Vaginal misoprostol enhances intrauterine insemination

This study examined whether the prostaglandin E(1) analogue misoprostol (400 microgram), when placed vaginally at the time of intrauterine insemination (IUI) improves pregnancy rates. A prospective, placebo-controlled, randomized and double-blind study involving 274 women in 494 IUI cycles resulted in a total of 64 pregnancies (13% per cycle). Misoprostol cycles totalled 253, with 43 pregnancies (17% per cycle), whereas placebo cycles totalled 241, with 21 pregnancies (9% per cycle). The cumulative pregnancy rate with misoprostol treatment was significantly greater than with placebo (P = 0.004, Cox proportional hazards regression). The benefit of misoprostol was seen in clomiphene cycles (14 versus 4%, P = 0.006), and was indicated in FSH cycles (33 versus 15%, borderline significance) and natural cycles (15.6 versus 7.7%, not significant), but was not seen in clomiphene/FSH cycles (18.2 versus 23.5%, not significant). Misoprostol treatment did not increase pain score on the day of IUI (1.1 versus 1.4) and at 1 day post IUI (0.6 versus 0.8). Complications were rare in both groups [six (2%) subject cycles in the misoprostol cycles compared with two (1%) in the placebo group]. It is concluded that the use of vaginal misoprostol may improve the chance for pregnancy in women having IUI in a wide variety of cycle types.     

Urethral bulking for recurrent stress urinary incontinence after midurethral sling failure

Aims

To assess the effectiveness of a polyacrylamide hydrogel (PAHG; Bulkamid®) in treating recurrent stress urinary incontinence (SUI) following a previous midurethral sling (MUS) implant.

Methods

This observational study, conducted since 2009, included 60 patients with recurrent SUI or mixed urinary incontinence (MUI) after a previous MUS and who chose to be treated with PAHG. Objective and subjective outcomes were assessed at 1, 6, and 12 months after the initial injection. Patients were classified as cured based on a negative cough test (supine and standing) and <2 g urine on 1‐hr pad test and a VAS score improved by ≥90%. Improved were those with the loss of only a few drops of urine during the cough test and 2–10 g urine on 1‐hr pad test or a reduction >50% compared with preoperative urine loss and a VAS score improved by ≥75%.

Results

The volume of PAHG injected in the current study ranged from 1–3 ml. Cured/improved rates were 93.3% (56/60), 88.3% (53/60), and 83.6% (46/55) at 1, 6, and 12 months, respectively. Patients with MUI had a cured urgency urinary incontinence rate of 36.8%, 47.4%, and 38.9%, respectively. Voiding dysfunction rates were 13.3% (8/60), 8.3% (5/60), and 1.8% (1/55) at 1, 6, and 12 months and urinary tract infection rates were 5% (3/60), 11.7% (7/60), and 3.6% (2/55), respectively. Other adverse events were short‐term and/or observed in <4% of patients.

Conclusions

PAHG can be used to treat recurrent SUI after MUS failure with good outcome and low complication rates. Neurourol. Urodynam. 36:722–726, 2017. © 2016 The Authors. Neurourology and Urodynamics published by Wiley Periodicals, Inc.     

Health Benefits of Fiber Fermentation

Although fiber is well recognized for its effect on laxation, increasing evidence supports the role of fiber in the prevention and treatment of chronic disease. The aim of this review is to provide an overview of the health benefits of fiber and its fermentation, and describe how the products of fermentation may influence disease risk and treatment. Higher fiber intakes are associated with decreased risk of cardiovascular disease, type 2 diabetes, and some forms of cancer. Fiber may also have a role in lowering blood pressure and in preventing obesity by limiting weight gain. Fiber is effective in managing blood glucose in type 2 diabetes, useful for weight loss, and may provide therapeutic adjunctive roles in kidney and liver disease. In addition, higher fiber diets are not contraindicated in inflammatory bowel disease or irritable bowel syndrome and may provide some benefit. Common to the associations with disease reduction is fermentation of fiber and its potential to modulate microbiota and its activities and inflammation, specifically the production of anti-inflammatory short chain fatty acids, primarily from saccharolytic fermentation, versus the deleterious products of proteolytic activity. Because fiber intake is inversely associated with all-cause mortality, mechanisms by which fiber may reduce chronic disease risk and provide therapeutic benefit to those with chronic disease need further elucidation and large, randomized controlled trials are needed to confirm causality.Teaching Points? Strong evidence supports the association between higher fiber diets and reduced risk of cardiovascular disease, type 2 diabetes, and some forms of cancer.? Higher fiber intakes are associated with lower body weight and body mass index, and some types of fiber may facilitate weight loss.? Fiber is recommended as an adjunctive medical nutritional therapy for type 2 diabetes, chronic kidney disease, and certain liver diseases.? Fermentation and the resulting shifts in microbiota composition and its activity may be a common means by which fiber impacts disease risk and management.     

TVT-O治疗女性压力性尿失禁的临床疗效评估

目的 评估经闭孔经阴道无张力尿道中段吊带术(TVT-O)治疗女性压力性尿失禁(SUI)的临床疗效。方法回顾性分析32例TVT-O术治疗中-重度SUI的患者,术前术后均采用国际尿控协会ICS推荐的尿失禁生活质量问卷(I-QOL)进行生活质量评分测定及尿流动力学全套检查;术前术后腹压漏尿点测压(ALPP),最大尿道关闭压(MUCP)进行对比。根据主观症状疗效评价标准评价术后临床疗效。结果手术时间25~35 min,平均31 min,术中出血量均＜35 mL。术后拔除导尿管29例即获得满意控尿。2例出现排尿困难,经尿道扩张留置导尿1周后排尿通畅,1例术后仍存在压力性尿失禁。全组均获随访1~5年,均无尿失禁复发和相关并发症出现,其中1例尿失禁术后效果欠佳随访3年,尿失禁程度未加重。主观症状评估疗效显著,尿动力学检查提示ALPP、MUCP较术前均有显著的控尿满意。结论TVT-O术创伤小,并发症少,恢复快,疗效满意,是一种治疗女性SUI安全有效的方法。     

无创接生联合阴部神经阻滞麻醉在自然分娩中的应用价值

目的:探析无创接生术+阴部神经阻滞麻醉在经阴道自然分娩初产妇中的临床意义.方法:分析2015年4月~2016年8月在我院产科进行阴道自然分娩的84例初产妇的临床资料.随机将入选者均分成A组(无创接生+阴部神经阻滞麻醉)和B组(无创接生)两组,每组42例.比较两组产妇的基线资料、会阴撕裂率及其程度、不同时段的视觉模拟评分(VAS)、第二产程时间及新生儿窒息率以及产后恢复情况.结果:两组产妇的基线资料无显著性差异.B组产妇的会阴撕裂率(35.7%)明显较A组(9.5%)高.B组产妇在胎儿娩出时(t1)、阴道缝合时(t2)及产妇产后2h时(t3)的VAS评分均显著高于A组.B组产妇第二产程时间明显长于A组产妇;但两组新生儿窒息率无显著差异.A组产妇产后总住院时间、首次下床活动时间及并发症发生率均显著低于B组.结论:创接生术+阴部神经阻滞麻醉在经阴道自然分娩初产妇中具有重要的临床指导意义,不仅安全可靠,而且可以显著提升阴道分娩结局,值得推广.     

间歇性断食对老年前期肥胖大鼠肠道菌群及代谢的影响

目的 研究间歇性断食对老年前期肥胖大鼠代谢和肠道菌群的影响.方法 雌性Wistar大鼠经42周高脂高糖饲料饲养造模,根据体质量选取模型鼠进行间歇性断食干预.干预方法为每2周断食72 h,总干预时间18周.干预后进行口服葡萄糖耐量试验、血脂4项检测.收集粪便,通过Illumina高通量测序检测16S rRNA基因V4可变区,运用QIIME及LEfSe分析肠道菌群.结果 间歇性断食组体质量相对于模型对照组显著下降(P<0.01);高密度脂蛋白胆固醇和低密度脂蛋白胆固醇均显著下降(P<0.05);空腹血糖显著上升(P<0.01);葡萄糖耐量测试曲线下面积显著高于模型对照组,糖耐量减退(P<0.05);HE染色显示间歇性断食轻度减少肝脏脂肪变性.肠道菌群结果显示,断食组肠道菌群得到显著改善,具体表现为YS2、RF32、Helicobacteraceae(螺杆菌科)增加,Lactobacillus(乳杆菌属)、Roseburia(罗氏菌属)、Erysipelotrichaceae(韦荣球菌科)、Ralstonia(青枯菌属)、Bradyrhizobiaceae(慢生根瘤菌科)和RF39减少.Spearman相关性分析发现Bradyrhizobiaceae与总胆固醇、高密度脂蛋白胆固醇呈正相关;大鼠体质量与RF39呈负相关.结论 间歇性断食能改善肠道菌群,降低老年前期肥胖大鼠体质量和血脂水平,但对糖代谢有不良影响.     

藤三七皂苷组分对代谢综合征小鼠及其肠道菌群的调节作用

目的 研究藤三七皂苷组分对代谢综合征小鼠及其肠道菌群的调节作用.方法 45只雄性BALB/c小鼠随机分为对照组、模型组和藤三七皂苷组(n=15).采用高脂饮食建立代谢综合征小鼠模型,对照组小鼠用普通饲料喂养,模型组小鼠饲以高脂饲料,藤三七皂苷组高脂饲料饲喂同时用1 00 mg/(kg·d)藤三七皂苷灌胃液灌胃.每周测体重,第2、4、6周每组随机处理3只小鼠,第8周每组处理6只小鼠.以体重、肝脏与附睾脂肪系数、血脂等指标,观察皂苷的作用.并采用16S rRNA高通量测序法分析小鼠肠道菌群.结果 第8周,模型组体重(36.36±2.44)g明显高于对照组(29.33±1.89)g(P ＜0.05);模型组体重增量(14.86±3.66)g明显高于对照组(8.41±1.83)g和藤三七皂苷组(9.70±1.55)g(均P＜0.05).第8周,模型组附睾脂肪系数(4.18±0.97)％明显高于对照组(2.29±0.69)％(P＜0.05),也高于藤三七皂苷组(3.65±0.81)％,但差异无统计学意义(P＞0.05).第6周,模型组血清总胆固醇(TC)(7.13±0.67)mmol/L明显高于对照组(4.81 ±0.55) mmol/L(P ＜0.05),也高于藤三七皂苷组(5.38±0.15) mmol/L,但差异无统计学意义(P＞0.05);第8周,模型组TC(7.20±0.35) mmol/L明显高于对照组(4.23±0.46) mmol/L和藤三七皂苷组TC(6.12±0.33) mmol/L(均P＜0.05).第6周,模型组血清低密度脂蛋白(LDL)(1.62±0.19) mmol/L明显高于对照组(1.03±0.32) mmol/L和藤三七皂苷组(1.06±0.18) mmol/L(均P ＜0.05);第8周模型组LDL(1.56±0.67) mmol/L显著高于对照组(0.57±0.30) mmol/L和藤三七皂苷组LDL(0.68±0.07) mmol/L(均P＜0.05).藤三七皂苷组与模型组相比,肠道嗜胆菌(Bilophila)、葡萄球菌(Staphlococcus)、乳球菌(Lactococcus)、Ruminococcaceae、Anaerotruncus丰度降低,Allobaculum、Alloprevotella丰度升高.结论 藤三七皂苷组分对代谢综合征小鼠有一定的减肥及降脂作用,并能改善肠道菌群.     

菌群移植联合PD-L1抑制剂及化疗治疗三阴性乳腺癌的展望

与其他乳腺癌亚型相比,三阴性乳腺癌(triple-negative breast cancer,TNBC)患者,无论他们的疾病阶段,总是被认为总体生存数据最差。近年来,PD-L1抑制剂联合白蛋白紫杉醇在治疗TNBC已经取得突破性进展,但在治疗过程中药物副作用也极大地限制了化疗的临床应用,造成它在杀伤癌细胞的同时却又损害了人体的健康。目前已有多方面的科研结果证实,平衡的肠道菌群可以增强化疗效果减轻其副作用。菌群移植作为一种新技术在重建胃肠道微生态方面已在国内外一些医疗研究机构广泛开展,本文就菌群移植联合PD-L1抑制剂及化疗治疗三阴性乳腺癌的价值作一综述。     

肠道微生态与银屑病的中医研究

银屑病是一种常见的以慢性炎性反应为特征的全身心身疾病,与肠道菌群紊乱密切相关。中医的整体观和恒动观与肠道微生态的整体性、动态性特征相契合;"肺与大肠相表里"、"肺主皮毛"、"肠-脑-皮轴"学说,及已有有关中医药维持肠道微生态稳态的研究,为从肠道微生态角度探索银屑病的中医诊治机制提供了依据。将传统中医证候与客观的微生态学相结合,明确不同中医证型肠道微生态的特征性变化,探究可调节此类肠道微生态失调的中药复方制剂或单味药物,通过肠道菌群与中医"方"和"证"结合研究以寻找中医药治疗银屑病的新思路及新方法。