Validation of the Modena bleeding score in endoscopic sinus surgery

IntroductionThe Modena bleeding score is a categorical rating scale that allows the assessment of the surgical field in relation to bleeding during endoscopic surgery. It has recently been presented and validated in the field of endoscopic ear surgery by the present authors. The Modena bleeding score provides five grades for rating the surgical field during endoscopic procedures (from grade 1 ? no bleeding to grade 5 ? bleeding that prevents every surgical procedure except those dedicated to bleeding control).ObjectiveThe aim of this study was to validate the Modena bleeding score in the setting of endoscopic sinus surgery.MethodsFifteen three-minute videos of endoscopic sinus surgery procedures (each containing three bleeding situations) were evaluated by 15 specialists, using the Modena bleeding score. Intra and inter-rater reliability were assessed, and the clinical validity of the Modena bleeding score was calculated using a referent standard.ResultsThe data analysis showed an intra-rater reliability ranging from 0.6336 to 0.861. The inter-rater reliability ranged from 0.676 to 0.844. The clinical validity was α = 0.70; confidence limits: 0.64 ? 0.75, corresponding to substantial agreement.ConclusionThe Modena bleeding score is an effective method to score bleeding during endoscopic sinus surgery. Its application in future research could facilitate the performance and efficacy assessment of surgical techniques, materials or devices aimed to bleeding control during endoscopic sinus surgery.     

早孕期监测子宫动脉多普勒参数在预测低危人群不良妊娠结局的价值

目的 建立妊娠11~13+6周子宫动脉多普勒参数在低危人群中的正常参考值，同时评估其对不良妊娠结局的预测价值。方法 收集2019年6月至2021年6月于我院行产前超声检查的妊娠11~13+6周孕妇，根据妊娠结局分组。收集两侧子宫动脉多普勒指标，包括搏动指数（PI）、阻力指数（RI）、舒张早期是否有切迹，以及孕妇基本临床资料和胎儿出生信息，将以上相关参数进行统计学分析。结果 最终纳入800例孕妇，包括正常妊娠结局组740例和不良妊娠结局组60例。两组孕妇体质量指数（BMI）、分娩孕周和胎儿出生体质量比较，差异均有统计学意义（均P＜0.05）。随着孕周的增加，子宫动脉两侧平均搏动指数（mPI）、平均阻力指数（mRI）和两侧舒张早期切迹检出率均呈逐渐下降的趋势。ROC曲线分析显示，mPI、mRI及两侧舒张早期切迹预测妊娠结局的曲线下面积（AUC）分别为0.542、0.574、0.521，三者联合预测妊娠结局的AUC为0.648；孕妇BMI、年龄mPI、mRI及两侧舒张早期切迹预测妊娠结局的AUC为0.751。结论 建立了低危人群在妊娠11~13+6周子宫动脉多普勒参数的正常参考值范围。在妊娠11~13+6周单纯应用子宫动脉多普勒参数预测妊娠结局的价值有限，将子宫动脉参数与临床相关指标结合可提高对不良妊娠结局的预测价值。     

Colonoscopy Versus Catheter Angiography for Lower Gastrointestinal Bleeding After Localization on CT Angiography

PurposeThe aim of this study was to compare catheter angiography (CA) and colonoscopy outcomes after successful CT angiographic (CTA) localization for patients with overt lower gastrointestinal bleeding (LGIB).MethodsSeventy-one consecutive patients from two institutions between 2010 and 2020 had both contrast extravasation on CTA imaging in the lower gastrointestinal tract and subsequent CA or colonoscopy. The primary outcome was confirmation of active bleeding during CA or colonoscopy (defined as confirmation yield). The secondary outcomes were to determine therapeutic yield (hemostatic therapy), time to procedure, rebleeding rate, and adverse outcome rates (defined as surgery, acute kidney injury, initiation of dialysis, and overall mortality). Univariate analyses and multivariable analyses with P < .05 were used to determine statistical significance.ResultsForty-four patients underwent CA and 27 underwent colonoscopy. CA had higher overall confirmation yield (55% vs 26%, P = .026), whereas therapeutic yields were similar (70% vs 56%, P = .214). Time to procedure was 5.1 ± 3.4 hours for CA and 15.5 ± 13.6 hours for colonoscopy (P < .001). On multivariable analysis, shorter time to procedure was the only statistically significant predictor of confirmation yield (P = .037) and therapeutic yield (P = .013), whereas procedure, hemoglobin, transfusions, and hemodynamic instability were not. Adverse events and rebleeding were not statistically different between patients who underwent CA and colonoscopy (P > .05).ConclusionsShorter time to procedure was the only statistically significant predictor of confirmation and therapeutic yield after CTA localization of LGIB. Because CA can be performed sooner than colonoscopy without increased rates of adverse outcomes or rebleeding, CA may be a reasonable first-line treatment option in patients with CTA localization of LGIB.     

Cáncer sincrónico de carcinosarcoma uterino y carcinoma seroso tubárico. A propósito de un caso y revisión de la bibliografía

We report a rare case of uterine carcinosarcoma involving a 74-year-old woman. The patient complained of posmenopausal bleeding. The disease was eventually diagnosed as simultaneous uterine carcinosarcoma and high-grade serous tubal carcinoma.Clinical examination found a cervical tumour and transvaginal ultrasound showed a heterogeneous intrauterine image. The histological result of both findings was carcinosarcoma.The computed tomography scan and magnetic resonance imaging reported similar findings for intrauterine and cervical tumour, with the same features as a possible myoma or mass with sarcomatous degeneration.Given the suspicion of a high-risk variant of endometrial adenocarcinoma, the primary management of carcinosarcoma is surgery. Complete surgical staging included total hysterectomy, bilateral salpingo-oophorectomy, omentectomy, pelvic and para-aortic lymph node dissection.The pathological findings revealed a uterine carcinosarcoma tumour, invading less than half the myometrium and the stromal connective tissue of the cervix but not extending beyond the uterus. The histopathological studies of bilateral adnexectomy and the peritoneal biopsy demonstrated the presence of high-grade serous tubal carcinoma. The lymph study was negative for malignancy.We concluded a synchronous diagnosis of uterine carcinosarcoma stage II and high-grade serous tubal carcinoma stage IIIB.A detailed literature search and management of this entity are discussed.     

米非司酮联合宫瘤消胶囊对子宫肌瘤治疗效果

目的分析米非司酮和宫瘤消胶囊的联合应用对子宫肌瘤的临床治疗效果。方法本研究对象为80例子宫肌瘤患者,收治时间均在2017年3月—2018年3月期间。将上述子宫肌瘤患者随机分成两组,各40例。给予对照组患者口服米非司酮进行治疗,研究组患者在上述治疗的基础上增加宫瘤消胶囊口服治疗,记录2组患者治疗效果,性激素水平及子宫体积及肿瘤体积变化。结果(1)研究组患者的总体有效率显著高于对照组;(2)研究组患者的P、E2、LH及FSH均显著低于对照组;(3)研究组患者子宫体积及肿瘤体积均显著低于对照组。结论米非司酮片和宫瘤消胶囊的联合治疗对子宫肌瘤患者的治疗效果较显著。     

Anti-Uterine Fibroid Effect of Standardized Labisia Pumila Var. Alata Extracts In Vitro and in Human Uterine Fibroid Cancer Xenograft Model

Background: Uterine fibroids are a common type of solid tumor presenting in women of reproductive age. There are very few alternative treatment available from conventional treatment involving surgeries. Labisia pumila var. alata or locally known as ‘Kacip Fatimah’ was widely used as traditional medicine in Malaysia. This plant has been used to maintain a healthy female reproductive system. The present study aimed to evaluate anti fibroid potential of L. pumila extracts through in vitro apoptosis activity against uterine leiomyoma cells (SK-UT-1) and in uterine leiomyoma xenograft model. Evaluation of bioactive markers content were also carried out. Methods: Apoptotic induction of the extracts was determined by morphological examination of AO/PI dual staining assay by flourescent microscopy and flow cytometry analysis on Annexin V-FITC/PI stained cells. In vivo study was done in immune-compromised mouse xenograft model. HPLC analysis was employed to quantify marker compounds. Results: Morphological analysis showed L. pumila induced apoptosis in a dose dependent manner against SK-UT-1 cells. In vivo study indicated that L. pumila significantly suppressed the growth of uterine fibroid tumor. All tested extracts contain bioactive marker of gallic acid and cafeic acid. Conclusion: This work provide significant data of the potential of L. pumila in management of uterine fibroids.     

圆锥型套筒冠修复体修复治疗对牙周病患者牙龈指数、龈乳头探诊出血指数、牙周探诊深度的影响

目的 探讨圆锥型套筒冠修复体修复治疗对牙周病患者牙龈指数、龈乳头探诊出血指数、牙周探诊深度的影响。方法 选取2017年3月～2019年3月我院收治的牙周病患者60例,随机分为对照组和研究组两组。对照组进行常规治疗,研究组进行圆锥型套筒冠修复体修复治疗。比较两组患者疗效、牙齿松动度(TM)、牙龈指数(GI)、龈乳头探诊出血指数(PBI)、牙周探诊深度(PD)、改良菌斑指数(mPLI)、改良龈沟出血指数(MSBI)、牙龈乳头指数(PIS)、白细胞介素-8(IL-8)、白细胞介素-2(IL-2)水平、口腔健康影响程度评分(OHIP-14)、咀嚼功能、满意率。结果 研究组有效率高于对照组(P0.05);研究组TM、GI、PBI、PD低于对照组(P0.05);研究组mPLI、MSBI、PIS低于对照组(P0.05);研究组IL-8、IL-2水平低于对照组(P0.05);研究组OHIP-14评分低于对照组(P0.05);研究组咀嚼功能高于对照组(P0.05);研究组修复满意率高于对照组(P0.05)。结论 牙周病治疗中,圆锥型套筒冠修复体修复疗效显著,应在临床上广泛推广与应用。     

子宫肌瘤微创手术中右美托咪定给药方式对比

目的探究右美托咪定不同给药方式在子宫肌瘤微创手术患者中的应用效果对比。方法选取于本院诊治的子宫肌瘤并进行微创手术的患者,分为两组,每组30例。第一组,单次注射组(SI组);第二组,持续注射组(CI组)。SI组和CI组患者在一般资料上差异无统计学意义。通过分析SI组和CI组患者心率、平均动脉压、应激反应相关指标、继发效应的差异性来探究右美托咪定不同给药方式在子宫肌瘤微创手术患者中的应用效果对比。结果在T0时间点,SI组和CI组患者心率、平均动脉压指标数据相近(P>0.05),在T1、T2时间点,SI组患者平均动脉压、心率等指标比CI组优良(P<0.05)。麻醉前,SI组和CI组患者应激反应相关指标数值相差较小(P>0.05),术后,SI组患者应激反应相关指标比CI组优良(P<0.05)。两组患者继发效应发生情况差异无统计学意义(P>0.05)。结论右美托咪定在手术过程中麻醉效果显著,但单次注射的方法对患者的麻醉效果更佳,继发效应更少。