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1.
BMC Cancer ; 24(1): 581, 2024 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-38741043

RESUMO

OBJECTIVES: To explore the effects of a 'Rebuilding Myself' intervention on enhancing the adaptability of cancer patients to return to work. METHODS: A single-center, single-blind, randomized controlled trial design was used. Eligible patients who were receiving routine hospital treatment were recruited from the university-affiliated hospital in our city. Patients in the control group only received usual care, while patients in the intervention group received additional 'Rebuilding Myself' intervention. Adaptability to return to work, self-efficacy of returning to work, mental resilience, quality of life and work ability were measured at baseline, the 6th and 12th of the intervention. The general estimation equations were used to compare the overall changes of each outcome index between the two groups at different time points. Considering that there may be patient shedding and rejection, Per-Protocol and Intention-to-Treat analysis were used to analyze the data in this study. RESULTS: There were statistically significant differences between the two groups of patients in the cancer patients' adaptability to return to work, self-efficacy to return to work, mental resilience, work abilities, the physical, emotional, cognitive function, fatigue, insomnia and overall health status dimensions of quality of life (P < 0.05). And no significant difference was found in other dimensions (P > 0.05). The group effect, time effect, and interaction effect of patients' return to work adaptability and return to work self-efficacy were statistically significant in both groups (P < 0.05). Mental resilience, working ability, and quality of life had obvious time effect and interaction effect (P < 0.05). CONCLUSION: This intervention could improve cancer patients' adaptability to return to work, self-efficacy to return to work, mental resilience, work abilities and quality of life. And it can be further expanded to improve the adaptability of patients to return to work, then to help patients achieve comprehensive rehabilitation. IMPLICATIONS FOR CANCER SURVIVORS: The application of 'Rebuilding Myself' interventions can effectively improve the adaptability of cancer patients returning to work. TRIAL REGISTRATION: This study was registered at the Chinese Clinical Trial Registry (Registration number: ChiCTR2200057943) on 23 March, 2022.


Assuntos
Adaptação Psicológica , Neoplasias , Qualidade de Vida , Resiliência Psicológica , Retorno ao Trabalho , Autoeficácia , Humanos , Masculino , Feminino , Neoplasias/reabilitação , Neoplasias/psicologia , Adulto , Pessoa de Meia-Idade , Retorno ao Trabalho/psicologia , Retorno ao Trabalho/estatística & dados numéricos , Método Simples-Cego
2.
Molecules ; 28(9)2023 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-37175103

RESUMO

The aroma, taste, and flavour profiles of mango cultivars vary, directly influencing their marketability and consumer acceptance. In this study, we explored the effects of volatile organic compounds (VOCs) on the distinct aromas of two mango cultivars during storage using GC-IMS and HS-SPME-GC-MS combined with OPLS-DA analysis. Our findings revealed that the terpene and aldehyde contents were higher in the 'Tainong' mango cultivar, compared to the 'Hongyu' mango, while the ester content was lower. The aroma was attributed to the presence of terpinolene, 2-nonenal, delta-carene, and alpha-phellandrene in the early stages of storage, and later-between 5 and 11 days-to ethyl acetate, ethyl butyrate, and ethyl propanoate. Further analysis of characteristic VOCs using OPLS-DA demonstrated and explained the strong grassy aroma of the 'Tainong' mango, and the strong fruity and sweet aromas of the 'Hongyu' mango. Additionally, esters mainly accumulated during the later periods of storage, especially propyl butyrate, which was produced and accumulated when fruit quality deteriorated in the later storage period. Our study provides a theoretical basis for detecting mango VOCs during storage to determine the appropriate marketing time for the two mango cultivars and enables informed consumer choice.


Assuntos
Mangifera , Compostos Orgânicos Voláteis , Odorantes/análise , Paladar , Cromatografia Gasosa-Espectrometria de Massas , Percepção Gustatória , Aromatizantes , Compostos Orgânicos Voláteis/análise , Ésteres
3.
Ultrasonics ; 128: 106864, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36308794

RESUMO

Unified pixel-based (PB) beamforming has been implemented for ultrasound imaging, offering significant enhancements in lateral resolution compared to the conventional dynamic focusing. However, it still suffers from clutter and off-axis artifacts, limiting the contrast resolution. This paper proposes an efficient method to improve image quality by integrating filtered delay multiply and sum (F-DMAS) into the framework. This hybrid strategy incorporates the spatial coherence of the received data into the beamforming process to improve contrast resolution and clutter rejection in the generated image. We also integrate a Wiener filter to suppress the spatiotemporal spreading using signals echoed from a single scatterer at the transmit focus as a kernel for the deconvolution. The Wiener filter is applied to the received waveforms before performing the hybrid strategy. The Wiener filter is shown to reduce interference due to the interaction between the excitation pulse and the transfer functions of the transducer elements, thus benefiting the axial resolution of the generated images. We validate the proposed method and compare it with other beamforming strategies through a series of experiments, including simulation, phantom, and in vivo studies. The results show that our approach can substantially improve both spatial resolution and contrast over the unified PB algorithm, while still maintaining the good features of this beamformer. The simplicity and good performance of our method show its potential for use in clinical applications.


Assuntos
Algoritmos , Processamento de Imagem Assistida por Computador , Processamento de Imagem Assistida por Computador/métodos , Ultrassonografia/métodos , Imagens de Fantasmas , Artefatos
4.
Front Psychol ; 14: 1275331, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-38741785

RESUMO

Introduction: The research on cancer patients returning to work in China is still in its infancy, and there is no research and discussion on the adaptability to return-to-work for cancer patients. It is critical to develop the Adaptability to Return-to-Work Scale (ARTWS) for cancer patients and evaluate its psychometric properties. Methods: The items of the initial scale were compiled based on the theoretical model and literature review results. Through two rounds of Delphi expert consultation (N = 15) and a pilot survey (N = 40), the initial scale was further checked and revised. Conduct a large sample survey (N = 376) and the construct validity and reliability of the ARTWS were assessed by confirmatory factor analysis (CFA) and exploratory factor analysis (EFA). Results: The final ARTWS consisted of 24 items. "Focusing on rehabilitation," "Rebuilding Self-efficiency," and "Adjusting plans" as common factors in determining adaptability to return to work for cancer patients, and the cumulative variance contribution rate for these three factors was 66.6%. The S-CVI of the total scale was 0.979. The Cronbach's α coefficient was 0.937 and the 2-week test-retest reliability was 0.814. Discussion: ARTWS has good correlation validity and can be used as a tool to measure the adaptability of cancer patients' return to work. The presentation of the manuscript in Research Square (https://doi.org/10.21203/rs.3.rs-2323264/v1).

5.
Gynecol Oncol ; 124(2): 292-5, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22019527

RESUMO

OBJECTIVE: To identify factors that may contribute to poor sensitivity of anal cytology in contrast to the sensitivity of anoscopy in heterosexual women. METHODS: We analyzed 324 patients with biopsy confirmed diagnosis of genital intraepithelial neoplasia (either vulva, vaginal, or cervical) from 2006 to 2011 who underwent both anal cytology and anoscopy. Cytology, anoscopy, and biopsy results were recorded. Biopsy specimens underwent independent analysis for quality of specimen. Also, biopsy specimens were analyzed for characteristics that may contribute to correlation, or lack thereof, between anal cytology and anoscopic directed biopsy. RESULTS: 133 (41%) patients had abnormal anoscopy and underwent directed biopsy. 120 patients with normal anal cytology had anoscopy directed biopsies, resulting in 58 cases of AIN (sensitivity 9.4%; 0.039-0.199). This cohort was noted to have extensive keratosis covering the entire dysplastic anal lesion. 18 patients yielded abnormal anal cytology. Of these patients, 13 had anoscopic directed biopsies revealing 6 with AIN and absent keratosis (specificity 88.6%; 0.78-0.95). The κ statistic for anal cytology and anoscopy was -0.0213 (95% CI=-0.128-0.086). CONCLUSION: Keratosis reduces the sensitivity of anal cytology. Furthermore, anal cytology poorly correlates with anoscopy in the detection of AIN (κ statistic=-0.0213).


Assuntos
Neoplasias do Ânus/patologia , Carcinoma in Situ/patologia , Ceratose/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Feminino , Neoplasias dos Genitais Femininos/patologia , Humanos , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Adulto Jovem
6.
Artigo em Inglês | MEDLINE | ID: mdl-36147649

RESUMO

Patients with breast cancer frequently experience psychological distress. This study aimed to investigate the effect of narrative nursing on middle-aged patients with breast cancer. In all, 82 patients with breast cancer admitted to the Affiliated Hospital of Nantong University were divided into two groups, namely, the observation group and the control group, by simple random sampling, with 41 cases in each group. The patients in both groups were treated with breast cancer surgery. Additionally, the control group received routine nursing, whereas the observation group received narrative nursing based on the control group. After 8 weeks of nursing, the SAS (self-rating anxiety scale) and SDS (self-rating depression scale) scores in the observation group were lower than those in the control group (P < 0.01). At the same time, the result of family hardiness showed that the patients with narrative nursing performed better in commitment, challenge, and control (P < 0.01). In conclusion, narrative nursing can alleviate the postoperative shame and negative emotions of patients with breast cancer and improve their quality of life.

7.
Ultrasonics ; 119: 106594, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34628298

RESUMO

Pixel-based beamforming generates focused data by assuming that the waveforms received on a linear transducer array are composed of spherical pulses. It does not take into account the spatiotemporal spread in the data from the length of the excitation pulse or from the transfer functions of the transducer elements. As a result, these beamformers primarily have impacts on lateral, rather than axial, resolution. This paper proposes an efficient method to improve the axial resolution for pixel-based beamforming. We extend our field pattern analysis and show that the received waveforms should be passed through a Wiener filter before being used in the coherent pixel-based beamformer. This filter is designed based on signals echoed from a single scatterer at the transmit focus. The beamformer output is then combined with a coherence factor, that is adaptive to the signal-to-noise ratio, to improve the image contrast and suppress artifacts that have arisen during the filtering process. We validate the proposed method and compare it with other beamforming strategies using a series of experiments, including simulation, phantom and in vivo studies. It is shown to offer significant improvements in axial resolution and contrast over coherent pixel-based beamforming, as well as other spatial filters derived from synthetic aperture imaging. The method also demonstrates robustness to modeling errors in the experimental data. Overall, the imaging results show that the proposed approach has the potential to be of value in clinical applications.


Assuntos
Aumento da Imagem/instrumentação , Ultrassonografia/instrumentação , Algoritmos , Artefatos , Simulação por Computador , Imagens de Fantasmas , Razão Sinal-Ruído
8.
Biomed Pharmacother ; 145: 112408, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34801855

RESUMO

Acute lung injury (ALI) and its serious form, the acute respiratory distress syndrome (ARDS) are devastating diseases without effective chemotherapy. Exuberant or uncontrolled proinflammation responses in the lung, also known as "cytokine storms", is one of the main culprits in the pathogenesis of organ failure, and anti-inflammatory therapy is essential to alleviate ALI/ARDS-associated injuries. Emerging evidence suggests that baicalein has potent anti-inflammatory and antioxidant properties. However, the underlined mechanism of baicalein to mitigate inflammation in ALI remains unclear. Herein, we demonstrated a critical role for baicalein in suppressing the inflammatory response of LPS-activated macrophages. We found that mitochondria function was restored in the condition of baicalein. Interestingly, results showed that mitochondrial dysfunction positively correlates with inflammatory cytokine generation at each corresponding baicalein concentration. Further mRNA analysis revealed that baicalein mitigates mitochondrial defects via attenuation of dynamin-related protein 1 (Drp1) expression. These reprogrammed mitochondria prevent their function shift from the ATP synthesis to reactive oxygen species (ROS) production after the LPS challenge, thereby dampening NF-κB-dependent inflammatory cytokine transcription. Baicalein reduces the production of inflammatory mediators TNF-α, MIP-1, IL-6, and diminishes neutrophil influx and severity of endotoxin-mediated ALI. Taken together, our results show that baicalein may serve as a new clinical therapeutic strategy in ALI by modulating Drp1-induced mitochondrial impairment, restraining inflammatory responses, and reducing the severity of lung injury.


Assuntos
Lesão Pulmonar Aguda/tratamento farmacológico , Anti-Inflamatórios/farmacologia , Dinaminas/genética , Flavanonas/farmacologia , Lesão Pulmonar Aguda/fisiopatologia , Animais , Citocinas/metabolismo , Modelos Animais de Doenças , Inflamação/tratamento farmacológico , Inflamação/patologia , Mediadores da Inflamação/metabolismo , Lipopolissacarídeos , Macrófagos/efeitos dos fármacos , Macrófagos/patologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Dinâmica Mitocondrial/efeitos dos fármacos , NF-kappa B/metabolismo , Células RAW 264.7
9.
Int Immunopharmacol ; 87: 106707, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32683297

RESUMO

BACKGROUND: Diffuse gliomas are the most prevalent primary brain tumors. The Chinese Glioma Genome Atlas (CGGA) and The Cancer Genome Atlas (TCGA) databases provide evidence of the relationships between gliomas and altered molecular pathways. In glioma pathogenesis, the microenvironment has emerged as a potential indicator of tumor progression. METHODS: We investigated and confirmed the role of RELT-like 1 (RELL1) oncogene in glioblastoma and low-grade glioma by data mining large cohorts of TCGA and the CGGA. Correlations between immune cells and RELL1 were verified using the CIBERSORT algorithm. RESULTS: Our analysis revealed that RELL1 expression was much higher in grade-dependent glioma patients with poor prognosis. Comparable prognostic values for isocitrate dehydrogenase 1 (IDH1) and RELL1 were observed during in-depth analyses of the integrated correlations. Moreover, RELL1 was found to be associated with numerous tumor-infiltrating immune cells in glioma-affected patients. CONCLUSION: We conclude that RELL1 might serve as a potential therapeutic target or prognostic marker in glioblastoma and diffuse glioma cases.


Assuntos
Biomarcadores Tumorais , Neoplasias Encefálicas , Proteínas de Transporte , Glioma , Proteínas de Membrana , Adulto , Biomarcadores Tumorais/genética , Biomarcadores Tumorais/imunologia , Neoplasias Encefálicas/genética , Neoplasias Encefálicas/imunologia , Neoplasias Encefálicas/mortalidade , Proteínas de Transporte/genética , Proteínas de Transporte/imunologia , Progressão da Doença , Feminino , Regulação Neoplásica da Expressão Gênica , Glioma/genética , Glioma/imunologia , Glioma/mortalidade , Humanos , Masculino , Proteínas de Membrana/genética , Proteínas de Membrana/imunologia , Oncogenes , Prognóstico , Modelos de Riscos Proporcionais
10.
Asian J Androl ; 10(4): 675-81, 2008 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-18478166

RESUMO

AIM: To identify the factors influencing diagnosis and treatment of chronic prostatitis (CP) among Chinese urologists. METHODS: A sample of 656 urologists from 29 provinces of China were asked to complete a questionnaire that explored attitudes towards CP as well as diagnosis and treatment patterns in the management of CP. Both univariate and multivariate logistic regression analysis schemes were used to determine the factors that influence the diagnosis and treatment of CP. RESULTS: A total of 656 questionnaires were given out. All were returned and 410 of those were included in the final univariate and multivariate analysis. Multivariate logistic regression analysis indicated that belief of bacterial infection in the etiology of CP (odds ratio [OR], 2.544; 95% confidence interval [CI], 1.650-3.923; P < 0.001) was the most significant factor influencing the routine performance of bacterial culture test. Using the same model, the type of hospital (OR, 2.799; 95% CI, 1.719-4.559; P < 0.001) and the routine use of the 4- or the 2-glass test (OR, 3.194; 95% CI, 2.069-4.931; P < 0.001) were determined to be significant factors influencing the use of the National Institutes of Health (NIH) new classification system. According to the same model, belief of bacterial infection in the etiology of CP (OR, 3.415; 95% CI, 2.024-5.762; P < 0.001) and the routine use of bacterial culture test (OR, 2.261; 95% CI, 1.364-3.749; P < 0.01) were important factors influencing the routine prescription of antibiotics. CONCLUSION: Our findings suggest that attitudes towards CP, and the characteristics of individual urologists' practices may influence the diagnosis and treatment of CP among Chinese urologists.


Assuntos
Padrões de Prática Médica , Prostatite/diagnóstico , Prostatite/tratamento farmacológico , Adulto , Idoso , Antibacterianos/uso terapêutico , China , Doença Crônica , Estudos Transversais , Conhecimentos, Atitudes e Prática em Saúde , Inquéritos Epidemiológicos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prostatite/microbiologia , Inquéritos e Questionários
11.
JOP ; 5(4): 225-30, 2004 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-15254352

RESUMO

CONTEXT: The endosonographic appearance of a microcystic "honeycomb" lesion of the pancreas usually indicates a serous cystic adenoma. CASE REPORT: We report a case of a non-functioning islet cell tumor that has the typical microcystic "honeycomb" appearance of a serous cystic adenoma. The implications for endoscopic ultrasound diagnosis and management of cystic pancreatic lesions are discussed. CONCLUSION: Islet cell tumors are a rare differential diagnosis of microcystic pancreatic lesions. If fine needle aspiration remains non-diagnostic preoperative distinction from serous cystic adenomas may be impossible.


Assuntos
Adenoma de Células das Ilhotas Pancreáticas/diagnóstico , Adenoma/diagnóstico , Neoplasias Pancreáticas/diagnóstico , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade
12.
J Pediatr Surg ; 42(11): 1882-6, 2007 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-18022440

RESUMO

PURPOSE: The purpose of this study was to evaluate the effectiveness of a new approach to repair the giant prostatic utricle (pseudovagina) associated with proximal hypospadias. METHODS: Three patients with giant prostatic utricle associated with proximal hypospadias sought medical advice in our department from 1998 to 2003. The giant prostatic utricles were repaired using the novel approach of divesting of utricular mucosa followed by muscular tunnel obliteration through the opening of the pseudovagina in the dorsal lithotomy position. RESULTS: Follow-up ranges from 3 to 8 years. The divesting of the prostatic utricle mucosa was successful, and the pseudovagina muscular tunnel was closed completely in all 3 patients. One patient underwent urethroplasty and another repair of urethrocutaneous fistula at the same setting. The third patient underwent a second-stage urethroplasty separately. On follow-up, both the urethral reconstruction and the pseudovagina repair remained successful in all the patients. CONCLUSIONS: The technique of the divesting of the prostatic utricle mucosa and closure of the muscular wall is an effective alternative approach for repairing giant prostatic utricles. It is safe and simple. The surgical exposure is very good.


Assuntos
Anormalidades Múltiplas/cirurgia , Hipospadia/cirurgia , Próstata/anormalidades , Anormalidades Urogenitais/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Anormalidades Múltiplas/diagnóstico , Adolescente , Seguimentos , Humanos , Hipospadia/diagnóstico , Masculino , Mucosa/cirurgia , Músculo Liso/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Medição de Risco , Estudos de Amostragem , Fatores de Tempo , Resultado do Tratamento , Anormalidades Urogenitais/diagnóstico
13.
J Pediatr Surg ; 41(1): e7-9, 2006 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-16410097

RESUMO

PURPOSE: The aim of the study was to evaluate the effectiveness of a new technique to repair penile torsion in children. METHODS: Eighteen boys with penile torsion were evaluated in our department from 1989 to 2003. Eleven had associated hypospadias, 4 had chordee without hypospadias, and 3 had torsion only. The direction of rotation was counterclockwise in 16 cases and clockwise in 2 cases. Torsion was repaired in 6 patients by degloving the penis and reattaching the dartos and the skin (comparative group). In 11 patients (1 with prior repair), the torsion was corrected by suturing the lateral edge of the corpus cavernosum to the pubic periosteum (study group). Two patients were not treated. RESULT: Follow-up ranges from 6 months to 7 years. All of the 11 cases in the study group had satisfactory correction of the penile torsion. All of the urethroplasties for hypospadias were successful. In the comparative group, none of 6 patients had satisfactory correction of the rotation. CONCLUSION: The technique of degloving the penis and reattaching the skin cannot reliably correct penile torsion in our experience. Lateral suturing of tunica albuginea to the pubic periosteum to repair penile torsion appears to be a better technique.


Assuntos
Doenças do Pênis/cirurgia , Técnicas de Sutura , Criança , Pré-Escolar , Humanos , Masculino , Estudos Retrospectivos , Anormalidade Torcional/cirurgia , Resultado do Tratamento , Procedimentos Cirúrgicos Urogenitais/métodos
14.
Urology ; 66(1): 170-3, 2005 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-15993479

RESUMO

OBJECTIVES: To compare the access to urologic care for a child with cryptorchidism insured by Medi-Cal versus one insured by private insurance. Medi-Cal (California State Medicaid) is a joint state and federal health insurance program that plays a significant role in providing healthcare coverage to low-income children. METHODS: A total of 54 randomly chosen urology offices throughout California were surveyed by telephone to determine whether the office accepted pediatric patients, accepted Medi-Cal, and when the earliest appointment date would be for a patient with Medi-Cal versus one with private insurance. RESULTS: Of the 46 practices that accepted pediatric patients, 96% offered a new patient appointment to a child with private insurance, but only 41% were willing to offer an appointment to a child with Medi-Cal (P < 0.0001). Of the offices that would not see a child with Medi-Cal, 75% were unable to recommend a urology office that might accept Medi-Cal. CONCLUSIONS: Children insured by Medi-Cal have significantly less access to necessary urologic care compared with children with private insurance.


Assuntos
Criptorquidismo/terapia , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Seguro Saúde , Medicaid , Urologia , California , Criança , Humanos , Masculino , Setor Privado
15.
J Pediatr Surg ; 38(9): 1329-32, 2003 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-14523814

RESUMO

BACKGROUND/PURPOSE: Traumatic urethral injury in girls is rare, and there is no consensus on its management. The authors report their 22-year experience. METHODS: Forty girls presented with urethrovaginal fistula. Twenty-six girls presented with cystostomy tube in place, whereas 17 girls presented with complete urinary incontinence. Incision and dilatation of the obliterated urethra was carried out in 7 patients. Vaginal repair of urethrovaginal fistula was performed in 4 patients. Transpubic reconstruction of the urethra using a modified Young-Dees-Leadbetter procedure with simultaneous repair of the urethrovaginal fistula was performed in 35 patients (once in 27, twice in 5, and 3 times in 3 patients). RESULTS: Follow-up in 40 girls averaged 3.5 years. Twenty-nine patients have regained normal urinary control, and 11 patients have mild stress urinary incontinence. Four patients were lost to follow-up. CONCLUSIONS: Simple dilation of the obliterated urethra can reestablish satisfactory urethral patency if the obliterated segment is short. The vaginal approach to urethrovaginal fistula may be successful in patients without concomitant urethral stricture or in those with stricture amenable to simple dilation. The transpubic approach remains the method of choice for repairing complete urethral disruption and severe urethral stricture, especially when associated with urethrovaginal fistula.


Assuntos
Uretra/lesões , Doenças Uretrais/etiologia , Doenças Uretrais/cirurgia , Adolescente , Criança , Pré-Escolar , Cistostomia , Dilatação , Feminino , Fístula/etiologia , Fístula/cirurgia , Humanos , Lactente , Estreitamento Uretral/etiologia , Estreitamento Uretral/terapia , Incontinência Urinária/etiologia , Fístula Vaginal/etiologia , Fístula Vaginal/cirurgia
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