Efficacy of online cognitive behavioral therapy for nonorganic erectile dysfunction in reproductive-age males during the COVID-19 pandemic: a randomized wait list-controlled trial.

BACKGROUND: Previous research has documented the impact of the COVID-19 pandemic on male sexual and mental health. However, no prior study has evaluated the efficacy of online cognitive behavioral therapy (CBT) during the COVID-19 pandemic for treating nonorganic erectile dysfunction (ED) by improving negative emotions and self-esteem. AIM: To test the efficacy of online CBT for nonorganic ED during the COVID-19 pandemic in Shanghai, China. METHODS: A randomized controlled trial was conducted during the COVID-19 pandemic. Paired t-tests and 1-way analysis of variance were used to analyze and compare erectile functioning, self-esteem, and emotional state between and within groups. OUTCOMES: The main outcome measures included scores on the 5-item International Index of Erectile Function, Rosenberg Self-esteem Scale, 9-item Patient Health Questionnaire, and 7-item Generalized Anxiety Disorder scale to evaluate erectile functioning, self-esteem, depression, and anxiety, respectively. RESULTS: In the CBT group, erectile functioning, intercourse satisfaction, orgasmic functioning, sexual desire, and overall satisfaction were significantly improved at posttreatment as compared with pretreatment (P < .05). After treatment, group differences in emotional state and self-esteem were observed between the CBT group and the control group. Results revealed that the CBT group had significantly better scores than the control group at posttreatment on the Rosenberg Self-esteem Scale (mean ± SD, 30.43 ± 6.51 vs 22.67 ± 10.74), Patient Health Questionnaire (7.07 ± 2.74 vs 11.07 ± 4.41), and Generalized Anxiety Disorder scale (8.36 ± 1.97 vs 11.13 ± 3.94; P < .05). CLINICAL IMPLICATIONS: This study represents an important advance in understanding of the efficacy of online CBT for treating nonorganic ED in reproductive-age males during the COVID-19 pandemic. STRENGTHS AND LIMITATIONS: The study participants, treatment modality, and COVID-19 pandemic background of this study are innovative and therefore strengths. However, our study has several limitations-namely, its sample size and use of self-report data to measure erectile functioning due to the pandemic. Further studies should incorporate sexual functioning-monitoring instruments as well as self-report data to measure erectile function. CONCLUSION: Online CBT clearly improved the emotional state and self-esteem of patients with ED during the COVID-19 pandemic.

Validation of models in predicting residual disease in ovarian cancer: comparing CT urography with PET/CT.

BACKGROUND: Many ovarian cancer (OC) residual-disease prediction models were not externally validated after being constructed, the clinical applicability needs to be evaluated. PURPOSE: To compare computed tomography urography (CTU) with PET/CT in validating models for predicting residual disease in OC. MATERIAL AND METHODS: A total of 250 patients were included during 2018-2021. The CTU and PET/CT scans were analyzed, generating CT-Suidan, PET-Suidan, CT-Peking Union Medical College Hospital (PUMC), and PET-PUMC models. All imagings were evaluated by two readers independently, then compared to pathology. According to surgical outcomes, all patients were divided into the R0 group, with no visible residual disease, and the R1 group, with any visible residual disease. Logistic regression was used to assess the discrimination and calibration abilities of each model. RESULTS: CTU and PET/CT showed good diagnostic performance in predicting OC peritoneal metastases based on the Suidan and PUMC model (all the accuracies >0.8). As for model evaluation, the value of correct classification of the CT-Suidan, PET-Suidan, CT-PUMC, and PET-PUMC models was 0.89, 0.84, 0.88, and 0.83, respectively, representing stable calibration. The areas under the curve (AUC) of these models were 0.95, 0.90, 0.91, and 0.90, respectively. Furthermore, the accuracy of these models at the optimal threshold value (score 3) was 0.75, 0.78, 0.80, and 0.80, respectively. All two-paired comparisons of the AUCs and accuracies did not show a significant difference (all P > 0.05). CONCLUSION: CT-Suidan, CT-PUMC, PET-Suidan, and PET-PUMC models had equal abilities in predicting the residual disease of OC. The CT-PUMC model was recommended for its economic and user-friendly characteristics.

Network-Based Analysis Reveals Novel Biomarkers in Peripheral Blood of Patients With Preeclampsia.

WGCNA is a potent systems biology approach that explains the connection of gene expression based on a microarray database, which facilitates the discovery of disease therapy targets or potential biomarkers. Preeclampsia is a kind of pregnancy-induced hypertension caused by complex factors. The disease's pathophysiology, however, remains unknown. The focus of this research is to utilize WGCNA to identify susceptible modules and genes in the peripheral blood of preeclampsia patients. Obtain the whole gene expression data of GSE48424 preeclampsia patients and normal pregnant women from NCBI's GEO database. WGCNA is used to construct a gene co-expression network by calculating correlation coefficients between modules and phenotypic traits, screening important modules, and filtering central genes. To identify hub genes, we performed functional enrichment analysis, pathway analysis, and protein-protein interaction (PPI) network construction on key genes in critical modules. Then, the genetic data file GSE149437 and clinical peripheral blood samples were used as a validation cohort to determine the diagnostic value of these key genes. Nine gene co-expression modules were constructed through WGCNA analysis. Among them, the blue module is significantly related to preeclampsia and is related to its clinical severity. Thirty genes have been discovered by using the intersection of the genes in the blue module and the DEGs genes as the hub genes. It was found that HDC, MS4A2, and SLC18A2 scored higher in the PPI network and were identified as hub genes. These three genes were also differentially expressed in peripheral blood validation samples. Based on the above three genes, we established the prediction model of peripheral blood markers of preeclampsia and drew the nomogram and calibration curve. The ROC curves were used in the training cohort GSE48424 and the validation cohort GSE149437 to verify the predictive value of the above model. Finally, it was confirmed in the collected clinical peripheral blood samples that MS4A2 was differentially expressed in the peripheral blood of early-onset and late-onset preeclampsia, which is of great significance. This study provides a new biomarker and prediction model for preeclampsia.

The value of MR-based radiomics in identifying residual disease in patients with carcinoma in situ after cervical conization.

Carcinoma in situ (CIS) of the uterine cervix is a precursor to cervical carcinoma. However, hysterectomy can be avoided in patients who can be treated by cone biopsy. Previous studies have shown that imaging-based approaches allow for the noninvasive visualization of cervical cancer, and radiomics has high accuracy in classifying cancer and predicting treatment outcome for different cancer types. To develop a magnetic resonance (MR)-based radiomics model for identifying residual disease in patients with CIS after cervical conization. Patients who had CIS after conization and finally underwent hysterectomy were collected to comprise a database to establish an imaging model for predicting the residual status after conization. Then, patients who opted for uterine preservation were classified as high-risk or low-risk patients according to the model. The disease-free survival was compared between the different risk groups using the Kaplan-Meier curve. The model built with the Boruta features outperformed the random forest model. Further validation with patients with uterine preservation showed that the patients classified as high risk were more likely to have tumor recurrence/residual disease in the follow-up period. In conclusion, radiomics can be used to identify residual disease in patients with CIS after cervical conization and could have the potential to predict recurrence in patients who opt for uterine preservation.

Radiomics nomogram for preoperative prediction of progression-free survival using diffusion-weighted imaging in patients with muscle-invasive bladder cancer.

PURPOSE: To develop a radiomics signature using diffusion-weighted imaging (DWI) for predicting progression-free survival (PFS) in muscle-invasive bladder cancer (MIBC) patients and to assess its incremental value over traditional staging system. METHOD: 210 MIBC patients undergoing preoperative DWI were enrolled. A radiomics signature was built using LASSO model. A radiomics nomogram was generated to assess the incremental value of the radiomics signature over existing risk factors in PFS estimation in terms of calibration, discrimination, reclassification and clinical usefulness. Kaplan-Meier analysis was used to assess the association of the radiomics signature with PFS. C-index was used as a discrimination measure. Net reclassification improvement (NRI) was calculated to evaluate the usefulness improvement added by the radiomics signature. Decision curve analysis was performed to evaluate the clinical usefulness of the nomograms. RESULTS: The radiomics signature was significantly associated with PFS (log-rank P = 0.0073) and was independent with clinicopathological factors (P = 0.0004). The radiomics nomogram achieved better performance in PFS prediction (C-index: 0.702, 95 % confidence interval [CI]: 0.602, 0.802) than either clinicopathological nomogram (C-index: 0.682, 95 % CI: 0.575, 0.788) or radiomics signature (C-index: 0.612, 95 % CI: 0.493, 0.731), and achieved better calibration and classification (NRI: 0.226, 95 % CI: 0.016, 0.415, P = 0.038). Decision curve analysis demonstrated the better clinical usefulness of the radiomics nomogram. CONCLUSIONS: The DWI-based radiomics signature was an independent predictor of PFS in MIBC patients. Combining the radiomics signature, clinical staging and other clinicopathological factors achieved better performance in individual PFS prediction.

Effects of low-dose aspirin on the prevention of preeclampsia and pregnancy outcomes: A randomized controlled trial from Shanghai, China.

OBJECTIVES: To evaluate the preventive effects of low-dose aspirin on the incidence of preeclampsia and pregnancy outcomes of women at high-risk for preeclampsia. STUDY DESIGN: This prospective randomized clinical trial was conducted at the Obstetrics Department of The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, China. It analyzed data from 1105 high-risk women who were divided into the control group (placebo group) and the aspirin group (including three subgroups: 25 mg, 50 mg and 75 mg). The aspirin group in this study was instructed to take aspirin daily before bedtime beginning in the 12th week of pregnancy. MAIN OUTCOME MEASURES: The primary outcome is the occurrence of preeclampsia. The secondary outcomes included maternal and neonatal outcomes (such as premature delivery, FGR etc.), maternal serum biomarkers (including d-dimers, platelet aggregation rates, etc.) and uterine arterial blood flow resistance. The onset of preeclampsia and pregnancy outcomes were recorded after all participants delivered. RESULTS: Low-dose aspirin significantly reduced the incidence of preeclampsia and early-onset preeclampsia. Aspirin also showed significant dose dependence in preeclampsia prevention. The results of Mantel-Haenszel trend test showed that there was a linear relationship between the dosage and the incidence of preeclampsia and early preeclampsia (P < 0.05). Pearson's results showed that the incidence of preeclampsia and early preeclampsia was negatively correlated with aspirin dosage. There was also a linear relationship between the dosage and the rates of postpartum hemorrhage, fetal growth restriction, premature births and cesarean section (P < 0.05). There was no evidence to suggest differences in the incidence of fetal distress, miscarriage and placental abruption among the four groups. The blood resistance S/D value of uterine artery in early pregnancy was the only independent factor affecting the efficacy of aspirin (OR = 1.405; 95 %CI,1.058-1.867; P = 0.019). CONCLUSION: Low-dose aspirin can prevent preeclampsia and early-preeclampsia. Its efficacy is dose-dependent. It can reduce the rates of postpartum hemorrhage, fetal growth restriction, premature births and cesarean section. The prophylactic effect of aspirin on preeclampsia seemed to be greater in patients with higher blood resistance S/D value of uterine artery during early pregnancy.

Fragile X-related protein 1 (FXR1) regulates cyclooxygenase-2 (COX-2) expression at the maternal-fetal interface.

Cyclooxygenase-2 (COX-2) is regulated post-transcriptionally by the AU-rich element (ARE) in the 3'-untranslated region (UTR) of its mRNA. However, the mechanism of COX-2 induction in infertility has not been thoroughly elucidated to date. The aim of this study was to examine the association between COX-2 and fragile X-related protein 1 (FXR1) in trophoblasts. Using quantitative reverse transcription polymerase chain reaction, our results showed that FXR1 mRNA expression levels were significantly decreased in trophoblasts from recurrent miscarriage patients compared with healthy controls; conversely, COX-2 mRNA expression levels were increased in patient samples. We also observed that FXR1 was highly expressed in human placental villi during early pregnancy. Furthermore, we used western blotting and immunofluorescence to analyse the expression levels of FXR1 and COX-2 in HTR-8 cells that were treated with tumour necrosis factor α; we observed that the expression of COX-2 was clearly increased in HTR-8 cells treated with FXR1 small interfering RNA, whereas the expression of COX-2 was effectively decreased in HTR-8 cells with FXR1 overexpressed via a plasmid. Importantly, bioinformatics analysis identified FXR1 binding sites in the 3'-UTR region of COX-2 and firefly luciferase reporter assay analysis verified that FXR1 binds directly to the 3'-UTR region of COX-2. ELISA assays showed that overexpression of FXR1 enhanced vascular endothelial growth factor-A and interleukin-8 expression in HTR-8 cells, whereas conversely, knockdown of FXR1 effectively repressed these effects. In conclusion, the results of this study indicate that FXR1 is a novel COX-2 regulatory factor.

Serum vaspin levels and vaspin mRNA expression in subcutaneous adipose tissue in women with gestational diabetes mellitus.

OBJECTIVE: To compare serum vaspin level and mRNA and protein levels of vaspin in adipose tissue in women with gestational diabetes mellitus (GDM) and normal glucose tolerance (NGR), along with the correlation between serum vaspin level with fasting insulin (FINS), homeostasis model assessment of insulin resistance (HOMA-IR) and birth-weight. STUDY DESIGN: Thirty-seven women with GDM and 36 with NGR were enrolled. Total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), fasting plasma glucose (FPG), FINS and vaspin levels were measured. The mRNA and protein levels were detected using RT-PCR and Western blot. Pearson correlation analysis (PCA) was performed to reveal the correlation between serum vaspin level and FINS, HOMA-IR. Spearman correlation analysis (SCA) was conducted to examine the association between serum vaspin level and birth-weight. RESULTS: HDL-C level in GDM was lower than NGR group (P<0.05), and there were no statistical differences in TC, TG, LDL-C, FPG, FINS and HOMA-IR between the two groups. Serum vaspin level, mRNA and protein expression levels of vaspin in GDM were higher than NGR group (P<0.05). Serum vaspin level was not significantly correlated with FINS and HOMA-IR, but had a positive correlation with birth-weight (P=0.023). CONCLUSION: Serum vaspin level cannot serve as an independent predictor of IR. The increased serum vaspin level and increased vaspin mRNA and protein expression in adipose tissues in GDM women indicate that vaspin may be involved in the pathogenesis of GDM, but its exact mechanism needs further study.

Screening for thyroid dysfunction during the second trimester of pregnancy.

The primary objective of this study is to explore the influence of different screening strategies on the prevalence of thyroid dysfunction and the missed diagnosis during pregnancy. A total of 1889 pregnant women (13-27 weeks) were divided into high-risk and low-risk groups according to the backgrounds of them collected by questionnaire. We detected the prevalence of thyroid dysfunction in high-risk groups and low-risk pregnant women by normal reference range during the second trimester in our research. High-risk groups accounted for 10.69% of all the pregnant women in this study. Using targeted high-risk case screening strategy, misdiagnosis rate of pregnancy with hyperthyroidism, subclinical hyperthyroidism, pregnancy with hypothyroidism, subclinical hypothyroidism, low T4 syndrome and positive TPOAb were 87.5% (14 cases), 87.08% (155 cases), 87.08% (155 cases), 83.93% (47 cases), 89.47% (17 cases) and 88.35% (91 cases), respectively. Furthermore, there was no statistically significant difference between high-risk group and low-risk group in the prevalence of thyroid dysfunction. Therefore, we believe that universal screening to pregnant women can effectively reduce misdiagnosis rate of thyroid dysfunction. Further, we recommend universal screening for thyroid function in second trimester of pregnancy.

Reference intervals for common thyroid function tests, during different stages of pregnancy in Chinese women.

BACKGROUND: The importance of diagnosis of thyroid dysfunction during pregnancy has been widely recognized. Our study was designed to compare two different detection reagents between Abbott and Roche and to establish the gestational related reference intervals for thyroid function tests (TFT) in Chinese women and to assay the reference ranges with the American Thyroid Association recommended standard. METHODS: Serum samples were collected from 693 normal pregnant Chinese women and divided into five groups according to their gestational age: 9-13, 16-20, 24-28, 32-34 and 37-40 weeks. Thyroid stimulating hormone (TSH) and free thyroxine (FT4) levels were determined by two different detection reagents: Abbott Architect I 2000 and Roche Cobas Elecsys 600. The reference ranges of the TFT indexes were calculated according to the National Academy of Clinical Biochemistry (NACB). The 2.5th and 97.5th percentiles of each stage were calculated, and the results were analyzed by one-way analysis of variances, t-test, and Spearman correlation analysis. RESULTS: Thyroid hormone levels varied greatly among different gestational stages. TSH levels, as assessed via two different TSH ELISA kits showed consistent changing pattern during pregnancy and displayed linear correlation (P < 0.001). In 9-13 gestational weeks, TSH levels were significantly lower than that of other groups; and in 37-40 gestational weeks, it was higher than that of other groups (all P < 0.001). TSH reference ranges determined by Roche detection reagent in each group were higher than those by Abbott detection reagent (P < 0.01 respectively). FT4 levels were higher in 9-13 gestational weeks than that of other groups (P < 0.001). FT4 levels determined by Roche reagent were higher than Abbott reagent in 9-13 weeks, (P < 0.001), and lower in 24-28 and 37-40 weeks (P < 0.001 and P = 0.016, respectively). The TSH level was correlated with FT4 levels in 9-13 gestational weeks by detection reagents (for Abbott reagent, r=-0.319 for FT4 P < 0.001; for Roche reagent, r=-0.352 for FT4, P <0.001). CONCLUSION: Accurate evaluation of TFT in pregnant women should be based on the gestational-related reference intervals in Chinese population, and different detection reagents should also establish their own reference intervals.