Scar Ectopic Pregnancy

Scar ectopic pregnancy is the rarest form of ectopic pregnancy and has been increasingly diagnosed all over the world. This is a life-threatening form of abnormal implantation of embryo within the myometrium and fibrous tissues in a previous scar on the uterus, especially following caesarean section. With the increasing rate of caesarean section, there is a substantial increase in this condition with better understanding of this disease. The early and accurate diagnosis with timely management can prevent pregnancy complications such as haemorrhage, uterine rupture and can preserve fertility.     

妇科恶性肿瘤患者保留生育功能的治疗要点

宫颈癌、卵巢癌和子宫内膜癌是妇科常见的三大恶性肿瘤,目前发病越来越年轻化,保留生育功能的治疗越来越受到重视。这需要我们正确理解妇科恶性肿瘤保留生育功能治疗的内涵,掌握治疗方法,把握治疗的适应证,本文从以上几点简述了妇科常见恶性肿瘤治疗要点,同时做到早期诊断、早期治疗以及正确认识癌前病变,是临床工作中的重点,我们也将会取得更大的成功。     

Lifespan extension and increased resistance to environmental stressors by N-Acetyl-L-Cysteine in Caenorhabditis elegans

OBJECTIVE:

This study was performed to determine the effect of N-acetyl-L-cysteine, a modified sulfur-containing amino acid that acts as a strong cellular antioxidant, on the response to environmental stressors and on aging in C. elegans.

METHOD:

The survival of worms under oxidative stress conditions induced by paraquat was evaluated with and without in vivo N-acetyl-L-cysteine treatment. The effect of N-acetyl-L-cysteine on the response to other environmental stressors, including heat stress and ultraviolet irradiation (UV), was also monitored. To investigate the effect on aging, we examined changes in lifespan, fertility, and expression of age-related biomarkers in C. elegans after N-acetyl-L-cysteine treatment.

RESULTS:

Dietary N-acetyl-L-cysteine supplementation significantly increased resistance to oxidative stress, heat stress, and UV irradiation in C. elegans. In addition, N-acetyl-L-cysteine supplementation significantly extended both the mean and maximum lifespan of C. elegans. The mean lifespan was extended by up to 30.5% with 5 mM N-acetyl-L-cysteine treatment, and the maximum lifespan was increased by 8 days. N-acetyl-L-cysteine supplementation also increased the total number of progeny produced and extended the gravid period of C. elegans. The green fluorescent protein reporter assay revealed that expression of the stress-responsive genes, sod-3 and hsp-16.2, increased significantly following N-acetyl-L-cysteine treatment.

CONCLUSION:

N-acetyl-L-cysteine supplementation confers a longevity phenotype in C. elegans, possibly through increased resistance to environmental stressors.     

Klinefelter syndrome and TESE-ICSI

Until few years ago, Klinefelter syndrome with a homogenous 47,XXY karyotype was considered a model of absolute male sterility. We will discuss first the potential fertility following Testicular Sperm Injection, then the physiopathology of spermatogenic failure and the origin of focal spermatogenesis and risk of aneuploidy in offspring, and third the advantage of searching spermatozoa earlier instead of adult age. The rate of positive sperm extraction seems to be better for younger patients. During childhood, there is a low rate of spermatogonia. The spermagonia, which completes the spermatogenesis, seems resulting from a rare clone of 46,XY gonia, having lost their extra X chromosome. Several arguments suggest that this focal spermatogenesis decreases with age. In addition, androgen treatment, frequently prescribed in case of Klinefelter syndrome, carries a risk of decreasing focal spermatogenesis by lowering gonadotropins. The question arises if it is necessary to expect the sperm cryopreservation before introducing androgen treatment. Further studies are necessary to determine the best age of sperm retrieval in case of Klinefelter syndrome.     

Poor socio-economic status in 47,XXX – An unexpected effect of an extra X chromosome

One of the most common sex chromosomal abnormalities in females is 47,XXX syndrome, which is characterized by tall stature and reduced IQ, but with a variable phenotype. In order to elaborate on the characteristics of this syndrome, we undertook an investigation in all diagnosed 47,XXX females at risk in Denmark and compared their socio-economic status with an age-matched cohort of the female background population as well as with all Danes diagnosed with Turner syndrome. We focused on cohabitation, motherhoods, income, education, retirement and convictions. Furthermore, we investigated whether some of these parameters influenced the increased mortality identified previously. Thus, socio-economic data were retrieved in 108 47,XXX persons, 10,297 controls, and 831 with Turner syndrome. Comparing the 47,XXX persons with their controls, we identified significantly decreased numbers of first partnership, number of mothers, and number of persons with an education in 47,XXX persons. Significantly more 47,XXX persons retired. In the younger age groups an increased number had income below the median among controls. The increased mortality identified previously was not explained by the reduced number of partnerships or the reduced number of persons with an education. Comparing the 47,XXX persons with Turner syndrome persons, we identified increased number of first partnership, number of mothers, and reduced level of education. We hypothesize that the significantly decreased number of 47,XXX persons becoming mothers could be due to hypogonadism in some. The affected socio-economic status suggests that the presence of an extra X chromosome has more detrimental effects than previously appreciated.     

宫腔镜治疗子宫中隔的疗效分析

目的探讨官腔镜治疗子宫中隔的效果。方法回顾性分析2003年1月～2011年10月114例官腔镜子宫中隔切除术（transcervical resection of septa,TCRS）的临床资料,随访其妊娠结局。结果官腔镜手术42．1％（48／114）B超监测完成,57．9％（66／114）在腹腔镜监测下完成。50．9％（58／114）术后放置官内节育器（IUD）。无子宫穿孔、出血等并发症。术后随访率92．1％（105／114）,随访时间6—96个月,（24．8±18．2）月。无宫腔粘连发生。术后妊娠率57．1％（60／105）,活产率49．5％（52／105）,自然流产率13．3％（8／60）。有自然流产史者术后妊娠率60．0％（24／40）,再次流产率12．5％（3／24）;有不孕史者术后妊娠率56．3％（27／48）,其中自然妊娠率39．6％（19／48）,体外受精一胚胎移植（IVF．ET）率16．7％（8／48）。术中放置IUD者术后妊娠率50．0％（26／52）,未放IUD者妊娠率64．2％（34／53）,差异无显著性（,：2．146,P=0．143）。结论宫腔镜子宫中隔切除术安全有效,不孕及有自然流产史的患者多可获得满意的妊娠结局。     

18～45岁已婚HIV感染者生育安全认知现状调查

目的了解18～45岁已婚HIV感染者生育安全认知现状, 为艾滋病感染家庭生育安全干预提供依据。方法选择重庆市6个区和四川省自贡市2021年11月至2022年4月接受随访的18～45岁已婚HIV感染者进行问卷调查, 收集其一般人口学特征、性行为史、生育意愿、生育安全认知等, 采用非条件logistic回归分析和Poisson回归分析研究对象生育安全认知的相关因素。结果 266名研究对象中, 女性占58.3%(155/266), 有生育意愿的HIV感染者占48.9%(130/266)。研究对象的生育安全知识知晓率为59.4%(158/266), 生育安全知识知晓情况的多因素logistic回归分析结果显示, 女性生育安全知识知晓率是男性的2.14(95%CI:1.25～3.66)倍;高中及以上文化程度者生育安全知识知晓率是高中以下文化程度的1.88(95%CI:1.08～3.27)倍;有生育意愿者生育安全知识知晓率是无生育意愿的1.88(95%CI:1.10～3.22)倍, 接受过艾滋病知识宣传教育者生育安全知识知晓率是未接受过艾滋病知识宣传教育的9.06(95%CI:2.46～33.32...     

Ovarian-Sparing Surgery in Pediatric Benign Ovarian Tumors

Study ObjectiveTo evaluate outcomes of children after ovarian-sparing surgery (OSS) for non-neoplastic and benign neoplastic ovarian lesions.DesignRetrospective cohort study from January 2003 to January 2012.SettingSingle, high-volume, tertiary care hospital.ParticipantsChildren 18 years of age and younger.InterventionsNone.Main Outcome MeasuresPostoperative complications and tumor recurrence after OSS.ResultsOne hundred nine patients underwent OSS with a median age of 13.3 years (interquartile range [IQR], 11.4-15.1 years). Eighty-two patients were treated laparoscopically with 4 conversions to an open procedure. Postoperative complications included surgical site infections in 7 patients (6%). Pathology most commonly revealed functional ovarian cysts (n = 57) and mature teratomas (n = 37). Ninety-four patients (86%) were followed for a median of 10.4 months (IQR, 0.72-30.8 months). Fifty-five patients (60%) had subsequent imaging surveillance a median of 7.6 months postoperatively (IQR, 3.9-13 months). Ten patients (10%) developed a second ipsilateral lesion within a median time of 11 months (IQR, 7.7-24 months), of whom 5 girls had repeated surgery for mass enlargement or persistent abdominal pain at a median time of 10.5 months (IQR, 8.0-12.65 months). Fifty-eight patients (63%) began or resumed menses at their most recent follow-up. Three girls became pregnant after OSS at a median follow-up of 5 years (range, 2.4-6.7 years).ConclusionBenign ovarian lesions in children can be treated successfully with OSS with low recurrence and repeat surgery rates.     

输卵管妊娠腹腔镜下输卵管切除术与输卵管切开取胚术应用比较

目的比较腹腔镜下输卵管切除术和输卵管切开取胚术治疗输卵管妊娠术后患者不同的生育结局。方法回顾性分析腹腔镜下双侧输卵管无明显粘连的55例接受输卵管切开取胚术和50例接受输卵管切除术的输卵管妊娠患者,比较两种术式患者术后再次获得宫内妊娠、术后持续性异位妊娠、重复异位妊娠的差异。结果腹腔镜下输卵管切开取胚术后组患者宫内妊娠(38/55,69.09%)发生率明显高于输卵管切除术组(25/50,50.00%),差异有统计学意义(P0.05),两组患者术后持续性异位妊娠和重复异位妊娠的发生率差异无统计学意义(P均0.05)。结论对于双侧输卵管外观无病变、且有生育要求的输卵管妊娠患者,应选择行腹腔镜下输卵管切开取胚术,对于患者术后生育力更为有利。