Effect of Exercise on Fatigue in Patients Receiving Maintenance Hemodialysis Treatment: A Systematic Review and Network Meta-analysis.

OBJECTIVE: This study aimed to evaluate the effect of different exercises for improving fatigue in maintenance hemodialysis patients. DESIGN: PubMed, Embase, Web of Science, Cochrane, PEDro, CNKI, VIP, Wanfang data, CBM, and CINAHL were conducted from the establishment of the database to July 2023. We independently screened the literature, evaluated the quality, analyzed the data using Stata 15.0, and performed subgroup analysis on intervention time and exercise intervention adherence. RESULTS: Twenty-three studies were analyzed, with 1867 patients and nine interventions. Based on the surface under cumulative ranking curves and pairwise comparisons effects, overall long-term, short-term, and exercise intervention adherence >90% effects have all presented that during dialysis aerobic-resistance combined exercise was ranked as the most effective compared with routine care (surface under cumulative ranking curves = 83.9%, standardized mean difference = -1.45, 95% CI = -2.23 to -0.67; surface under cumulative ranking curves = 85.9%, standardized mean difference = -1.38, 95% CI = -2.24 to -0.52; surface under cumulative ranking curves = 86.6%, standardized mean difference = -1.54, 95% CI = -2.58 to -0.49; surface under cumulative ranking curves = 83.6%, standardized mean difference = -1.45, 95% CI = -2.25 to -0.66, respectively), followed by interdialytic period muscle relaxation exercise, interdialytic period aerobic-resistance combined exercise, interdialytic period aerobic exercise, and interdialytic period Baduanjin. CONCLUSIONS: Dialysis aerobic-resistance combined exercise may be considered in practice when resources allow. However, high-quality, multicenter, and large-sample randomized control trials must further verify this conclusion.

Effectiveness of nonpharmacological multi-component intervention on depressive symptoms in patients with mild cognitive impairment and dementia: A systematic review and meta-analysis.

Patients with mild cognitive impairment (MCI) and dementia are more prone to depression than people without MCI or dementia. Some studies have found nonpharmacological multi-component intervention to be more effective than single-component intervention in improving the condition of patients with MCI and dementia; however, their effect on depressive symptoms is still inconsistent. Therefore, it is necessary to explore the effectiveness of nonpharmacological multi-component intervention in improving depressive symptoms in patients with MCI and dementia. This review retrieved papers from PubMed, Embase, Cochrane Library, CINAHL, PsycINFO and CNKI. The retrieval time limit was set from 1 January 1990 to 25 November 2022. The PRISMA 2020 guideline was used to report the included studies. The result showed that nonpharmacological multi-component intervention could improve depressive symptoms in patients with MCI and dementia. Among them, nonpharmacological multi-component intervention with a duration of <6 months, physical and cognitive activities, or other activities had significant effects. However, each study differed in terms of specific measures, duration and frequency of intervention methods. Accordingly, more randomized controlled trials with larger samples are required to discover the best scheme for nonpharmacological multi-component intervention.

Prevalence, associated factors, and nursing practice-related outcomes of workplace violence towards nursing students in clinical practice: A systematic review and meta-analysis.

OBJECTIVES: To estimate the prevalence of Workplace violence (WPV) among nursing students in clinical practice, and examine the associated factors and nursing practice-related outcomes. DESIGN: A systematic review and meta-analysis. REVIEW METHODS AND DATA SOURCES: A comprehensive literature search was performed in nine databases from inception to Mar 2023. Two researchers independently screened studies, extracted data and assessed the quality of included studies. The random-effects model was used to estimate the pooled prevalence of WPV. Separate analyses were conducted by WPV type and source. RESULTS: 57 studies involving 23,451 nursing students were identified. The overall prevalence of WPV experienced and witnessed by nursing students was 45.37 % and 53.76 %, respectively, and 13.73 % were unsure if they had WPV. Psychological violence was the most prevalent form of WPV, but the prevalence of WPV also varied by setting and source, with obstetrics and gynaecology (41.25 %) being the most common settings and patients and their relatives (50.80 %) being the most common sources. When exposed to WPV, 65 % of nursing students did nothing except keep quiet, and 74 % did not report it. Concerning the associated factors of WPV, there were few reports on patient-related factors, and the selected studies focused primarily on nursing student- and occupational-related factors. Regarding nursing practice-related outcomes, WPV had a predominantly negative impact on nursing students' professional practice, but it also had a certain motivating effect. CONCLUSIONS: This meta-analysis estimates the global prevalence, associated factors, and nursing practice-related outcomes of WPV among nursing students. The findings confirm the high prevalence of WPV; therefore, schools and institutions should prioritize WPV education and training. The hospital should then formulate WPV laws and regulations, enhance the WPV reporting procedure, and protect the rights and interests of nursing students. Finally, hospital administrators should employ individualized intervention strategies for nursing students based on the variables that affect them.

Instruments for assessing the spiritual needs of cancer patients: A systematic review of psychometric properties.

AIMS AND OBJECTIVES: To identify available instruments for assessing cancer patients' spiritual needs and to examine their psychometric properties using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) methodology. BACKGROUND: Cancer patients frequently have significant spiritual needs. The nurse plays an integral role in assessing the patient's spiritual needs as part of providing holistic care. It is crucial to assess these needs using appropriate and reliable instruments. DESIGN: A systematic review based on COSMIN methodology. METHODS: Seven electronic databases (PubMed, EMBASE, CINAHL, Web of Science, ProQuest, CNKI and WANFANG) were systematically searched from inception until 14 February 2023. Two authors independently screened eligible literature, extracted data and evaluated methodological and psychometric quality. This systematic review was conducted following the PRISMA checklist. RESULTS: Sixteen studies have reported 16 different versions of the instruments. None of the instruments were properly assessed for all psychometric properties, nor were measurement error, responsiveness and cross-cultural validity/measurement invariance reported. All of the instruments failed to meet the COSMIN quality criteria for content validity. The quality of evidence for structural validity and/or internal consistency in five instruments did not meet the COSMIN criteria. Eventually, five instruments were not recommended, and 11 were only weakly recommended. CONCLUSION: Instruments to assess spiritual needs exhibited limited reliability and validity. The Spiritual Care Needs Scale is provisionally recommended for research and clinical settings, but its limitations regarding content validity and cross-cultural application must be considered in practice. Future research should further revise the content of available instruments and comprehensively and correctly test their psychometric properties. RELEVANCE TO CLINICAL PRACTICE: The review findings will provide evidence for healthcare professionals to select instruments for recognising spiritual needs in cancer patients. NO PATIENT OR PUBLIC CONTRIBUTION: This study is a systematic review with no patient or public participation.

Tacrolimus and Diabetes in Kidney Transplantation: The Impact of Cyp3a5 Gene Polymorphism.

BACKGROUND: To explore the correlation between single nucleotide polymorphisms (SNPs) of CYP3A4 rs2740574 and CYP3A5 rs776746 and post-transplant diabetes mellitus (PTDM) in Chinese renal allograft recipients treated with tacrolimus. METHODS: A total of 244 patients treated with tacrolimus were included in this study, wherein DNA sequencing was detected through fluorescence in situ hybridization, and SNP genotyping was performed. RESULTS: Among the 244 patients, 44 (18%) developed PTDM. The PTDM group exhibited higher preoperative body mass index and fasting plasma glucose levels, with higher creatinine values one year after surgery. The CYP3A4 rs2740574 genotype was found to be unique in its homozygous AA form. For CYP3A5 rs776746, the genotypes were distributed as follows: 28 (11.5%) cases with AA, 101 (41.4%) cases with AG, and 115 (47.1%) cases with GG, respectively (P = .042). The AA genotype showed a statistically significant difference from both AG and GG genotypes. Furthermore, the A allele of CYP3A5 rs776746 was found to be associated with an increased risk for PTDM development. CONCLUSIONS: The occurrence of tacrolimus-related PTDM is associated with body mass index, fasting plasma glucose levels, and CYP3A5 genotype before renal transplantation. Post-transplant diabetes mellitus is correlated with unfavorable long-term renal graft function, whereas the expression of the CYP3A5 rs776746 gene is linked to an elevated risk of PTDM.

The effect of psychological contract on turnover intention among nurses: a meta-analytic review.

BACKGROUND: The turnover intention (TI) of nurses is common, posing a threat to modern healthcare organizations. Psychological contract (PC) is a predictor of TI, affecting significantly nurse's TI. However, the extent of the association between PC and nurse's TI is unknown. We performed a meta-analysis to quantitatively analyze the relationship between PC and nurse's TI. METHODS: We searched nine electronic databases from inception to July 2023. Observational studies were included using a retrieval strategy related to PC and TI. Meta-analyses of common effect and random effect models were performed using R software with Spearman or Pearson correlation coefficients. Meta-regression, subgroup analysis, publication bias, and sensitivity analysis were also carried out . RESULTS: Eighteen studies including 8,908 nurses were identified. Based on various PC-related perspectives, 16 studies explored nurses' TI in terms of the content and three-dimensional structure of PC. Of these, 9 studies reported the negative direction of the correlation between PC and TI (r ranged from - 0.20 to -0.45), whereas 7 studies reported the positive direction of the correlation between PC and TI (r ranged from 0.32 to 0.50). The PC total and its dimensions were found to have moderately significant associations with TI, with the exception of the PCE and PCE-I. Additional, 2 studies reported the relationship between the outcome of PC and TI, the PCF, PCB, and PCV were powerful predictors of nurses' TI. Meta-regression and subgroup analysis found that only nurses working in specialized departments might be the source of heterogeneity. CONCLUSIONS: To our knowledge, this was the first meta-analysis to quantitatively examine the relationship between PC and TI among nurses. The findings reaffirmed the necessity for healthcare administrators and the medical profession to valued nurse' good interpersonal, social support, humanistic environment, and meet nurses' psychological and spiritual needs in addition to their material demands. Moderators of the connection between PC and TI, based on meta-regression and subgroup analyses, should be carefully explored as they may aid in identifying nurses' TI. Additional, longitudinal research, as well as mixed research, should be conducted to more comprehensively explore the relationship between PC and TI.

Fear of disease progression among breast cancer patients in China: a meta-analysis of studies using the fear of progression questionnaire short form.

Background: Fear of disease progression (FoP) is among the most prevalent and major psychological burdens breast cancer patients encounter. Excessive FoP may result in serious adverse effects for patients. FoP in breast cancer patients has gained attention recently; however, its prevalence in China is unknown. Objectives: This meta-analysis and systematic review aimed to assess the overall FoP among Chinese breast cancer patients to make recommendations for treatment and care. Methods: Systematic search databases included PubMed, EMbase, The Cohrane Library, Web of Science, CINAHL, PsycINFO and 4 Chinese databases (Wan Fang Data, CBM, VIP and CNKI). The retrieval time ranged from the database's establishment to March 20, 2023. After two researchers independently evaluated the literature, retrieved information, and assessed the risk of bias for the included literature, Stata 15.1 software was used to conduct a meta-analysis. Results: A total of 37 moderate or high-quality studies involving 9,689 breast cancer patients were included. Meta-analysis showed that the pooled mean score of FoP for Chinese breast cancer patients was 33.84 [95% CI (31.91, 35.77)], prediction interval (21.57 ~ 46.11). The subgroup study found that FoP levels varied among breast cancer patients of different regions, ages, educational levels, marital statuses, residences, illness stages, and disease statuses. Conclusion: Breast cancer patients have higher FoP scores. Healthcare workers should be concerned. We expect that more relevant research will be undertaken and more effective interventions will be developed. Patients can manage their illness and improve their quality of life by reducing their fears. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier: PROSPERO CRD42023408914.

Incidence of delirium after non-cardiac surgery in the Chinese elderly population: a systematic review and meta-analysis.

Background: POD places a heavy burden on the healthcare system as the number of elderly people undergoing surgery is increasing annually because of the aging population. As a large country with a severely aging population, China's elderly population has reached 267 million. There has been no summary analysis of the pooled incidence of POD in the elderly Chinese population. Methods: Systematic search databases included PubMed, Web of Science, EMBASE, Cochrane Library Databases, China Knowledge Resource Integrated Database (CNKI), Chinese Biomedical Database (CBM), WanFang Database, and Chinese Science and Technology Periodicals (VIP). The retrieval time ranged from the database's establishment to February 8, 2023. The pooled incidence of delirium after non-cardiac surgery was calculated using a random effects model. Meta-regression, subgroup, and sensitivity analyses were used to explore the source of heterogeneity. Results: A total of 52 studies met the inclusion criteria, involving 18,410 participants. The pooled incidence of delirium after non-cardiac surgery in the elderly Chinese population was 18.6% (95% CI: 16.4-20.8%). The meta-regression results revealed anesthesia method and year of publication as a source of heterogeneity. In the subgroup analysis, the gender subgroup revealed a POD incidence of 19.6% (95% CI: 16.9-22.3%) in males and 18.3% (95% CI: 15.7-20.9%) in females. The year of publication subgroup analysis revealed a POD incidence of 20.3% (95% CI: 17.4-23.3%) after 2018 and 14.6 (95% CI: 11.6-17.6%) in 2018 and before. In the subgroup of surgical types, the incidence of hip fracture surgery POD was 20.7% (95% CI: 17.6-24.3%), the incidence of non-cardiac surgery POD was 18.4% (95% CI: 11.8-25.1%), the incidence of orthopedic surgery POD was 16.6% (95% CI: 11.8-21.5%), the incidence of abdominal neoplasms surgery POD was 14.3% (95% CI: 7.6-21.1%); the incidence of abdominal surgery POD was 13.9% (95% CI: 6.4-21.4%). The anesthesia methods subgroup revealed a POD incidence of 21.5% (95% CI: 17.9-25.1%) for general anesthesia, 15.0% (95% CI: 10.6-19.3%) for intraspinal anesthesia, and 8.3% (95% CI: 10.6-19.3%) for regional anesthesia. The measurement tool subgroup revealed a POD incidence of 19.3% (95% CI: 16.7-21.9%) with CAM and 16.8% (95% CI: 12.6-21.0%) with DSM. The sample size subgroup revealed a POD incidence of 19.4% (95% CI: 16.8-22.1%) for patients ≤ 500 and 15.3% (95% CI: 11.0-19.7%) for patients > 500. The sensitivity analysis suggested that the pooled incidence of postoperative delirium in this study was stable. Conclusion: Our systematic review of the incidence of delirium after non-cardiac surgery in elderly Chinese patients revealed a high incidence of postoperative delirium. Except for cardiac surgery, the incidence of postoperative delirium was higher for hip fracture surgery than for other types of surgery. However, this finding must be further explored in future large-sample studies. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier: PROSPERO CRD42023397883.

Contrast-Enhanced Ultrasonography as a Diagnostic Strategy for Severe Endometrial Injury.

ABSTRACT: Endometrial injury is associated with poorer pregnancy outcomes. The purpose of this study was to evaluate the diagnostic efficacy of contrast-enhanced ultrasonography (CEUS) in the detection of endometrial injury. This study included women who underwent CEUS of the uterus at the author's hospital between April 2020 and January 2021. The diagnostic performances of the CEUS-derived parameters in the detection of severe endometrial injury were evaluated by receiver operating characteristic curve analyses. The study included 67 participants (healthy control, n = 14; mild endometrial injury, n = 24; severe endometrial injury, n = 29). Enhancement intensity (EI) and area under the time-intensity curve (AUC TIC ) were significantly lower in the severe endometrial injury patients than healthy and mild endometrial injury subjects for both endometrial and subendometrial regions ( P < 0.05). Correlations analysis showed that EI and AUC TIC were positively correlated with endometrial thickness ( r = 0.460, P = 0.01, and r = 0.555, P < 0.01, respectively) and subendometrial thickness ( r = 0.501, P < 0.01, and r = 0.438, P = 0.01, respectively). The area under the receiver operating characteristic curve, sensitivity, and specificity were 0.720 ( P = 0.002), 79.31%, and 66.67% for endometrial EI; 0.818 ( P < 0.001), 75.86%, and 79.17% for subendometrial EI; 0.917 ( P < 0.001), 72.41%, and 95.83% for endometrial AUC TIC ; and 0.810 ( P < 0.001), 89.66%, and 70.83% for subendometrial AUC TIC , respectively. Contrast-enhanced ultrasonography may have clinical utility in the prediction of endometrial injury in women of childbearing age.

Reduction of portosystemic gradient during transjugular intrahepatic portosystemic shunt achieves good outcome and reduces complications.

BACKGROUND: Transjugular intrahepatic portosystemic shunt (TIPS) is placed important role in the therapy of complications of portal hypertension, there is still no suitable criterion for a reduction in portosystemic gradient (PSG), which can both reduce PSG and maximize clinical results and minimize hepatic encephalopathy (HE). AIM: To compare the clinical outcomes and incidence of HE after one-third PSG reduction during TIPS in patients with variceal bleeding and refractory ascites. METHODS: A total of 1280 patients with portal-hypertension-related complications of refractory ascites or variceal bleeding who underwent TIPS from January 2016 to January 2019 were analyzed retrospectively. Patients were divided into group A (variceal hemorrhage and PSG reduced by one third, n = 479); group B (variceal hemorrhage and PSG reduced to < 12 mmHg, n = 412); group C (refractory ascites and PSG reduced by one third, n = 217); and group D (refractory ascites and PSG reduced to < 12 mmHg of PSG, plus medication, n = 172). The clinical outcomes were analyzed. RESULTS: By the endpoint of follow-up, recurrent bleeding was no different between groups A and B (χ 2 = 7.062, P = 0.374), but recurrent ascites did differ significantly between groups C and D (χ 2 = 14.493, P = 0.006). The probability of total hepatic impairment within 3 years was significantly different between groups A and B (χ 2 = 11.352, P = 0.005) and groups C and D (χ 2 = 13.758, P = 0.002). The total incidence of HE differed significantly between groups A and B (χ 2 = 7.932, P = 0.016), groups C and D (χ 2 = 13.637, P = 0.007). There were no differences of survival rate between groups A and B (χ 2 = 3.376, P = 0.369, log-rank test), but did differ significantly between groups C and D (χ 2 = 13.582, P = 0.014, log-rank test). CONCLUSION: The PSG reduction by one third may reduce the risk of HE, hepatic function damage and achieve good clinical results.

Relationship between social support and fear of cancer recurrence among Chinese cancer patients: A systematic review and meta-analysis.

Background: To quantitatively analyze the association between social support (SS) and fear of cancer recurrence (FCR) by reviewing current evidence from observational studies. Methods: A comprehensive literature search was performed in nine databases from inception to May 2022. Observational studies that used both SS and FCR as study variables were included. Regression coefficient (ß') and correlation coefficient (r) were calculated with R software. Subgroup analysis was utilized to investigate the degree of the relationship between SS and FCR as well as the impact of various forms of SS on FCR in cancer patients. Results: Thirty-seven studies involving 8,190 participants were identified. SS significantly reduced FCR risk [pooled ß' = -0.27, 95% confidence interval (CI) = -0.364 to -0.172], with moderate negative correlations (summary r = -0.52, 95% CI = -0.592 to -0.438). Meta-regression and subgroup analysis showed that types of cancer and study type were the source of heterogeneity. However, types of SS [actual SS, perceived social support (PSS), and others], source of actual SS, and source of PSS were not significant moderators. Conclusion: To the best of our knowledge, this is the first systematic review and meta-analysis to quantitatively investigate the association between SS and FCR in Chinese cancer patients using ß' and r coefficients. The results re-emphasized that social workers should enhance the use of SS by cancer patients and establish a sound SS system by either implementing more relevant research or developing targeted policies. Based on meta-regression and subgroup analyses, moderators of the association between SS and FCR should also be studied closely as they may help identify patients in need. In addition, longitudinal research, as well as mixed research, should be conducted to more comprehensively explore the relationship between SS and FCR. Systematic review registration: https://www.crd.york.ac.uk/prospero, identifier CRD42022332718.

Prognostic value of hysterosalpingography after salpingostomy in patients with hydrosalpinx.

To assess whether post-hysterosalpingography evaluation was associated with pregnancy rate and to identify independent risk factors for pregnancy success after salpingostomy in patients with hydrosalpinx. A retrospective analysis was conducted on the clinical data of 47 patients diagnosed with hydrosalpingography (HSG) in our hospital from 2015 to 2018. These patients received laparoscopic surgery and another salpingography within 2 months after surgery. According to the fallopian tube conditions evaluated by HSG before and after surgery, the patients could be divided into two groups. According to the pregnancy rate and postoperative HSG of patients with hydrosalpinx after laparoscopy, the total pregnancy rate of the tubal improved group was 65.62%, while that of the non-improved group was 20%, with statistical significance (p < 0.05). We found that hysterosalpingography after salpingostomy in patients with hydrosalpinx can provide reference for clinical treatment and improve the prognosis of patients.

Postoperative HSG improvement was an independent risk factor for pregnancy rate in patients with hydrosalpinx after laparoscopic surgery. Impact statementWhat is already known on this subject? Fallopian tube obstruction is an important cause of female infertility. Current studies have shown that most spontaneous pregnancies in patients with hydrosalpinx after salpingostomy occur within 18 months, however, pregnancy rates and outcomes vary from report to report.What do the results of this study add? Many studies have shown that hydrosalpinx reduces the success rate of natural pregnancy and embryo transfer, but the mechanism of hydrosalpinx affecting pregnancy remains unclear. This study explored the mechanism of successful pregnancy through hysterosalpingography after salpingostomy in patients with hydrosalpinx.What are the implications of these findings for clinical practice and/or further research? To evaluate the prognosis of patients with hydrosalpinx after laparoscopic salpingostomy by hysterosalpingography (HSG), and to reflect the improvement according to the postoperative pregnancy rate of the patients. To provide clinical personalized treatment plan.

A meta-analysis of nursing students' knowledge and attitudes about end-of-life care.

OBJECTIVES: To synthesize nursing students' knowledge and attitudes about end-of-life care and to identify strategic directions for optimizing end-of-life care education. DESIGN: A meta-analysis of observational studies. DATA SOURCES: PubMed, Web of Science, EMBASE, CINAHL, PsycINFO, MEDLINE, CNKI, and WANFANG 8 electronic databases in English and Chinese were systematically searched from inception until 10 April 2022. REVIEW METHODS: Two reviewers independently screened literature and extracted data using structured tables. The Agency for Healthcare Research and Quality (AHRQ) was used to appraise the methodological quality of included studies. The study outcomes were synthesized using a meta-analysis. RESULTS: 26 cross-sectional studies of medium or high quality from 13 countries met the eligibility criteria, involving 9749 nursing students. In our review, nursing students demonstrated insufficient knowledge about end-of-life care, with a pooled mean score of 7.50 (95 % CI: 6.55-8.45); of these, knowledge about philosophy and principles, psychosocial and spiritual care, and pain and symptom management were all deficient, with pooled mean scores of 1.49 (95 % CI: 0.78-2.21), 1.00 (95 % CI: 0.35-1.65), and 3.44 (95 % CI: 2.25-4.63), respectively. Conversely, nursing students showed positive attitudes toward end-of-life care, with a pooled mean score of 102.97 (95 % CI: 99.43-106.51). The subgroup analysis revealed that male nursing students had lower pooled mean scores for end-of-life care knowledge and attitudes. CONCLUSION: There is a mismatch between nursing students' knowledge and attitudes about end-of-life care, they have a positive attitude but lack the necessary knowledge. Male nursing students seem to have a greater deficit of knowledge and a relatively conservative attitude toward end-of-life care. These findings may provide a significant reference for nursing educators to adjust educational strategies promptly.

Factors affecting the success of fallopian tube recanalization in treatment of tubal obstructive infertility.

OBJECTIVE: To examine potential risk factors associated with the success rate following fallopian tube recanalization (FTR) in infertile women with obstruction of the proximal fallopian tube. METHODS: We retrospectively studied patients who underwent FTR for tubal obstructive infertility between January 2016 and December 2018 at the Third Affiliated Hospital of Guangzhou Medical University. FTR was performed using a catheter and guidewire system to clear tubal obstruction. Predictive factors potentially associated with the success rate were assessed by logistic regression. RESULTS: A total of 762 patients were included. Multivariable analysis showed that age (odds ratio [OR] = 2.38, 95% confidence interval [CI]: 1.24-4.58), infertility type (OR = 2.82, 95% CI: 1.36-6.21), history of ectopic pregnancy (OR = 7.87, 95% CI: 4.05-15.81), history of abdominal surgery (OR = 4.30, 95% CI: 2.22-8.60), history of artificial abortion curettage (OR = 4.08, 95% CI: 2.12-8.03), and duration of infertility (OR = 2.03, 95% CI: 1.06-3.85) were independently associated with postoperative tubal patency. CONCLUSIONS: Our findings suggest that risk factors, such as age ≥35 years, secondary infertility, duration of infertility ≥5 years, and histories of ectopic pregnancy, abdominal surgery, and artificial abortion curettage, affect the success rate of FTR. These factors may also predict surgical success in treating tubal obstructive infertility.

Modified sandwich embolization technique for postpartum hemorrhage caused by uterine artery pseudoaneurysm: a case series.

PURPOSE: Uterine artery pseudoaneurysm (UAP) is rare but can cause life-threatening postpartum hemorrhage (PPH). To evaluate a novel sandwich embolization technique as a treatment for PPH caused by UAP. METHODS: This retrospective study included 10 patients with PPH caused by UAP who were treated using a modified sandwich embolization technique at the Radiology Department, Third Affiliated Hospital of Guangzhou Medical University between April 2009 and September 2018. Baseline clinical characteristics, intraoperative data (including treatment effectiveness) and postoperative data (including re-bleeding events and complications) were extracted from the medical records. RESULTS: Uterine arterial angiography showed cystic shadowing of the vascular wall during the arterial phase in all patients. Spraying of contrast agent into the pseudoaneurysm was observed for large UAPs, and the pseudoaneurysm disappeared in the venous phase. The pseudoaneurysm blood supply was from the uterine artery in 9 patients (90%) and the uterine, superior vesical, internal pudendal and nameless little arteries in 1 patient (10%). Bleeding symptoms were completely relieved in all patients after sandwich embolization. Eight patients experienced painful contractions in the perioperative period, but there were no other postoperative complications. During the 1-year postoperative follow-up, 9 patients (90%) had no re-bleeding symptoms/signs. One patient (10%), who had a pseudoaneurysm supplied by the uterine, superior vesical, internal pudendal and nameless little arteries, experienced re-bleeding 20 days after surgery and was treated by hysterectomy. CONCLUSION: Modified sandwich embolization is an effective treatment for PPH caused by UAP.

Diagnostic efficacy of 3-D hysterosalpingo-contrast sonography in the detection of tubal occlusion: Systematic meta-analysis.

AIM: Evaluation of tubal status is critical in the diagnostic work-up of infertile women. The purpose of this study was to explore the diagnostic efficacy of three-dimensional hysterosalpingo-contrast sonography (3-D HyCoSy) for tubal occlusion. METHODS: MedLine, Embase, Cochrane Library, ScienceDirect, CNKI, Chinese VIP Database, Chinese Wanfang Database and Chinese Biomedicine Database were searched for relevant trials published from June 1994 to August 2013. Meta-DiSc (version 1.4) was used for the meta-analysis. Diagnostic accuracy was determined by pooled estimates of sensitivity and specificity, as well as area under the curve (AUC) and the pooled diagnostic accuracy (Q*) derived from a summary receiver operating characteristic analysis. The heterogeneity test was done using the Cochran Q statistic and the I(2) statistic. Significant difference was defined as P < 0.10 (Q-statistic) or I(2) > 50% (I(2) -statistic) and a random effect model was used to pool data, otherwise the fixed effects model was used. RESULTS: A total of 11 studies (1037 Fallopian tubes) were included in this meta-analysis. The pooled estimates for diagnostic efficacy of 3-D HyCoSy had a sensitivity of 0.92 (95%CI: 0.89-0.94) and specificity of 0.95 (95%CI: 0.93-0.96). AUC and Q* were 0.976 and 0.929, respectively, but there was significant heterogeneity in sensitivity across the included studies. CONCLUSIONS: 3-D HyCoSy had good diagnostic performance in the detection of tubal occlusion.

Diffusion tensor imaging in the cervical spinal cord.

There are discrepancy between MR findings and clinical presentations. The compressed cervical cord in patients of the spondylotic myelopathy may be normal on conventional MRI when it is at the earlier stage or even if patients had severe symptoms. Therefore, it is necessary to take a developed MR technique--diffusion tensor imaging (DTI)--to detect the intramedullary lesions. Prospective MR and DTI were performed in 53 patients with cervical compressive myelopathy and twenty healthy volunteers. DTI was performed along six non-collinear directions with single-shot spin echo echo-planar imaging (EPI) sequence. Intramedullary apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values were measured in four segments (C2/3, C3/4, C4/5, C5/6) for volunteers, in lesions (or the compressed cord) and normal cord for patients. DTI original images were processed to produce color DTI maps. In the volunteers' group, cervical cord exhibited blue on the color DTI map. FA values between four segments had a significant difference (P < 0.01), with the highest FA value (0.85 ± 0.03) at C2/3 level. However, ADC value between them had no significant difference (P > 0.05). For patients, only 24 cases showed hyperintense on T2-weighted image, while 39 cases shown patchy green signal on color DTI maps. ADC and FA values between lesions or the compressed cord and normal spinal cord of patients had a significant difference (both P < 0.01). FA value at C2/3 cord is the highest of other segments and it gradually decreases towards the caudal direction. Using single-shot spin echo EPI sequence and six non-collinear diffusion directions with b value of 400 s mm(-2), DTI can clearly show the intramedullary microstructure and more lesions than conventional MRI.