摘要：In previous studies, N,O-carboxymethyl chitosan has been shown to decrease the incidence and intensity of abdominal adhesions. In the present study, adhesions were induced in 220 rabbits using a double uterine horn model. Rabbits were randomized to receive an operation only or an operation+medical chitosan intraperitoneally. Twenty-two rabbits from each group were euthanized at one of five different times(Day 3, 7, 14, 28, or 42), and adhesion formation was given gross and histopathological scores. Reductions were observed in adhesion extent(P=0.0337) and tenacity(P=0.0271) as well as inflammation(P<0.0001) on Day 3 when medical chitosan was applied. Prior to Day 14, fibrosis was less obvious in the medical chitosan group(P<0.0005). The tenacity scores were significantly lower in the medical chitosan group following Day 14(P<0.05), while the type scores were lower in the medical chitosan group following Day 28(P<0.03). Thus, medical chitosan decreased both the gross and the histopathological scores of the induced adhesions.

摘要：Introduction: Women’s sexual function is a complex ensemble of variables that involve physical, emotional, and psychosocial states. Objective: This review aims to evaluate the evidence about the sexual behavior of women during pregnancy. Methods: Survey of PubMed for the period from 1996 to 2011 for prospective, retrospective and case-control studies, randomized clinical trials, meta-analyses and systematic reviews on the sexual function of women during pregnancy using the terms “sexual function”, “sexual dysfunction”, “sexuality”, “pregnancy”, and “pregnant woman”. Results: Changes occur in the sexual function of women during pregnancy;however, due to the heterogeneity of the studies and the incomparability of samples for lack of pairing for cultural, age, length of relationship and gestational age variables, and other methodological biases, it is not possible to characterize the sexual response of pregnant women. Conclusions: The changes observed are not sufficient to characterize sexual behavior during pregnancy as pathological. It is therefore necessary to standardize the study groups and the instruments for the assessment of sexual function, to determine the presence of distress concomitant with changes in sexual function, and to assess the sexual function of the partner and the impact of changes on the dyadic relationship before and after the gestational period.

摘要：Objective: The purpose of the study was to evaluate the stability of the maternal pelvis over the course of the third trimester and the puerperium. Study design: Pregnant patients were recruited to undergo comparative magnetic resonance-based pelvimetry and fetal ultrasonography at 37 to 38 weeks of gestation. Most of the patients were recruited from a study of women who planned a trial of labor after a previous cesarean delivery for cephalopelvic disproportion. These results have been reported previously. Patients then underwent magnetic resonance-based pelvimetry within 3 days and at 3 months after delivery. Postdelivery analysis was used to answer the question: Do pelvic dimensions change after delivery? Results: Eighteen patients completed the study. Eleven of the patients underwent cesarean deliveries, of which 4 deliveries were before labor. Seven patients had successful vaginal births after their previous cesarean delivery. Statistical analysis of the 18 patients determined that pelvic measurements did not demonstrate change over the course the study. Conclusion: Serial magnetic resonance-based pelvimetry showed relative stability of pelvic measurements through the course of pregnancy and delivery. If comparative pelvimetry is to be useful as an antepartum predictor of labor success, then it may be possible to obtain reliable pelvimetry in those patients anytime after delivery.

摘要：Background: The development of anitiretroviral drug resistance may limit the benefit of antiretroviral therapy. Therefore the need to closely monitor these mutations, especially the use of ART is increasing. This study was therefore designed to determine the ARV drug resistance pattern among ART na?ve and expose individuals attending a PEPFAR supported by antiretroviral clinic in Nigeria. Methodology: The study participants included patients attending the PEPFAR supported by University College Hospital (UCH), Ibadan ART clinic who have been on HIV treatment for at least one year with consecutive viral load of over 2000 copies/ml as well some ART Na?ve individuals with high (>50,000 copies/ml) baseline viral level attending the hospital for pre-ART assessment. Blood sample was collected from each individual for CD4 enumeration, viral load level determination and DNA sequencing for genotypic typing. Antiretroviral drug resistance mutations (DRM) were determined by using the Viroseq software and drug mutations generated by using a combination of Viroseq and Stanford algorithm. DRM were classified as major or minor mutations based on the June 2013 Stanford DR database. Results: The most common major NRTI, NNRTI and PI mutation were D67N (33.3%), Y181C (16.7%) and M46L/I (55.6%) respectively. Lamivudine (3TC) and emtricitabine (FTC);nevirapine (NVP) and nelfinavir (NFV) were the most common NRTI, NNRTI, and PI drugs to which the virus in the infected individuals developed resistance. Isolates from 4 patients were resistant to triple drug class, including at least one NRTI, NNRTI and a PI. Only one (4.8%) of the isolates from drug Na?ve individuals had major DRM that conferred resistance to any drug. Conclusion: Demonstration of high rates of antiretroviral DRM among patients on 1st and 2nd line ART and the presence of DRM in drug Na?ve individuals in this study show the importance of surveillance for resistance to ARV in line with the magnitude of scaling up of treatment

摘要：Objective: To screen a triple helix-forming oligodeoxyribonucleotide (TFO) that can bind HBV core promoter at target site with high affinity and specificity, and to observe the ability of manganese porphyrin modified TFO to combine and cleave HBV DNA. Methods: Similar homopurine domain (1 734 - 1 754) in HBV core promoter was selected as target sequence. Several corresponding TFOs were synthesized. The affinities and specificities of TFOs binding target sequence were tested with electrophoretic mobility shift and DNase I footprinting assays. The selected best TFO was modified with manganese porphyrin and acridine. The ability of the TFO derivative to cleave HBV DNA was observed with cleavage experiment. Results: Under the condition of 371 and pH 7. 4, the TFO consisting of cytidylate and thymidylate (CT-TFO) and the parallel TFO consisting of guanylate and thymidylate (GT-TFOp) bound the target sequence weakly with Kd values much more than 10 -6 mol/L. The affinities of anti-parallel GT-TFO ( GT-TFOap) and short TFO consisting of adenine nucleotide and guanylate (AG-TFOsh) binding the target sequence were higher than those of the formers, with Kd values of 5 μ 10-7 mol/L and 2. 5 μ 10-8 mol/L respectively. Long AG-TFO (AG-TF01) had the highest binding affinity with a Kd value of 3 μ 10 -9 mol/L among all the TFOs studied for sequence specificity. In the presence of potassium monopersulfate, KHSO5, TFO modified with manganese porphyrin and acridine cleaved the target sequence where the triplex DNA formed. Conclusion: TFO containing AG or GT binds homopurine in HBV core promoter in adverse parallel direction to form triple helix. AG-TFO1 has the highest binding affinity among all the TFOs studied. After modified with manganese porphyrin, AG-TFO1 completely binds and cleaves the target HBV DNA sequence where triplex DNA is formed.

摘要：Objective:The purpose of this study was to calculate the prospective risk of fetal death in monochorionic-diamniotic twins. Study design:We evaluated 193 monochorionic diamniotic twin pregnancies that were followed and delivered after 24 weeks. Surveillance included cardiotocography and sonography performed at least once weekly. The prospective risk of fetal death was calculated as the total number of deaths at the beginning of the gestational period divided by the number of continuing pregnancies at or beyond that period. Results:The fetal death rate was 5 of 193 pregnancies (2.6%; 95%CI,1.1,5.9); the prospective risk of stillbirth per pregnancy after 32 weeks of gestation was 1.2%(95%CI,0.3%-4.2%). Conclusion:Under intensive surveillance,the prospective risk of fetal death in monochorionic-diamniotic pregnancies after 32 weeks of gestation is much lower than reported and does not support a policy of elective preterm delivery.

摘要：Objective: To investigate the effects of hormone therapy, estrogen therapy and tibolone on markers of apoptosis including bcl-2, and bax and cyclin D 1 expression in postmenopausal vaginal epithelium. Study design: Thirty postmenopausal women were randomized to the treatment protocols (0.625 mg conjugated equine estrogen (CEE) ? 2.5 mg medroxyprogesterone acetate (MPA); 2 mg estradiol valerate; 2.5 mg tibolone). After baseline vaginal biopsy, control biopsies were performed after 70 days following the initiation of the therapy. Bcl-2, bax, Bcl-2/bax ratio, cyclin D1 measurements were performed immunohistochemically. Data were analyzed by Kruskal-Wallis, Mann-Whitney U and Wilcoxon tests. Results: After the treatment period the above-mentioned parameters were not different among the groups except for cyclin D1 levels. Cyclin D1 expression was found to be strong in patients with treated estradiol valerate. Conclusions: The effects of estrogen on cyclin D1 expression were not detected with tibolone or with the addition of progesterone to estrogen in the vaginal epithelium. Cyclin D1 appeared to have stronger effects on the estrogen related proliferation compared to apoptotic markers in vaginal epithelial cells.

摘要：Objective: This study was undertaken to analyze bleeding problems with tension-free vaginal tape (TVT) operations in a national registry. Study design: We studied patients for whom increased intraoperative bleeding or reoperation for bleeding/hematoma with TVT operation were reported to the registry. Results: Bleeding problems were reported for 151 of 5578 (2.7% )TVT operations. Increased intraoperative bleeding was reported for 106 (1.9% ) and reoperation (or conversion) in 45 (0.8% ) patients (both in 5 patients). Increased intraoperative bleeding was managed conservatively in 103 patients (95% ). Overall, 45 (0.8% ) patients required reintervention for bleeding or hematoma. The reinterventions comprised 34 laparotomies, 4 transvaginal evacuations of hematomas, 3 revisions for bleeding from a suprapubic catheter site, and 2 revisions of the vaginal incision (details unclear in 1 patient). Bleeding was considered arterial in 12% (including 1 external iliac artery injury and 1 obturator artery injury) and venous or unknown in 88% . Of reoperated patients, 39% were reoperated within 24 hours, 20% within 2 to 10 days, and 41% within 11 to 56 days after TVT placement. Overall, 19 patients received blood transfusions (range, 1- 10 units). There were no deaths from bleeding complications. Conclusion: Bleeding complications were reported with less than 3% of 5578 TVT operations. Most cases of increased intraoperative bleeding were managed conservatively; 0.8% of patients required conversion or reoperation.

摘要：Objective: The purpose of this study was to compare 2- dimensional and 3- dimensional power- Doppler imaging diagnostic performance for the prediction of ovarian cancer in complex adnexal masses. Study design: Sixty- nine complex adnexal masses in 60 women (mean age, 48.4 years [range, 17- 82 years]) were evaluated by 2- dimensional and 3- dimensional power- Doppler imaging for differentiating benign from malignant masses. Complex adnexal mass was defined in the presence of at least 1 of the following features: solid areas, thick papillary projections, thick septa, or purely solid echogenicity. One examiner performed 2- dimensional power- Doppler imaging, and a second examiner performed 3- dimensional power- Doppler imaging. All masses were removed surgically, and definitive diagnosis was obtained. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated for both techniques. Results: Forty- five tumors (65.2% ) were proved to be malignant, and 24 tumors (34.8% ) were proved to be benign. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for 2- dimensional power- Doppler imaging were 97.8% , 87.5% , 93.6% , 95.5% , and 94.2% , respectively. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for 3- dimensional power- Doppler imaging were 97.8% , 79.2% , 89.9% , 95% , and 91.3 % respectively. There were no statistical differences in sensitivity and specificity (McNemar test: P =. 250) Conclusion: Three- dimensional power- Doppler imaging did not have a better diagnostic performance than 2- dimensional power- Doppler imaging for the discrimination of benign from malignant complex adnexal masses.

摘要：The purpose of this study was to describe levator ani (LA) anatomy in postterm nulliparas using 3- dimensional (3- D) magnetic resonance (MR). Study design: Nulliparas (n = 84) with uncomplicated, postterm pregnancies underwent an MR (4 mm slices, 0 gap) of the uterus and pelvis. LA volume and morphometry were assessed using 3- D post-processing software. Results: LA insertion into the symphysis was visible in 93% , and the iliococcygeus muscle assumed a convex shape (arch) in the 92% of the 84 women. The LA shape was characterized as “ U” in 53% and “ V” in 47% . Mean LA volume was 13.5 (3.7) cm3. There was a positive association between LA volume and higher fetal station (P = .02) and increasing BMI (P < .001). However, no relationship between LA volume and station was found after adjusting for BMI. Conclusion: BMI was correlated with LA volume in postterm nulliparas. LA insertion into the symphysis and the iliococcygeus arch were well-preserved overall and morphometry was variable.