Research progress on the correlation between gestational vaginal microecology and vaginal infectious diseases

The health status of the vaginal microenvironment, a complicated system, is an important indicator of female reproductive health. The vaginal flora is in a state of balance, and the microorganisms coexist and are interdependent to maintain the vaginal micro-ecological balance, which is a kind of dynamic balance influenced by endogenous and exogenous factors. Vaginal infections are traditionally treated by killing microbes in the vagina. Given the extensive study of the internal vaginal environment, people become gradually aware of the significance of maintaining the vaginal micro-ecological balance rather than blindly using antimicrobial agents. The balance in the vaginal internal environment is disrupted during the gestation period as the secretion of progesterone increases. The imbalanced vaginal micro-ecological environment may lead to vaginal infectious diseases. This paper provides a review of the relationship between the vaginal microecology and infectious diseases during gestation period.

Vulvar Swelling in a 12-Year-Old Girl: An Early Manifestation of Crohn’s Disease

Vulvar Crohn’s disease (VCD) is a rare complication of Crohn’s disease, especially in pediatric population. An early diagnosis can result difficult if the complication does not present in conjunction with the classic gastrointestinal symptoms that characterize this disease. In this study we present the case of a 12-year-old girl whose initial symptom of Crohn’s disease was a symptomatic vulvar swelling promoted by a rectovaginal fistula. We also provide an overview of Crohn’s disease and the vulvar changes found in the course of this disease.

罕见抗-Di^(b)致严重胎儿新生儿溶血病的实验室检测与相关研究

目的对1例高频抗体导致的胎儿新生儿溶血病(hemolytic disease of the fetus and newborn,HDFN)进行检测、鉴定及配血。方法对患儿进行新生儿溶血试验,对母亲进行血清学意外抗体鉴定,并对母亲红细胞进行常见高频抗原鉴定;对检出抗体进行IgG分型检测,并用流式细胞术进行单核细胞体外吞噬致敏红细胞试验,以检测抗体相关的吞噬率;对患儿母亲、父亲及舅舅进行相关红细胞血型基因测序;利用稀释的母亲血浆和抗人球卡法,在献血者中进行大规模相合血液的筛选。结果产妇鉴定为Di(b-)稀有血型,产生了抗-Di b(效价512)并导致了严重的HDFN;抗-Di b亚型分型为IgG1和IgG2型,单核细胞体外吞噬效率为88.83%(74.7/84.09);产妇亲属中没有相合献血者,后续从5520名献血者中筛选到2例Di(b-)相合血液,患儿接收输血治疗后康复出院。后续在51334名献血者中筛查到17名Di(b-)献血者,该数据表明Di(b-)在广州地区献血者中的分布频率约为三千分之一(0.033%,17/51334)。结论综合利用血型血清学及分子生物学方法诊断了抗-Di b所致的严重HDFN,建立了1种有效大规模筛查Di(b-)稀有血型的方法并找到相合血液,为建立Di(b-)稀有血型库奠定了基础。

Diet therapy for inflammatory bowel diseases: The established and the new

Although patients with inflammatory bowel diseases(IBD) have a strong interest in dietary modifications as part of their therapeutic management, dietary advice plays only a minor part in published guidelines. The scientific literature shows that dietary factors might influence the risk of developing IBD, that dysbiosis induced by nutrition contributes to the pathogenesis of IBD, and that diet may serve as a symptomatic treatment for irritable bowel syndrome-like symptoms in IBD. The role of nutrition in IBD is underscored by the effect of various dietary therapies. In paediatric patients with Crohn's disease(CD) enteral nutrition(EN) reaches remission rates similar to steroids. In adult patients, however, EN is inferior to corticosteroids. EN is not effective in ulcerative colitis(UC). Total parenteral nutrition in IBD is not superior to steroids or EN. The use of specific probiotics in patients with IBD can be recommended only in special clinical situations. There is no evidence for efficacy of probiotics in CD. By contrast, studies in UC have shown a beneficial effect in selected patients. For patients with pouchitis, antibiotic treatment followed by probiotics, like VSL#3 or Lactobacillus GG, is effective. When probiotics are used, the risk of bacterial translocation and subsequent bacteremia has to be considered. More understanding of the normal intestinal microflora, and better characterization of probiotic strains at the phenotypic and genomic levels is needed as well as clarification of the mechanisms of action in different clinical settings. A FODMAP reduced diet may improve symptoms in IBD.

Epidemiological studies of migration and environmental risk factors in the inflammatory bowel diseases

Inflammatory bowel diseases(IBD)are idiopathic chronic diseases of the gastrointestinal tract well known to be associated with both genetic and environmental risk factors.Permissive genotypes may manifest into clinical phenotypes under certain environmental influences and these may be best studied from migratory studies.Exploring differences between first and second generation migrants may further highlight the contribution of environmental factors towards the development of IBD.There are few opportunities that have been offered so far.We aim to review the available migration studies on IBD,evaluate the known environmental factors associated with IBD,and explore modern migration patterns to identify new opportunities and candidate migrant groups in IBD migration research.

Three Cases of Treating Diseases with Tiaozhong Yiqi Decoction

This paper introduced three cases of treating diseases with Tiaozhong Yiqi Decoction.Tiaozhong Yiqi Decoction,first proposed in Treatise on the Spleen and Stomach written by Li Gao,is an effective prescription for treating the syndrome of dampness stagnancy due to spleen deficiency.The authors sorted out the treatment of some difficult and complicated diseases with this prescription and the curative effect is remarkable.Tiaozhong Yiqi Decoction is evolved from Buzhong Yiqi Decoction by removing ATRACTYLODIS MACROCEPHALAE RHIZOMA and ANGELICAE SINENSIS RADIX,and adding ATRACTYLODIS RHIZOMA and AUCKLANDIAE RADIX.It uses ASTRAGALI RADIX,GINSENG RADIX ET RHIZOMA,and GLYCYRRHIZAE RADIX ET RHIZOMA to benefit qi and invigorate spleen,so as to treat the deficiency of spleen;it uses BUPLEURI RADIX and CIMICIFUGAE RHIZOMA to raise the clear yang;it also uses ATRACTYLODIS RHIZOMA,CITRI RETICULATAE PERICARPIUM,and AUCKLANDIAE RADIX to harmonize the middle to dispel the dampness.In this paper,the case of tinnitus and deafness belongs to the syndrome of dampness stagnancy due to spleen deficiency,dampness obstruction due to qi block,and dampness accumulation affecting clear orifices.The case of red vaginal discharge belongs to the syndrome of sunken spleen qi due to spleen deficiency and sunken yin fire.The case of cough belongs to the spleen deficiency combined with earth not engendering metal.All cases were treated with Tiaozhong Yiqi Decoction,fully proving the mechanism of the same treatment for different diseases.Only by identifying disease causes and syndromes,may it be able to obtain remarkable curative effect.

Blue LED as a new treatment to vaginal stenosis due pelvic radiotherapy:Two case reports

BACKGROUND Currently,the advancement cancer treatment technology improves overall survival,however,adverse events are still a challenge for health professional.Genitourinary syndrome of menopause and vaginal stenosis are conditions that impact the quality of life of patients undergoing radiotherapy.We present two such cases in patients with previous cervical and endometrial cancer.These conditions were handled with an innovative method using an energy-based device with blue light emitting diode for concomitant vaginal and vulvar irradiation.Positive impact in clinical findings,cytologic changes,and referred symptoms were documented.CASE SUMMARY One patient diagnosed with vaginal severe vaginal stenosis with previous cervix cancer treatment and other patient diagnosed with mild stenosis with severe dyspareunia and recent endometrium cancer treatment were considered for vulvovaginal treatment with weekly blue led device and closely evaluated with repeated validated questionnaires and cytological samples.CONCLUSION This innovative technique showed an improvement in all areas of the examiner's criteria,the cytological criteria,and most bothered symptoms.

Modified Vecchietti’s vaginoplasty with Remeex^(■) system in patient with chronic graft-versus-host disease

We present a case report of a chronic graft-versus-host disease manifestation in 33-year-old patient with an unusual complication of vaginal stenosis with complete obstruction after allogeneic bone marrow transplantation for myelocytic leukemia. The patient complained on a progressive dyspareunia and sexual intercourse inability. She has received hormone replacement therapy due to the ovarian failure after the chemotherapy treatment. The hormonal treatment was used in continuous combined manner and hematocolpos wasn’t seen during an abdominal ultrasound examination. The reconstructive surgery was performed by the modified Vecchietti’s neovagina technique with a Remeex®system after histological confirmation of main diagnosis. The immediate postoperative course was uneventful with gradual normalization of sexual function.

VAGINAL HYSTERECTOMY FOR PATIENTS WITH MODERATELY ENLARGED UTERUS OF BENIGN LESIONS

Objective To evaluate the possibility of vaginal hysterectomy for patients with moderately enlarged uterus of benign lesions. Methods One hundred and seventeen women with benign uterine diseases underwent vaginal hysterectomy. These patients were divided into two groups according to uterine weight. Group Ⅰ contained 60 patients with uterine enlargement to a weight of 200 to 750 g, and group Ⅱ contained 57 patients with uterine weight of less than 200 g. Uterine morcellation was performed in some cases. The peri-operative data in both groups were analyzed. Results In group Ⅰ, 59 cases underwent transvaginal hysterectomy successfully, except 1 case con-verted to abdominal operation and the uterine morcellation was performed in 21 women. In group Ⅱ, all patients successfully underwent transvaginal hysterectomy without any assistance of special technique. The mean uterine weight of group Ⅰ was significantly heavier than that of group Ⅱ(280.18 ± 100.40 g vs 146.48 ± 35.19 g). The mean operating time was significantly longer for group Ⅰ than that for group Ⅱ(83.93 ± 26.26 minutes vs 35.22 ± 20.55 minutes). There were no significant differences in blood loss and complications between groupⅠ and group Ⅱ. There was no injury of urinary bladder or rectum, and no vaginal vault infection. Conclusions Vaginal hysterectomy of moderately enlarged uterus can be safely and effectively performed by experienced operators. In some cases, in order to reduce the uterine volume, uterine mor-cellation should be used to shorten operative time, reduce the bleeding, and lower the postoperative complications.

Inflammatory bowel disease and thromboembolism

Patients with inflammatory bowel disease (IBD) have an increased risk of vascular complications. Thromboembolic complications, both venous and arterial, are serious extraintestinal manifestations complicating the course of IBD and can lead to significant morbidity and mortality. Patients with IBD are more prone to thromboembolic complications and IBD per se is a risk factor for thromboembolic disease. Data suggest that thrombosis is a specific feature of IBD that can be involved in both the occurrence of thromboembolic events and the pathogenesis of the disease. The exact etiology for this special association between IBD and thromboembolism is as yet unknown, but it is thought that multiple acquired and inherited factors are interacting and producing the increased tendency for thrombosis in the local intestinal microvasculature, as well as in the systemic circulation. Clinicians’ awareness of the risks, and their ability to promptly diagnose and manage tromboembolic complications are of vital importance. In this review we discuss how thromboembolic disease is related to IBD, specifically focusing on: (1) the epidemiology and clinical features of thromboembolic complications in IBD; (2) the pathophysiology of thrombosis in IBD; and (3) strategies for the prevention and management of thromboembolic complications in IBD patients.

Nonalcoholic fatty liver disease and cardiovascular disease

Nonalcoholic fatty liver disease(NAFLD)and cardiovascular disease(CVD)are two diseases that are common in the general population.To date,many studies have been conducted and demonstrate a direct link between NAFLD and CVD,but the exact mechanisms for this complex relationship are not well established.A systematic search of the PubMed database revealed that several common mechanisms are involved in many of the local and systemic manifestations of NAFLD and lead to an increased cardiovascular risk.The possible mechanisms linking NAFLD and CVD include inflammation,oxidative stress,insulin resistance,ectopic adipose tissue distribution,dyslipidemia,endothelial dysfunction,and adiponectin,among others.The clinical implication is that patients with NAFLD are at an increased risk of CVD and should undergo periodic cardiovascular risk assessment.

Role of the gut microbiota in inflammatory bowel disease pathogenesis: What have we learnt in the past 10 years?

Our understanding of the microbial involvement in inflammatory bowel disease (IBD) pathogenesis has increased exponentially over the past decade. The development of newer molecular tools for the global assessment of the gut microbiome and the identification of nucleotide-binding oligomerization domain-containing protein 2 in 2001 and other susceptibility genes for Crohn’s disease in particular has led to better understanding of the aetiopathogenesis of IBD. The microbial studies have elaborated the normal composition of the gut microbiome and its perturbations in the setting of IBD. This altered microbiome or “dysbiosis” is a key player in the protracted course of inflammation in IBD. Numerous genome-wide association studies have identified further genes involved in gastrointestinal innate immunity (including polymorphisms in genes involved in autophagy: ATG16L1 and IGRM), which have helped elucidate the relationship of the local innate immunity with the adjacent luminal bacteria. These developments have also spurred the search for specific pathogens which may have a role in the metamorphosis of the gut microbiome from a symbiotic entity to a putative pathogenic one. Here we review advances in our understanding of microbial involvement in IBD pathogenesis over the past 10 years and offer insight into how this will shape our therapeutic management of the disease in the coming years.

Nonalcoholic fatty liver disease as a multi-systemic disease

Nonalcoholic fatty liver disease(NAFLD) is the most common cause of chronic liver disease. NAFLD includes a wide spectrum of liver conditions ranging from simple steatosis to nonalcoholic steatohepatitis and advanced hepatic fibrosis. NAFLD has been recognized as a hepatic manifestation of metabolic syndrome linked with insulin resistance. NAFLD should be considered not only a liver specific disease but also an early mediator of systemic diseases. Therefore, NAFLD is usually associated with cardiovascular disease, chronic kidney disease, type 2 diabetes, obesity, and dyslipidemia. NAFLD is highly prevalent in the general population and is associated with increased cardiovascular morbidity and mortality. The underlying mechanisms and pathogenesis of NAFLD with regard to other medical disorders are not yet fully understood. This review focuses on pathogenesis of NAFLD and its relation with other systemic diseases.

Prevention of post-operative recurrence of Crohn's disease

Endoscopic and clinical recurrence of Crohn’s disease (CD) is a common occurrence after surgical resection. Smokers, those with perforating disease, and those with myenteric plexitis are all at higher risk of recurrence. A number of medical therapies have been shown to reduce this risk in clinical trials. Metronidazole, thiopurines and anti-tumour necrosis factors (TNFs) are all effective in reducing the risk of endoscopic or clinical recurrence of CD. Since these are preventative agents, the benefits of prophylaxis need to be weighed-against the risk of adverse events from, and costs of, therapy. Patients who are high risk for post-operative recurrence should be considered for early medical prophylaxis with an anti-TNF. Patients who have few to no risk factors are likely best served by a three-month course of antibiotics followed by tailored therapy based on endoscopy at one year. Clinical recurrence rates are variable, and methods to stratify patients into high and low risk populations combined with prophylaxis tailored to endoscopic recurrence would be an effective strategy in treating these patients.

Oral manifestation in inflammatory bowel disease:A review

Inflammatory bowel diseases (IBDs), including Crohn’s disease (CD) and ulcerative colitis, not only affect the intestinal tract but also have an extraintestinal involvement within the oral cavity. These oral manifestations may assist in the diagnosis and the monitoring of disease activity, whilst ignoring them may lead to an inaccurate diagnosis and useless and expensive workups. Indurated tag-like lesions, cobblestoning, and mucogingivitis are the most common specific oral findings encountered in CD cases. Aphthous stomatitis and pyostomatitis vegetans are among non-specific oral manifestations of IBD. In differential diagnosis, side effects of drugs, infections, nutritional deficiencies, and other inflammatory conditions should also be considered. Treatment usually involves managing the underlying intestinal disease. In severe cases with local symptoms, topical and/or systemic steroids and immunosuppressive drugs might be used.

Disease Development Caused by Ascochyta rabiei on Chickpea Detached-Leaves in Petri Dishes

A study using detached-leaves aimed to improve selection method. The improving method was done by scoring both disease symptom and lesion size. The research was begun by selecting agar concentration and dose of conidia that could distinguish response of very susceptible or resistant chickpea genotype. The result was used to determine disease severity (DS) and disease incident (DI) of eight genotypes that were previously tested in the field. Results of the tested agar concentration and dose of conidia showed that 1.5% and 2% agar were good to determine susceptible or resistant genotype;while 1 × 105 or 5 × 104 conidia dose was suitable for inoculation. The formula of DS (no. of leaflets in category × category value/Total no. of leaflets ×10) × 100, and DI (no. leaflets with pycnidial lesions + no. leaflets with necrotic lesions)/Total no. of leaflets × 100 successfully measured genotype response. The lesions development on detached leaves of the susceptible cultivar (Lasseter) began as circular, pale-colored areas, extending to the area covered by the drop of inoculum, then became light brown and finally dark brown. However, the response of resistant line (FLIP508) was restricted in area (and often confined to a tiny speck) surrounded by chlorosis or drying of the tissue.

Periodontal disease is associated with increased coronary heart disease risk:A meta-analysis based on 38 case-control studies

AIM: To investigate whether periodontal disease(PD) is associated with increasing coronary heart disease(CHD) risk by performing a meta-analysis.METHODS: Two authors independently searched Pub Med and China National Knowledge Infrastructure up to January 10 th, 2013 for relevant case-control studies that investigated the association between PD and CHD. After quality assessment using Newcastle-Ottawa Scale and data extraction by two independent authors, the overall and subgroup meta-analyses were performed and publication bias were examined using the Comprehensive Meta-Analysis V2 software. Potential publication bias was assessed using visual inspection of the funnel plots, Egger linear regression test, and trims and fill method.RESULTS: Finally 38 relevant case-control studies were identified, involving 4950 CHD patients and 5490 controls. Eleven studies were rated low quality and 27 were high quality. Based on random-effects, a significant association was identified between PD and CHD(OR 3.79, 95%CI: 2.23-6.43, P < 0.001, I2 = 98.59%), and sensitivity analysis showed that this result was robust. Subgroup analyses according to adjusted/unadjusted ORs, source of control, methodological quality, end point, assessment of PD/CHD, and ethnicity also indicated a significant association. Publication bias was detected, and the estimated OR including the "missing" studies did not substantially differ from our estimate with adjustment for missing studies(OR 4.15, 95%CI: 2.62-6.54, P < 0.001).CONCLUSION: Based on the meta-analysis, PD is probably associated with CHD risk independently and significantly.

Temporal trends in inflammatory bowel disease publications over a 19-years period

AIM: To determine whether temporal changes occurred in the pediatric vs adult inflammatory bowel disease(IBD), both in terms of number and type of yearly published articles.METHODS:We aimed to evaluate all Pub Med-registered articles related to the field of IBD from January1,1993 and until December 31,2011.We searched for articles using the key words"inflammatory bowel disease"or"Crohn’s disease"or"ulcerative colitis"or"undetermined colitis",using the age filters of"child"or"adult".We repeated the search according to the total number per year of articles per type of article,for each year of the specified period.We studied randomized controlled trials,clinical trials,case reports,meta-analyses,letters to the editor,reviews,systematic reviews,practice guidelines,and editorials.RESULTS:We identified 44645 articles over the 19year-period.There were 8687 pediatric-tagged articles vs 19750 adult-tagged articles.Thus 16208 articles were unaccounted and not assigned a"pediatric"or"adult"tag by Pub Med.There was an approximately3-fold significant increase in all articles recorded both in pediatric and adult articles.This significant increase was true for nearly every category of article but the number of clinical trials,meta-analysis,and randomized controlled trials increased proportionally more than the number of"lower quality"articles such as editorials or letters to the editor.Very few guidelines were published every year.CONCLUSION:There is a yearly linear increase in publications related to IBD.Relatively,there are more and more clinical trials and higher quality articles.

Green tea polyphenols alleviate di-(2-ethylhexyl)phthalate-induced liver injury in mice

BACKGROUND Di(2-ethylhexyl)phthalate(DEHP)is a common plasticizer known to cause liver injury.Green tea is reported to exert therapeutic effects on heavy metal exposureinduced organ damage.However,limited studies have examined the therapeutic effects of green tea polyphenols(GTPs)on DEHP-induced liver damage.AIM To evaluate the molecular mechanism underlying the therapeutic effects of GTPs on DEHP-induced liver damage.METHODS C57BL/6J mice were divided into the following five groups:Control,model[DEHP(1500 mg/kg bodyweight)],treatment[DEHP(1500 mg/kg bodyweight)+GTP(70 mg/kg bodyweight),oil,and GTP(70 mg/kg bodyweight)]groups.After 8 wk,the liver function,blood lipid profile,and liver histopathology were examined.Differentially expressed micro RNAs(miRNAs)and mRNAs in the liver tissues were examined using high-throughput sequencing.Additionally,functional enrichment analysis and immune infiltration prediction were performed.The miRNA-mRNA regulatory axis was elucidated using the starBase database.Protein expression was evaluated using immunohistochemistry.RESULTS GTPs alleviated DHEP-induced liver dysfunction,blood lipid dysregulation,fatty liver disease,liver fibrosis,and mitochondrial and endoplasmic reticulum lesions in mice.The infiltration of macrophages,mast cells,and natural killer cells varied between the model and treatment groups.mmu-miR-141-3p(a differentially expressed miRNA),Zcchc24(a differentially expressed mRNA),and Zcchc24(a differentially expressed protein)constituted the miRNA-mRNA-protein regulatory axis involved in mediating the therapeutic effects of GTPs on DEHP-induced liver damage in mice.CONCLUSION This study demonstrated that GTPs mitigate DEHP-induced liver dysfunction,blood lipid dysregulation,fatty liver disease,and partial liver fibrosis,and regulate immune cell infiltration.Additionally,an important miRNAmRNA-protein molecular regulatory axis involved in mediating the therapeutic effects of GTPs on DEHP-induced liver damage was elucidated.

360°腔内三维超声在阴道周围囊性病变诊断中的价值

目的:探讨经阴道360°腔内三维超声在阴道周围囊性病变中的应用价值。方法:常规经阴道超声检查发现阴道周围囊性病变42例,先利用二维超声观察阴道周围囊性病变大小、位置及与阴道、尿道和直肠的关系,再利用经阴道360°腔内三维超声获取矢状切面、横切面、冠状切面、任意切面图像,不同视角观察阴道周围囊性病变的空间关系,从而进行定位诊断。结果:常规经阴道超声检查发现阴道周围囊性病变42例,经手术病理、尿道镜、肾盂输尿管造影证实阴道壁囊肿21例、尿道旁腺囊肿13例、尿道憩室3例、先天性输尿管异位开口2例、骶尾部囊性畸胎瘤3例。经阴道360°腔内三维超声检查诊断符合率为95.23%(40/42),经阴道常规二维超声检查诊断符合率为71.42%(30/42),经阴道360°腔内三维超声检查与经阴道常规二维超声检查诊断符合率比较,差异具有统计学意义(P<0.05)。结论:经阴道360°腔内三维超声是准确、方便、快捷诊断阴道周围囊性病变的影像学手段,具有重要的应用价值。