Gynecology and Obstetrics Clinical Medicine最新文献

Hypoactive sexual desire disorder (HSDD) is a widely known type of female sexual dysfunction that could also cause emotional distress and relationship problems. Flibanserin, a benzimidazole, was being studied as a treatment for premenopausal women with hypoactive sexual desire disorder because there was no accurate drug therapy available at the time (HSDD). The US Food and Drug Administration (FDA) approved Flibanserin in 2015 for the treatment of generalised acquired HSDD in premenopausal women. It has a high affinity for postsynaptic 5-HT-1A receptors (agonist) and 5-HT-2A receptors (antagonist), and it tends to work by increasing dopamine and noradrenaline levels in the brain while decreasing serotonin levels. This review was to assess Flibanserin efficacy and safety and it is found the drug Flibanserin benefits did not outweigh the risks in premenopausal and postmenopausal women.

Background

Urinary catheterization after vaginal prolapse surgery can cause inconvenience for patients, elevate the risk of urinary tract infections, and potentially prolong the hospitalization. In China, there is no consensus on the optimal time to remove the urinary catheter after vaginal prolapse surgery. Thus, it will be valuable to gain insight into the nationwide catheterization management after the vaginal prolapse surgery.

Methods

From March to May 2020, an online questionnaire was shared and purposive non-probabilistic sampling was used to recruit the participants. The urogynecologists currently performing vaginal prolapse surgery and involved nurses were included in this study.

Results

1363 urogynecologists and 436 nurses responded and 99.5% of them reported using transurethral indwelling catheters (TIC) for post-operative bladder drainage in their practices. The duration of initial catheterization after vaginal prolapse surgery was generally 1–7 days, with a median duration of 3 days for anterior colporrhaphy (AC) and anterior & posterior colporrhaphy (APC), and 2 days for other procedures. For the same type of surgery, the median duration of catheterization varied by region. For AC, it was shorter by 1 day in West China and South China (P ​< ​0.001); for PC, it was 2 days in most regions, while 1 day in East China (P ​< ​0.05); and for APC, it was 3 days in most regions, while 4 days in Northeast China (P ​< ​0.05). No statistically significant difference was found in duration of catheterization in hospital levels.

Conclusions

The findings suggested that duration of catheterization after prolapse surgery varied greatly in China, potentially resulting in unnecessary prolonging of catheterization. Well-designed studies are urgently needed to optimize catheterization management after vaginal prolapse surgery in China.

Background

High salt-diets have become significant threats to human health, resulting in hypertension and cardiovascular diseases. Hypertensive disorders during pregnancy are complicated, since the maternal cardiovascular system undergoes extensive physiological changes during pregnancy. High-salt diets during pregnancy can disturb the intrauterine environment and negatively affect fetal development. Therefore, we explored how high-salt diets during pregnancy could affect the offspring.

Methods

Rats were divided into three groups and fed with low, normal, and high salt diets. The offspring were separated into three groups after weaning based on dietary salt concentration. The blood pressure and urine protein content of both dams and offspring were measured. To evaluate cardiac function, we used Masson staining and immunodetection to confirm the fibrosis status. Finally, we extracted protein from cardiac tissue to test the expression levels of the Nitric Oxide (NO)/cGMP-dependent protein kinase I (PKGI) pathway and the angiotensin receptor.

Results

High-salt diets increased blood pressure, and offspring previously exposed to high-salt environments were predisposed to hypertension. High-salt diets were also found to induce cardiac fibrosis and exacerbate fibrosis in offspring and alter the epithelial-mesenchymal transition (EMT). Under these conditions, the NO/PKGI pathway was activated in cardiac tissue and the type-1angiotensin II receptor (AT1R) was upregulated, though the type-2 angiotensin II receptor (AT2R) had the opposite effect.

Conclusion

High-salt diets induce high blood pressure and increase predisposition to hypertension in offspring. They are accompanied by cardiac fibrosis, which could be caused by the activation of NO/PKGI and upregulation of AT1R.

Gestational trophoblastic diseases are a heterogeneous group of pregnancy related tumors that show extensive metastatic spread but are readily responsive to chemotherapy. This one of a kind treatability of gestational trophoblastic tumors may to some extent be inferable from a host immunologic reaction to the paternal antigens that are expressed on the trophoblastic cells. In this review, we evaluate the current cognizance of immunobiology of gestational trophoblastic diseases and also establish the immunologic behaviour of gestational trophoblastic diseases which should be researched further in order to gain a better understanding of the aetiology of these neoplasias. This will further help structuring immunotherapeutic methodologies for their treatment.

Background

Approximately 7% of all women will require surgery to correct pelvic organ prolapse during their lives. Of these, approximately 10%-13% will require another operation within 5 years due to recurrence of the disease. Increases in life expectancy and elderly individuals with estrogen deficiencies will mean higher rates of pelvic organ prolapse, significantly reducing the quality of life for millions of people. This study introduces technologies that can help treat pelvic prolapse while reducing the rate of recurrence.

Methods

This paper outlines how to properly perform sacrospinous ligament fixation using the Miyazaki technique.

Results

A needle was used to successfully perform a sacrospinous ligament fixation using Miyazaki's technique.

Conclusions

Considering the Food and Drug Administration’s 2019 decision to permit surgeries with native tissue, this method can be used with sacrospinous ligament fixation as the primary treatment option for pelvic organ prolapse.

Overview and aim

The precocity of sexual intercourse among adolescent girls is a prominent source of unwanted pregnancy. Here, we aim to survey the past issues relating to the pregnancy, childbirth, and materno-fetal prognosis of Ivorian adolescent women.

Methods

We conducted a retrospsective study with adolescent group (n ​= ​1040) versus young adult group aged 20 to 24 (n ​= ​736) over three years from1^st January 2016 to 31^rd December 2018 ​at the Department of Obstetrics and Gynecology at the University of Abidjan-Yopougon Hospital. Maternal and fetal outcomes of the two groups were analyzed and compared by using Pearson's Chi² tests and Fisher's exact tests, followed by multivariate analysis and logistic regression using Stata software version 20.

Results

The average age of adolescent girls in our study was 17.45 years (SD ​= ​1.39) and a minimum of 12 years. Adolescents consulted less (P ​< ​0.0001) and later (P ​< ​0.0001) versus young adults aged 20 to 24. The proportion of adolescent girls (47.6%) versus young adults (39.1%) who had underwent caesarean section was significantly higher (P ​= ​0.0004). These adolescents were 3.5-fold more likely to develop hypertension and its complications in the postpartum period and 2.5-fold more likely to contract a postpartum infection. Maternal mortality was not significantly associated with adolescence (OR ​= ​0.52 (95%CI: 0.22–1.19; P ​= ​0.0891). The risk of prematurity, early neonatal death, and neonatal admission were 2.02 (95%CI: 1.56–2.63; P ​< ​0.0001), 1.55 (95%CI: 1.14–2.13; P ​= ​0.0040), and 1.73 (95%CI:1.12–2.71; P ​= ​0.0097) in adolescence, respectively.

Conclusion

Adolescent childbirth remains associated with a poor prognosis.

Aims

To evaluate the medium term efficacy and safety of Altis and Solyx single incision slings (SIS) compared with tension-free vaginal tape (TVT) Abbrevo trans-obturator sling. We hypothesize that both SIS show little difference in efficacy and safety and perform similarly to TVT Abbrevo.

Methods

We conducted an ambispective comparative cohort study of women with stress urinary incontinence who received a SIS in comparison to matched TVT Abbrevo subjects from a concurrent randomized controlled trial (RCT). Subjects were identified retrospectively, and prospectively invited for examination and questionnaires>12 months post-operatively. Exclusions included intrinsic sphincter deficiency, previous sling surgery, and others. Primary outcome was subjective cure [negative response to International Consultation Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) question 6, leakage during coughing/activity]. Secondary outcomes include objective cure (negative cough stress test), functional outcomes, and adverse events.

Results

Between 2012 and 2018, a total of 113 women received one of two SIS surgeries; Solyx (n ​= ​50) followed by the Altis (n ​= ​63); 104 were available for final efficacy analysis. Mean follow-up was 21.7 (Altis), 46.0 (Solyx), and 29.0 (Abbrevo) months. Baseline characteristics were comparable between the groups. There was no significant differences in the subjective or objective cure rates between the groups, and no differences in functional outcomes such as patient global impression of improvement, and post-operative ICIQ-UI SF score. There was a low rate of mesh related complications and no differences seen between the groups.

Conclusions

Despite being an underpowered study, Altis and Solyx SIS have favourable efficacy and safety profiles which are comparable to an established trans-obturator mid-urethral slings (MUS).