Clinical Characteristics of Gynecologic Problems During Childhood in the Korean Population.

BACKGROUND: This study analyzed common gynecologic problems among Korean patients younger than ten years. METHODS: We performed a retrospective analysis of medical records of patients younger than ten years who visited the Pediatric and Adolescent Gynecology Clinic at Samsung Medical Center between 1995 and 2020. RESULTS: Among the 6,605 patients who visited the Pediatric and Adolescent Gynecology Clinic, data from 642 patients younger than ten years were analyzed in this study. The most common chief complaint was genital anomalies, followed by increased vaginal discharge and abnormal findings on clinical examinations. The most common disease entity was agglutination of the labia minora, which was commonly discovered incidentally during routine screenings. Vulvovaginitis, the second most common disease, was identified by symptoms of vaginal discharge, pruritus, and vaginal spotting. Neoplasm, issues with vaginal bleeding, and "other causes" were additional categories of gynecologic problems. 245 patients (38.2%) were referred from primary care sources, 175 patients (27.4%) sought care directly at the clinic, 169 patients (26.3%) were referrals from the institution's pediatric department, and the remainder were referrals from other departments. CONCLUSION: This study provides information about the gynecologic problems most frequently encountered in pediatric patients. The study provides helpful insight for primary care physicians into the proper management and timing of referrals for these gynecologic problems of pediatric patients.

Postoperative analgesic efficacy of continuous wound infusion with local anesthetics after laparoscopy (PAIN): a randomized, double-blind, placebo-controlled trial.

BACKGROUND: To investigate the efficacy of continuous wound infusion (CWI) with local anesthetics for reducing postoperative pain compared with placebo in patients undergoing benign gynecologic laparoscopy. METHODS: In this double-blind trial, 66 patients were randomly assigned to receive either ropivacaine or normal saline though a multi-orifice catheter placed into the umbilical surgical wound for 50 h postoperatively. The primary outcome measure was the severity of postoperative pain 1, 6, 12, 24, and 48 h after surgery. The secondary outcome measure was the number of rescue analgesics requested. RESULTS: Baseline characteristics did not statistically differ between the ropivacaine and placebo groups. The intensity of postoperative pain was significantly lower in the ropivacaine group than in the placebo group 1, 6, 12, 24, and 48 h after surgery (all P < 0.05). The number of rescue analgesics requested was also significantly lower in the ropivacaine group than in the placebo group. There were no significant differences between the two groups regarding other surgical outcomes. CONCLUSION: CWI with local anesthetics after laparoscopic surgery provides good analgesia and reduces rescue analgesics consumption.

Preoperative Oral Carbohydrate Loading in Laparoscopic Gynecologic Surgery: A Randomized Controlled Trial.

STUDY OBJECTIVE: To determine whether carbohydrate loading improves the postoperative quality of recovery (QoR) better than the midnight fasting policy in laparoscopic gynecologic surgeries. DESIGN: Randomized, parallel-group trial. SETTING: Tertiary university hospital. PATIENTS: Female patients scheduled for laparoscopic gynecologic surgery for nonmalignant gynecologic diseases. INTERVENTIONS: Eighty-eight women were randomly assigned to the midnight fasting group (nil per os, NPO group) or the carbohydrate loading group (carbohydrate group). Patients in both groups adhered to the enhanced recovery after surgery protocol except for carbohydrate intake in the carbohydrate group. MEASUREMENTS AND MAIN RESULTS: The postoperative QoR was evaluated using the QoR 15-item questionnaire on postoperative day 2. The times to readiness for discharge of the groups were compared. The QoR 15-item questionnaire scores were 97.7 ± 23.0 in the NPO group and 99.6 ± 22.4 in the carbohydrate group; they were not statistically different (p = .702). The times to readiness for discharge of both groups were also not different: 36.8 ± 12.2 hours in the NPO group and 37.6 ± 11.8 hours in the carbohydrate group (p = .684). CONCLUSION: The benefit of carbohydrate beverage intake was not significant in laparoscopic gynecologic surgeries when following the enhanced recovery after surgery protocol.

Clinical characteristics of endometrioma with and without dysmenorrhea diagnosed by laparoscopy: A retrospective cohort study in a tertiary center.

OBJECTIVE: Clinical characteristics of patients with endometrioma without dysmenorrhea have not been well delineated; our goal was to remedy this issue by performing a retrospective cohort study. METHODS: A total of 379 patients who underwent laparoscopic surgery for endometrioma ≥4 cm at a tertiary hospital were included in this retrospective study. Patients were divided into two groups based on the presence of dysmenorrhea at the time of hospital visit; with dysmenorrhea group and without dysmenorrhea group. RESULTS: Patients without dysmenorrhea comprised 9.5% of all surgically confirmed endometriomas. Significant differences were found in the revised American Society for Reproductive Medicine (rASRM) stage, age at surgery, and bilaterality. Patients with rASRM stage IV were more likely to have dysmenorrhea than were subjects with rASRM stage III (odds ratio (OR), 10.58; 95% confidence interval (CI), 4.63-24.21; P < 0.001). Older patients were less likely to have dysmenorrhea (OR, 0.94; 95% CI, 0.88-1.00; P = 0.045), as were patients with bilateral rather than unilateral endometrioma (OR, 0.36; 95% CI, 0.15-0.82; P = 0.015). No significant differences in cyst size, age at menarche, body mass index (BMI), parity, or history of previous ovarian surgery were found between the two groups. CONCLUSION: Patients without dysmenorrhea comprised 9.5% of endometrioma cases and had less advanced rASRM stage, were older at surgery, and had a higher probability of bilateral than unilateral endometrioma than patients with dysmenorrhea.

Comparison of Reduced-Port Robotic Surgery (RPRS) with conventional 2 port laparoscopy for myomectomy.

OBJECTIVE: To compare the surgical outcomes between Reduced-Port Robotic Surgery (RPRS) using the Octo-Port system and conventional 2 port laparoscopy for myomectomy. STUDY DESIGN: This is a prospective, non-randomized study, which compared and analyzed data from 41 patients who underwent RPRS myomectomy and 22 patients who underwent conventional 2 port laparoscopic myomectomy from April 2016 through July 2019. We compared the myoma enucleation time, suture time, myoma type, and the location of the largest myoma between the two groups. RESULTS: The patients were not different between the two groups. The myoma enucleation time (26.7 ± 20.9 vs. 22.0 ± 13.7, p = 0.380), hemoglobin drop (2.38 ± 0.9 vs 2.1 ± 0.8, p = 0.280), weight of the myomas (205.3 ± 161.5 vs. 163.4 ± 89.1, p = 0.261), and estimated blood loss (181.1 ± 163.4 vs. 187.3 ± 77.5, p = 0.840) were not significantly different between the two groups. Notably, only the suture time (15.5 (10-21.5) vs. 20 (18-27), p = 0.005) was lesser in women who underwent RPRS myomectomy than in those who underwent conventional 2 port myomectomy. CONCLUSION: Our data suggest that RPRS myomectomy is comparable to conventional 2 port laparoscopic myomectomy in terms of safety and feasibility and may be more advantageous for suturing after myoma enucleation.

Amelioration of neurodegenerative diseases by cell death-induced cytoplasmic delivery of humanin.

Inhibition of the early intracellular event that triggers neurodegenerative cascades and reversal of neuronal cell death are essential for effective treatment of Alzheimer's disease (AD). In this study, a novel therapeutic for AD, a transducible humanin with an extended caspase-3 cleavage sequence (tHN-C3), was developed and showed multiple mechanisms of therapeutic action. These included targeted delivery of anti-apoptotic protein humanin through the blood-brain barrier (BBB) to neuronal cells, specific inhibition of caspase-3 activation to inhibit the early triggering of AD progression, and delivery of humanin into the cytoplasm of neuronal cells undergoing apoptosis where it exerts its anti-apoptotic functions effectively. The tHN-C3 prevented neuronal cell death induced by H2O2, or soluble Aß42, via Bax binding. In animal models of AD induced by amyloid beta, in Tg2576 mice, and in the rat middle cerebral artery occlusion model of stroke, tHN-C3 effectively prevented neuronal cell death, inflammatory cell infiltration into the brain, and improved cognitive memory. The therapeutic effectiveness of tHN-C3 was comparable to that of Aricept, a clinically approved drug for AD treatment. Therefore, tHN-C3 may be a new remedy with multiple therapeutic functions targeting the early and late stages of neurodegeneration in AD and other brain injuries.

Treatment of wastewater containing Cu(II)-EDTA using immobilized TiO2/solar light.

The photocatalytic oxidation (PCO) of Cu(II)-ethylene diamine tetra-acetic acid (EDTA), employing immobilized TiO2, under natural sunlight rather than artificial UV light conditions, was investigated at a latitude 38 degrees. The immobilized TiO2 film was prepared using a sol gel process, the crystalline structure of which was identified, by X-ray diffraction analysis, as a mixture of the rutile and anatase forms. The PCO of Cu(II)-EDTA was examined in a circulating reactor with 20 L of 10(-4) M Cu(II)-EDTA and synthetic and real wastewaters at pH 4 and 6.5, respectively. The removals of both Cu(II) and DOC were initially relatively rapid, but slowed as the reaction proceeded and generally followed first-order kinetics. The rate constants for the removal of Cu(II) and DOC were 1.1 x 10(-3) and 1.6 x 10(-3) min-1, respectively. The efficiency of the PCO in the decomplexation of Cu(II)-EDTA increased with increasing H2O2 dose using both the synthetic and real wastewaters. Therefore, we suggest the PCO process using the solar/immobilized TiO2 system, with addition of H2O2 as well as filtration for the removal of suspended solids, can be effectively applied to the treatment of Cu(II)-EDTA containing real wastewater.

Solar-chemical treatment of groundwater contaminated with petroleum at gas station sites: ex situ remediation using solar/TiO(2) photocatalysis and Solar Photo-Fenton.

Groundwater samples contaminated by BTEX (benzene, toluene, ethylbenzene, xylene isomers and TPHs (total petroleum hydrocarbons) were treated with advanced oxidation processes (AOPs), such as TiO(2) photocatalysis and Fe(2+)/H(2)O(2) exposed to solar light (37 degrees N and 128 degrees E) with an average intensity of 1.7 mW/cm(2) at 365 nm. These AOP processes showed feasibility in the treatment of groundwater contaminated with BTEX, TPH and TOC (Total Organic Carbon). Outdoor field tests showed that the degradation efficiency of each contaminant was higher in the Fe(2+)/H(2)O(2) system without solar light compared to the TiO(2)/solar light and H(2)O(2)/solar light systems. However, the TiO(2)/solar light and the Fe(2+)/H(2)O(2)/solar light systems showed significantly enhanced efficiencies in the degradation of BTEX, TPH and TOC with the additional use of H(2)O(2). Near complete degradation of BTEX and TPH was observed within 2 and 4 hrs, respectively, however, that of TOC was slower. Without pretreatment of the groundwater, fouling of the TiO(2), due to the ionic species present, was observed within 1 hr of operation, which resulted in the inhibition of further BTEX, TPH and TOC destruction. The degradation rate of n-alkanes with carbon numbers ranging from C10 to C15 was relatively greater than that of n-alknaes with carbon numbers ranging from C16 to C20. From this work, the AOP process (Fe(2+)/H(2)O(2)/solar light and TiO(2)/H(2)O(2)/solar light) illuminated with solar light was identified as an effective ex situ technique in the remediation of groundwater contaminated with petroleum.