ABSTRACT
Objective @#To analyze the clinical characteristics of patients with adenomyosis (AM) and endometrial cancer (EC) and their role in preoperative diagnosis.@*Methods @#A total of 142 patients with AM complicated with EC or endometrial atypical hyperplasia (EAH) and AM with abnormal uterine bleeding ( AUB) during the same period were collected from this hospital. They were divided into AM with EC or EAH group (71 cases) and control group (71 cases) according to whether they were complicated with EC or EAH. The clinical data of the patients were retrospectively analyzed , and the clinical characteristics and treatment strategies of the patients with adenomyosis complicated with endometrial cancer were discussed. @*Results @#Univariate analysis showed that age , increased proportion of CA125 and CA125 , uterine volume , proportion of hypertension and abnormal endometrial ultrasonography in patients with AM with EC or EAH were significantly higher than those in the control group , and the proportion of dysmenorrhea was significantly lower than that in the control group , and the difference was statistically significant (P < 0. 05) . Multivariate Logistic regression analysis showed that endometrial thickening , endometrial echogenicity , and endometrial thickening combined with echogenicity were independent risk factors for AM with EC or EAH.@*Conclusion @#In clinical practice , the patients with AM with endometrial thickening or uneven echo - echo of ultrasound should be treated by hysteroscopy and curettage before further operation plan is formulated , so as to achieve the purpose of early diagnosis and treatment of EC.
ABSTRACT
Objective:To explore the value of symptom-oriented clinical lateral thinking training in gynecology internship teaching.Methods:We enrolled a total of 166 medical students of the five-year program of grades 2017 and 2018 who would participate in internships at the First Department of Gynecology of Renmin Hospital of Wuhan University. They were randomly divided into experimental group and control group, with 43 students of grade 2017 and 37 students of grade 2018 in the experimental group and 46 students of grade 2017 and 40 students of grade 2018 in the control group. The experimental group was taught using a symptom-oriented clinical lateral thinking training mode, and the control group was taught using a traditional teaching mode. At the end of the internship, the teaching quality was evaluated by means of an exam and satisfaction survey. The data were analyzed using the t test with the use of SPSS 24.0. Results:For both grades 2017 and 2018, the two groups had similar scores of theoretical knowledge, but the experimental group had significantly higher scores of medical history taking, physical examination, and medical record analysis compared with the control group ( P<0.05); for example, among students of grade 2017, the score of medical record analysis was (37.34±1.08) in the experimental group and (32.18±1.32) in the control group. The experimental group had significantly higher degrees of satisfaction than the control group in terms of doctor-patient communication ability, effective information acquisition ability, clinical case analysis ability, self-learning ability, literature search and review ability, team cooperation ability, and learning interest motivation (all P<0.05). Conclusions:The symptom-oriented clinical lateral thinking training mode can help students master the diagnosis and treatment principles of gynecological diseases, improve their abilities of clinical analysis, doctor-patient communication, effective information acquisition, self-learning, and literature search and review, and motivate their interest in learning.
ABSTRACT
Objective The objective of this study was to investigate the clinical value of serum microRNA in predicting chemotherapy efficacy in patients with nasopharyngeal carcinoma. Methods A total of 187 patients with nasopharyngeal carcinoma who received cisplatin combined chemotherapy were enrolled in our hospital from January 2010 to December 2016,including 123 pa-tients with chemotherapy sensitivity and 64 patients with chemotherapy resistance. The serum levels of miRNA before the initial chem-otherapy were measured,the efficacy and predictive value of serum miRNA in nasopharyngeal carcinoma patients were evaluated using healthy subjects as controls. Results Serum level of miR-127 in nasopharyngeal carcinoma patients was significantly higher than that in healthy controls(4. 3 ± 1. 6 vs. 1. 4 ± 0. 5,P<0. 001). Serum level of miR-127 was significantly higher in chemotherapy-resistant patients than that in chemotherapy-sensitive patients(4. 5 ± 1. 3 vs. 3. 8 ± 1. 7,P<0. 001). The ROC curve showed that the predictive value of serum miR-127 for chemotherapy resistance in nasopharyngeal carcinoma patients was 0. 702(P<0. 001), with the optimal cut-off value of 4. 2,sensitivity of 82. 3% and specificity of 76. 3% . Compared with the chemotherapy-sensitive group,the proportion of patients with T3-4 ,N3 and TNM Ⅲ~Ⅳ in the chemotherapy-resistant group was significantly increased(P<0. 01),and the proportion of miR-127≥4. 2 was also increased(P<0. 001). Multivariate logistic regression analysis showed that TNM staging(OR=1. 655,95% CI:1. 142~2. 584,P=0. 016)and serum miR-127≥4. 2(OR=2. 231,95% CI:1. 762~4. 503,P=0. 001)were independent risk factors affecting chemotherapy resistance in nasopharyngeal carcinoma patients. Conclusion The el-evated serum level of miR-127 is an important risk factor for predicting chemotherapy resistance in patients with nasopharyngeal car-cinoma.
ABSTRACT
Objective To compare the influence of postoperative pelvic floor function after different surgical procedures of hysterectomy. Methods A total of 260 patients who underwent hysterectomy in Renmin hospital of Wuhan University from January 2012 to January 2014 were enrolled in the study, and divided into 5 groups by different surgical procedures, which were total abdominal hysterectomy (A-TH;46 cases), total laparoscopic hysterectomy (L-TH;59 cases), total vaginal hysterectomy (V-TH;42 cases), abdominal intrafascial hysterectomy (A-CISH;78 cases), laparoscopic intrafascial hysterectomy (L-CISH;35 cases). Pelvic examination, pelvic organ prolapse quantitation (POP-Q), test of pelvic muscle strength, pelvic floor distress inventory-short form 20 (PFDI-20) and the female sexual function index (FSFI) questionnaire were measured after 6 months and 12 months. Results The differences of pelvic organ prolapse incidence after 6 months, A-TH and A-CISH [7%(3/46) versus 3%(2/78)], A-TH and L-CISH [7%(3/46) versus 3% (1/35)] were statistically significance (all P＜0.05).POP-Q grade after 6 months between A-TH and A-CISH was statistically different in degree (P＜0.05). The differences of incidence of abnormal pelvic floor muscle fatigue after 6 months of A-TH and A-CISH [59% (27/46) versus 29% (23/78)], A-TH and L-CISH [59%(27/46) versus 26%(9/35)] were statistically significant (all P＜0.05), after 12 months the difference of L-TH and A-CISH [61% (36/59) versus 29%(23/78)] was statistically different (P＜0.05). The differences of incidence of abnormal pelvic floor muscle strength after 6 months of L-TH and A-CISH [53%(31/59) verus 24%(19/78)], V-TH and A-CISH [60%(25/42) verus 24%(19/78)], V-TH and L-CISH [60%(25/42) verus 23%(8/35)] were statistically significant (all P＜0.05);after 12 months the difference of V-TH and A-CISH [57% (24/42) versus 26% (20/78)] was statistically significant (P＜0.05). Stress urinary incontinence, abnormal bowel movements after 6 months and 12 months were no significant difference between groups (all P＞0.05), PFDI-20 total score was not statistically significant (P＞0.05). FSFI total score after 6 months and 12 months in A-TH and A-CISH, L-TH and A-CISH, A-CISH and L-CISH were statistically significant (all P＜0.05). Conclusion The influences of different surgical procedures to pelvic floor function are no statistical difference; as to the surgical resection of hysterectomy, intrafascia hysterectomy compared with extrafascia hysterectomy, the former is more helpful to the protection of the structure and function of the pelvic floor.
ABSTRACT
Objective To investigate the value of using gonadotropin-releasing hormone agonist (GnRH-a) pretreatment in adenomyosis patients before adenomyomectomy. Methods From May 2012 to September 2015, 87 patients with adenomyosis who were non-effective to conservative therapy in Renmin Hospital of Wuhan University were enrolled in this study. According to the principle of randomized control, 41 patients were in the treatment group who were treated with GnRH-a 2-3 cycles before adenomyomectomy, while 46 patients in the control group. The control group paients were operated without any pretreatments. The blood loss, the number of penetrating into uterine cavity, duration of operation, duation of peritoneal drainage and the amount of drainage fluid, the difference of hemoglobin value before and after operation, total white blood cell count, duration of hospitalization, the maximum diameter of uterus and other indicators between the two groups were compared. Results In the treatment group, before and after treatment with GnRH-a, the uterus size, blood hemoglobinand CA125 value were statistically different (all P<0.05);between the treatment group of GnRH-a treated for 2 cycles and for 3 cycles, there were statistical differences of blood hemoglobin value [(108 ± 20) versus (118 ± 24) g/L], CA125 value [(26 ± 11) versus(19 ± 4) kU/L; all P<0.05]. There were statistical differences of blood loss in operation [(113 ± 32) versus (194 ± 42) ml], ratio of penetrating into uterine cavity [12%(5/41) versus 12%(8/46)], duration of operation[(79±23) versus (91±25) minutes], duration of peritoneal drainage after operation [(2.1±0.9) versus (3.0±1.2) days] and the amount of drainage fluid [(152±43) versus (232±32) ml], the difference of hemoglobin value before and after surgery [(-15.6±2.9) versus (-23.7±3.5) g/L], white blood cell count after 2-3 days of operation [(11.4±4.2)×109/L versus (13.5 ± 3.2) × 109/L], ratio of peri-operative blood transfusion [5% (2/41) versus 20% (9/46)] and duration of hospitalization [(11.2±1.9) versus (13.6±3.1) days] between the treatment group and the control group (all P<0.05). Conclusion The pretreatment of using GnRH-a before adenomyomectomy in adenomyosis patients has benefits for implementation of surgery and reducing peri-operative and postoperative complications.