Objective To define an evidence-based conclusion concerning ultrasound screening for fetal genital system malformations during pregnancy. Methods In order to assess whether or not ultrasound screening for fetal genital system malformations is effective and feasible, we searched The Cochrane Library (Issue 3, 2009), MEDLINE (1981 to 2009), ACP Journal Club (1991 to 2008), and BMJ Clinical Evidence (1999 to 2008) for systematic reviews, randomized controlled trials (RCTs), cohort studies, and controlled clinical trials. Results Five cohort studies and three crosssectional studies were retrieved. The results showed ultrasound screening detected fetal sex determination by the contour of the rump and the angle of the genital tubercle to a horizontal line through the lumbosacral skin surface in the first trimester. Scrotal size and penile length increases with gestational age for male fetuses, and by 32 weeks, bilateral testicular descent was observed in most cases. Ultrasonographic scans, fetal genetic studies, and hormonal assays of amniotic fluid can diagnosis certain diseases, fetal sex differentiation disorders, fetal endocrinal disorders, and chromosome abnormality. Conclusion The findings of this study should reassure physicians and parents alike that ultrasound screening is an reliable option for the prenatal diagnosis of fetal genital system malformations, but more randomized controlled trials are needed to further supply relevant evidence.
Since the concept of total mesorectal excision (TME) was proposed and carried out in 1982, the postoperative local recurrence rate of rectal cancer has decreased significantly and the long-term survival rate has increased, thus TME has become the gold standard for middle and low rectal cancer surgery. However, the incidence of postoperative urination and sexual dysfunctions caused by pelvic autonomic nerve injury during TME operation remains high, which needs to be investigated and solved. Over the years, through systematic studies of anatomy, histology and physiology, we have confirmed that dissection anterior to Denonvilliers’ fascia for the anterior wall of rectum, and thus partial resection of Denonvilliers’ fascia, were the leading cause of nerve injury during TME operation. On the contrary, dissection posterior to Denonvilliers’ fascia and entire preservation of Denonvilliers’ fascia are feasible and necessary. Moreover, through anatomical study, Wei’s Line, the surgical marker line of Denonvilliers’ fascia is discovered for the first time, and thus innovative TME (iTME) navigated with Wei’s Line is proposed. The multi-center clinical study has confirmed that compared with traditional TME surgery, the incidences of postoperative urination and sexual dysfunctions in iTME group decrease significantly, with comparable oncologic outcomes, suggesting that iTME surgery could be a better choice for male patients with middle and low rectal cancer at specific stages. This study systematically reviews the research process and operation standard of iTME, and summarizes the application status and future prospects of iTME.
目的 探讨泌尿生殖系统结核的临床特点。 方法 对2006年5月－2011年5月住院确诊为泌尿生殖系统结核的83例患者，总结分析其临床特点、诊疗情况。 结果 患者病程平均3.2年，临床特征多为尿路刺激症状、肾区疼痛及尿检异常等，尿抗酸杆菌阳性率仅6.67%，诊断困难。器官功能受损重，手术比例高达44.58%。 结论 泌尿生殖系统结核虽发病率逐年下降，但临床表现缺乏特异性，常延误诊断治疗。注重对该疾患临床资料的全面收集和深入分析，对提高诊疗水平有重要意义。
ObjectiveTo systematically review the infection and colonization of Mycoplasma genitalium (Mg) in the reproductive tract of pregnant females in China. MethodsPubMed, Web of Science, SinoMed, CNKI, VIP and WanFang Data databases were electronically searched to collect cross-sectional studies on Mg infection in pregnant females in China from inception to October 10, 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies; then, meta-analysis was performed by using R1.1.463 software. ResultsA total of 23 cross-sectional studies were included. The results of meta-analysis showed that the prevalence rate of Mg infection in pregnant females was 4.86% (95%CI 2.84% to 7.38%). The prevalence rates of Mg infection in females with ectopic pregnancy, spontaneous abortion, induced abortions and PROM were 13.01% (95%CI 6.90% to 20.69%), 11.81% (95%CI 3.30% to 24.59%), 6.11% (95%CI 2.70% to 10.77%), and 12.63% (95%CI 9.56% to 16.06%), respectively. ConclusionCurrent evidence shows that the prevalence rate of Mg infection in females with ectopic pregnancy, spontaneous abortion and premature rupture of membranes are higher than those in other pregnant females. Due to limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
ObjectiveTo investigate the potential causal relationship between four types of reproductive behaviors and rheumatoid arthritis (RA), with the goal of establishing a theoretical foundation for clinical prevention and treatment strategies. MethodsPooled gene-wide association study (GWAS) data were obtained from large publicly searchable databases. Four characteristics like menarche, menopause, the age of first pregnancy and the age of last pregnancy, which related to reproductive behavior were selected as the exposure factors and RA as the outcome factors. Single nucleotide polymorphisms (SNPs), which were strongly correlated with the phenotype of the exposure factors, were screened as the instrumental variables, and two-sample Mendelian randomization analyses were used to assess the potential causal relationship between the exposure and the disease. Results① The Mendelian randomization analysis utilizing the inverse variance weighted method on two distinct samples revealed a significant negative correlation between the age of first pregnancy and last pregnancy with the risk of RA (OR=0.91, 95%CI 0.85 to 0.98, P=0.011; OR=0.54, 95%CI 0.31 to 0.93, P=0.026). Conversely, no causal relationship was observed between menarche and menopause with RA. Sensitivity analysis confirmed the robustness of the causal relationship, while MR Egger intercept analysis did not identify any potential horizontal pleiotropy (Page of first gestation -RA=0.169, Page of last gestation -RA=0.283). ② Reverse Mendelian randomization analysis revealed a significant positive causal association between RA and the age of first pregnancy, while no causal relationship was observed with the age of last pregnancy (OR=1.07, 95%CI 1.02 to 1.11, P=0.001). ③ Multivariate Mendelian randomization analysis demonstrated that both the age of first pregnancy and last pregnancy in women were inversely associated with the risk of RA (OR=0.88, 95%CI 0.80 to 0.97, P=0.010; OR=0.68, 95%CI 0.48 to 0.97, P=0.033). ④ There existed a negative correlation between the age of pregnancy in women and the risk of developing RA, suggesting a potential protective effect. ConclusionPregnancy age may have a negative causal relationship with the risk of RA, while menarche and menopause have no causal relationship with RA.
目的 通过检测人睾丸生殖细胞肿瘤中的Skp2蛋白质异常表达,探讨相关意义。 方法 应用S-P免疫组织化学法检测睾丸生殖细胞肿瘤，正常睾丸组织和慢性睾丸炎组织中Skp2的表达。 结果 睾丸生殖细胞肿瘤中Skp2阳性表达率为74.5%，正常睾丸组织中Skp2阳性表达率为20.0%，在慢性睾丸炎组织中Skp2阳性表达率为40.0%，在3种不同睾丸组织中表达差异有统计学意义（P＜0.05）；Skp2表达与不同组织学类型的睾丸生殖细胞肿瘤无相关性（P＞0.05）；随着临床分期的增高，睾丸生殖细胞肿瘤中的Skp2表达增多，差异无统计学意义（P＞0.05）。 结论 在人睾丸生殖细胞肿瘤中的Skp2高表达，提示细胞周期的异常调控在睾丸生殖细胞肿瘤的发生、分化中起着重要的作用。
ObjectiveTo explore the suitable division of male genitalia subunits and the effectiveness of large-area perineum defect repair under its guidance.MethodsAccording to the anatomical and functional characteristics of male genitalia, the subunit division scheme was proposed: area Ⅰ, glans penis; area Ⅱ, body of penis; area Ⅲ, scrotum; area Ⅳ, scrotum. Between April 2017 and July 2019, 12 patients with large genitalia defects were treated, with an average age of 60.9 years (range, 57-66 years) and an average disease duration of 2.7 years (range, 2-5 years). The defect area involved area Ⅰ in 1 case, area Ⅱ in 7 cases, area Ⅲ in 5 cases, and area Ⅳ in 8 cases; the size of area ranged from 6 cm×4 cm to 23 cm×16 cm. The causes of defect included 3 cases of trauma, 6 cases of Paget disease, 2 cases of squamous cell carcinoma, 1 case of spindle cell tumor. According to the design of the corresponding repair scheme, the main repair methods were to rotate and advance the skin flap and pedicled skin flap in the same area. When the defect was large, the free skin flap transplantation, free skin grafting, and free mucosa transplantation were used to repair the defect.ResultsAll the patients were followed up 6-13 months with an average of 8.6 months. Skin flap, skin graft, and mucosa survived in one stage in 10 patients; infection occurred in 1 case after the scrotal flap of area Ⅲ was transferred to repair the defect in area Ⅱ, 1 case had distal venous crisis at 2 days after repair area Ⅲ defect used free anterolateral thigh flap, and after active treatment, the condition improved. The appearance of the receiving area and the supplying area was good, and the local feeling was recovered satisfactorily. The range of motion of hip joint was good in 10 cases, and 2 cases were slightly stretched but did not affect normal life. All patients had normal urination and defecation function, and were satisfied with the treatment effectiveness.ConclusionThe subunits of male genitalia can be used to guide the repair of the defect, which can better restore the physiological appearance and function, and has positive clinical significance.