Evaluation of Bodily Pain Associated with Polycystic Ovary Syndrome: A Review of Health-Related Quality of Life and Potential Risk Factors.

Polycystic ovary syndrome (PCOS) is the most common reproductive disease affecting the hormone and metabolic status of women. Its associated symptoms are diverse among the patients, including hyperandrogenism, insulin resistance, anovulation, infertility, obesity, hirsutism, acne, and more. In addition, PCOS can potentially increase the risk of dysmenorrhea, endometriosis, endometrioma, and irritable bowel syndrome, which are highly related to pelvic pain and sexual difficulty. However, little known is whether PCOS exacerbates other chronic bodily pain or contributes to hyperalgesia. Health-related quality of Life (HRQoL) reflects the life satisfaction and quality derived by an individual from mental, physical, emotional, and social activities under specific conditions. In this study, we reviewed pain perception from HRQoL of PCOS patients (SF-36). The review data evidently indicated that pain perception is significantly more prevalent in patients with PCOS than in healthy controls, and obesity and infertile status could be the rationales associated with pain development. Nevertheless, underlying causes remain undetermined due to the limited information from SF-36. Furthermore, we reviewed pathophysiologic factors to pain development or exacerbation, such as the deregulation of inflammation levels, adipokines, and insulin resistance. Although current evidence of pain perception and pathophysiologic risk factors are solid in PCOS, patients' pain perception is often ignored in clinical settings. Clinicians should note the perception and treatment of pain in PCOS patients. The correlation or causality between pain and PCOS warrants further clinical examination and basic studies, thereby providing new insights into this topic in the context of clinical diagnosis and health care.

Ovatodiolide Inhibits Breast Cancer Stem/Progenitor Cells through SMURF2-Mediated Downregulation of Hsp27.

Cancer stem/progenitor cells (CSCs) are a subpopulation of cancer cells involved in tumor initiation, resistance to therapy and metastasis. Targeting CSCs has been considered as the key for successful cancer therapy. Ovatodiolide (Ova) is a macrocyclic diterpenoid compound isolated from Anisomeles indica (L.) Kuntze with anti-cancer activity. Here we used two human breast cancer cell lines (AS-B145 and BT-474) to examine the effect of Ova on breast CSCs. We first discovered that Ova displayed an anti-proliferation activity in these two breast cancer cells. Ova also inhibited the self-renewal capability of breast CSCs (BCSCs) which was determined by mammosphere assay. Ova dose-dependently downregulated the expression of stemness genes, octamer-binding transcription factor 4 (Oct4) and Nanog, as well as heat shock protein 27 (Hsp27), but upregulated SMAD ubiquitin regulatory factor 2 (SMURF2) in mammosphere cells derived from AS-B145 or BT-474. Overexpression of Hsp27 or knockdown of SMURF2 in AS-B145 cells diminished the therapeutic effect of ovatodiolide in the suppression of mammosphere formation. In summary, our data reveal that Ova displays an anti-CSC activity through SMURF2-mediated downregulation of Hsp27. Ova could be further developed as an anti-CSC agent in the treatment of breast cancer.

Perforation of the right innominate vein by pulmonary artery catheter introducer sheath: a case report.

A complication following placement of the pulmonary artery catheter (PAC) is presented. Resistance was experienced during insertion of the introducer sheath, and the PAC could not be advanced into the right heart. Finally, the PAC was successfully placed through the left internal jugular vein. Perforation of the right innominate vein was identified following emergent exploratory surgery for cardiovascular collapse.

Tracheo-innominate artery fistula after tracheostomy--a case report.

Tracheo-innominate artery fistula (TIF) is a rare but fatal complication after tracheostomy. There are no reports of survival without surgical intervention. We report a patient with an undiagnosed TIF who suffered massive bleeding from tracheostomy when we replaced the tracheostomy tube with an oral endotracheal tube. We emphasize the importance of keeping a high suspicion toward a possible TIF in any patient with bleeding from the tracheostomy site.

The valid time of soda lime could be safely prolonged according to the inspired pressure of carbon dioxide.

BACKGROUND: Carbon dioxide (CO2) absorbent, a disposable chemical mixture enclosed in a canister of anesthetic breathing systems functions to remove the carbon dioxide expired from the patients during general anesthesia. The timing of replacing the exhausted CO2 absorbent is usually decided by discoloration of the indicator dye or the valid time of use. However, these methods are subjective. We designed a study to validate our idea of replacing the exhausted CO2 absorbent according to the inspired pressure of carbon dioxide (PiCO2) and comparison of the pressure difference between the arterial carbon dioxide tension (PaCO2) and end-tidal CO2 in the exhausted and fresh CO2 absorbent circuits. METHODS: Fifty-five adult patients undergoing general anesthesia for elective surgeries were enrolled in this study. All the canisters containing fresh soda lime were labeled with the date of filling and valid time of clinical use. The soda lime was replaced only when the PiCO2 reached 6 mmHg. Before and 20 minutes after the replacement, PaCO2 and end-tidal CO2 were obtained and designated as group-Pre and group-Post, respectively. The pressure differences between PaCO2 and end-tidal CO2 in both groups were checked for statistical analysis. RESULTS: The pressure differences in group-Pre and group-Post were 5.8 +/- 3.4 mmHg and 6.1 +/- 3.3 mmHg, respectively, both of which were not statistically significant (P = 0.62). The PaCO2 in group-Pre and group-Post was 43.7 +/- 4.2 mmHg and 40.9 +/- 4.6 mmHg respectively. The end-tidal CO2 in group-Pre and group-Post was 38 +/- 3.5 mmHg and 35 +/- 3.6 mmHg, respectively. There were significant differences in PaCO2 and end-tidal CO2 between the two groups (P < 0.001). By this determination the valid time of soda lime in Omeda, Cato and Kion anesthesia machines was 57.3 +/- 7.2, 35.6 +/- 6.3 and 21.7 +/- 4.2 hours, respectively, all of which were much longer than 8 hours of routine use previously delimited. CONCLUSIONS: Even though the PiCO2 concentration reached 6 mmHg in the rebreathing circuit with exhausted soda lime, the gradient between the PaCO2 and end-tidal CO2 was of no statistical difference compared with that of the fresh soda lime circuit. Thus the pressure difference was not affected by the exhausted CO2 absorbent in spite of a reach of PiCO2 to 6 mmHg. Under CO2 monitoring, the valid time of soda lime could be safely prolonged until the PiCO2 was elevated to 6 mmHg rather than 8 h strictly pursuant to traditional method of discoloration of indicator dye.