Huaifang Li

TVT-O vs. TVT for the treatment of SUI: a non-inferiority study

Introduction and hypothesisThis study aimed to prospectively compare, in terms of efficacy and safety, the tension-free vaginal tape (TVT) and the transobturator vaginal tape inside-out (TVT-O) procedure for stress urinary incontinence.MethodsA cough stress test was applied to the objective outcomes, while urinary incontinence-specific quality of life questionnaire was applied to the subjective outcomes. A test for non-inferiority was carried out for detecting the success rate between the two groups.ResultsThe objective success rates were found to be 95.4% (62/65) in the TVT group and 96.4% (108/112) in the TVT-O group. No significant difference was found between these two groups in the success rate by non-inferiority test (P < 0.0005), with significant improvement in quality of life and no significant difference in patient satisfaction rates in the two groups (P > 0.05).ConclusionsIn the study, the TVT-O procedure could be defined to be identical to the TVT approach in success rate by non-inferiority test.

Analysis of the original causes of placental oxidative stress in normal pregnancy and pre-eclampsia: A hypothesis

Pre-eclampsia (PE) and eclampsia remain enigmatic despite intensive research. Growing evidence suggests that placental oxidative stress (OS) is involved in the etiopathogenesis of pre-eclampsia. Reduced perfusion as a result of abnormal placentation was proposed to be responsible for placental OS in PE. However, placental OS was also observed in normal pregnancy. The exact differences and correlation of placental OS in PE and normal pregnancy remain elusive. In this review, we attempted to link both normal pregnancy and PE on the causes of placental OS and proposed a hypothesis that placental OS in normal pregnancy, plus the exploration of other placental and/or maternal factors, could provide a novel explanation of that in PE. We concluded that pregnancy, placental abnormality and preexisting maternal constitutional conditions are three principle factors that could contribute to placental OS in PE. The specific causes in each clinical case could be heterogeneous, which requires individual analysis.

The comparison of an inexpensive–modified transobturator vaginal tape versus TVT-O procedure for the surgical treatment of female stress urinary incontinence

OBJECTIVE To compare the safety and efficacy of an inexpensive-modified transobturator vaginal tape procedure with the transobturator tension-free vaginal tape (TVT-O) procedure for the surgical treatment of female stress urinary incontinence (SUI). MATERIALS AND METHODS Patients with SUI were randomly allocated to either the test group receiving the inexpensive-modified transobturator vaginal tape procedure or the control group receiving the GYNECARE TVT-O procedure. Treatment outcomes and Quality-of-life scores were recorded and analyzed between two groups. RESULTS A total of 156 patients were enrolled in this trial. Eighty patients underwent the modified transobturator vaginal tape procedure. Among them 75(93.8%) were cured and 5(6.2%) were improved. The rest of the 76 patients underwent the GYNECARE TVT-O procedure with a 92% (70 of 76) cure rate and an 8% (6 of 76) improvement rate. No inefficient or aggravated cases occurred in both groups. The success rates between groups had no significant statistic difference (p > 0.05). The operative time, blood loss, hospital stay, and medical cost were significantly lower in the test group (p < 0.01); the increases in Quality-of-life scores were comparable between groups. CONCLUSIONS The modified transobturator vaginal tape procedure is an efficacious and economic surgical treatment for female SUI.

Management of pancreatic ectopic pregnancy.

Abdominal pregnancy is a rare and high-risk complication that ultimately requires laparotomy. Atrash et al estimated that there are 10.9 abdominal pregnancies per 100,000 births, and 9.2 abdominal pregnancies per 1000 ectopic pregnancies [1]. The most commonly reported sites of primary peritoneal implantation are the pouch of Douglas and the posterior uterine wall [2e4]. At present, we would like to report a case of pancreatic ectopic pregnancy in which laparoscopic resection of the pancreatic body and tail, and splenectomywere performed successfully without any complications. A 30-year-old, gravida 1, para 0, Chinese woman visited our unit complaining of epigastric and left abdominal pain. Her last menses was 36 days before she presented to the hospital. No contraception was used. She had no history of Pelvic Inflammatory Disease (PID), no prior Intra Uterine Device (IUD), no use of fertility drugs, and no pelvic surgery. Transvaginal ultrasound on September 12, 2014 demonstrated massive pelvic effusion (deepest point, 38 mm), and no gestational sac was detected in the uterine cavity. Her serum bhuman chorionic gonadotropin (HCG) level was 2500.09 mIU/mL, amylase was 336.8 U/L and lipase was 1671.4 U/L. Physical examination revealed stable vital signs: blood pressure of 110/70 mmHg and a pulse rate of 88 beats/min. There was no tenderness of the fornices upon vaginal examination. The patient had slight abdominal tenderness and rebound pain. A presumptive diagnosis of ectopic pregnancy complicated with acute pancreatitis was made. Later in our gynecology ward, conservative treatment was done with a single-dose methotrexate (MTX) injection (50 mg/m2). However, during the night, without a decrease in serum b-HCG level, a dramatic increase of serum amylase and abdominal tenderness were observed. The hemoglobin and hematocrit levels

Pelvic reconstruction improves pelvic floor strength in pelvic organ prolapse patients

OBJECTIVE To evaluate pelvic floor muscle strength after the modified pelvic reconstruction procedure for pelvic organ prolapse (POP). MATERIALS AND METHODS Patients were assigned to two groups consisting of 37 patients diagnosed with POP and undergoing modified pelvic reconstruction (reconstruction group), and 30 patients admitted to our hospital during the same period for other surgical indications (control group). Vaginal palpation of pelvic floor muscle strength was performed according to the modified Oxford grading system before operating on the two groups and again in the 3(rd) month following surgery for the reconstruction group. A comparative study was performed to evaluate the differences between the two groups and the improvement of pelvic floor muscle strength in the reconstruction group. RESULTS The pelvic floor muscle strength was significantly improved postoperatively when compared with preoperative results in the reconstruction group (t = -17.478, p < 0.001). However, pre- and postoperative muscle strength in the reconstruction group was significantly lower relative to the control group, respectively (χ(2) = 63.293, p < 0.001; χ(2) = 31.550, p < 0.001). CONCLUSION The modified pelvic reconstruction procedure could improve pelvic floor muscle strength in POP patients, which remains lower when compared with the normal population. Pelvic floor muscle strength should be included in the assessment of surgical outcomes in POP.