Stem-cell therapy in stress urinary incontinence: A review.

The incidence of urinary incontinence (UI) is approximately 10%-40% in women, affecting one to two hundred million women worldwide. Stress UI (SUI) is characterized by involuntary urination due to increased abdominal stress and urine leakage without bladder contraction. Surgical treatments include midurethral slings, bulking agents, and Burch colposuspension to restore urethral continence. Nevertheless, an optimal treatment for all types of incontinence has not yet been established. Stem-cell therapy has emerged as a novel treatment for many diseases. Stem cells can self-renew and can differentiate into other cell types. Adult stem cells are suitable for clinical applications because they can be easily obtained noninvasively or minimal invasively. Stem-cell therapy for SUI has been studied preclinically and clinically. Muscle-derived progenitors have been used to treat SUI by promoting the regeneration of rhabdomyosphincters. The human trial used transurethral injection of autologous muscle-derived stem cells to improve sphincter contractility and function. Other sources of stem cells have also been studied in SUI treatment, such as umbilical cord blood, amniotic fluid, bone marrow, urine, and adipose tissue. The success rate of stem-cell therapy for SUI ranges from 13% to 100%. This review aimed to summarize the current status of stem-cell treatments for SUI, with respect to clinical trials, cell types, transplantation routes, and dosage volume and frequency.

Comparison of Er:YAG and CO2 laser therapy for women with stress urinary incontinence.

OBJECTIVE: To compare the effectiveness of Er:YAG and CO2 laser therapies for treating female stress urinary incontinence (SUI). METHODS: This retrospective study included 139 women who were divided into four groups: group 1 received two therapy sessions with the Er:YAG laser, group 2 received two therapy sessions with the CO2 laser, group 3 received one therapy session with the Er:YAG laser, and group 4 received one therapy session with the CO2 laser. Patients completed three questionnaires to assess SUI symptom severity at baseline, 1 month, and 3 months after laser therapy. RESULTS: Urinary incontinence symptoms significantly improved in groups 1 and 2 at both the 1- and 3-month follow-up evaluations compared to the baseline (p < 0.001). Symptoms improved after one therapy session in groups 3 and 4 at the 3-month follow-up (p < 0.001). The Er:YAG laser was more effective than the CO2 laser in improving SUI symptoms (Urogenital Distress Inventory 6 and Incontinence Impact Questionnaire 7) 3 months after treatment, regardless of the number of sessions. Both Er:YAG and CO2 laser therapies were found to be effective in reducing symptoms associated with an overactive bladder, as demonstrated by improvements in overactive bladder symptom scores. Two sessions of laser therapy were more effective than one. CONCLUSION: Vaginal laser therapy could be an effective alternative treatment for mild to moderate SUI. The Er:YAG laser was more effective than CO2 laser therapy, with results lasting for at least 3 months. However, further large-scale, randomized, controlled trials are needed to confirm our findings.

Electroacupuncture Reduces Ocular Surface Neuralgia in Dry-Eyed Guinea Pigs by Inhibiting the Trigeminal Ganglion and Spinal Trigeminal Nucleus Caudalis P2X3R-PKC Signaling Pathway.

PURPOSE: To observe the effects of electroacupuncture on ocular surface neuralgia and the P2X3R-PKC signaling pathway in guinea pigs with dry eye. METHODS: A dry eye guinea pig model was established by subcutaneous injection of scopolamine hydrobromide. Guinea pigs were monitored for body weight, palpebral fissure height, number of blinks, corneal fluorescein staining score, phenol red thread test, and corneal mechanical perception threshold. Histopathological changes and mRNA expression of P2X3R and protein kinase C in the trigeminal ganglion and spinal trigeminal nucleus caudalis were observed. We performed a second part of the experiment, which involved the P2X3R-specific antagonist A317491 and the P2X3R agonist ATP in dry-eyed guinea pigs to further validate the involvement of the P2X3R-protein kinase C signaling pathway in the regulation of ocular surface neuralgia in dry eye. The number of blinks and corneal mechanical perception threshold were monitored before and 5 min after subconjunctival injection and the protein expression of P2X3R and protein kinase C was detected in the trigeminal ganglion and spinal trigeminal nucleus caudalis of guinea pigs. RESULTS: Dry-eyed guinea pigs showed pain-related manifestations and the expression of P2X3R and protein kinase C in the trigeminal ganglion and spinal trigeminal nucleus caudalis was upregulated. Electroacupuncture reduced pain-related manifestations and inhibited the expression of P2X3R and protein kinase C in the trigeminal ganglion and spinal trigeminal nucleus caudalis. Subconjunctival injection of A317491 attenuated corneal mechanoreceptive nociceptive sensitization in dry-eyed guinea pigs, while ATP blocked the analgesic effect of electroacupuncture. CONCLUSIONS: Electroacupuncture reduced ocular surface sensory neuralgia in dry-eyed guinea pigs, and the mechanism of action may be associated with the inhibition of the P2X3R-protein kinase C signaling pathway in the trigeminal ganglion and spinal trigeminal nucleus caudalis by electroacupuncture.

The Association between Cervical Length and Successful Labor Induction: A Retrospective Cohort Study.

This study aimed to determine whether transvaginal sonographic measurement of cervical length before labor induction can predict successful induction. This retrospective study recruited 138 pregnant women who underwent labor induction at 37-41 weeks of gestation. Cervical length was measured using transvaginal ultrasonography before labor induction. Labor was induced according to the hospital protocol. Age, gestational age (GA), parity, body mass index (BMI), Bishop score, hemoglobin level, maternal disease, and epidural anesthesia were also recorded. Labor induction outcomes, including cesarean section for failed induction, time of induction, and the three labor stages, were assessed. From December 2018 to December 2021, 138 women were recruited for our study, including 120 and 18 women with successful and failed labor induction, respectively. Shorter cervical length (≤3.415 cm, OR = 6.22, 95% CI = 1.75-22.15) and multiparity (OR = 17.69, 95% CI = 2.94-106.51) were associated with successful induction. Higher BMI was associated with failed induction (OR = 0.87, 95% CI = 0.75-0.99). Age, GA, Bishop score, and fetal birth weight were not associated with successful labor induction. The ROC curve showed a cervical length cutoff value of 3.415 cm, revealing 76.8% of the area under the curve. In conclusion, a shorter cervical length (≤3.415 cm) was associated with a higher chance of successful labor induction (76.8%). This parameter might be used to predict the chance of successful labor induction. This information could help better inform clinician discussions with pregnant women concerning the chance of successful labor induction and consequent decision-making. Nevertheless, further large-scale clinical trials are warranted.

Clinical course of patients with severe SARS-CoV-2 infection co-treatment with Jin Si Herbal Tea in Eastern Taiwan: A retrospective cohort study.

Introduction: Coronavirus disease-2019 (COVID-19) has affected more than 608 million people and has killed 6.5 million people in the world. A few studies showed traditional Chinese medicine can be beneficial for COVID-19 treatment. An herbal preparation Jin Si Herbal Tea (JS) was formulated with herbal extracts known for their potential to decrease spike protein and ACE2 interaction, 3CL, and TRPMSS2 protease activity, and thus aimed to evaluate the clinical course of JS co-treatment along with the usual treatment schedule given for severe COVID-19 patients. Methods: This retrospective cohort study included patients with severe COVID-19 admitted to Hualien Tzu Chi Hospital between June and July 2021. All the patients were co-treated with JS and the primary outcome was death. The secondary outcomes included laboratory exam, Ct value, clinical course, and hospital stays. There were 10 patients recruited in this study and divided into < 70 years and ≧ 70 years groups (n = 5 in each group). Results: Older patients (≧70 years) had a higher Charlson Comorbidity Index, VACO index, and lower hemoglobin levels than < 70 years patients. The trend of lymphocyte count, LDH, D-dimer, and Ct value of non-survivors was not consistent with previous studies. The death rate was 20% and the recovery rate to mild illness in 14 days was 40%. Conclusion: In conclusion, this is the first clinical study of JS co-treatment in severe COVID-19 patients. JS co-treatment might reduce death rate and recovery time. Further large-scale clinical trials would be expected.

Possible Association of Hysterectomy Accompanied with Opportunistic Salpingectomy with Early Menopause: A Retrospective Cohort Study.

Opportunistic salpingectomies (OSs) are concurrently performed with hysterectomies to prevent epithelial ovarian cancer. This study aimed to investigate the correlation between OS and early menopause in females who have undergone hysterectomies. This was a retrospective cohort study involving 79 females who had undergone a hysterectomy, with or without an OS, between January 2007 and December 2015. Their ages at surgery, at menopause, and the lengths of time from surgery to menopause were compared. An OS had been performed in 54 and not performed in 25 of the enrolled patients, comprising the OS and non-OS groups. Body mass index was significantly higher in the OS group (OS: 25.27 ± 4.17 vs. non-OS: 22.97 ± 3.27, p = 0.01). Additionally, menopausal sleep problems were more prevalent in the OS group than in the non-OS group (41% vs. 12%, p = 0.01). Notably, the time from surgery to menopause was significantly shorter in the OS group than in the non-OS group (OS: 1.84 ± 1.85 vs. non-OS: 2.93 ± 2.43, p = 0.031). After adjusting the covariates, the OS group was associated with a significantly shorter period between surgery and menopause (p = 0.029). In conclusion, these results showed that a hysterectomy plus an OS might cause earlier menopause than a hysterectomy only. An OS should be preoperatively discussed with patients regarding the possibility of early menopause. The findings of this study require further large-scale investigations to reinforce the results.

Clinical characteristics and a 2-year follow-up of unsatisfactory conventional Pap smears: a retrospective case-control study.

The objective of this study was to conduct a 2-year follow-up of individuals having unsatisfactory reports of Pap smears and to analyze the contributing factors. This was a retrospective study at a medical center that performed about 5000-6000 Pap smears annually in Eastern Taiwan. Women who had unsatisfactory results due to scant cellularity between January 1, 2015-December 31, 2016, were included in this study. The control group comprised age-matched women with normal Pap smears at a 1:4 ratio, during the same period. The clinical characteristics and the 2-year outcomes were followed. Patients who were unavailable for follow-up assessments or who had insufficient clinical information were excluded. Student's t-test and chi-square test were used for continuous and categorical variables, respectively. Statistical significance was defined as a p-value < 0.05. A total of 887 Pap smears were included. A total of 717 and 170 women had normal Pap and unsatisfactory Pap tests, respectively. After excluding women who were unavailable for follow-up, the final analysis included 248 and 67 women with normal and unsatisfactory Pap tests, respectively. The mean age was not significantly different between the two groups (49.97 ± 10.69 and 51.61 ± 11.28 years in the unsatisfactory Pap and control groups, respectively [p > 0.05]). The percentage of menopause and vaginal discharge were significantly different between the two groups. Multivariate analysis revealed that premenopausal status, increased discharge were associated with the risk of unsatisfactory Pap tests. Of the 67 women with unsatisfactory Pap tests, all tested negative for any malignancies at a 2-year follow-up assessment. Women with increased vaginal discharge and without menopause were at an increased risk of having an unsatisfactory Pap test. Our results indicate that an unsatisfactory Pap smear due to scant cellularity might not increase the risk of intraepithelial neoplasia or cancer after 2 years. Further, large-scale studies with longer follow-up periods are required.

The feasibility of reduced sutures in 3D laparoscopic tubal sterilization reversal.

STUDY OBJECTIVE: To show the technique of reduced sutures in 3D laparoscopic tubal reanastomosis. DESIGN: Step-by-step demonstration of the procedure using video. SETTING: Laparoscopic tubal sterilization reversal demands high precision and requires both skill and experience. Conventionally, 4 to 6 interrupted patterns using 6-0 to 8-0 absorbable sutures are used for laparoscopic tubal reanastomosis. We used fewer and larger sutures under a magnified 3D view to perform the procedure. INTERVENTIONS: We presented a case of a 42-year-old woman, gravida 3, para 3, who underwent tubal sterilization during Cesarean section 10 years ago. Preoperative hysterosalpingography (HSG) showed bilateral distal tubal occlusion. The procedure started with the subserosal injection of diluted vasopressin in both proximal and distal ends and in the mesosalpinx to facilitate dissection and hemostasis. After transection of tubal stump and removal of scar tissue, we used a 3 Fr ureteral catheter as the stent to facilitate suturing. Three interrupted 4-0 monocryl sutures were used for suturing both tubal mucosal and muscular layers at 6, 2, and 10 o'clock sites. We performed bilateral ampullo-ampullary reanastomosis. The tubes were successfully reanastomosed, and patency was confirmed by chromotubation performed at the end of the procedure (Figure 1). The operation lasted for 71 minutes. The operative blood loss was less than 50 ml. Patent right fallopian tube was confirmed on postoperative HSG 1 month later. The patient had a successful pregnancy 8 months after the operation. CONCLUSION: Our experience shows the feasibility of 3D laparoscopy for tubal reanastomosis using reduced sutures. The technique alleviates the damage to the fallopian tube. The operative time, hospital stay, and postoperative adhesions were significantly lower than the conventional method with a comparable success rate.

Serosal Injury to a Distended Stomach during Open Entry for Laparoendoscopic Single-Site Surgery.

Complications related to open entry for laparoscopic procedures are relatively rare, and the incidence of closed entry-related complications is 0.4 per 1000 cases. We report a case of serosal injury to a distended stomach that was caused during open entry. A 37-year-old woman presented with a 1-year history of dysmenorrhea. Transvaginal ultrasonography revealed a uterine myoma and cesarean section (C/S) wound defect. Laparoscopic single-site myomectomy and repair of the C/S wound defect were planned. Open abdominal entry was achieved at the umbilicus, and the patient's stomach was distended and injured by the electric knife (30 watts). After identifying the injury, we inserted a nasogastric tube to deflate the stomach and repaired the gastric serosal injury. The laparoscopic myomectomy and C/S defect repair were subsequently performed without complications. The patient has remained free from complications during the 1-year follow-up. Gastric serosal injury during open entry is a rare complication. Insertion of a nasopharyngeal tube and routine percussion of the abdomen before entering the abdominal cavity are the most important steps to prevent this complication.

Risk factors and clinical characteristics associated with a ruptured ectopic pregnancy: A 19-year retrospective observational study.

ABSTRACT: Ectopic pregnancy is the most common cause of maternal mortality in the first trimester of pregnancy. The aim of this study was to find risk factors and clinical characteristics associated with ruptured ectopic pregnancies at a medical center in eastern Taiwan in a 19-year period. This was a retrospective observational study that included patients diagnosed with ectopic pregnancy between August 1999 and December 2018. Data about the demographic variables, initial presentation, pre-treatment beta-human chorionic gonadotropin levels, treatment routes (laparoscopy or laparotomy), surgical methods (salpingostomy or salpingectomy), operation time, blood loss amount, the status of ectopic pregnancy (ruptured or unruptured), the requirement for transfusion, and duration of hospital stay were collected. The categorical and continuous variables were analyzed using the correlation coefficients. This study included 225 women who were diagnosed as having an ectopic pregnancy. There were 49 and 176 women with unruptured and ruptured ectopic pregnancies, respectively. The beta-human chorionic gonadotropin levels, history of previous ectopic pregnancy, pelvic inflammatory disease, tubal surgery, abdominal history, and vaginal bleeding were not significantly different between the 2 groups. The ratio of women with abdominal pain was significantly higher in the ruptured ectopic pregnancy group than in the unruptured group (89.1% vs. 63.8%, respectively, P < .001). Preoperative hemoglobin was lower in the ruptured group compared with the unruptured group (P < .001). Blood loss, postoperative hemoglobin, and blood transfusion were significantly higher in the ruptured group than in the unruptured group (P = .000 and P = .001 for blood loss and blood transfusion, respectively). Multiple logistic regression analysis revealed that abdominal pain and blood loss were associated with ruptured tubal pregnancies (adjusted odds ratio [95% confidence intervals]: 3.42 {1.40, 8.40}; 1.01 {1.005, 1.014}, respectively). In conclusion, early pregnancy with abdominal pain, more parity, and lower preoperative hemoglobin should be aware of the possibility of ruptured ectopic pregnancy. More blood loss, transfusion and lower postoperative hemoglobin were also noted with ruptured ectopic pregnancy.

[Effect of electroacupuncture on ocular surface sensory neuralgia and expression of P2X3 receptor and PKC in cornea and trigeminal ganglion of dry eye guinea pigs].

OBJECTIVE: To observe the effect of electroacupuncture (EA) on ocular surface sensory neuralgia and the expression of P2X3 receptor (P2X3R) and protein kinase C(PKC)in cornea and trigeminal ganglion (TG) in dry eye disease (DED) guinea pigs, so as to explore its mechanism underlying improvement of ocular surface sensory neuralgia in DED. METHODS: Male British tricolor short haired guinea pigs were randomly divided into control, model, medication (pranoprofen), EA and sham acupuncture groups, with 8 guinea pigs in each group. The dry eye model was induced by subcutaneous injection of scopolamine hydrobromide solution (0.6 mg/0.2 mL,once daily) for 10 d. Guinea pigs in the medication group were treated by applying pranoprofen eye drops to eyes, 1 drop for one eye each time, three times a day. Guinea pigs of the EA group received EA stimulation (4 Hz/20 Hz,1 mA) of bilateral "Cuanzhu" (BL2) and "Taiyang" (HN5) and acupuncture at "Jingming" (BL1) "Sizhukong" (TE23), "Tongziliao" (GB1) for 15 min, once a day. Guinea pigs in the sham acupuncture group received blunt stimu-lation at the surface of the same acupoint with the tip of the acupuncture needle, once a day. All the treatments were conducted for 14 d. The corneal epithelium fluorescein staining score (0-3 points) was given according to the number of fluorescence-positive dots and flake-like coloration, the corneal mechanical perception thread (CMPT) detected using a corneal perception meter, and the palpebral fissure height measured. The number of sensory neurons in the cornea and TG was determined by using cholera toxin subunit B conjugated with Alexa Fluor 488 fluorescence labelling, and the expression levels of P2X3R and PKC in the cornea and TG detected by using immunohistochemistry and Western blot, separately. RESULTS: Compared with the control group, the corneal fluorescein staining score, immunoactivity and expression of P2X3R proteins in both cornea and TG, PKC proteins in TG were significantly increased (P<0.01), whereas the CMPT and the height of palpebral fissure and the number of TG neurons significantly decreased in the model group (P<0.05,P<0.01). In comparison with the model group, the fluorescein staining score in the medication and EA groups, the immunoactivity and expression of P2X3R in cornea and TG in the EA group, and that of TG PKC in the EA group and the sham acupuncture groups were significantly decreased (P<0.05, P<0.01), while the height of palpebral fissure and CMPT after EA and the number of labelling TG sensory neurons were remarkably increased in the EA group (P<0.01) rather than in the medication and sham acupuncture groups (P>0.05). CONCLUSION: EA can alleviate the damage of corneal epithelium and sensory neurons in dry eye model guinea pigs, which may be related to its functions in down-regu-lating the expression of P2X3R and PKC in the cornea and TG.

Endometriosis Is Associated with an Increased Risk of Coronary Artery Disease in Asian Women.

Endometriosis is a common systemic chronic inflammatory disease. Inflammation is the key mechanism responsible for the development of endothelial dysfunction and atherosclerosis. We aimed to investigate the risk of coronary artery disease (CAD) among Asian women with endometriosis. This retrospective population-based cohort study included patients with endometriosis diagnosed from 2000 to 2012 and registered in the Longitudinal Health Insurance Database, Taiwan. The comparison cohort (those without endometriosis) were selected (1:4) by matching the age frequency and the index year. We followed up the patients until the diagnosis of CAD (ICD-9-CM codes: 410-414, A270, and A279), withdrawal from the National Health Insurance system, death, or the end of the study. We used a multivariable-adjusted Cox proportional hazard model for evaluating the risk of CAD. We included 19,454 patients with endometriosis and 77,816 women as a comparison group. The mean age of the women at the diagnosis of endometriosis was 37.4 years. A total of 3245 women developed CAD in both groups during a median follow-up of 7 years. The incidence of CAD was higher in women with endometriosis than in those without (5.96 vs. 4.38 per 10,000 person-years; adjusted hazard ratio [95% confidence interval], 1.34 [1.22-1.47]). In conclusion, Asian women with endometriosis had a significantly higher risk of CAD. Further large-scale studies are needed to elucidate the cause-effect relationship between endometriosis and CAD.

Pelvic inflammatory disease and causative pathogens in older women in a medical center in eastern Taiwan: A retrospective cross-sectional study.

OBJECTIVES: Most research into the management of pelvic inflammatory disease (PID) is in younger women and focuses on sexually transmitted pathogens such as N. gonorrhoeae or C. trachomatis. Non-sexually transmitted bacterial pathogens and PID in older women are rarely examined. The objective of this study is to explore cervical culture pathogens in women of different age groups in a medical center in eastern Taiwan. METHODS: We enrolled patients whose medical records were diagnosed with PID (ICD-9-CM 614.0 [N70.01-03], 614.1[N70.11-13], 614.9 [N73.5, N73.9]) at our hospital from October 2014 to March 2020. Patients were divided into three groups according to age: the age <25 years, age 25-44 years, and the ≥ 45 years group. Chi-square test, ANOVA and logistic regression were used for statistical analysis. In subgroup analysis, endocervical pathogens were further stratified into vaginal, respiratory, enteric, skin, oral, and other. RESULTS: A total of 96 patients were included in the study. There were 31 patients in the age ≥ 45 years group, 52 patients in the age 25-44 years group, and 13 patients in the age <25 years group. Vagina and enteric pathogens were the most common pathogens among all groups. The isolated respiratory and other pathogens were more in the age ≥ 45 years group than in the other two groups. Prevotella bivia was more common in the age <25 years and 25-44 years groups. CONCLUSIONS: This may be due to different pathogeneses of PID in the age ≥ 45 years patients. Our study can be used as a reference for antibiotic choice of non-sexually transmitted PID and to prevent long-term sequelae of PID.

Shoulder pain after natural orifice transluminal endoscopic surgery decreased with abdominal compression and pulmonary recruitment maneuver: A retrospective study.

OBJECTIVE: The study aimed to assess the efficacy of abdominal compression and pulmonary recruitment maneuver (CPRM) after transvaginal natural orifice transluminal endoscopic surgery (vNOTES) to alleviate post-laparoscopic shoulder pain (PLSP). MATERIALS AND METHODS: In this retrospective cross-sectional study conducted in a tertiary referral medical center, women who underwent vNOTES between January 2018 and May 2019 were classified into control group and CPRM group with CO2 force expelled. Data on the demographic characteristics, indications for surgery, and surgical history were collected. Postoperative pain was assessed 24 and 48 h postoperatively using the visual analog scale (VAS, 0-10). Chest radiography was used to determine the residual air volume 24 h after surgery. RESULTS: Of 10 patients, 6 and 4 underwent vNOTES adnexal surgeries and vNOTES hysterectomy, respectively. The median volumes of residual pneumoperitoneum were 9.02 mL and 28.11 mL in the CPRM and control groups, respectively (p = 0.001). The intensity of PLSP in the CPRM and control groups were 0 ± 0 vs. 3.4 ± 3.4 and 0.4 ± 0.8 vs. 2.2 ± 2.2 24 and 48 h after surgery, respectively (p = 0.005 for 24 h and p = 0.04 for 48 h). CONCLUSION: CPRM might facilitate decrease in residual gas volume and PLSP after vNOTES. CPRM might be considered using in vNOTES to decrease PLSP.

Vulvar myoma: A case report and review of literature.

OBJECTIVE: To present a case of vulvar myoma and the factors differentiating this tumor from Bartholin's cyst. CASE REPORT: A 50-year-old woman presented with a nodule over the left labia majora. Pelvic examination showed swelling and redness of the left labia majora. A 2-cm nodule with firm consistency was found near the vaginal opening. There was no inguinal lymphadenopathy. Bartholin's cyst was suggested, and oral cephalexin was prescribed for 1 week, but no improvement was seen. Therefore, she underwent excision of the nodule. Pathology revealed it to be a benign vulvar myoma. The patient recovered well, and no recurrence was noted after 2 months of follow-up. CONCLUSION: Vulvar myoma is rare. Sexual history, nodule consistency, and imaging are helpful, but the final diagnosis of vulvar myoma is usually made following surgical excision and histopathological analysis.

Peripartum cardiomyopathy and acute heart failure associated with prolonged tocolytic therapy in pregnancy: A case report.

RATIONALE: Peripartum cardiomyopathy (PPCM) is a rare and sometimes fatal systolic heart failure that affects women during late pregnancy or the early postpartum period. Heart failure symptoms can mimic the physiological changes of normal pregnancy, and the diagnosis is based on echocardiography. PATIENT CONCERNS: A 38-year-old multiparous woman with a history of cervical incompetence underwent cervical cerclage and received tocolysis for 100 days. DIAGNOSES: She delivered vaginally at 37 weeks of gestation but developed postpartum decompensated acute heart failure with low left ventricular ejection fraction (LVEF: 34%) and was diagnosed with PPCM. INTERVENTIONS: She received standard therapy for acute heart failure. OUTCOMES: The patient's pulmonary edema cleared, and she was fully ambulatory 6 days after admission. A follow-up echocardiogram 3 months later demonstrated recovery of LVEF to 66%. LESSONS: Prolonged tocolysis may contribute to cardiomyopathy and should be used with caution. PPCM management requires standard treatments for acute heart failure with modifications for fetal safety.

Total uterine prolapse complicated with vesicovaginal fistula: A case report.

RATIONALE: Vesicovaginal fistula (VVF) most commonly occurs due to iatrogenic injury during surgery or obstructed labor. We report a rare case of a patient with severe pelvic organ prolapse who developed VVF even though pessary had not been used. PATIENT CONCERNS: A 63-year-old postmenopausal woman, para 3 (all spontaneous vaginal deliveries), complained of vaginal bulging sensation and involuntary urinary leakage for 3 years. DIAGNOSIS: Stage IV uterine prolapse with VVF. INTERVENTIONS: She underwent transvaginal VVF repair combined with total vaginal hysterectomy and sacrospinous ligament fixation. The postoperative course was uncomplicated. OUTCOMES: The patient remained free of complications during the 1-year follow-up. LESSONS: This case illustrates the point that patients with pelvic organ prolapse (POP) should be treated promptly and careful follow-up should be conducted. Clinicians should be aware of the symptoms of VVF to ensure its early diagnosis and treatment.

Outcome comparison between vaginoscopy and standard hysteroscopy: A retrospective cohort study.

BACKGROUND: Hysteroscopy is a traditional diagnostic method, whereas vaginoscopy is a more recent but proven approach. However, most physicians are unfamiliar with vaginoscopy. We aimed to compare the feasibility and tolerability between the two techniques to increase clinical awareness. METHODS: We retrospectively reviewed the data of 100 patients who underwent office hysteroscopy with either the standard approach or the vaginoscopic approach between May and July 2019. While the standard hysteroscopy group underwent speculum insertion and the cervix was grasped with forceps, the vaginoscopy group did not. The primary outcome was a successfully completed examination. Related outcomes were the pain score, complications, and absence of signs of infection at 1 week after completing the examination. RESULTS: The success rates of vaginoscopy and standard hysteroscopy were comparable (95.5% vs 96.3%). The median time to complete a vaginoscopy (135 seconds) was significantly shorter than to complete a standard hysteroscopy (190 seconds, p = 0.02). The median pain score was 3 for vaginoscopy, which was significantly lower than that for standard hysteroscopy (5; p = 0.01). There were no differences in the surgical complication rate between vaginoscopy (n = 4) and standard hysteroscopy (n = 3) (relative risk = 0.81, 95% confidence interval = 0.11-6.00). CONCLUSION: Vaginoscopy required a shorter time for the completion of the examination and involved lesser pain than the standard hysteroscopy. The success rates were comparable between the two techniques. Therefore, vaginoscopy is a good option for office hysteroscopic examinations.

Gelatin scaffold with multifunctional curcumin-loaded lipid-PLGA hybrid microparticles for regenerating corneal endothelium.

Corneal transplantation is currently the only approach to cure corneal blindness. Cell-based strategies that employ corneal endothelial cells (CECs) grown on supporting biomaterials hold great promise as possible alternative therapies for treating corneal endothelial dysfunction. Nevertheless, most biomaterials are used merely because of their robust mechanical properties, providing passive physical support for the transplantation of CEC monolayers. Based on the versatility of curcumin in ophthalmic applications, this study aims to develop a multifunctional scaffold system that can not only support the function and transplantation of CECs but also prevents post-engraftment complications by sustained curcumin release, thus enhancing the long-term success of CEC engraftment. Curcumin-loaded lipid-poly(lactic-co-glycolic acid) (PLGA; Cur@MPs) hybrid microparticles (MPs) fabricated using an oil-in-water single emulsion method are embedded into gelatin-based scaffolds. The anti-inflammatory, antioxidative, and anti-angiogenic potentials of the developed scaffolds and their capacity in supporting CEC monolayer formation are evaluated. The Cur@MPs are capable of promoting CEC proliferation, protecting CECs from oxidative stress-induced cell death via modulating Nrf2/HO-1 signaling axis, suppressing the secretion of pro-inflammatory cytokines by macrophages, and inhibiting the migration and angiogenesis of vascular endothelial cells. By incorporating the Cur@MPs into a thin gelatin membrane, the fabricated scaffold is able to support the growth and organization of CECs into a polygonal morphology with tight junctions. These experimental results demonstrate the potential of the Cur@MPs-loaded gelatin scaffold for actively supporting the survival and function of CEC monolayers after transplantation.

Association of laparoscopy and laparotomy with adverse fetal outcomes: a retrospective population-based case-control study.

BACKGROUND: This study aimed to evaluate fetal adverse outcomes of laparoscopy and laparotomy in pregnant women to determine the safety of these surgical approaches. METHODS: This was a retrospective nationwide case-control study of women who became pregnant for the first time between 2000 and 2012 in Taiwan. The case (with adverse fetal outcomes) and control groups comprised 208,604 and 417,124 participants, respectively. Participants who underwent appendectomy, cholecystectomy, ovarian cystectomy, or myomectomy were treated with either laparoscopy or laparotomy. A conditional logistic regression model was used to calculate the odds ratios (ORs) for adverse fetal outcomes. RESULTS: The laparotomy and laparoscopy groups comprised 632 and 536 patients, respectively. Women who underwent laparoscopy had a significantly higher risk of adverse fetal outcomes (adjusted OR [AOR] = 2.33; 95% CI 1.66-2.99) than those who underwent laparotomy. Adverse fetal outcomes were found to be significantly associated with laparoscopy among women aged 20-39 years (AOR = 2.30; 95% CI 1.70-3.31). Regarding surgical indication, unlike laparotomy, laparoscopic cholecystectomy and appendectomy were not associated with adverse fetal outcomes. However, laparoscopic myomectomy and ovarian surgeries were associated with a higher incidence of adverse fetal outcomes than the laparotomy group (AOR = 2.29 [95% CI 1.57-3.35, p < 0.0001] and AOR = 2.52 [95% CI 1.58-4.04, p = 0.0001], respectively). CONCLUSIONS: Pregnant women who underwent laparoscopic surgery experienced significantly more adverse fetal outcomes than those who underwent laparotomy. Therefore, pregnant women undergoing either laparotomy or laparoscopy should be informed of the risk of adverse fetal outcomes.