PNPLA5-knockout rats induced by CRISPR/Cas9 exhibit abnormal bleeding and lipid level

Patatin-like phospholipase domain containing 5 （PNPLA5） is a neotype neutral lipase with dual activity of anabolism and catabolism in vitro and in vivo, which has a low mRNA expression level in humans and mice. PNPLA5, which is localized to lipid droplets and required for efficient autophagy by optimal initiation, has been speculated to possess triglyceride hydro- lase activity, and has been associated with low density lipoprotein cholesterol （LDL-C）. Above all, PNPLA5 is a relatively new gene, which is reported less about its biological function research, especially the function research in the rats is still blank. In this study, we examined the spatiotemporal expression profile of PNPLA5 and found that it was expressed at low levels in most organs of Sprague Dawley （SD） rats, but was present at very high levels in the skin and testes. To furth.er determine the biological function of PNPLA5 in mammals, we generated PNPLA5-knockout SD rats using the clustered regularly-interspaced short palindromic repeats （CRISPR）/Cas9 system. PNPLA5-null rats were viable, but showed a variety of phenotypic abnormalities, such as abnormal bleeding, and varied hematobiochemical parameters including increased serum total cholesterol （TC）, tdglycerides and high density lipoprotein cholesterol （HDL-C） level, and reduced LDL-C level, compared with wild-type control rats. These data are consistent with an important role for PNPLA5 in lipid metabolism, provJdJng a new target gene and animal model for treatment of cardiovascular diseases in the future.

Coagulation abnormalities and their relationship with bleeding manifestations in patients with dengue-A single center observational study

Objective:To evaluate coagulation abnormalities and their relationship with bleeding manifestations among patients with dengue.Methods:This observational study was conducted on 292 adult dengue patients who were admitted to a tertiary care hospital of Western India from July 2021 to June 2022.Coagulation tests including prothrombin time(PT),international normalized ratio(INR),activated partial thromboplastin time(aPTT),fibrinogen,and D-dimer were performed.Patients were monitored for bleeding manifestations.Results:Coagulation abnormalities were reported in 42.8%of the patients.Overall,prolonged aPTT was the most common coagulation abnormality(40.8%),followed by low fibrinogen(38.7%),raised D-dimer(31.2%),raised INR(26.0%)and prolonged PT(19.2%).Bleeding manifestations were present in 19.9%patients.PT,INR,aPTT and D-dimer levels were significantly higher(P<0.01)and fibrinogen level was significantly lower(P<0.001)in patients with bleeding compared to patients without bleeding.Patients with bleeding had a significantly higher rate of all coagulation abnormalities than patients without bleeding(P<0.01).Conclusions:Patients with bleeding showed a significantly higher frequency of coagulation abnormalities compared to patients without bleeding.Patients with dengue should be assessed for coagulation abnormalities.

A Comparative Observational Study of the Use Transvaginal Ultrasound and Hysteroscopy for the Detection of Uterine Cavity Pathologies in Women with Abnormal Uterine Bleeding

Background: 70% of all gynecological consultations are for abnormal uterine bleeding. Any approach to optimal management begins with an appropriate diagnosis. 40% of premenopausal women with abnormal uterine bleeding were found to have some intrauterine pathology. This study aims to compare the diagnostic value of transvaginal ultrasonography in comparison to hysteroscopy in detecting uterine abnormalities in patients with abnormal uterine bleeding. Methods: Retrospective observational cross sectional study of 250 women presented with abnormal uterine bleeding. The patients who fulfilled the selection criteria and have been sequentially investigated by transvaginal ultrasound (TVS) and hysteroscopy were included. Results: 90% of patients were from 35 - 49 yrs. 81.2% of patients have body mass index above 25 kg/m2. Transvaginal ultrasound (TVS) compared well with high sensitivity as regards normal endometrium. (TVS) missed 4 patients of endometrial polyps and one patient of sub mucous fibroid. Three patients of adenomyosis were only diagnosed by (TVS);they were reported as being normal by hysteroscopy. Conclusion: (TVS) is considered as an excellent approach to the initial evaluation of uterine pathologies in patients with abnormal uterine bleeding.

Epidemiological Profile of Abnormal Uterine Bleeding at the Gyneco-Obstetric and Pediatric Hospital of Yaounde

Introduction:?Abnormal uterine bleeding (AUB) is one of the most commonly encountered symptoms in gynecological consultations. The prognosis is rarely endangered but the impact on the quality of life is sometimes important. Objective:?Our objective was to assess the epidemiological profiles of patients consulting for AUB at the Yaounde Gyneco-Obstetrics and Pediatrics Hospital.?Methodology:?We carried out a descriptive cross-sectional study at the Yaounde Gyneco-Obstetrics and Pediatrics Hospital. We included all women with acute or chronic per vaginal bleeding and we excluded all cases of bleeding in pregnancy, bleeding due to infection, pre pubertal bleeding and the incomplete files. Data were?collected from January to May 2019, using a questionnaire, and analyzed using Epi Info version 3.5.4 and SPSS version 7. softwares. Results:?A total of 163 patient files were exploited and analyzed. The frequency of AUB in outpatient gynaecology clinics was 3.7%. AUB patients had a mean age of 36 ± 12.27 years and the most represented age group was 30 to 35 years, with 17.1% cases. Sixty-seven representing 41.1% patients were married, 23.9% were civil servants, 23.1% were tertiary employees, and 40.3% had secondary level of education. Almost 44.1% were nulliparous and 53.9% had unknown HIV status an 83.4% have never used contraception. Conclusion:?The frequency of AUB during gynecological consultations is 3.7%. Those women have an average age of 36 years, most of them are nulliparous and have never use contraception.

Comparison of Transvaginal Ultrasound, Saline Infusion Sonohysterography versus Diagnostic Hysteroscopy in Evaluation of Endometrial Cavity Pathology amongst Women with Abnormal Uterine Bleeding in Low Resource Setting

Introduction: Hysteroscopy is currently the gold-standard protocol for evaluating patients with abnormal uterine bleeding (AUB). Unfortunately, though accurate, its adoption in low-resource countries such as in Africa is limited due to lack of equipment and qualified personnel. As such, there is a need for an alternative diagnostic procedure that is as accurate as hysteroscopy, but also affordable, easy to administer, and acceptable by women with endometrial pathologies. Transvaginal Sonography (TVS) and Saline Infusion Sonohysterography (SIS) are proposed. However, their diagnostic accuracy versus hysteroscopy has not been determined in low resource setting. Objective: To compare the diagnostic efficacy of TVS and SIS versus diagnostic hysteroscopy in evaluation of endometrial pathology among pre-menopausal and post-menopausal women and to determine the etiology of AUB amongst these women. Methodology: A prospective cohort study was done at a hospital in Nairobi, Kenya between May and September 2019. Forty patients with AUB were recruited using consecutive sampling, and women who consented were recruited. The etiology of AUB was recorded. All participants underwent TVS, SIS and Diagnostic Hysteroscopy (DH) evaluation in the first half of the menstrual cycle and the findings recorded on a patient’s information sheet. The sociodemographic and bleeding characteristics of patients and the outcomes of TVS, SIS, and DH evaluations were also recorded and the data was analysed using version 5 of the Software for Statistics and Data Science (STATA). Summary statistics on the etiology of AUB were presented and the sensitivity of TVS and SIS versus DH as the gold-standard evaluated using two by two tables and the ROC curve. Results: The mean age of participants was 38.1 ± 8.8 years, range of 25 - 71 years. Heavy Menstrual Bleeding (HMB) was reported in 70.0% of participants, while about 12.0%, 7.5%, and 7.5% had post-menopausal bleeding, amenorrhea, and hypomenorrhea. The incidence of submucosal fibroids and endometrial polyps was 17.5% and 15.0% via TVS, 47.5% and 20.0% via SIS and 52.5% and 20% via DH respectively. The overall sensitivity, specificity, Positive Predictive Value (PPV), Positive Predictive Value (NPV), and diagnostic accuracy of SIS were 92.1%, 83.3%, 96.9%, 62.5%, and 90.0% while TVS was 38.2%, 100%, 100%, 22.2%, and 47.5%. The sensitivity, specificity, PPV, and NPV of TVS in diagnosis of endometrial polyp were 75.0%, 100%, 100%, and 94.0%. SIS did better with a sensitivity, specificity, PPV, and NPV of 100%, 100%, 100%, and 100%. Conclusion: Our data suggests SIS had a higher diagnostic accuracy than TVS and showcased a comparable diagnostic accuracy to hysteroscopy. SIS is more suitable safe alternative technique for investigating AUB in pre/post-menopausal women in low resource setting where hysteroscopy is unavailable or unaffordable.

Research progress in the treatment of perimenopausal abnormal uterine bleeding with traditional Chinese and western medicine

In order to fully understand the research progress of Chinese and Western medicine in the treatment of perimenopausal abnormal uterine bleeding,this paper reviews all kinds of research by referring to related literature reports at home and abroad.The results showed that western medicine mainly used hormone drugs,supplemented by surgery,but the clinical adverse reactions were more and the recurrence rate was higher;traditional Chinese medicine often obtained satisfactory results through the treatment of traditional Chinese medicine,syndrome differentiation,stage treatment,acupuncture and other treatment methods,with fewer adverse reactions and low recurrence rate,but the effect of sudden collapse and hemostasis was slower;the combination of Chinese and Western medicine can learn from each other and become The research focus in recent years is worthy of further discussion.

Study on Relevance of Endothelin to Abnormal Uterine Bleeding Associated with Long-Term Subdermal Implants Use

ve To investigate the relationship between estradiol, progesterone and endothe-lin (ET) and abnormal uterine bleeding after using sub-dermal contraceptive implant

Study on mechanism of Radix Paeoniae Rubra-Cortex Moutan in treatment of abnormal uterine bleeding based on network pharmacology

Objective:To explore the mechanism of the treatment of abnormal uterine bleeding with Radix Paeoniae Rubra-Cortex Moutan.Methods:To search the effective elements and action targets of paeony peony skin drug pair by searching the pharmacology platform of traditional Chinese medicine system;to select the disease targets of abnormal uterine bleeding by searching the human gene information database;to select the common targets of drugs and diseases by R language,to construct the interaction network of drugs compounds action targets diseases by using the software of Cytoscape;to construct the protein-protein interaction network by using the string platform The interaction network(PPI)was used to visualize the results,and the bio information package of Bioconductor was used to analyze go function enrichment and KEGG pathway.Results:This study included 16 compounds and 67 key targets.After enrichment analysis,87 go functional items and 116 KEGG signaling pathways were obtained.Quercetin,scutellarin,kaempferol and stigmasterol in Radix Paeoniae Rubra-Cortex Moutan directly act on interleukin-6,epidermal growth factor receptor,cystatin 3,mitogen activated protein kinase 8,vascular endothelial growth factor and other related targets,and are mainly enriched in Kaposi sarcoma associated herpesvirus infection and hepatis B.Age-range,TNF and other signal pathways.Conclusion:Radix Paeoniae Rubra-Cortex Moutan may play the role of anti-cell proliferation and apoptosis,protection of vascular endothelium,anti-inflammatory response,regulation of hormone secretion,and improvement of antioxidant activity through multi-component and multi-target,and play the role of treatment of abnormal uterine bleeding.

Clinical analysis of the delivery outcomes of women with abnormal uterus

Objective:To guide the pregnancy and delivery of patients with abnormal uterus through analyzing the delivery outcomes of them.Methods:A total of 32 pregnant cases with abnormal uterus were collected in the North China University of Science and Technology Affiliated Hospital from 2011 to 2018.7615 cases with normal uterus who visited the hospital and delivered during the same period were also collected.The rate of abnormal fetal position,premature rupture of membranes,premature delivery,postpartum complications,and caesarean section,were compared between the two groups by the χ^2 test through SPSS.P values less than 0.05 were considered statistically significant.Results:There were significant differences in abnormal fetal position,premature rupture of membranes,premature delivery and spontaneous birth rate between the two groups(P<0.05),but there was no significant difference in the incidence of postpartum hemorrhage between the two groups(P>0.05).In the cause of cesarean section,there was significant difference in abnormal fetal position and scarred uterus(P<0.05),but no significant difference in placenta previa and other causes(P>0.05).Conclusion:Abnormal fetal position,premature rupture of membranes and premature delivery are more likely to occur in pregnant women with abnormal uterus than in normal ones.The rate of cesarean section in patients with abnormal uterus is significantly higher than that of normal uterus,due to the main reason of abnormal fetal position.Abnormal uterus is a high-risk factor for pregnant women,and patients with abnormal uterus should be strengthened the management of pregnancy and relaxed the indications of cesarean section.

Abnormal Uterine Bleeding due to Retention of Fetal Bones after Abortion: A Case Report

Background: Retention of fetal bones is a rare cause of abnormal uterine bleeding. Others may present as subfertility, chronic pelvic pain, abnormal vaginal discharge, menometrorrhagia, dysmenorrhea and spontaneous expulsion of bony fragments. Incidence is 0.26% among patients undergoing hysteroscopy. Aim: To document a pattern of presentation of retained fetal bone and its management. Case Presentation: Our patient is an 18-year old who presented with vaginal bleeding of four weeks duration and managed for abnormal uterine bleeding due to retained fetal bone following second trimester abortion. Conclusion: The use of transvaginal ultrasound in making diagnosis of retained fetal bone is effective. Treatment by removal of bones through evacuation by dilatation and curettage or hysteroscopy brings about resolution of symptoms. Use of pelvic ultrasonography to confirm complete evacuation of the uterus after abortion especially second trimester abortion could aid in early diagnosis and management of incomplete abortion.

Research Progress on Treatment of Abnormal Uterine Bleeding during Puberty with Traditional Chinese and Western Medicine

In recent years,the frequency of clinical occurrence of abnormal uterine bleeding in adolescence has gradually increased.In order to fully understand the research progress in the treatment of abnormal uterine bleeding in adolescence,various studies and clinical experience have been reviewed by consulting related literature reports.The results found that currently Western medicine mainly uses hormone drugs in clinical treatment,but there are risks such as more clinical adverse reactions and higher recurrence rate;traditional Chinese medicine(TCM)treatment has achieved satisfactory results,but the advantages of sudden collapse and hemostasis are not obvious.Combined TCM and Western medicine treatment,it can learn from each other and has become a research hotspot in recent years,which is worthy of an in-depth discussion.

Laparoscopy combined with hysteroscopy in the treatment of Robert’s uterus accompanied by adenomyosis:A case report

BACKGROUND Gynaecologists should be aware of a rare obstructive Mullerian duct abnormality like Robert’s uterus and perform further surgery when necessary.CASE SUMMARY We report a 41-year-old mother of two children with Robert’s uterus who was examined and treated by laparoscopy and hysteroscopy.Unlike the existing cases reported in the literature,this patient had a late onset of Robert’s uterus symptoms.Due to right tubal ectopic pregnancy 3 years previously,the patient was treated with right salpingectomy and left tubal ligation but suffered aggravated left lower abdominal pain.She was examined and treated by laparoscopy and hysteroscopy,and is completely asymptomatic at 5-year followup.CONCLUSION The typical obstructive Mullerian abnormality requires further surgery.Combined laparoscopy and hysteroscopy is an effective,minimally invasive technique with better recovery outcomes than traditional transabdominal procedures.

Recurrent gastrointestinal bleeding and hepatic infarction after liver biopsy

Hepatic artery pseudoaneurysms(HAP)are rare events,particularly after liver biopsy,but can be associated with serious complications.Therefore a high suspicion is necessary for timely diagnosis and appropriate treatment.We report on a case of HAP that potentially formed after a liver biopsy in a patient with sarcoidosis.The HAP in our case was virtually undetectable initially by angiography but resulted in several complications including recurrent gastrointestinal bleeding,hemorrhagic cholecystitis and finally hepatic infarction with abscess formation until it became detectable at a size of 5-mm.The patient remains asymptomatic over a year after endovascular embolization of the HAP.In this report,we demonstrate that a small HAP can avoid detection by angiography at an early stage while being symptomatic for a prolonged course.A high clinical suspicion with a close clinical/radiological follow-up is needed in symptomatic patients with history of liver biopsy despite initial negative work up.Once diagnosed,HAP can be safely and effectively treated by endovascular embolization.

PREGNANCY AND ITS OUTCOME IN WOMEN WITH MALFORMED UTERUS

Objective. To analyze the clinical characteristics of fertility and pregnancy in women with congenital uterine malformations and explore optimal treatments to improve the prognosis.Methods. A retrospective study was conducted on the fertility and obstetric outcome in 153 patients with uterine malformations treated in our hospital from January 1984 to December 1998. Twenty - seven cases with other kinds of genital and/or urinary anomalies but with normal uterus during the same period were enrolled as the control group.Results. The infertility rate was 26.6% (34/128), the miscarriage rate 44.3% (86/194), premature birth rate 9.3% (18/194), abnormal fetal presentation rate 28.4% (29/102), the cesarean section rate 61.8% (63/102), and the perinatal mortality rate 11.8% (12/102).Conclusion. Women with congenital uterine malformation usually have higher incidence of infertility and complications during pregnancy and delivery. Bicornuate and septate uterus can be associated with poor obstetric outcome.

Novasure treatment for one case of abnormal uterine bleeding with active systemic lupus erythematosus

Abnormal uterine bleeding（AUB）, especially in the menopausal transition period,is showing a tendency of rising in recent years, and after treatment, high recurrence rate for the treatment of hormone treatment, the endometrial resection and uterine resection. But for patients with severe systemic disease with AUB, it may get worse with the conventional treatment. Novasure provides us with an effective measure for the treatment of AUB with active systemic lupus erythematosus（SLE）.

基于真实世界数据的青春期异常子宫出血用药规律研究

目的:通过对女童青春期异常子宫出血患儿临床实际诊疗病例资料进行数据挖掘分析其中药治疗的用药规律。方法:基于医院信息管理系统提取2020年1月至2022年12月首都医科大学附属北京儿童医院女童青春期异常子宫出血患儿的病历数据,分为止血期和调理期2个阶段,总结归纳其辨治规律。结果:纳入止血期663例患儿,1020例病历;调理期796例患儿,2047例病历。止血期涉及中药169味,排名前5位为侧柏炭、牡丹皮、小蓟、麸炒椿皮和白芍,性味以寒、苦药为最多,归经以肝经为最多,功效以止血、补虚类药物为最多;调理期涉及中药232味,排名前5位为当归、酒女贞子、炙淫羊藿、黄芪和生地黄,性味以温、甘药最多,归经以肝、肾经为最多,功效以补虚类为最多。聚类分析分别获得4类和5类核心药物组合。结论:真实世界临床数据显示肾阴亏虚、血热内扰为青春期异常子宫出血常见证型,治则先以止血为主,待崩漏缓解后,重在调补脾肾以复旧,组方注重止血、补虚、收涩和清热等药物的配伍应用。

腔内三维超声联合临床指标对剖宫产术后子宫切口憩室致子宫异常出血的价值

目的 探讨腔内三维超声联合临床指标在剖宫产术后子宫切口憩室致子宫异常出血的价值。方法 收集2017年1月~2023年4月在石河子市人民医院行阴道超声检查的126例剖宫产术后合并子宫切口憩室的患者资料。根据患者剖宫产术后出血情况分为组1(无异常出血,n=72)、组2(异常出血,n=54),所有患者均行阴道超声(二维超声及三维超声)检查。分析比较两组间临床特征(子宫位置、剖宫产次数以及剖宫产缝线方式等)以及子宫切口憩室超声特征(憩室形态、憩室容积、憩室长度、憩室深度以及残余肌层厚度等)的差异,建立基于临床及超声特征的预测模型,探索剖宫产术后合并子宫切口憩室患者子宫异常出血的独立危险因素,并评价此模型的预测价值。结果 两组间剖宫产次数、子宫位置、子宫内膜厚度、憩室深度、憩室长度、憩室容积、憩室比以及残余肌层厚度的差异均有统计学意义(P<0.05);多因素回归分析显示,子宫位置、剖宫产次数、憩室容积、憩室比以及残余肌层厚度是子宫异常出血的独立危险因素(OR=0.087、10.385、4.658、12.892、0.001,P<0.05),与各单因素相比,此模型预测子宫异常出血的AUC为0.936,高于各单因素(AUC=0.567、0.705、0.836、0.895、0.870,P<0.05),该联合预测模型以-6.28为截断值时,敏感度为87.04%,特异性为91.67%,准确度为89.68%,且与临床诊断结果有良好一致性(Kappa=0.789,P<0.001)。结论 子宫位置、剖宫产次数、憩室容积、憩室比以及残余肌层厚度是剖宫产术后子宫切口憩室合并子宫异常出血的独立危险因素,超声及临床特征对预测剖宫产术后子宫切口憩室致子宫异常出血有重要预测价值。

宫腔镜下电切术与宫腔镜下刮宫术在异常子宫出血临床治疗中的作用分析

目的探讨不同术式(宫腔镜下电切术、宫腔镜下刮宫术)治疗异常子宫出血患者的临床应用。方法方便选择2021年1月—2022年6月江苏省睢宁县中医院收治的84例择期采取手术治疗的异常子宫出血患者为研究对象,依据不同治疗方法分为对照组和观察组,每组42例。对照组采用宫腔镜下刮宫术治疗,观察组采用宫腔镜下电切术治疗,对比两组患者手术指标、并发症发生率、治疗有效率及复发率。结果观察组手术时间、月经恢复时间和住院时间均短于对照组,术中出血量少于对照组,差异有统计学意义(P均<0.05)。观察组并发症总发生率为4.76%(2/42),低于对照组的19.05%(8/42),差异有统计学意义(χ^(2)=4.087,P<0.05)。观察组治疗有效率高于对照组,差异有统计学意义(P<0.05)。术后3个月、6个月,两组患者术后复发率比较,差异无统计学意义(P均>0.05)。结论宫腔镜应用于异常子宫出血治疗具有创伤性小、疗效显著等优势,能够减少并发症的发生、促进术后恢复,且宫腔镜下电切术的应用价值更为显著。

自拟如意散治疗药物流产后气虚血瘀型阴道异常出血效果及对血β-HCG的影响

目的探讨自拟如意散治疗药物流产后气虚血瘀型阴道异常出血的效果。方法选取80例药物流产后气虚血瘀型阴道异常出血患者作为研究对象,根据随机数字表法分为研究组与对照组,各40例。对照组给予益母草颗粒治疗,研究组给予中药自拟如意散治疗。比较两组相关临床指标、临床疗效。结果研究组阴道出血量少于对照组,出血持续时间短于对照组,宫腔内残留组织面积小于对照组,血β-人绒毛膜促性腺激素(β-HCG)水平低于对照组,差异有统计学意义(P<0.05)。研究组总有效率为87.5%,高于对照组的60.0%,差异有统计学意义(P<0.05)。结论自拟如意散治疗药物流产后气虚血瘀型阴道异常出血患者疗效显著,可有效促进宫腔内残留组织的排出,改善β-HCG水平,减少阴道出血量,缩短出血持续时间,值得临床推广。

超声引导下子宫内膜消融术在异常子宫出血中的疗效及影响因素

目的:探讨超声引导下子宫内膜消融术在异常子宫出血中的疗效及相关影响因素。方法:选取2019年1月—2020年12月梅州市人民医院接受超声引导下子宫内膜消融术的41例异常子宫出血患者,失访2例,根据末次随访结果将39例患者分为三组,痊愈25例、有效10例、无效4例。收集临床资料并进行比较。在彩超引导下,用微波针穿刺宫腔及子宫病灶,对子宫内膜进行消融3~5 min,通过产生热效应使子宫内膜组织凝固性坏死,达到阴道流血显著减少或闭经。治疗41例,随访39例,随访时间1.5年以上。结果:术后1.5年子宫出血治愈率达95.1%,术后感染率4.8%,术后穿刺点皮下血肿率2.4%。结论:超声引导下子宫内膜消融术,方法简便、保护正常组织、术后恢复快、缓解患者症状、减少患者痛苦。患者体重指数、孕次、合并子宫肿物大小是影响子宫内膜消融术疗效的独立因素。