperature of rats in GnRH-a+E2 and GnRH-a+Xiang shao groups showed a gradual decreasing trend, and the decreasing of the temperature in Xiang shao granules compared with that of rats in E2 group was (4) Plasma sex hormone levels (E2, FSH, LH) were significantly lower in the GnRH-a+NS, GnRH-a+E2, and GnRH-a+Xiang shao groups than in the NS+NS group (P<0.001), and the levels of E2 in the GnRH-a+E2 and GnRH-a+Xiang shao groups were significantly higher than those in the GnRH-a+NS group (P<0.001, P<0.05), and the levels of E2 in the GnRH-a+NS group were significantly lower than those in the GnRH-a+Xiang shao group (P<0.001, P<0.05). 0.05), and the E2 level in GnRH-a+E2 group was higher than that in GnRH-a+Xiangshao Granules group (P<0.05); the FSH level in GnRH-a+E2 group was significantly lower than that in GnRH-a+ Xiangshao granules group (P<0.05), and there was a slight downward trend in the FSH level of GnRH-a+E2 group compared to that of GnRH-a+NS, but the difference was not statistically significant (P> 0.05); LH levels in the GnRH-a+E2 group were significantly lower than those in the GnRH-a+NS and GnRH-a+Xiang shao groups (P<0.001, P=0.001), whereas there was no significant difference in the LH and FSH levels between the two groups, GnRH-a+NS and GnRH-a+ Xiang shao groups (P>0.05); (5) compared with the NS+NS group, GnRH-a injected rats in each model, uterine weight and uterine index, ovarian weight and ovarian index were significantly decreased (P<0.001); comparing between the groups, the uterine weight and uterine index, ovarian weight and ovarian index of GnRH-a+ E2 and GnRH-a+Xiang shao groups were significantly higher than those of GnRH-a+NS group (P<0.001, P<0.05); uterine weight and uterine index, ovarian weight and ovarian index of GnRH-a+E2 group were significantly higher than those of GnRH-a+NS group (P<0.001, P<0.05); and uterine weight and uterine index, ovarian weight and ovarian index were elevated compared with the GnRH-a+Xiang shao group (P<0.05); (6) compared with the NS+NS group, the number of primordial follicles was significantly higher and the number of growing follicles and mature follicles was significantly lower in the GnRH-a+NS, GnRH-a+E2 and GnRH-a+Xiang shao groups; (7) the number of rats' uterine wall was significantly higher and the number of rats' uterine wall was significantly lower in the NS+NS group than in the GnRH-a NS+NS group and GnRH-a group, the uterine wall of rats in each group was significantly thinner, the endothelial layer was atrophied, the thickness of the uterine wall increased in the GnRH-a+E2 and GnRH-a+Xiang shao groups, and the number of vaginal folds and blood vessels also increased. Among them, the improvement of uterus and vagina was more obvious in GnRH-a+E2 than in GnRH-a+NS and GnRH-a+Xiangshao groups. Conclusion: GnRH-a injection could reduce the levels of sex hormones E2, FSH and LH in rats, causing perimenopausal symptoms such as hot flashes, while E2 and Xiang shao granules significantly improved such symptoms, and Xiang shao granules had a slight oestrogenic effect, but to a lesser extent than E2.
Background: To evaluate the effect of carbohydrate antigen 125 (CA125) and CA19-9 in distinguishing stage Ⅲ and Ⅳ endometriosis from benign and malignant tumors, and to explore whether it is related to the clinical features of the disease. Methods: In a retrospective cohort study based on clinical data from hospitals, a total of 183 patients with pathologically confirmed diagnosis of ovarian endometriotic cysts (OEC) in Hainan Provincial People’s Hospital for surgical treatment from January 2019 to August 2022 were selected as the case group, and a total of 276 cases of benign diseases, including 184 cases of benign ovarian tumors, 94 cases of gynecological common diseases, and 102 cases of malignant ovarian tumors were selected as the control group, with a total of 276 cases of benign diseases, including 184 cases of benign ovarian tumors, 94 cases of gynecological common diseases, and 102 cases of malignant ovarian tumors. There were also 23 cases of ruptured ectopic cysts. We compared the clinical characteristics (age of onset, fertility, dysmenorrhea, preoperative CA125 and CA19-9 values) of the patients in the OEC group with those of the other control groups; analyzed the serum CA125 and CA19-9 values in relation to the pathological characteristics of OEC (recurrence, unilateral and bilaterality, multilocularity and unilocularity, rupture, dysmenorrhea, fertility, and staging); and analyzed the CA125 and CA19-9 values by unordered logistic regression, CA19-9 to predict OEC; sensitivity, specificity and cut-off values of CA125, CA19-9 and their combined indexes to diagnose OEC. Results: The symptoms of dysmenorrhea and infertility in OEC group were significantly higher than those in the other three groups. The preoperative CA125 value in OEC group was higher than that in benign tumor and other gynecological diseases group, and significantly lower than that in malignant tumor group. There was no significant difference in the value of CA19-9 and CA125 in the degree of dysmenorrhea, recurrence and infertility. The values of CA19-9 and CA125 of multilocular cysts were higher than those of unicameral cysts, bilateral cysts were higher than unilateral cysts, and ruptured cysts were significantly higher than unruptured cysts. The value of CA125 in the dysmenorrhea group was higher than that in the non-dysmenorrhea group, and that in the fourth stage was higher than that in the third stage, and the difference was statistically significant (p < 0.05). Unordered multicategorical logistic regression analysis determined that CA125, could be a predictor in the comparison of OEC with benign disease; in the benign control group the cut-off value for CA125 was >23.1 IU/mL with an area under the curve (AUC) value of 0.90 (0.869–0.926), a sensitivity of 89.62% and a specificity of 81.52%. In the malignant control group the cut-off value for CA125 was ≤209.2 with an AUC value of 0.859 (0.813–0.897), sensitivity 95.08% and specificity 71.57%. Conclusions: The effect of serum CA19-9 in the diagnosis of Endometriosis (EMT) is not ideal. CA125 has a certain value in the diagnosis of endometriosis, but it is necessary to explore the range of cut-off value.
Lymphoma is a malignant tumour of the lymphatic system with an incidence rate of about 6.6 per 100,000 people. Among the many lymphoma types, the most common is non-Hodgkin’s lymphoma. Lymphomas are common in the gastrointestinal tract, breast, neck, etc., while those in female genital tracts are rare. In this article, we report four cases of primary female genital system lymphoid malignancies diagnosed and treated at our hospital from 2018 to 2023, with a systematic review.
AbstractBackground: Single-port laparoscopic surgery offers unique minimally invasive and cosmetic results and facilitates the patient's postoperative recovery.In transumbilical single-port laparoscopic myomectomy, suturing of the uterine wound is a critical intraoperative step.Due to the difficulty of operating with a single hole, it takes longer to suture the uterine wound, which somewhat increases the potential risk and limits the development of this procedure.This study describes the technique of the "suture formula" and compares it with the traditional randomized suture pattern. Materials and Methods:The author's team summarized the uterine incision selection and suture pattern in single-port laparoscopic myomectomy, conceptualizing the steps of uterine incision selection and suture closure to reduce unnecessary intraoperative backstitching and thread winding operations.In this study, we retrospectively analyzed 91 patients who underwent transumbilical single-port laparoscopic myomectomy and compared the intraoperative and postoperative indices between the two groups. Results:Surgical time, intraoperative bleeding, and hemoglobin drop were lower in the "suture mode" group than in the traditional randomized suture group (p<0.05).There was no statistically significant difference between the "suture formula" group and the traditional randomized suture group in terms of the number of days of postoperative hospitalization, the time to the first postoperative anal evacuation, the VAS score at 12h postoperatively, the VAS score at 24h postoperatively, and the postoperative complications (P > 0.05).Suture pattern (Beta: -19, P=0.043), number of leiomyosarcomas (Beta: 43, P=0.002), maximum diameter of the tumor (Beta: 6.2, P=0.032), and BMI (Beta: 4.0, P=0.018) were the factors influencing the duration of surgery.Suture pattern (Beta: -46, p=0.011), and maximum tumor diameter (Beta: 13, p=0.027) were the factors influencing intraoperative bleeding. Conclusion:The "Suture Formula" technique conceptualizes the selection of the uterine incision and the suture steps, which reduces the difficulty of the operation and ensures the hemostatic effect while reducing the unnecessary inverted needle and thread wrapping during the operation, thus shortening the operation time and improving the efficiency of the operation.The use of the "suture formula" does not increase the risk of surgery or the incidence of surgical complications compared with conventional single-port laparoscopic myomectomy.This suture pattern provides a new breakthrough in single-port laparoscopic myomectomy.
Objective: The purpose of this review is to summarize drug selection for peri-menopausal symptoms caused by gonadotropin releasing-hormone agonist (GnRH-a) in the treatment of endometriosis. Mechanism: GnRH-a treatment often leads to low estrogen levels, resulting in peri-menopausal symptoms and osteoporosis. Add-back therapy relieves clinical symptoms by supplementing low-dose estrogen. The idea of “combined regulation” is to improve symptoms by adding plant preparations or proprietary Chinese medicines. Studies have shown that they may play a role by regulating serotonin activity. Findings in Brief: For patients treated with GnRH-a for less than 3 months, the combined-regulation regimen can be considered, whereas for patients who have had more than 3 courses of GnRH-a, add-back therapy with sex hormones must be used because the patients will have begun to have obvious bone-mass loss and even bone pain; this bone-mass loss is often irreversible. Conclusions: In the early treatment of endometriosis with GnRH-a, non-hormone combined-regulation therapy is a relatively safe and feasible choice, but hormone add-back therapy should be selected for patients who have had more than 3 courses of GnRH-a.
Endometrial cancer is mainly treated clinically by surgery, supplemented by postoperative radiotherapy. Pelvic and abdominal lymph node dissection is usually an important part of surgery, and one of the most common postoperative complications is lymph node cysts. Infection of cysts is very rare in clinical practice and can be cured mainly by anti-infection and puncture drainage. However, in this case, the patient was found to have a pelvic abscess due to radiating pain in the left lower limb, and the infection of the local lymphocyst was found to have formed a pelvic abscess, and laparoscopic open drainage was performed after puncture drainage with no improvement in symptoms. The patient recovered after surgery.
Polycystic ovary syndrome (PCOS) is a multifactorial disease, which is closely related to obesity. This study evaluated the efficacy of bariatric surgery on obesity complicated with PCOS through meta-analysis. PubMed, Cochrane, EMbase, and WOS databases were searched from 2012 to November 2022. Studies on the efficacy of bariatric surgery in the treatment of obesity combined with PCOS were included. Outcome indicators included menstrual abnormalities, BMI, free testosterone, hypertrichosis, and ovarian volume. Methodological quality of the included studies was evaluated, and statistical analysis was performed using RevMan 5.3 software. Finally, 9 studies were included, and the results of meta-analysis were as follows: After weight loss surgery, menstrual irregularity decreased (RR = -0.83, 95%CI:-1.00∼-0.65, P < 0.00001), and BMI decreased significantly (MD = -13.64, 95%CI:-16.29∼-10.99, P < 0.00001). Free testosterone levels decreased (MD = -22.70, 95 % CI: -36.07 ∼ -9.34, P < 0.00001), the incidence of hypertrichosis decreased (RR = 0.63, 95%CI: 0.45-0.88, p = 0.007 < 0.01), and the ovarian volume decreased (MD = -3.09, 5%CI: -5.76 ∼ -0.42, P < 0.00001).
AbstractObjective Screen the relevant diagnostic indicators of endometriosis, build a diagnostic model and verify it, so as to provide a scientific basis for diagnosis and differentiation.zig. Method(s) A total of 625 patients with pathologically confirmed endometriosis were selected from December 2016 to June 2022 in Hainan Provincial people's Hospital. 308 patients with endometriosis were selected as case group and 317 patients without endometriosis as control group. There were 41 cases in the case group and 28 cases in the control group. The clinical characteristics and laboratory indexes of patients in the case group and the control group were compared: age, dysmenorrhea, progressive aggravation of symptoms, dysuria, abnormal menstruation, difficulty in sexual intercourse, low back and abdominal pain, infertility, carbohydrate antigen 125, monocyte percentage, monocyte absolute value, platelet, mean platelet volume, platelet volume distribution width, platelet volume ratio, lactate dehydrogenase, alkaline phosphatase. The independent risk factors were screened by binary Logistic regression analysis and the prediction model was constructed. Hosmer-Lemeshow was used to test the goodness of fit of the model and the subject working characteristic curve was used to judge the prediction efficiency of the model. Result(s) There were significant differences in age, dysmenorrhea, progressive aggravation of symptoms, abnormal menstruation, infertility, CA125, PCT, LDH and ALP between the two groups. The higher the CA125, the higher the risk of endometriosis, with statistical significance [OR = 1.023 (95% CI:1.016–1.029)], dysmenorrhea symptoms [OR = 3.467 (95% CI:2.052–5.859)], progressive symptoms [OR = 4.501 (95% CI:1.389–14.584)] and infertility [OR = 2.776 (95% CI:1.216–6.335)]. The higher the risk of endometriosis. The higher the LDH [OR = 0.993 (95% CI:0.987–0.999)] and the higher the ALP [OR = 0.977 (95% CI:0.962–0.991)], the lower the risk of endometriosis. The constructed model was verified by Hmurl and the result showed that P = 0.103, which suggested that the model fitted well. When the area under the model curve was 0.846 (95%CI:0.815–0.873) and the Jordan index was 0.5498, the best critical value was 0.478, the sensitivity was 69.81 and the specificity was 85.17. Conclusion(s) The model has good degree of fit and distinguishing ability, and can be used as an auxiliary means.
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