Objective: The aim of this study was to evaluate the efficacy of a new Professionalism curriculum in an Obstetrics and Gynecology (OB/GYN) residency after introducing Narrative Medicine and Professional Development/Su...Objective: The aim of this study was to evaluate the efficacy of a new Professionalism curriculum in an Obstetrics and Gynecology (OB/GYN) residency after introducing Narrative Medicine and Professional Development/Support Group (PDSG) programs. Methods: 32 OB/GYN residents participated in this IRB approved pilot study. Twenty residents were assessed with the Barry Challenges to Professionalism Questionnaire (Barry), the Jefferson Scale of Empathy-Physician Version (JSE), and the Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration (JSAT) in August 2010, as controls. Five Narrative Medicine sessions and four PDSG sessions were then used from August 2010-May 2011, for resident physician professionalism education. Seventeen residents then underwent post-testing with the Barry, JSE, and JSAT in May 2011. Results: The pre-test/post-test Barry comparison showed an improvement in scores after introduction of the new Narrative Medicine and PDSG curriculum (7.6 +/- 2.1 versus 8.4 +/- 1.6;p = 0.10) though this was not statistically significant. Pre-test/post-test comparison of JSAT scores showed a statistically significant decline in collaboration (52.3 +/- 4.1 versus 49.7 +/- 3.7;p = 0.028) while JSE scores showed a downward trend in empathy (109.3 +/- 10.0 versus 104.8 +/- 9.2;p = 0.086). Conclusion: Narrative Medicine and PDSG small group sessions could be an effective component of OB/GYN resident physician Professionalism curriculum. This pilot project was underpowered, due to limited resources.展开更多
AIM: To investigate the use of the Gaumard's Noelle S550.100 Maternal and Neonatal Simulators for teaching forceps delivery.METHODS: Twenty two(n = 22) resident physicians were enrolled in a simulation course on o...AIM: To investigate the use of the Gaumard's Noelle S550.100 Maternal and Neonatal Simulators for teaching forceps delivery.METHODS: Twenty two(n = 22) resident physicians were enrolled in a simulation course on operative forceps deliveries. The physicians enrolled in the course were all part of an accredited Obstetrics and Gynecology residency program and ranged in their training from post graduate year(PGY) 1-4. Each participant received simulation based teaching on the indications, contraindications, proper application, delivery and removal of forceps by a single teacher. The Gaumard's simulator and Simpson forceps were used for this course. Statistical analysis using SPSS statistical software was performed after the completion of the simulation training program. A paired student t-test was performed to compare the cohort's mean pretest and post simulation training scores. Follow up skills assessment scores at one month, 3 mo and 6 mo were compared to thebaseline pretest score using a paired student t-test. RESULTS: There was statistically significant improvement in the post simulation training performance evaluations compared to the pretest, 13.7(SD = 3.14) vs 7.9(SD = 4.92), P < 0.05. Scores at 1 mo, 3 mo, and 6 mo were compared to the pretest score and showed retention of skills: 4.6(SD = 5.5, 95%CI: 2.21-7.07), 4.4(SD = 5.2, 95%CI: 2.13-6.70), and 5.6(SD = 4.8, 95%CI: 3.53-7.75) points, respectively. There were statistically significant differences between residents by post graduate training year on pretest scores, however these differences were not present after simulation training. Pretest scores for PGY 1, 2, 3, 4 were 3.5(SD = 2.27, 95%CI: 2.13-5.00), 7.25(SD = 6.70, 95%CI: 1.50-13.00), 10.75(SD = 1.5, 95%CI: 9.50-12.00), 12.17(SD = 2.57, 95%CI: 10.33-14.00). After simulation training PGY 1 residents did as well as well as the upper level residents. Posttest mean test scores for PGY 1, 2, 3, 4 were 13.75(SD = 1.49, 95%CI: 12.75-14.63), 10.25(SD = 0.24, 95%CI: 4.25-14.00), 15.00(SD = 1.16, 95%CI: 14.00-16.00), 15.17(SD = 0.75, 95%CI: 14.67-15.67). CONCLUSION: Our simulation based training program not only produced short term gains, but participants were able to retain the skills learned and demonstrate their knowledge months later.展开更多
Introduction: The effect of Body Mass Index (BMI), which reflects the woman’s obesity, in IVF treatment cycle, remains unclear. In 1997, the World Health Organization (WHO) provided authoritative refinements to the o...Introduction: The effect of Body Mass Index (BMI), which reflects the woman’s obesity, in IVF treatment cycle, remains unclear. In 1997, the World Health Organization (WHO) provided authoritative refinements to the over-weight terminology and BMI cutoffs [1]. Objective: To verify the relationship between BMI and ovarian response in IVF treatment cycle. Design: Retrospective study. Materials & Methods: The study includes 2625 IVF treatment cycles performed in our IVF center in the period of 4 years. Patients were divided into five groups using the WHO criteria according to their BMI [2]. Cancellation rate, mean last E2 before hCG administration, mean endometrial thickness, mean duration of stimulation, number of eggs retrieved, fertilization rate, pregnancy and abortion rates were analyzed. The unpaired t-test was used in statistical analysis. Results: There was statistically significant less mean oestradiol level prior to hCG, less endometrial thickness and less number of simulation days as BMI gets higher. In contrast, there was a positive relationship between cancellation rate and higher BMI except with BMI >39 which was not, possibly due to lower number of patients available. But if we look at the cause of cancellation, it was 100% due to insufficient number of follicles obtained for this group (BMI >39). Also, days of stimulation are significantly lower for the same group of patients in comparison with the other groups. Retrieval, fertilization and pregnancy rates were not significant between all groups. Abortion rate gets significantly higher as BMI increased. Conclusion: Overweight affects ovulation, if we consider the cause of cancellation being insufficient number of follicles reflects the poor response. The fertilization and pregnancy rate were not affected once oocytes retrieved. The reduction of weight is an important part of infertility treatment in obese women with regards to the ovarian response and abortion rate in IVF cycle.展开更多
Testicular descent occurs in two consecutive stages:the transabdominal stage and the inguinoscrotal stage.Androgens play a crucial role in the second stage by influencing the development of the gubernaculum,a structur...Testicular descent occurs in two consecutive stages:the transabdominal stage and the inguinoscrotal stage.Androgens play a crucial role in the second stage by influencing the development of the gubernaculum,a structure that pulls the testis into the scrotum.However,the mechanisms of androgen actions underlying many of the processes associated with gubernaculum development have not been fully elucidated.To identify the androgen-regulated genes,we conducted large-scale gene expression analyses on the gubernaculum harvested from luteinizing hormone/choriogonadotropin receptor knockout(Lhcgr KO)mice,an animal model of inguinoscrotal testis maldescent resulting from androgen deficiency.We found that the expression of secreted protein acidic and rich in cysteine(SPARC)-related modular calcium binding 1(Smoc1)was the most severely suppressed at both the transcript and protein levels,while its expression was the most dramatically induced by testosterone administration in the gubernacula of Lhcgr KO mice.The upregulation of Smoc1 expression by testosterone was curtailed by the addition of an androgen receptor antagonist,flutamide.In addition,in vitro studies demonstrated that SMOC1 modestly but significantly promoted the proliferation of gubernacular cells.In the cultures of myogenic differentiation medium,both testosterone and SMOC1 enhanced the expression of myogenic regulatory factors such as paired box 7(Pax7)and myogenic factor 5(Myf5).After short-interfering RNA-mediated knocking down of Smoc1,the expression of Pax7 and Myf5 diminished,and testosterone alone did not recover,but additional SMOC1 did.These observations indicate that SMOC1 is pivotal in mediating androgen action to regulate gubernaculum development during inguinoscrotal testicular descent.展开更多
Objectives Salpingectomy and tubal ligation are commonly performed for permanent contraception in women.Salpingectomy has been suggested to reduce the risk of ovarian cancer,but its comparative operative and periopera...Objectives Salpingectomy and tubal ligation are commonly performed for permanent contraception in women.Salpingectomy has been suggested to reduce the risk of ovarian cancer,but its comparative operative and perioperative risks have not been well established.The objective of this study is to compare the peri-and postoperative complications of laparoscopic tubal ligation with those of salpingectomy for permanent contraception.Methods A retrospective review of 49,445 patients who underwent laparoscopic salpingectomy or tubal ligation for permanent contraception between 2017 and 2021 was conducted using data from the American College of Surgeons National Surgical Quality Improvement Program database.Statistical analysis involved t test,chi-square test,and logistic regression analysis with the use of the random forest algorithm.The primary outcomes were perioperative and postoperative complications.Results Of the total cohort,45,307(91.6%)underwent laparoscopic salpingectomy,and 4138(8.4%)received laparoscopic tubal ligation.There were significant differences between the salpingectomy and tubal ligation groups with respect to several demographic characteristics,including age,BMI,minority status,and variations in past medical history.These demographic characteristics were controlled for in the multivariate regression analysis.Salpingectomy had a higher rate of operative and postoperative complications than did tubal ligation(OR=1.78,95%CI:1.46-2.20,p<0.001).Salpingectomy was associated with a greater risk of longer operation time(OR=2.03,95%CI:2.02-2.04,p<0.001),longer hospital stay(OR=5.26,95%CI:4.57-6.09,p<0.001),increased readmission(OR=3.15,95%CI:1.92-5.65,p<0.001),and increased unplanned reoperation(OR=2.42,95%CI:1.32-5.12,p=0.010).In addition,the occurrence rates of organ space surgical site infection(OR=2.68,95%CI:1.21-7.59,p=0.032)and sepsis(OR=3.93,95%CI:1.48-16.02,p=0.020)were significantly greater in the salpingectomy group than in the tubal ligation group.Conclusions Laparoscopic tubal ligation and salpingectomy are both safe and effective procedures for permanent contraception;however,salpingectomy is more likely to be associated with peri-and postoperative complications.These findings may help guide clinical decision-making when selecting the optimal permanent contraception method for women.展开更多
According to the minimal criteria of the International Society of Cellular Therapy, mesenchymal stem cells(MSCs) are a population of undifferentiated cells defined by their ability to adhere to plastic surfaces when c...According to the minimal criteria of the International Society of Cellular Therapy, mesenchymal stem cells(MSCs) are a population of undifferentiated cells defined by their ability to adhere to plastic surfaces when cultured under standard conditions, express a certain panel of phenotypic markers and can differentiate into osteogenic, chondrogenic and adipogenic lineages when cultured in specific inducing media. In parallel with their major role as undifferentiated cell reserves, MSCs have immunomodulatory functions which are exerted by direct cell-to-cell contacts, secretion of cytokines and/or by a combination of both mechanisms. There are no convincing data about a principal difference in the profile of cytokines secreted by MSCs isolated from different tissue sources, although some papers report some quantitative but not qualitative differences in cytokine secretion. The present review focuses on the basic cytokines secreted by MSCs as described in the literature by which the MSCs exert immunodulatory effects. It should be pointed out that MSCs themselves are objects of cytokine regulation. Hypothetical mechanisms by which the MSCs exert their immunoregulatory effects are also discussed in this review. These mechanisms may either influence the target immune cells directly or indirectly by affecting the activities of predominantly dendritic cells. Chemokines are also discussed as participants in this process by recruiting cells of the immune systems and thus making them targets of immunosuppression. This review aims to present and discuss the published data and the personal experience of the authors regarding cytokines secreted by MSCs and their effects on the cells of the immune system.展开更多
Aim: To compare the recovery rate of morphologically normal and chromatin condensed spermatozoa from native se-men samples using the SpermPrep^(TM) filtration columns and Percoll gradient centrifugation and to determi...Aim: To compare the recovery rate of morphologically normal and chromatin condensed spermatozoa from native se-men samples using the SpermPrep^(TM) filtration columns and Percoll gradient centrifugation and to determine the influenceof the two processing techniques on fertilization and pregnancy rates in an IVF-ET program. Methods: Sixteen se-men samples obtained from patient's husband were included in this study. Each was divided into two aliquots. The firstaliquot was processed with SpermPrep^(TM) filtration columns and the second, Percoll gradient centrifugation. Smears weremade before and after semen processing with both methods for the evaluation of chromatin condensation (chromomycineCMA3) as well as morphology (strict criteria) of spermatozoa. One hundred and seventy oocytes were retrieved fromthe patients and the oocytes from each patient were subdivided into two sets : one set was inseminated using spermatozoaprocessed with SpermPrep^(TM) and the other inseminated after semen processing with Percoll gradient centrifugation. Re-sults: The Percoll method yielded a significantly higher percentage of chromatin condensed (90.8 ±6.5% vs 82.3±8.8%, P = 0.017) and morphologically normal spermatozoa (12.9±7.4% vs 6.9±4.8%, P =0.001) in com-parison to SpermPrep^(TM). Whereas, sperm count recovery rate was significantly higher after the use of SpermPrep^(TM) thanafter the Percoll gradient centrifugation. The fertilization rate was similar between the two methods. Conclusion:Semen processing with Percoll should be recommended for intracytoplasmic sperm injection as the natural selection isbypassed and the SpermPrep^(TM) technique could be recommended for IVF and IUI programs as the sperm concentrationplays a more significant role in these procedures.展开更多
We aim to provide an up-to-date summary of infantile hepatic hemangioma(IHH) and its misnomers and to dialectically present the differential diagnosis of these rare entities of the liver.Eligible peer-reviewed article...We aim to provide an up-to-date summary of infantile hepatic hemangioma(IHH) and its misnomers and to dialectically present the differential diagnosis of these rare entities of the liver.Eligible peer-reviewed articles on hepatic infantile hemangiomas,published between 2000 and 2015,were reviewed for this study.IHH is the most common hepatic vascular tumor in children.Once a liver mass is identified in an infant,the differential diagnosis ranges from vascular malformations to benign and malignant tumors including mesenchymal hamartoma,hepatoblastoma,metastatic neuroblastoma,so careful physical examination,imaging studies,and,if indicated,tumor markers and biopsy,are of pivotal importance to ascertain the correct diagnosis.Despite the benign nature of IHHs,some of these lesions may demand medical and/or surgical intervention,especially for multiple and diffuse IHH.Complications can include hepatomegaly,hypothyroidism and cardiac failure.Therefore,a close follow-up is required until complete involution of the lesions.We propose an algorithm to guide the physicians towards the proper management of hepatic lesions.展开更多
Ovarian cancer is the second most common gyneco-logical cancer and the leading cause of death in the United States. In this article we review the diagnosis and current management of epithelial ovarian cancer which acc...Ovarian cancer is the second most common gyneco-logical cancer and the leading cause of death in the United States. In this article we review the diagnosis and current management of epithelial ovarian cancer which accounts for over 95 percent of the ovarian malignancies. We will present various theories about the potential origin of ovarian malignancies. We will discuss the genetic anomalies and syndromes that may cause ovarian cancers with emphasis on Breast cancer type 1/2 mutations. The pathology and pathogenesis of ovarian carcinoma will also be presented. Lastly, we provide a comprehensive overview of treatment strategies and staging of ovarian cancer, conclusions and future directions.展开更多
Background: Community based cervical cancer screening models using self-collection can effectively place the identification of who is positive in the hands of the patient. The key areas we have identified as critical ...Background: Community based cervical cancer screening models using self-collection can effectively place the identification of who is positive in the hands of the patient. The key areas we have identified as critical are 1) education, 2) notification of screening opportunities, 3) registration, 4) submission of samples, 5) receiving results with an explanation, and 6) being advised where to receive evaluation and management from qualified healthcare personnel. Methods: Our primary objectives were to create, register, and pilot a website as a public platform for cervical cancer prevention for both city and rural, individual and organizational application. We selected two sites: Shenzhen City in China as the local city (individual participant) site, and Sangzhi County in Hunan Province as the remote (group management) site. The website was reviewable to all of China, but applications for screening and registration were open only to the women from the 2 pilot sites. In the local site, the women would first sign up (obtain a password) to view the website (www.mcareu.com), and then if they desired, they could register for screening using their true name and their state ID. After an offline confirmation of the address, the sampling kit would arrive. Results were available with additional education and guidance for care also on the website. Findings: 120,099 people nationwide visited the website in 27 months by the end of May, 2015, 1148 women from the sites registered at the website and 87.5% enrolled in the pilot trial. 72.3% of those testing positive returned for management. Virtually 100% of the registration/historical information was entered appropriately and 100% of the samples were handled properly. Interpretation: Web-based decision aids help patients through the uncertainties of healthcare. Applied to cervical cancer screening using self-collection, the effectiveness of the model specifically in respect to accessibility, education, registration, data input, and instructions for positive management was clearly demonstrated by this pilot as well as the potential for future diagnostics applicable to self-collection.展开更多
Many authors have reported an epidemiologic relationship between endometrial polyps and endometriosis. The joining link could be an unopposed and unbalanced estrogenic milieu. The prevalence of both, endometrial polyp...Many authors have reported an epidemiologic relationship between endometrial polyps and endometriosis. The joining link could be an unopposed and unbalanced estrogenic milieu. The prevalence of both, endometrial polyp</span><span style="font-size:12px;font-family:Verdana;">s and endometriosis, is quite high among general population. The presenc</span><span style="font-size:12px;font-family:Verdana;">e of </span><span style="font-size:12px;font-family:Verdana;">endometrial polyps and endometriosis could affect infertile women. We performed </span><span style="font-size:12px;font-family:Verdana;">a retrospective multicentric study, based on data collected from three </span><span style="font-size:12px;font-family:Verdana;">Hospitals (S. Antonio Abate, Trapani, Civico-Ascoli, Palermo, and Cannizzaro,</span> <span style="font-size:12px;font-family:Verdana;">Catania). We analyzed 285 women undergoing diagnostic/office hysteroscopy. Clinical history demographic and hysteroscopic data were collected in the same sheet, containing within informed consent. On the base of our results no relationship exists between endometrial polyps and endometriosis nor</span><span> </span><span style="font-size:12px;font-family:Verdana;">cervical polyps. It’s the first time that none correlation is proved for the coexisten</span><span style="font-size:12px;font-family:Verdana;">ce of endometrial polyps and endometriosis. Further research is needed.展开更多
Objective： To estimate the impact of parametrial infiltration and lymph node metastasis on clinical outcome in women with early-stage cervical cancer following radical hysterectomy and pelvic lymphadenectomy. Methods...Objective： To estimate the impact of parametrial infiltration and lymph node metastasis on clinical outcome in women with early-stage cervical cancer following radical hysterectomy and pelvic lymphadenectomy. Methods： Clinical records and pathologic slides of 532 patients with early-stage cervical cancer （330 Ib and 202 Ila） treated with radical hysterectomy and pelvic lymphadenectomy were reviewed. The study group comprised 520 patients with squamous call carcinoma and 12 patients with adenocarcinoma of the cervix. Median follow-up time was 67 months. The association among the various histopathologic predictors of outcome was determined with analysis. The influence of the predictors on outcome was examined with log rank survival methods and the Cox regression model. Results： FIGO stage, histologic type, tumor size, depth of invasion, parametdal infiltration, lymph node metastasis, and remote metastasis were identified as significantly biologically relevant and therefore were included as candidate predictors in multivariate analysis. In particular, parametrial infiltration and lymph node metastasis were found to be simultaneous predictors of death on multivariate analysis （P 〈 0.05）. After controlling for these two factors, the other variables considered were not statistically significant up to a two-way interaction. Conclusion： Presence of parametdal infiltration and/or lymph node metastasis in women with early-stage cervical cancer is an independent poor prognostic factor. In addition, the relatively poor survival of women with more than one lymph nodes identified with cancer cells.展开更多
<正>Objective:To explore the efficacy of 400μg of misoprostol administered sublingually on medical abortion for early pregnancy by comparing with routine administration of misoprostol. Methods;Women presenting ...<正>Objective:To explore the efficacy of 400μg of misoprostol administered sublingually on medical abortion for early pregnancy by comparing with routine administration of misoprostol. Methods;Women presenting for termination of early pregnancy,whose gestational ages were not more than 37 days,were randomly allocated into two groups.Women in group A were given 50 mg of mifepristone orally on the first day and 25 mg of mifepristone 8 to 12 hours later.The schedule on the second day was as the same as above followed by 400μg of misoprostol orally on the third day.Women in group B were given a dose of 150 mg of mifepristone orally followed by 400μg of misoprostol sublingually 36 to 48 hours later.Both completed abortion rates and side effects were evaluated. Results:The completed abortion rates were 93.4%in group A and 91.0%in group B,showing no significant difference(χ~2 =2.3846,P>0.05).About 80%of the women experienced nausea,vomit,dizziness,headache and breast tenderness.There were no significant differences in side effects of the two groups(P all>0.05).The duration of vaginal bleeding in the two groups were(9.08 + 3.49) days and(9.04 + 3.43) days,showing no significant difference(t= 0.15,P>0.05).About 97.3%of validated questionnaires on patient satisfaction were recovered.The proportions of patient satisfaction were 88.1%in group A and 92.0%in group B,showing no significant difference (P>0.05). Conclusion:Administration of 150 mg mifepristone orally followed by 400μg of misoprostol sublingually could be more suitable for termination of early pregnancy due to its higher complete abortion rate and less side effects.展开更多
Preeclampsia complicates 3%-5% of pregnancies and is one of the major causes of maternal morbidity and mortality. The pathologic mechanisms are well described but despite decades of research, the exact etiology of pre...Preeclampsia complicates 3%-5% of pregnancies and is one of the major causes of maternal morbidity and mortality. The pathologic mechanisms are well described but despite decades of research, the exact etiology of preeclampsia remains poorly understood. For years it was believed that the etiology of preeclampsia was the result of maternal factors, but recent evidence suggests that preeclampsia may be a couple specific disease where the interplay between both female and male factors plays an important role. Recent studies have suggested a complex etiologic mechanism that includes genetic imprinting, immune maladaptation, placental ischemia and generalized endothelial dysfunction. The immunological hypothesis suggests exaggerated maternal response against fetal antigens. While the role of maternal exposure to new paternal antigens in the development of preeclampsia was the initial focus of research in this area, studies examining pregnancy outcomes in pregnancies from donor oocytes provide intriguingly similar findings. The pregnancies that resulted from male or female donor gametes or donor embryos bring new insight into the role of immune response to new antigens in pathogenesis ofpreeclampsia. The primary goal of the current review is the role of exposure to new gametes on the development of preeclampsia. The objective was therefore to provide a review of current literature on the role of cohabitation length, semen exposure and gamete source in development of preeclampsia.展开更多
Objective: We tested the hypothesis that the three clinical phenotypes of polycystic ovary syndrome (PCOS) represent forms of the same metabolic disorder. Design: Prospective cohort analysis. Setting: University- base...Objective: We tested the hypothesis that the three clinical phenotypes of polycystic ovary syndrome (PCOS) represent forms of the same metabolic disorder. Design: Prospective cohort analysis. Setting: University- based tertiary care. Patient(s): Three- hundred sixteen untreated consecutive women diagnosed as having PCOS. Intervention(s): None. Main Outcome Measure(s): Each subject underwent an evaluation of ovulatory function, body habitus, acne, and hirsutism; serum free and total testosterone (T), 17- hydroxyprogesterone (17- HP), and DHEAS; and fasting plasma glucose and insulin levels. Insulin resistance and β - cell function were assessed using the homeostatic assessment model equation (HOMA- IR and HOMA- β - cell, respectively). Result(s): The Oligo+ HA+ Hirsutism phenotype was present in 48% of subjects, Oligo+ HA in 29% , and Oligo+ Hirsutism in 23% . The three phenotypes did not differ in mean body mass index, waist- to- hip ratio, racial composition, degree of oligo- ovulation, prevalence of acne, or family history of hyperandrogenic symptomatology. However, subjects demonstrating the Oligo+ HA+ Hirsutism phenotype were the youngest and had the greatest degrees of hyperandrogenemia, hyperinsulinemia, and β - cell function; patients with the Oligo+ Hirsutism phenotype where the oldest and had the mildest degrees of hyperandrogenemia, hyperinsulinemia, and β - cell function. Subjects with the Oligo+ HA phenotype demonstrated intermediate degrees of hyperandrogenemia and metabolic dysfunction. Conclusion(s): We conclude that the three clinical phenotypes of PCOS do not represent forms of the same metabolic disorder and may be the result of varying degrees of metabolic dysfunction; greater degrees of β - cell function and circulating insulin levels favored the development of hirsutism and frank hyperandrogenemia.展开更多
文摘Objective: The aim of this study was to evaluate the efficacy of a new Professionalism curriculum in an Obstetrics and Gynecology (OB/GYN) residency after introducing Narrative Medicine and Professional Development/Support Group (PDSG) programs. Methods: 32 OB/GYN residents participated in this IRB approved pilot study. Twenty residents were assessed with the Barry Challenges to Professionalism Questionnaire (Barry), the Jefferson Scale of Empathy-Physician Version (JSE), and the Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration (JSAT) in August 2010, as controls. Five Narrative Medicine sessions and four PDSG sessions were then used from August 2010-May 2011, for resident physician professionalism education. Seventeen residents then underwent post-testing with the Barry, JSE, and JSAT in May 2011. Results: The pre-test/post-test Barry comparison showed an improvement in scores after introduction of the new Narrative Medicine and PDSG curriculum (7.6 +/- 2.1 versus 8.4 +/- 1.6;p = 0.10) though this was not statistically significant. Pre-test/post-test comparison of JSAT scores showed a statistically significant decline in collaboration (52.3 +/- 4.1 versus 49.7 +/- 3.7;p = 0.028) while JSE scores showed a downward trend in empathy (109.3 +/- 10.0 versus 104.8 +/- 9.2;p = 0.086). Conclusion: Narrative Medicine and PDSG small group sessions could be an effective component of OB/GYN resident physician Professionalism curriculum. This pilot project was underpowered, due to limited resources.
文摘AIM: To investigate the use of the Gaumard's Noelle S550.100 Maternal and Neonatal Simulators for teaching forceps delivery.METHODS: Twenty two(n = 22) resident physicians were enrolled in a simulation course on operative forceps deliveries. The physicians enrolled in the course were all part of an accredited Obstetrics and Gynecology residency program and ranged in their training from post graduate year(PGY) 1-4. Each participant received simulation based teaching on the indications, contraindications, proper application, delivery and removal of forceps by a single teacher. The Gaumard's simulator and Simpson forceps were used for this course. Statistical analysis using SPSS statistical software was performed after the completion of the simulation training program. A paired student t-test was performed to compare the cohort's mean pretest and post simulation training scores. Follow up skills assessment scores at one month, 3 mo and 6 mo were compared to thebaseline pretest score using a paired student t-test. RESULTS: There was statistically significant improvement in the post simulation training performance evaluations compared to the pretest, 13.7(SD = 3.14) vs 7.9(SD = 4.92), P < 0.05. Scores at 1 mo, 3 mo, and 6 mo were compared to the pretest score and showed retention of skills: 4.6(SD = 5.5, 95%CI: 2.21-7.07), 4.4(SD = 5.2, 95%CI: 2.13-6.70), and 5.6(SD = 4.8, 95%CI: 3.53-7.75) points, respectively. There were statistically significant differences between residents by post graduate training year on pretest scores, however these differences were not present after simulation training. Pretest scores for PGY 1, 2, 3, 4 were 3.5(SD = 2.27, 95%CI: 2.13-5.00), 7.25(SD = 6.70, 95%CI: 1.50-13.00), 10.75(SD = 1.5, 95%CI: 9.50-12.00), 12.17(SD = 2.57, 95%CI: 10.33-14.00). After simulation training PGY 1 residents did as well as well as the upper level residents. Posttest mean test scores for PGY 1, 2, 3, 4 were 13.75(SD = 1.49, 95%CI: 12.75-14.63), 10.25(SD = 0.24, 95%CI: 4.25-14.00), 15.00(SD = 1.16, 95%CI: 14.00-16.00), 15.17(SD = 0.75, 95%CI: 14.67-15.67). CONCLUSION: Our simulation based training program not only produced short term gains, but participants were able to retain the skills learned and demonstrate their knowledge months later.
文摘Introduction: The effect of Body Mass Index (BMI), which reflects the woman’s obesity, in IVF treatment cycle, remains unclear. In 1997, the World Health Organization (WHO) provided authoritative refinements to the over-weight terminology and BMI cutoffs [1]. Objective: To verify the relationship between BMI and ovarian response in IVF treatment cycle. Design: Retrospective study. Materials & Methods: The study includes 2625 IVF treatment cycles performed in our IVF center in the period of 4 years. Patients were divided into five groups using the WHO criteria according to their BMI [2]. Cancellation rate, mean last E2 before hCG administration, mean endometrial thickness, mean duration of stimulation, number of eggs retrieved, fertilization rate, pregnancy and abortion rates were analyzed. The unpaired t-test was used in statistical analysis. Results: There was statistically significant less mean oestradiol level prior to hCG, less endometrial thickness and less number of simulation days as BMI gets higher. In contrast, there was a positive relationship between cancellation rate and higher BMI except with BMI >39 which was not, possibly due to lower number of patients available. But if we look at the cause of cancellation, it was 100% due to insufficient number of follicles obtained for this group (BMI >39). Also, days of stimulation are significantly lower for the same group of patients in comparison with the other groups. Retrieval, fertilization and pregnancy rates were not significant between all groups. Abortion rate gets significantly higher as BMI increased. Conclusion: Overweight affects ovulation, if we consider the cause of cancellation being insufficient number of follicles reflects the poor response. The fertilization and pregnancy rate were not affected once oocytes retrieved. The reduction of weight is an important part of infertility treatment in obese women with regards to the ovarian response and abortion rate in IVF cycle.
基金supported in part by the Department of OB/GYN research funds(University of Louisville,Louisville,KY,USA)Jilin Province Health Technology Capability Enhancement funds(No.2022JC055).
文摘Testicular descent occurs in two consecutive stages:the transabdominal stage and the inguinoscrotal stage.Androgens play a crucial role in the second stage by influencing the development of the gubernaculum,a structure that pulls the testis into the scrotum.However,the mechanisms of androgen actions underlying many of the processes associated with gubernaculum development have not been fully elucidated.To identify the androgen-regulated genes,we conducted large-scale gene expression analyses on the gubernaculum harvested from luteinizing hormone/choriogonadotropin receptor knockout(Lhcgr KO)mice,an animal model of inguinoscrotal testis maldescent resulting from androgen deficiency.We found that the expression of secreted protein acidic and rich in cysteine(SPARC)-related modular calcium binding 1(Smoc1)was the most severely suppressed at both the transcript and protein levels,while its expression was the most dramatically induced by testosterone administration in the gubernacula of Lhcgr KO mice.The upregulation of Smoc1 expression by testosterone was curtailed by the addition of an androgen receptor antagonist,flutamide.In addition,in vitro studies demonstrated that SMOC1 modestly but significantly promoted the proliferation of gubernacular cells.In the cultures of myogenic differentiation medium,both testosterone and SMOC1 enhanced the expression of myogenic regulatory factors such as paired box 7(Pax7)and myogenic factor 5(Myf5).After short-interfering RNA-mediated knocking down of Smoc1,the expression of Pax7 and Myf5 diminished,and testosterone alone did not recover,but additional SMOC1 did.These observations indicate that SMOC1 is pivotal in mediating androgen action to regulate gubernaculum development during inguinoscrotal testicular descent.
文摘Objectives Salpingectomy and tubal ligation are commonly performed for permanent contraception in women.Salpingectomy has been suggested to reduce the risk of ovarian cancer,but its comparative operative and perioperative risks have not been well established.The objective of this study is to compare the peri-and postoperative complications of laparoscopic tubal ligation with those of salpingectomy for permanent contraception.Methods A retrospective review of 49,445 patients who underwent laparoscopic salpingectomy or tubal ligation for permanent contraception between 2017 and 2021 was conducted using data from the American College of Surgeons National Surgical Quality Improvement Program database.Statistical analysis involved t test,chi-square test,and logistic regression analysis with the use of the random forest algorithm.The primary outcomes were perioperative and postoperative complications.Results Of the total cohort,45,307(91.6%)underwent laparoscopic salpingectomy,and 4138(8.4%)received laparoscopic tubal ligation.There were significant differences between the salpingectomy and tubal ligation groups with respect to several demographic characteristics,including age,BMI,minority status,and variations in past medical history.These demographic characteristics were controlled for in the multivariate regression analysis.Salpingectomy had a higher rate of operative and postoperative complications than did tubal ligation(OR=1.78,95%CI:1.46-2.20,p<0.001).Salpingectomy was associated with a greater risk of longer operation time(OR=2.03,95%CI:2.02-2.04,p<0.001),longer hospital stay(OR=5.26,95%CI:4.57-6.09,p<0.001),increased readmission(OR=3.15,95%CI:1.92-5.65,p<0.001),and increased unplanned reoperation(OR=2.42,95%CI:1.32-5.12,p=0.010).In addition,the occurrence rates of organ space surgical site infection(OR=2.68,95%CI:1.21-7.59,p=0.032)and sepsis(OR=3.93,95%CI:1.48-16.02,p=0.020)were significantly greater in the salpingectomy group than in the tubal ligation group.Conclusions Laparoscopic tubal ligation and salpingectomy are both safe and effective procedures for permanent contraception;however,salpingectomy is more likely to be associated with peri-and postoperative complications.These findings may help guide clinical decision-making when selecting the optimal permanent contraception method for women.
文摘According to the minimal criteria of the International Society of Cellular Therapy, mesenchymal stem cells(MSCs) are a population of undifferentiated cells defined by their ability to adhere to plastic surfaces when cultured under standard conditions, express a certain panel of phenotypic markers and can differentiate into osteogenic, chondrogenic and adipogenic lineages when cultured in specific inducing media. In parallel with their major role as undifferentiated cell reserves, MSCs have immunomodulatory functions which are exerted by direct cell-to-cell contacts, secretion of cytokines and/or by a combination of both mechanisms. There are no convincing data about a principal difference in the profile of cytokines secreted by MSCs isolated from different tissue sources, although some papers report some quantitative but not qualitative differences in cytokine secretion. The present review focuses on the basic cytokines secreted by MSCs as described in the literature by which the MSCs exert immunodulatory effects. It should be pointed out that MSCs themselves are objects of cytokine regulation. Hypothetical mechanisms by which the MSCs exert their immunoregulatory effects are also discussed in this review. These mechanisms may either influence the target immune cells directly or indirectly by affecting the activities of predominantly dendritic cells. Chemokines are also discussed as participants in this process by recruiting cells of the immune systems and thus making them targets of immunosuppression. This review aims to present and discuss the published data and the personal experience of the authors regarding cytokines secreted by MSCs and their effects on the cells of the immune system.
文摘Aim: To compare the recovery rate of morphologically normal and chromatin condensed spermatozoa from native se-men samples using the SpermPrep^(TM) filtration columns and Percoll gradient centrifugation and to determine the influenceof the two processing techniques on fertilization and pregnancy rates in an IVF-ET program. Methods: Sixteen se-men samples obtained from patient's husband were included in this study. Each was divided into two aliquots. The firstaliquot was processed with SpermPrep^(TM) filtration columns and the second, Percoll gradient centrifugation. Smears weremade before and after semen processing with both methods for the evaluation of chromatin condensation (chromomycineCMA3) as well as morphology (strict criteria) of spermatozoa. One hundred and seventy oocytes were retrieved fromthe patients and the oocytes from each patient were subdivided into two sets : one set was inseminated using spermatozoaprocessed with SpermPrep^(TM) and the other inseminated after semen processing with Percoll gradient centrifugation. Re-sults: The Percoll method yielded a significantly higher percentage of chromatin condensed (90.8 ±6.5% vs 82.3±8.8%, P = 0.017) and morphologically normal spermatozoa (12.9±7.4% vs 6.9±4.8%, P =0.001) in com-parison to SpermPrep^(TM). Whereas, sperm count recovery rate was significantly higher after the use of SpermPrep^(TM) thanafter the Percoll gradient centrifugation. The fertilization rate was similar between the two methods. Conclusion:Semen processing with Percoll should be recommended for intracytoplasmic sperm injection as the natural selection isbypassed and the SpermPrep^(TM) technique could be recommended for IVF and IUI programs as the sperm concentrationplays a more significant role in these procedures.
文摘We aim to provide an up-to-date summary of infantile hepatic hemangioma(IHH) and its misnomers and to dialectically present the differential diagnosis of these rare entities of the liver.Eligible peer-reviewed articles on hepatic infantile hemangiomas,published between 2000 and 2015,were reviewed for this study.IHH is the most common hepatic vascular tumor in children.Once a liver mass is identified in an infant,the differential diagnosis ranges from vascular malformations to benign and malignant tumors including mesenchymal hamartoma,hepatoblastoma,metastatic neuroblastoma,so careful physical examination,imaging studies,and,if indicated,tumor markers and biopsy,are of pivotal importance to ascertain the correct diagnosis.Despite the benign nature of IHHs,some of these lesions may demand medical and/or surgical intervention,especially for multiple and diffuse IHH.Complications can include hepatomegaly,hypothyroidism and cardiac failure.Therefore,a close follow-up is required until complete involution of the lesions.We propose an algorithm to guide the physicians towards the proper management of hepatic lesions.
基金Supported by In part by Georgia Cancer Coalition Distinguished Cancer Scholar award,NIH-NCRR-RCMI,No.G-12-RR003034,No.U54 RR02613,and No.5P20RR11104NIHMD research endowment,No.2S21MD000101,and No.U54CA118638ING foundation grant to Rao VN
文摘Ovarian cancer is the second most common gyneco-logical cancer and the leading cause of death in the United States. In this article we review the diagnosis and current management of epithelial ovarian cancer which accounts for over 95 percent of the ovarian malignancies. We will present various theories about the potential origin of ovarian malignancies. We will discuss the genetic anomalies and syndromes that may cause ovarian cancers with emphasis on Breast cancer type 1/2 mutations. The pathology and pathogenesis of ovarian carcinoma will also be presented. Lastly, we provide a comprehensive overview of treatment strategies and staging of ovarian cancer, conclusions and future directions.
文摘Background: Community based cervical cancer screening models using self-collection can effectively place the identification of who is positive in the hands of the patient. The key areas we have identified as critical are 1) education, 2) notification of screening opportunities, 3) registration, 4) submission of samples, 5) receiving results with an explanation, and 6) being advised where to receive evaluation and management from qualified healthcare personnel. Methods: Our primary objectives were to create, register, and pilot a website as a public platform for cervical cancer prevention for both city and rural, individual and organizational application. We selected two sites: Shenzhen City in China as the local city (individual participant) site, and Sangzhi County in Hunan Province as the remote (group management) site. The website was reviewable to all of China, but applications for screening and registration were open only to the women from the 2 pilot sites. In the local site, the women would first sign up (obtain a password) to view the website (www.mcareu.com), and then if they desired, they could register for screening using their true name and their state ID. After an offline confirmation of the address, the sampling kit would arrive. Results were available with additional education and guidance for care also on the website. Findings: 120,099 people nationwide visited the website in 27 months by the end of May, 2015, 1148 women from the sites registered at the website and 87.5% enrolled in the pilot trial. 72.3% of those testing positive returned for management. Virtually 100% of the registration/historical information was entered appropriately and 100% of the samples were handled properly. Interpretation: Web-based decision aids help patients through the uncertainties of healthcare. Applied to cervical cancer screening using self-collection, the effectiveness of the model specifically in respect to accessibility, education, registration, data input, and instructions for positive management was clearly demonstrated by this pilot as well as the potential for future diagnostics applicable to self-collection.
文摘Many authors have reported an epidemiologic relationship between endometrial polyps and endometriosis. The joining link could be an unopposed and unbalanced estrogenic milieu. The prevalence of both, endometrial polyp</span><span style="font-size:12px;font-family:Verdana;">s and endometriosis, is quite high among general population. The presenc</span><span style="font-size:12px;font-family:Verdana;">e of </span><span style="font-size:12px;font-family:Verdana;">endometrial polyps and endometriosis could affect infertile women. We performed </span><span style="font-size:12px;font-family:Verdana;">a retrospective multicentric study, based on data collected from three </span><span style="font-size:12px;font-family:Verdana;">Hospitals (S. Antonio Abate, Trapani, Civico-Ascoli, Palermo, and Cannizzaro,</span> <span style="font-size:12px;font-family:Verdana;">Catania). We analyzed 285 women undergoing diagnostic/office hysteroscopy. Clinical history demographic and hysteroscopic data were collected in the same sheet, containing within informed consent. On the base of our results no relationship exists between endometrial polyps and endometriosis nor</span><span> </span><span style="font-size:12px;font-family:Verdana;">cervical polyps. It’s the first time that none correlation is proved for the coexisten</span><span style="font-size:12px;font-family:Verdana;">ce of endometrial polyps and endometriosis. Further research is needed.
文摘Objective： To estimate the impact of parametrial infiltration and lymph node metastasis on clinical outcome in women with early-stage cervical cancer following radical hysterectomy and pelvic lymphadenectomy. Methods： Clinical records and pathologic slides of 532 patients with early-stage cervical cancer （330 Ib and 202 Ila） treated with radical hysterectomy and pelvic lymphadenectomy were reviewed. The study group comprised 520 patients with squamous call carcinoma and 12 patients with adenocarcinoma of the cervix. Median follow-up time was 67 months. The association among the various histopathologic predictors of outcome was determined with analysis. The influence of the predictors on outcome was examined with log rank survival methods and the Cox regression model. Results： FIGO stage, histologic type, tumor size, depth of invasion, parametdal infiltration, lymph node metastasis, and remote metastasis were identified as significantly biologically relevant and therefore were included as candidate predictors in multivariate analysis. In particular, parametrial infiltration and lymph node metastasis were found to be simultaneous predictors of death on multivariate analysis （P 〈 0.05）. After controlling for these two factors, the other variables considered were not statistically significant up to a two-way interaction. Conclusion： Presence of parametdal infiltration and/or lymph node metastasis in women with early-stage cervical cancer is an independent poor prognostic factor. In addition, the relatively poor survival of women with more than one lymph nodes identified with cancer cells.
基金State Science and Technology Support Program (2006BAI03B10)
文摘<正>Objective:To explore the efficacy of 400μg of misoprostol administered sublingually on medical abortion for early pregnancy by comparing with routine administration of misoprostol. Methods;Women presenting for termination of early pregnancy,whose gestational ages were not more than 37 days,were randomly allocated into two groups.Women in group A were given 50 mg of mifepristone orally on the first day and 25 mg of mifepristone 8 to 12 hours later.The schedule on the second day was as the same as above followed by 400μg of misoprostol orally on the third day.Women in group B were given a dose of 150 mg of mifepristone orally followed by 400μg of misoprostol sublingually 36 to 48 hours later.Both completed abortion rates and side effects were evaluated. Results:The completed abortion rates were 93.4%in group A and 91.0%in group B,showing no significant difference(χ~2 =2.3846,P>0.05).About 80%of the women experienced nausea,vomit,dizziness,headache and breast tenderness.There were no significant differences in side effects of the two groups(P all>0.05).The duration of vaginal bleeding in the two groups were(9.08 + 3.49) days and(9.04 + 3.43) days,showing no significant difference(t= 0.15,P>0.05).About 97.3%of validated questionnaires on patient satisfaction were recovered.The proportions of patient satisfaction were 88.1%in group A and 92.0%in group B,showing no significant difference (P>0.05). Conclusion:Administration of 150 mg mifepristone orally followed by 400μg of misoprostol sublingually could be more suitable for termination of early pregnancy due to its higher complete abortion rate and less side effects.
文摘Preeclampsia complicates 3%-5% of pregnancies and is one of the major causes of maternal morbidity and mortality. The pathologic mechanisms are well described but despite decades of research, the exact etiology of preeclampsia remains poorly understood. For years it was believed that the etiology of preeclampsia was the result of maternal factors, but recent evidence suggests that preeclampsia may be a couple specific disease where the interplay between both female and male factors plays an important role. Recent studies have suggested a complex etiologic mechanism that includes genetic imprinting, immune maladaptation, placental ischemia and generalized endothelial dysfunction. The immunological hypothesis suggests exaggerated maternal response against fetal antigens. While the role of maternal exposure to new paternal antigens in the development of preeclampsia was the initial focus of research in this area, studies examining pregnancy outcomes in pregnancies from donor oocytes provide intriguingly similar findings. The pregnancies that resulted from male or female donor gametes or donor embryos bring new insight into the role of immune response to new antigens in pathogenesis ofpreeclampsia. The primary goal of the current review is the role of exposure to new gametes on the development of preeclampsia. The objective was therefore to provide a review of current literature on the role of cohabitation length, semen exposure and gamete source in development of preeclampsia.
文摘Objective: We tested the hypothesis that the three clinical phenotypes of polycystic ovary syndrome (PCOS) represent forms of the same metabolic disorder. Design: Prospective cohort analysis. Setting: University- based tertiary care. Patient(s): Three- hundred sixteen untreated consecutive women diagnosed as having PCOS. Intervention(s): None. Main Outcome Measure(s): Each subject underwent an evaluation of ovulatory function, body habitus, acne, and hirsutism; serum free and total testosterone (T), 17- hydroxyprogesterone (17- HP), and DHEAS; and fasting plasma glucose and insulin levels. Insulin resistance and β - cell function were assessed using the homeostatic assessment model equation (HOMA- IR and HOMA- β - cell, respectively). Result(s): The Oligo+ HA+ Hirsutism phenotype was present in 48% of subjects, Oligo+ HA in 29% , and Oligo+ Hirsutism in 23% . The three phenotypes did not differ in mean body mass index, waist- to- hip ratio, racial composition, degree of oligo- ovulation, prevalence of acne, or family history of hyperandrogenic symptomatology. However, subjects demonstrating the Oligo+ HA+ Hirsutism phenotype were the youngest and had the greatest degrees of hyperandrogenemia, hyperinsulinemia, and β - cell function; patients with the Oligo+ Hirsutism phenotype where the oldest and had the mildest degrees of hyperandrogenemia, hyperinsulinemia, and β - cell function. Subjects with the Oligo+ HA phenotype demonstrated intermediate degrees of hyperandrogenemia and metabolic dysfunction. Conclusion(s): We conclude that the three clinical phenotypes of PCOS do not represent forms of the same metabolic disorder and may be the result of varying degrees of metabolic dysfunction; greater degrees of β - cell function and circulating insulin levels favored the development of hirsutism and frank hyperandrogenemia.
