Multiple evanescent white dot syndrome(MEWDS)is an inflammatory fundus disease primarily affecting the outer retina.It is characterized by transient yellow-white dots on the outer retina.Although the exact pathogenesi...Multiple evanescent white dot syndrome(MEWDS)is an inflammatory fundus disease primarily affecting the outer retina.It is characterized by transient yellow-white dots on the outer retina.Although the exact pathogenesis remains unclear,the progress in multimodal imaging(MMI)has enhanced our understanding of MEWDS.Most cases of MEWDS are idiopathic,lacking a definite cause,and can spontaneously recover;these are what we term classic MEWDS.Consequently,MEWDS is often referred to as the“common cold of the retina”.Simultaneously,patients with other disorders may present with varying degrees of manifestations similar to MEWDS.The resemblance in clinical or imaging findings can lead to misdiagnosis and inappropriate treatment.These MEWDS-like presentations are actually caused by other systemic or ocular disorders with diverse mechanisms.Thus,they differ from classic MEWDS in certain aspects.Using the keywords“MEWDSlike”and“Secondary MEWDS”,we searched for all relevant studies published in the PubMed database from January 2021 to January 2024.Subsequently,we retrospectively summarized the clinical and imaging characteristics of MEWDS,along with the manifestations in other diseases that resembled those of MEWDS,and compared classic MEWDS with these similar presentations.Based on our review,we classified such similar presentations under other conditions into two categories and summarized their features for differential diagnosis.We recommend paying close attention to patients suspected of having MEWDS,as there may be more serious systemic or ocular disorders that require prompt treatment.展开更多
A rapid and accurate COVID-19 diagnosis is a prerequisite for blocking the source of infection as soon as possible and taking the appropriate medical action.Herein,we developed GeneClick,a device for nucleic acid self...A rapid and accurate COVID-19 diagnosis is a prerequisite for blocking the source of infection as soon as possible and taking the appropriate medical action.Herein,we developed GeneClick,a device for nucleic acid self-testing of SARS-CoV-2,consisting of three modules:a sampling kit,a microfluidic chip-based disposable cartridge,and an amplification reader.In addition,we evaluated the clinical performance of GeneClick using 2162 nasal swabs collected at three medical institutions,using three commercial RT-qPCR kits and an antigen self-test as references.Compared to RT-qPCR,the sensitivity and specificity of the GeneClick assay were 97.93%and 99.72%,respectively,with a kappa value of 0.979(P<0.01).Of the 2162 samples,2076 were also tested for SARS-CoV-2 antigens.Among the 314 positive samples identified by GeneClick assay,63 samples were undetected by antigen tests.Overall,the GeneClick nucleic acid self-test demonstrated higher accuracy than the antigen-based detection.Based on the additional features,including simple operation,affordable price,portable device,and reliability of smartphone APP-driven sampling and result reporting,GeneClick offers a powerful tool for field-based SARS-CoV-2 detection in primary healthcare institutions or at-home use.展开更多
BACKGROUND Giant cellulitis-like Sweet syndrome(SS) is a rare subtype of SS,and reports of the combined histiocytoid type of pathology are scarce.Here,we report a case of SS with distinctive clinical presentations and...BACKGROUND Giant cellulitis-like Sweet syndrome(SS) is a rare subtype of SS,and reports of the combined histiocytoid type of pathology are scarce.Here,we report a case of SS with distinctive clinical presentations and which was difficult to distinguish from cellulitis.By sharing this case and a discussion of the related literature in detail,we aim to provide clinicians with new insights into the characteristics of histiocytoid giant cellulitis-like(HGC)-SS and the pathogenesis of SS.CASE SUMMARY A 52-year-old male was admitted after experiencing progressive fatigue for 1 mo and tongue swelling with pain for 1 d.He was diagnosed with myelodysplastic syndrome(MDS) and angioneurotic edema of the tongue and floor of the mouth.However,7 d after examination by sternal aspiration,a violaceous,tender,and swollen nodule developed at the site,with poorly demarcated erythema of the surrounding skin.Considering his profile of risk factors,the diagnosis of cellulitis was made and he was administered broad-spectrum antibiotics.When the lesion continued to worsen and he developed chills and fever,pathogenic and dermatopathological examination led to the diagnosis of HGC-SS.Treatment with prednisone led to the fever being relieved within 24 h and the skin lesion being resolved within 1 wk.The patient refused intensive treatment and was instead given thalidomide,erythropoietin,stanozolol,and supportive care.The prednisone was gradually tapered,with no signs of recurrence,but he died 2 mo later of severe pneumonia.CONCLUSION HGC-SS demonstrates unique manifestation.SS and leukemia cutis share cytological origin.Myelofibrosis and SS are adverse prognostic factors for MDS.展开更多
Dear Editor,We present a case of acute zonal occult outer retinopathy(AZOOR)complex in a myopic patient with angioid streaks(ASs).A 19-year-old female has been experiencing visual field defects in her left eye for mor...Dear Editor,We present a case of acute zonal occult outer retinopathy(AZOOR)complex in a myopic patient with angioid streaks(ASs).A 19-year-old female has been experiencing visual field defects in her left eye for more than 3y.She was diagnosed with ASs and choroiditis at a local hospital.She has a seven-year history of bilateral high myopia.A fundus examination confirmed the presence of ASs and myopic fundus changes in both eyes.Multimodal imaging revealed an AZOOR complex in the left eye.展开更多
Background： Fibroblasts were the main seed cells in the studies of tissue engineering of the pelvic floor ligament. Basic fibroblast growth factor （bFGF） and epidermal growth factor （EGF） were widely studied but ...Background： Fibroblasts were the main seed cells in the studies of tissue engineering of the pelvic floor ligament. Basic fibroblast growth factor （bFGF） and epidermal growth factor （EGF） were widely studied but at various concentrations. This study aimed to optimize the concentrations of combined bFGF and EGF by evaluating their effects on proliferation and collagen secretion of fibroblasts. Methods： Fibroblasts were differentiated from rat adipose mesenchymal stem cells （ADSCs）. Flow cytometry and immunohistochemistry were used for cell identification. The growth factors were applied at concentrations of 0, 1, 10, and 100 ng/ml as three groups： （1） bFGF alone, （2） EGF alone, and （3） bFGF mixed with EGF. Cell proliferation was evaluated by Cell Counting Kit-8 assays. Expression of Type I and III collagen （Col-I and Col-1II） mRNAs was evaluated by real-time quantitative reverse transcription-polymerase chain reaction. Statistical analysis was performed with SPSS software and GraphPad Prism using one-way analysis of variance and multiple t-test. Results： ADSCs were successfully isolated from rat adipose tissue as identified by expression of typical surface markers CD29, CD44, CD90, and CD45 in flow cytometry. Fibroblasts induced from ADSC, compared with ADSCs, were with higher mRNA expression levels of Col I and Col III （F = 1.29, P = 0.0390）. bFGF, EGF, and the mixture ofbFGF with EGF can enhanced fibroblasts proliferation, and the concentration of 10 ng/ml of the mixture ofbFGF with EGF displayed most effectively （all P 〈 0.05）. The expression levels of Col-I and Col-Ill mRNAs in fibroblasts displayed significant increases in the 10 ng/ml bFGF combined with EGF group （all P 〈 0.05）. Conclusions： The optimal concentration of both bFGF and EGF to promote cell proliferation and collagen expression in fibroblasts was 10 ng/ml at which fibroblasts grew faster and secreted more Type I and III collagens into the extracellular matrix, which might contribute to the stability of the pelvic floor microenvironment.展开更多
Background： Some patients with pelvic organ prolapse may suffer from incontinence （SUI） named de novo SUI alter pelvic floor reconstruction of de novo SUI. ower urinary tract symptoms （LUTS）, especially stress ur...Background： Some patients with pelvic organ prolapse may suffer from incontinence （SUI） named de novo SUI alter pelvic floor reconstruction of de novo SUI. ower urinary tract symptoms （LUTS）, especially stress urinary This study aimed to investigate the incidence and risk factors Methods： This is a nested case-control study of 533 patients who underwent pelvic floor reconstruction due to pelvic organ prolapse （POP） at the Department of Gynecology in Peking University People＇s Hospital from January 2011 to March 2013. According to the inclusion and exclusion criteria, 401 patients were enrolled in the study with the follow-up rate of 74.8% （101 patients lost to follow-up）. There were 75 patients with de novo SUI postoperatively. According to the ratio of 1：3, we ensured the number of control group （n = 225）. The preoperative urinary dynamics, POP-quantification scores, and LUTS were compared between the two groups by univariate and multivariate logistic regression analyses to investigate the risk factors of de novo SUI. Results： The incidence of de novo SUI was 25% （75/300）. Univariate analysis showed that the ratio of lower urinary tract obstruction （LUTO） before surgery in de novo SUI group was significantly higher than the control group （odds ratio [OR] = 2.1, 95% confidence interval [（7] [1.1-4.0], P = 0.022）. The interaction test of LUTO and other factors displayed that Aa value was an interaction factor. With the increasing score of Aa, the incidence of de novo SUI become higher （OR = 2.1, 95% CI [1.0-3.7], P = 0.045）. After multivariable adjustment, multiple regression analysis showed that LUTO was independently associated with a greater risk of de novo SUI after pelvic floor surgery （OR = 2.3, 95% CI [1.2-4.6], P = 0.013）. Conclusions： Preoperative LUTO in patients with POP is a high-risk factor of de novo SUI, and high score of Aa-point is related to the occurrence of de novo SUI, which might be due to the outlet obstruction caused by bladder prolapse.展开更多
Background:After radical hysterectomy for cervical cancer,the most common complication is lower urinary tract symptoms.Post-operatively,bladder capacity can alter bladder function for a prolonged period.This study aim...Background:After radical hysterectomy for cervical cancer,the most common complication is lower urinary tract symptoms.Post-operatively,bladder capacity can alter bladder function for a prolonged period.This study aimed to identify factors affecting bladder storage function.Methods:A multicenter,retrospective cohort study was conducted.Information of patients with stages IA2 to IIB cervical cancer with urodynamic study results were retrospectively collected from nine hospitals between June 2013 and June 2018 according to the inclusion criteria.Demographic,surgical,and oncological data were collected.The univariate and multivariate logistic regression was used to identify clinical factors associated with bladder storage function.Results:Two hundred and three patients with cervical cancer had urodynamic testing post-operatively.Ninety-five(46.8%)patients were diagnosed with stress urinary incontinence(SUI).The incidence of low bladder compliance(LBC)was 23.2%.Twenty-seven(13.3%)patients showed detrusor overactivity(DO).Fifty-seven patients(28.1%)presented with a decreased maximum cystometric capacity(DMCC).The probability of composite bladder storage dysfunction was 68.0%.Multivariate analysis confirmed that laparoscopy represents a protective factor for SUI with an odds ratio of 0.498(P=0.034).Patients who underwent a nerve-sparing procedure were less odds to experience SUI(P=0.014).A significant positive correlation between LBC and DO was observed(P<0.001).A greater length of the resected vagina and chemoradiotherapy were common risk factors for LBC and DO,while radiotherapy exerted a stronger effect than chemotherapy.Additionally,patients who received chemoradiotherapy frequently developed a DMCC.The follow-up time was not correlated with bladder storage function.Conclusion:A nerve-sparing procedure without longer resected vagina is recommended for protecting the bladder storage function.展开更多
Background：Pelvic organ prolapse （POP） is a major health concern that affects women.Surgeons have increasingly used prosthetic meshes to correct POP.However,the most common used is synthetic mesh,and absorbable mes...Background：Pelvic organ prolapse （POP） is a major health concern that affects women.Surgeons have increasingly used prosthetic meshes to correct POP.However,the most common used is synthetic mesh,and absorbable mesh is less reported.This research aimed to evaluate the clinical effectiveness of porcine small intestinal submucosa （SIS）.Methods：Consecutive forty POP patients who met the inclusion criteria underwent pelvic reconstruction surgery with SIS between March 2012 and December 2013.The patients＆#39; clinical characteristics were recorded preoperatively.Surgical outcomes,measured by objective and subjective success rates,were investigated.We evaluated the quality of life （QOL） using the Pelvic Floor Distress Inventory-20 （PFDI-20） and the Pelvic Floor Impact Questionnaire-7 （PFIQ-7）.Sexual QOL was assessed by the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire-12 （P1SQ-12）.Results：At postoperative 12 months,the subjective recurrence rate （7.5%） was much lower than the objective recurrence rate （40.0%）.Postoperatively,no erosion was identified.One underwent a graft release procedure because of urinary retention,and one had anus sphincter reconstruction surgery due to defecation urgency.Another experienced posterior vaginal wall infection where the mesh was implanted,accompanied by severe vaginal pain.Estrogen cream relieved the pain.One patient with recurrence underwent a secondary surgery with Bard Mesh because of stage 3 anterior vaginal wall prolapse.Scoring system of PFDI-20 was from 59.150 ± 13.143 preoperatively to 8.400 ± 4.749 postoperatively and PFIQ-7 was from 73.350 ± 32.281 to 7.150 ± 3.110,while PISQ-12 was from 15.825 ± 4.050 to 12.725 ± 3.471.Conclusions：QOL and the degree of subjective satisfaction were significantly improved postoperatively.Anterior repair deserves more attention because of the higher recurrence rate.The long-term follow-up of the patient is warranted to draw firm conclusion.展开更多
Background:Endometrial cancer is one of the most common malignancies of the reproductive system.Effective and cost-effective screening method for populations at high risk is not available.This study aimed to investiga...Background:Endometrial cancer is one of the most common malignancies of the reproductive system.Effective and cost-effective screening method for populations at high risk is not available.This study aimed to investigate specimen adequacy and the influencing factors in microscale endometrial sampling biopsy and to evaluate the diagnostic accuracy and medical cost of biopsy in endometrial cancer and atypical hyperplasia screenings in comparison with hysteroscopic endometrial biopsy.Methods:A total of 1551 patients at high risk for endometrial lesions who required hysteroscopic endometrial biopsy from November 2017 to August 2018 were included.Microscale endometrial sampling biopsy was performed,followed by hysteroscopic endometrial biopsy.We evaluated the specimen adequacy and influencing factors of microscale endometrial sampling.Diagnostic consistency between microscale endometrial sampling biopsy and hysteroscopic endometrial biopsy was evaluated.The sensitivity,specificity,positive predictive value,and negative predictive value of microscale endometrial sampling biopsy in screening for endometrial cancer and atypical hyperplasia were analyzed,and the medical costs of the two procedures were compared.Results:The specimen adequacy was 81.2%.Patient age,menopausal status,endometrial thickness,and endometrial lesion type were correlated with specimen adequacy.There was good consistency in distinguishing benign and malignant endometrial diseases between microscale endometrial sampling biopsy and hysteroscopic biopsy(kappa 0.950,95%CI 0.925-0.975).The sensitivity,specificity,positive predictive value,and negative predictive value of microscale endometrial sampling biopsy were 91.7%,100.0%,100.0%,and 99.3%for endometrial cancer screening,respectively,and 82.0%,100.0%,100.0%,and 99.4%for atypical hyperplasia screening.The medical cost of endometrial sampling biopsy was only 22.1%of the cost of hysteroscopic biopsy.Conclusions:Microscale endometrial sampling biopsy is a minimally invasive alternative technique for obtaining adequate endometrial specimens for histopathological examination.It has the potential to be used in detecting endometrial cancer and atypical hyperplasia with high efficiency and low cost.展开更多
Dear Editor,Triple-negative breast cancer(TNBC)is a heterogeneous disease characterized by a deficiency in the expression of three well-known biomarkers of breast cancers,namely estrogen receptor(ER),progesterone rece...Dear Editor,Triple-negative breast cancer(TNBC)is a heterogeneous disease characterized by a deficiency in the expression of three well-known biomarkers of breast cancers,namely estrogen receptor(ER),progesterone receptor(PR),and human epidermal growth factor receptor 2(HER2).Its treatment has become an important clinical challenge because TNBC is more aggressive than other breast cancer subtypes,and is usually associated with higher tumor recurrence and lower survival rate[1-3].Breast cancer patients with ER,PR,and/or HER2 positive tumors often respond positively to targeted therapies whereas TNBC patients remain unresponsive to conventional treatment due to lack of specific biomarkers for determining appropriate treatment(e.g.trastuzumab-based therapy).Hence,identifying novel and effective biomarkers for predicting TNBC prognosis and to improve their survival has become an urgent need for developing effective targeted therapy against TNBC.展开更多
of main observation and conclusion A copper catalyzed enantioselective[3+2]annulation of donor-acceptor cyclopropanes with cyclic ketones has been developed,providing a concise protocol to enantioenriched l-oxaspiro[4...of main observation and conclusion A copper catalyzed enantioselective[3+2]annulation of donor-acceptor cyclopropanes with cyclic ketones has been developed,providing a concise protocol to enantioenriched l-oxaspiro[4.5]decanes in up to 98%yield with up to>99/1 dr and up to 92%ee.In addition,this method also provides a facile access to the enantioselective desymmetrisation of various 4-substituted cyclohexanones.The resulting products were easily converted to the core structures of two natural products Heliespirones A and halogenated sesquiterpene isolated from L saitoi.展开更多
A highly efficient asymmetric cyclopropanation of trisubstituted olefins with methyl diazoacetate has been developed in terms of an elaborate modified chiral bisoxazoline/copper complex as a catalyst. A broad scope of...A highly efficient asymmetric cyclopropanation of trisubstituted olefins with methyl diazoacetate has been developed in terms of an elaborate modified chiral bisoxazoline/copper complex as a catalyst. A broad scope of substrates is compatible with this catalyst system, including various trisubstituted olefins bearing different aryl-, fused aryl-and alkyl-substituents, providing an easy access to optically active 1,1-dimethyl cyclopropanes in good yields with excellent diastereo-and enantio-selectivity.展开更多
文摘Multiple evanescent white dot syndrome(MEWDS)is an inflammatory fundus disease primarily affecting the outer retina.It is characterized by transient yellow-white dots on the outer retina.Although the exact pathogenesis remains unclear,the progress in multimodal imaging(MMI)has enhanced our understanding of MEWDS.Most cases of MEWDS are idiopathic,lacking a definite cause,and can spontaneously recover;these are what we term classic MEWDS.Consequently,MEWDS is often referred to as the“common cold of the retina”.Simultaneously,patients with other disorders may present with varying degrees of manifestations similar to MEWDS.The resemblance in clinical or imaging findings can lead to misdiagnosis and inappropriate treatment.These MEWDS-like presentations are actually caused by other systemic or ocular disorders with diverse mechanisms.Thus,they differ from classic MEWDS in certain aspects.Using the keywords“MEWDSlike”and“Secondary MEWDS”,we searched for all relevant studies published in the PubMed database from January 2021 to January 2024.Subsequently,we retrospectively summarized the clinical and imaging characteristics of MEWDS,along with the manifestations in other diseases that resembled those of MEWDS,and compared classic MEWDS with these similar presentations.Based on our review,we classified such similar presentations under other conditions into two categories and summarized their features for differential diagnosis.We recommend paying close attention to patients suspected of having MEWDS,as there may be more serious systemic or ocular disorders that require prompt treatment.
基金funded by the National Key R&D Program of China (2021YFC2301102)National Natural Science Foundation of China (82202593)Natural Science Foundation of Shandong Province,China (ZR2022MH115).
文摘A rapid and accurate COVID-19 diagnosis is a prerequisite for blocking the source of infection as soon as possible and taking the appropriate medical action.Herein,we developed GeneClick,a device for nucleic acid self-testing of SARS-CoV-2,consisting of three modules:a sampling kit,a microfluidic chip-based disposable cartridge,and an amplification reader.In addition,we evaluated the clinical performance of GeneClick using 2162 nasal swabs collected at three medical institutions,using three commercial RT-qPCR kits and an antigen self-test as references.Compared to RT-qPCR,the sensitivity and specificity of the GeneClick assay were 97.93%and 99.72%,respectively,with a kappa value of 0.979(P<0.01).Of the 2162 samples,2076 were also tested for SARS-CoV-2 antigens.Among the 314 positive samples identified by GeneClick assay,63 samples were undetected by antigen tests.Overall,the GeneClick nucleic acid self-test demonstrated higher accuracy than the antigen-based detection.Based on the additional features,including simple operation,affordable price,portable device,and reliability of smartphone APP-driven sampling and result reporting,GeneClick offers a powerful tool for field-based SARS-CoV-2 detection in primary healthcare institutions or at-home use.
基金Supported by the National Natural Science Foundation of China,No. 82100125。
文摘BACKGROUND Giant cellulitis-like Sweet syndrome(SS) is a rare subtype of SS,and reports of the combined histiocytoid type of pathology are scarce.Here,we report a case of SS with distinctive clinical presentations and which was difficult to distinguish from cellulitis.By sharing this case and a discussion of the related literature in detail,we aim to provide clinicians with new insights into the characteristics of histiocytoid giant cellulitis-like(HGC)-SS and the pathogenesis of SS.CASE SUMMARY A 52-year-old male was admitted after experiencing progressive fatigue for 1 mo and tongue swelling with pain for 1 d.He was diagnosed with myelodysplastic syndrome(MDS) and angioneurotic edema of the tongue and floor of the mouth.However,7 d after examination by sternal aspiration,a violaceous,tender,and swollen nodule developed at the site,with poorly demarcated erythema of the surrounding skin.Considering his profile of risk factors,the diagnosis of cellulitis was made and he was administered broad-spectrum antibiotics.When the lesion continued to worsen and he developed chills and fever,pathogenic and dermatopathological examination led to the diagnosis of HGC-SS.Treatment with prednisone led to the fever being relieved within 24 h and the skin lesion being resolved within 1 wk.The patient refused intensive treatment and was instead given thalidomide,erythropoietin,stanozolol,and supportive care.The prednisone was gradually tapered,with no signs of recurrence,but he died 2 mo later of severe pneumonia.CONCLUSION HGC-SS demonstrates unique manifestation.SS and leukemia cutis share cytological origin.Myelofibrosis and SS are adverse prognostic factors for MDS.
基金Supported by the National Natural Science Foundation of China(No.82171073).
文摘Dear Editor,We present a case of acute zonal occult outer retinopathy(AZOOR)complex in a myopic patient with angioid streaks(ASs).A 19-year-old female has been experiencing visual field defects in her left eye for more than 3y.She was diagnosed with ASs and choroiditis at a local hospital.She has a seven-year history of bilateral high myopia.A fundus examination confirmed the presence of ASs and myopic fundus changes in both eyes.Multimodal imaging revealed an AZOOR complex in the left eye.
基金This study was supported by grants from the National Natural Science Foundation of China （No. 8157142） and Beijing Municipal Science and Technology Commission （No. D151100001915003）.
文摘Background： Fibroblasts were the main seed cells in the studies of tissue engineering of the pelvic floor ligament. Basic fibroblast growth factor （bFGF） and epidermal growth factor （EGF） were widely studied but at various concentrations. This study aimed to optimize the concentrations of combined bFGF and EGF by evaluating their effects on proliferation and collagen secretion of fibroblasts. Methods： Fibroblasts were differentiated from rat adipose mesenchymal stem cells （ADSCs）. Flow cytometry and immunohistochemistry were used for cell identification. The growth factors were applied at concentrations of 0, 1, 10, and 100 ng/ml as three groups： （1） bFGF alone, （2） EGF alone, and （3） bFGF mixed with EGF. Cell proliferation was evaluated by Cell Counting Kit-8 assays. Expression of Type I and III collagen （Col-I and Col-1II） mRNAs was evaluated by real-time quantitative reverse transcription-polymerase chain reaction. Statistical analysis was performed with SPSS software and GraphPad Prism using one-way analysis of variance and multiple t-test. Results： ADSCs were successfully isolated from rat adipose tissue as identified by expression of typical surface markers CD29, CD44, CD90, and CD45 in flow cytometry. Fibroblasts induced from ADSC, compared with ADSCs, were with higher mRNA expression levels of Col I and Col III （F = 1.29, P = 0.0390）. bFGF, EGF, and the mixture ofbFGF with EGF can enhanced fibroblasts proliferation, and the concentration of 10 ng/ml of the mixture ofbFGF with EGF displayed most effectively （all P 〈 0.05）. The expression levels of Col-I and Col-Ill mRNAs in fibroblasts displayed significant increases in the 10 ng/ml bFGF combined with EGF group （all P 〈 0.05）. Conclusions： The optimal concentration of both bFGF and EGF to promote cell proliferation and collagen expression in fibroblasts was 10 ng/ml at which fibroblasts grew faster and secreted more Type I and III collagens into the extracellular matrix, which might contribute to the stability of the pelvic floor microenvironment.
文摘Background： Some patients with pelvic organ prolapse may suffer from incontinence （SUI） named de novo SUI alter pelvic floor reconstruction of de novo SUI. ower urinary tract symptoms （LUTS）, especially stress urinary This study aimed to investigate the incidence and risk factors Methods： This is a nested case-control study of 533 patients who underwent pelvic floor reconstruction due to pelvic organ prolapse （POP） at the Department of Gynecology in Peking University People＇s Hospital from January 2011 to March 2013. According to the inclusion and exclusion criteria, 401 patients were enrolled in the study with the follow-up rate of 74.8% （101 patients lost to follow-up）. There were 75 patients with de novo SUI postoperatively. According to the ratio of 1：3, we ensured the number of control group （n = 225）. The preoperative urinary dynamics, POP-quantification scores, and LUTS were compared between the two groups by univariate and multivariate logistic regression analyses to investigate the risk factors of de novo SUI. Results： The incidence of de novo SUI was 25% （75/300）. Univariate analysis showed that the ratio of lower urinary tract obstruction （LUTO） before surgery in de novo SUI group was significantly higher than the control group （odds ratio [OR] = 2.1, 95% confidence interval [（7] [1.1-4.0], P = 0.022）. The interaction test of LUTO and other factors displayed that Aa value was an interaction factor. With the increasing score of Aa, the incidence of de novo SUI become higher （OR = 2.1, 95% CI [1.0-3.7], P = 0.045）. After multivariable adjustment, multiple regression analysis showed that LUTO was independently associated with a greater risk of de novo SUI after pelvic floor surgery （OR = 2.3, 95% CI [1.2-4.6], P = 0.013）. Conclusions： Preoperative LUTO in patients with POP is a high-risk factor of de novo SUI, and high score of Aa-point is related to the occurrence of de novo SUI, which might be due to the outlet obstruction caused by bladder prolapse.
基金the National Key R&D Program of China(2018YFC2002200 and 2018YFC2002204)the Beijing Municipal Science&Technology Commission(No.D151100001915003).
文摘Background:After radical hysterectomy for cervical cancer,the most common complication is lower urinary tract symptoms.Post-operatively,bladder capacity can alter bladder function for a prolonged period.This study aimed to identify factors affecting bladder storage function.Methods:A multicenter,retrospective cohort study was conducted.Information of patients with stages IA2 to IIB cervical cancer with urodynamic study results were retrospectively collected from nine hospitals between June 2013 and June 2018 according to the inclusion criteria.Demographic,surgical,and oncological data were collected.The univariate and multivariate logistic regression was used to identify clinical factors associated with bladder storage function.Results:Two hundred and three patients with cervical cancer had urodynamic testing post-operatively.Ninety-five(46.8%)patients were diagnosed with stress urinary incontinence(SUI).The incidence of low bladder compliance(LBC)was 23.2%.Twenty-seven(13.3%)patients showed detrusor overactivity(DO).Fifty-seven patients(28.1%)presented with a decreased maximum cystometric capacity(DMCC).The probability of composite bladder storage dysfunction was 68.0%.Multivariate analysis confirmed that laparoscopy represents a protective factor for SUI with an odds ratio of 0.498(P=0.034).Patients who underwent a nerve-sparing procedure were less odds to experience SUI(P=0.014).A significant positive correlation between LBC and DO was observed(P<0.001).A greater length of the resected vagina and chemoradiotherapy were common risk factors for LBC and DO,while radiotherapy exerted a stronger effect than chemotherapy.Additionally,patients who received chemoradiotherapy frequently developed a DMCC.The follow-up time was not correlated with bladder storage function.Conclusion:A nerve-sparing procedure without longer resected vagina is recommended for protecting the bladder storage function.
文摘Background：Pelvic organ prolapse （POP） is a major health concern that affects women.Surgeons have increasingly used prosthetic meshes to correct POP.However,the most common used is synthetic mesh,and absorbable mesh is less reported.This research aimed to evaluate the clinical effectiveness of porcine small intestinal submucosa （SIS）.Methods：Consecutive forty POP patients who met the inclusion criteria underwent pelvic reconstruction surgery with SIS between March 2012 and December 2013.The patients＆#39; clinical characteristics were recorded preoperatively.Surgical outcomes,measured by objective and subjective success rates,were investigated.We evaluated the quality of life （QOL） using the Pelvic Floor Distress Inventory-20 （PFDI-20） and the Pelvic Floor Impact Questionnaire-7 （PFIQ-7）.Sexual QOL was assessed by the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire-12 （P1SQ-12）.Results：At postoperative 12 months,the subjective recurrence rate （7.5%） was much lower than the objective recurrence rate （40.0%）.Postoperatively,no erosion was identified.One underwent a graft release procedure because of urinary retention,and one had anus sphincter reconstruction surgery due to defecation urgency.Another experienced posterior vaginal wall infection where the mesh was implanted,accompanied by severe vaginal pain.Estrogen cream relieved the pain.One patient with recurrence underwent a secondary surgery with Bard Mesh because of stage 3 anterior vaginal wall prolapse.Scoring system of PFDI-20 was from 59.150 ± 13.143 preoperatively to 8.400 ± 4.749 postoperatively and PFIQ-7 was from 73.350 ± 32.281 to 7.150 ± 3.110,while PISQ-12 was from 15.825 ± 4.050 to 12.725 ± 3.471.Conclusions：QOL and the degree of subjective satisfaction were significantly improved postoperatively.Anterior repair deserves more attention because of the higher recurrence rate.The long-term follow-up of the patient is warranted to draw firm conclusion.
基金supported by grants from the Special Projects for Strengthening Basic Research of Peking University(No.BMU2018JC005)the Application Research and Achievement Popularization of Clinical Characteristics in Capital from Beijing Municipal Science and Technology Commission(No.z161100000516227)。
文摘Background:Endometrial cancer is one of the most common malignancies of the reproductive system.Effective and cost-effective screening method for populations at high risk is not available.This study aimed to investigate specimen adequacy and the influencing factors in microscale endometrial sampling biopsy and to evaluate the diagnostic accuracy and medical cost of biopsy in endometrial cancer and atypical hyperplasia screenings in comparison with hysteroscopic endometrial biopsy.Methods:A total of 1551 patients at high risk for endometrial lesions who required hysteroscopic endometrial biopsy from November 2017 to August 2018 were included.Microscale endometrial sampling biopsy was performed,followed by hysteroscopic endometrial biopsy.We evaluated the specimen adequacy and influencing factors of microscale endometrial sampling.Diagnostic consistency between microscale endometrial sampling biopsy and hysteroscopic endometrial biopsy was evaluated.The sensitivity,specificity,positive predictive value,and negative predictive value of microscale endometrial sampling biopsy in screening for endometrial cancer and atypical hyperplasia were analyzed,and the medical costs of the two procedures were compared.Results:The specimen adequacy was 81.2%.Patient age,menopausal status,endometrial thickness,and endometrial lesion type were correlated with specimen adequacy.There was good consistency in distinguishing benign and malignant endometrial diseases between microscale endometrial sampling biopsy and hysteroscopic biopsy(kappa 0.950,95%CI 0.925-0.975).The sensitivity,specificity,positive predictive value,and negative predictive value of microscale endometrial sampling biopsy were 91.7%,100.0%,100.0%,and 99.3%for endometrial cancer screening,respectively,and 82.0%,100.0%,100.0%,and 99.4%for atypical hyperplasia screening.The medical cost of endometrial sampling biopsy was only 22.1%of the cost of hysteroscopic biopsy.Conclusions:Microscale endometrial sampling biopsy is a minimally invasive alternative technique for obtaining adequate endometrial specimens for histopathological examination.It has the potential to be used in detecting endometrial cancer and atypical hyperplasia with high efficiency and low cost.
基金supported by the National Natural Science Foundation of China(No.81602346 and No.31260266)Guangdong Medical Science and Technology Found A2016295.
文摘Dear Editor,Triple-negative breast cancer(TNBC)is a heterogeneous disease characterized by a deficiency in the expression of three well-known biomarkers of breast cancers,namely estrogen receptor(ER),progesterone receptor(PR),and human epidermal growth factor receptor 2(HER2).Its treatment has become an important clinical challenge because TNBC is more aggressive than other breast cancer subtypes,and is usually associated with higher tumor recurrence and lower survival rate[1-3].Breast cancer patients with ER,PR,and/or HER2 positive tumors often respond positively to targeted therapies whereas TNBC patients remain unresponsive to conventional treatment due to lack of specific biomarkers for determining appropriate treatment(e.g.trastuzumab-based therapy).Hence,identifying novel and effective biomarkers for predicting TNBC prognosis and to improve their survival has become an urgent need for developing effective targeted therapy against TNBC.
基金We thank the NSFC(Nos.91956103,21772224)the CAS(Nos.QYZDY-SSW-SLH016,XDB20000000)the STCSM(No.17JC1401200)for the financial support.
文摘of main observation and conclusion A copper catalyzed enantioselective[3+2]annulation of donor-acceptor cyclopropanes with cyclic ketones has been developed,providing a concise protocol to enantioenriched l-oxaspiro[4.5]decanes in up to 98%yield with up to>99/1 dr and up to 92%ee.In addition,this method also provides a facile access to the enantioselective desymmetrisation of various 4-substituted cyclohexanones.The resulting products were easily converted to the core structures of two natural products Heliespirones A and halogenated sesquiterpene isolated from L saitoi.
基金supported by the National Natural Science Foundation of China(21432011,21772224)Key Research Program of Frontier Sciences of Chinese Academy of Sciences(QYZDY-SSWSLH016)+2 种基金the Strategic Priority Research Program of the Chinese Academy of Sciences(XDB20000000)the Youth Innovation Promotion Association CAS(2017301)the National Basic Research Program of China(2015CB856600)
文摘A highly efficient asymmetric cyclopropanation of trisubstituted olefins with methyl diazoacetate has been developed in terms of an elaborate modified chiral bisoxazoline/copper complex as a catalyst. A broad scope of substrates is compatible with this catalyst system, including various trisubstituted olefins bearing different aryl-, fused aryl-and alkyl-substituents, providing an easy access to optically active 1,1-dimethyl cyclopropanes in good yields with excellent diastereo-and enantio-selectivity.
