ObjectiveTo investigate the effectiveness of clitoroplasty of reserving the clitoris dorsal neurovascular bundle and the ventral complete urethral plate for genital virilization in girls with congenital adrenal hyperplasia (CAH). MethodsBetween June 2000 and October 2015, 27 girls with genital virilization were treated with clitoroplasty of reserving the clitoris dorsal neurovascular bundle and the ventral complete urethral plate. The chromosomal karyotype was 46, XX in all patients, whose age ranged from 3 to 11 years (mean, 3.9 years). According to Parder's virilization scale, 5 cases were classified as stage Ⅱ, 18 cases as stage Ⅲ, and 4 cases as stage Ⅳ. The hormone tests showed decreased cortisol level and increased testosterone and 17-hydroxyprogesterone levels. They were diagnosed with non-salt-wasting CAH. ResultsAll of the patients underwent clitoroplasty successfully. The mean operation time was 74 minutes (range, 58-95 minutes). Incision healed primarily. The patients were followed up 6 months to 10 years (median, 19 months). The external genitalia had good appearance, without necrosis of flap and the glans clitoris, abnormal sensation of the glans clitoris, or clitorism recurrence. Five girls had breast development and normal menstrual cycle during adolescence, and 1 patient who was followed up for 10 years gave birth to a son. ConclusionClitoroplasty of reserving the clitoris dorsal neurovascular bundle and the ventral complete urethral plate is a relatively ideal method for treating genital virilization in girls. It has less complications, good aesthetic and functional results. There are satisfactory outcomes when combining with the endocrine treatment.
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.
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.
目的：探讨女性生殖道瘘的病因及预防措施。方法：回顾性分析我院妇产科2000年1月至2005年12月收治入院的57例女性生殖道瘘病例的病因。结果：产伤和妇科手术占女性生殖道瘘病因的前两位，分别占56.1%（32/57）和33.3%（19/57）。结论：产伤和妇科手术是引起女性生殖道瘘的主要原因。加强围产期保健、积极处理产科合并症以及提高妇科手术技术是降低女性生殖道瘘发生率的关键因素。
ObjectiveTo explore the effect of chronic unpredictable mild stress (CUMS) on the reproductive function of mice and provide a suitable animal model for reproduction and stress. MethodsA total of 240 female Kunming mice were feed for 5 days, and then divided randomly into the control group (n=90) and experimental group (n=150). The mice in the experimental group were stressed by 9 chronic mild unpredictable stress factors for 4 weeks and validated by open field test and sucrose consumption test. We administrated pregnant mare serum gonadotropin (PMSG)/human chorionic gonadotropin (HCG) for induction of superovulation and observed the ovarian response and embryo development potential. ResultsAfter 4-week CUMS stimulation, the weight gain, 2% sugar consumption test and open field test were significantly different between the mice in two groups (P>0.05). After PMSG/HCG was administrated, the antra follicles and preovulatory follicles significantly reduced significantly in the experiment group than that in the control group (P<0.05); the number of oocytes, fertilization rate, 2-cell embryos, D4 embryos, blastocysts, high quality embryo rate and D5 bed points were all significantly decreased in the experiment group than those in the control group (P<0.05). ConclusionThe CUMS female Kunming mice model is a kind of emotional stress animal model with low reproductive function, which is effective, operable and repeatable; it could be used for further study on the mechanism of reproductive medicine.
Objective To evaluate the correlation between mycoplasma genitalium and HIV infection. Methods Databases including MEDLINE, ScienceDirect, EMbase, WanFang Data, and CNKI were searched from inception to March 2012, so as to identify the independent cohort studies, case-control studies and cross-sectional studies. Moreover, the references of relevant studies were also retrieved. According to the inclusion and exclusion criteria, the studies were screened, the data were extracted, and the methodological quality of the included studies was assessed. Then meta-analysis was performed using RevMan 4.2 and SAS 9.1.3 softwares. Results A total of 19 studies were included, including 3 430 HIV infected patients and 7 656 controlled participants. The results of meta-analyses showed that the HIV infection group was more likely to infect mycoplasma genitalium than the control group (OR=2.34, 95%CI 1.68 to 3.28, Plt;0.000 01). The same results were found in both subgroup and sensitivity analyses. Conclusion Mycoplasma genitaliuman infection is closely related to HIV infection. However, detailed pathogenesis is still unknown. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to prove the above.
ObjectiveTo investigate the effectiveness of posterior sagittal anorectoplasty (PSARP) and total urogenital mobilization in treatment of cloacal malformation. MethodsThree girls with cloacal malformation were admitted between June 2010 and June 2013. The age was 2 years, 5 months, and 4 months, respectively. All patients received previous separated sigmoid colostomy. PSARP and total urogenital mobilization were performed to correct the malformation. Colostomy stoma was closed after confirming the patent of rectum and anus. Dilation of anus was sustained for 6 months after anorectoplasty. ResultsOperations were successfully completed in 3 cases. The durations of operation were 3 hours and 40 minutes, 4 hours and 20 minutes, and 3 hours and 50 minutes; the blood loss was 10, 20, and 10 mL; and the time of colostomy stoma closure was 3, 5, and 3 months, respectively. Three cases were followed up 13, 18, and 4 months, respectively; no anal stenosis or rectal prolapse occurred. They had normal micturition; the B ultrasonic examination showed that the residual urine volume was less than 10 mL. At 12 months after anorectoplasty, the Wexner scores were 1 and 5 in 2 cases followed up 13 and 18 months; according to Krickenbeck postoperative effect, 2 cases had defecation and no constipation; 1 case had soiling (grade 1). ConclusionPSARP and total urogenital mobilization should be the first choice in treatment of cloacal malformation with common channel less than 3 cm.