Introduction: Hysterectomy is a surgical procedure involving partial or total removal of the uterus. It is the most common gynaecological surgery in the world. Objective: To describe the epidemio-clinical and prognost...Introduction: Hysterectomy is a surgical procedure involving partial or total removal of the uterus. It is the most common gynaecological surgery in the world. Objective: To describe the epidemio-clinical and prognostic aspects of gynaecological hysterectomies. Patients and methods: This was an 18-month retrospective prospective descriptive study with a six-month follow-up period from 1 December 2020 to 31 May 2022 carried out in the gynaecology department of the Segou regional hospital. Results: Fifty-six (56) hysterectomies were performed out of 118 gynaecological surgical procedures (47.45%). The mean age was 47 ± 11.77 years. Large multiparous women were the most common (50%), with an average parity of 4.58. The main indications were uterine fibroids (30.4%), precancerous lesions of the cervix (17.85%) and uterine prolapse (17.85%). The abdominal route was the most commonly used surgical route (82.14%). Hysterectomy was total in 100% of cases and associated with bilateral adnexectomy in 48.2% of cases. The intra- and post-operative prognosis was satisfactory in 94.6% of cases. No deaths were recorded. The average length of stay was 3.28 days, irrespective of the surgical approach. Three cases of dyspareunia were noted among those who had resumed sexual activity.展开更多
BACKGROUND Postpartum hemorrhage(PPH)is a leading cause of maternal mortality,and hysterectomy is an important intervention for managing intractable PPH.Accurately predicting the need for hysterectomy and taking proac...BACKGROUND Postpartum hemorrhage(PPH)is a leading cause of maternal mortality,and hysterectomy is an important intervention for managing intractable PPH.Accurately predicting the need for hysterectomy and taking proactive emergency measures is crucial for reducing mortality rates.AIM To develop a risk prediction model for PPH requiring hysterectomy in the ethnic minority regions of Qiandongnan,China,to help guide clinical decision-making.METHODS The study included 23490 patients,with 1050 having experienced PPH and 74 who underwent hysterectomies.The independent risk factors closely associated with the necessity for hysterectomy were analyzed to construct a risk prediction model,and its predictive efficacy was subsequently evaluated.RESULTS The proportion of hysterectomies among the included patients was 0.32%(74/23490),representing 7.05%(74/1050)of PPH cases.The number of deliveries,history of cesarean section,placenta previa,uterine atony,and placenta accreta were identified in this population as independent risk factors for requiring a hysterectomy.Receiver operating characteristic curve analysis of the prediction model showed an area under the curve of 0.953(95%confidence interval:0.928-0.978)with a sensitivity of 90.50%and a specificity of 90.70%.CONCLUSION The model demonstrates excellent predictive power and is effective in guiding clinical decisions regarding PPH in the ethnic minority regions of Qiandongnan,China.展开更多
Background: Cervical cancer (CC) is one of the most frequent cancers and the leading cause of death from gynecological cancer in Low and middle income countries, Cameroon inclusive. Surgery is the primary treatment mo...Background: Cervical cancer (CC) is one of the most frequent cancers and the leading cause of death from gynecological cancer in Low and middle income countries, Cameroon inclusive. Surgery is the primary treatment modality when the disease is diagnosed at early stage. Radical hysterectomy in cervical cancer has not been evaluated in recent years in Cameroon. The purpose of this study is thus to evaluate the epidemiological and clinical features and short term outcomes of patients who underwent surgery. Patients and methods: This retrospective study was conducted at the Douala Gynaeco-obstetric and Pediatric Hospital and the Douala General Hospital. Cervical cancer patients who underwent Radical hysterectomy between January 2015 and December 2020 were included. A pre-established data collection tool was used to record socio-demographic, clinical and outcomes information from patients’ files;additional outcome information was obtained from phone calls. Descriptive analysis was done using the SPSS version 26. Bivariate analysis was used to determine associations between disease and patients characteristics and occurrence of adverse postoperative outcome. P value of 0.05 was considered. Results: Sixty one patients were enrolled. Their ages ranged from 33 to 74 years with a mean age of 51.95 ± 10.29 years. Over 85% of women were married, 65.57% were unemployed and 86.88% were multiparous. Only 28% had never done cervical cancer screening. Most patients had stage IB1 to IB2 stage disease (57.1%). Less than 9% underwent radical hysterectomy and 8 of those (13.11%) suffered intraoperative complications. Twenty-five patients (40.98%) presented immediate and short term complications. There was no significant association between the disease or patients’ characteristics and adverse outcomes. Conclusion: Cervical cancer patients are relatively young in our settings and only 9% of them reach the hospital at early stage. Postoperative adverse outcomes rate is higher than that reported in the literature. Sensitization on screening and awareness of early symptoms can reverse the situation.展开更多
Introduction: Emergency obstetric hysterectomy (EOH) is a lifesaving procedure that is performed as a last resort in cases of severe postpartum haemorrhage. Objective: The objective of this study was to determine the ...Introduction: Emergency obstetric hysterectomy (EOH) is a lifesaving procedure that is performed as a last resort in cases of severe postpartum haemorrhage. Objective: The objective of this study was to determine the incidence, socio-demographic profile of patients, indications, management and maternal-fetal outcomes of EOH in a maternity hospital with limited resources in Niger. Methodology: This was an eight-year retrospective cohort study involving the analysis of medical records from patients who underwent emergency obstetric hysterectomies between 1 January 2015 and 31 December 2022 at the Mother and Child Health Centre (MCHC) in Maradi, Niger. The epidemiological data, indications, and outcomes of EOH were collated and subjected to analysis using the statistical software package SPSS 21.0. Comparisons were made using the Chi-squared test. A p-value of less than 0.05 was considered statistically significant. Results: During the study period, 239 cases of emergency obstetric hysterectomy were recorded out of 269,710 deliveries, representing a frequency of 0.89%. The mean age of the patients was 32.41 years (range: 17 - 50 years). The patients were identified as married (239 cases, 100%), unemployed (228 cases, 95.4%), and not attending school (215 cases, 90%). The largest number of cases were observed in large multiparous women (i.e., those with more than five children), representing 58.6% of the total number of cases (140 patients). The average parity among this group was 6.15 children. The majority of patients (229 patients, 95.82%) had undergone in utero transfer, with 169 patients (70.71%), originating from peripheral maternity units in the Maradi region. Upon admission, 116 patients (48.53%) exhibited active genital haemorrhage, while 58 patients (24.26%) were in shock. The primary indications for hysterectomy were uterine rupture (153 patients, 64%), uterine atony (77 patients, 32.2%), and placental accreta (six patients, 2.5%). Hysterectomy was performed by an obstetric gynaecologist (230 patients, 96.2%), an obstetric gynaecology resident (six patients, 2.5%), or a general practitioner with district surgical expertise (three patients, 1.3%). In the majority of cases (180 patients, 75.3%), total hysterectomy was performed. The incidence of maternal mortality (26 patients, 10.9%), and perinatal mortality (223 newborns, 93.4%) was notably elevated in our series. Conclusion: Our findings are in close alignment with those previously documented in the literature. The practice of emergency obstetric hysterectomy is a common occurrence in our region. It is considered a last resort when conservative procedures have failed or are not an option. Improved obstetric management would result in a reduction in the number of cases of haemostatic hysterectomy. The availability of blood products is expected to improve maternal prognosis.展开更多
Industrial activities such as smelting emissions,mineral combustion and industrial wastewater discharge might lead to copper pollution in the environment.This kind of copper pollution has harmful effects on aquatic o ...Industrial activities such as smelting emissions,mineral combustion and industrial wastewater discharge might lead to copper pollution in the environment.This kind of copper pollution has harmful effects on aquatic o rganisms,plants and animals through direct or indirect exposure.However,the current understanding of the toxicity of copper is rather limited.Copper overload can perturb intracellular homeostasis and induce oxidative stress and e ven cell death.Recently,cuproptosis has been identified as a copper-dependent form of cell death induced by o xidative stress in mitochondria.We uncover here that zinc transporter 1(ZNT1)is an important regulator involved in cuproptosis.Firstly,we established the copper overload-induced cell death model with the overexpression of copper importer SLC31A1 in HeLa cells.Using this model,we conducted unbiased genome-wide CRISPR-Cas9 screens in cells treated with copper.Our results revealed a significant enrichment of ZNT1 gene in both library A and library B plasmids.Knocking out of ZNT1 in HeLa cells notably prevented cuproptosis.Subsequent knockout of metal transcription factor 1(MTF1)in ZNT1-deficient cells nearly abolished their ability to resist copper-induced cell death.However,overexpression of metallothionein 1X(MT1X)in the double-knockout cells could p artially restored the resistance to cuproptosis by loss of MTF1.Mechanistically,knockout of ZNT1 could promote MT1X expression by activating MTF1.As a consequence,the interaction between MT1X and copper was e nhanced,reducing the flow of copper into mitochondria and eliminating mitochondria damage.Taken together,this study reveals the important role of ZNT1 in cuproptosis and shows MTF1-MT1X axis mediated resistance to c uproptosis.Moreover,our study will help to understand the regulatory mechanism of cellular and systemic copper homeostasis under copper overload,and present insights into novel treatments for damages caused by both genetic copper overload diseases and environmental copper contamination.展开更多
Mountain streams act as conveyors of sediments within the river continuum,where the physical transport of sediments between river reaches through the catchment or between individual parts(e.g.,between hillslopes and c...Mountain streams act as conveyors of sediments within the river continuum,where the physical transport of sediments between river reaches through the catchment or between individual parts(e.g.,between hillslopes and channels)of the catchment is assumed.This study focused on sediment connectivity analysis in the SlavíčRiver catchment in the MoravskoslezskéBeskydy Mts in the eastern part of the Czech Republic.The connectivity index and connectivity index target modelling were combined with an analysis of anthropogenic interventions.Additionally,field mapping,grain size of bed sediments and stream power analysis were used to obtain information about connectivity in the catchment.Based on the analysis and obtained results,terrain topography is the current main driving factor affecting the connectivity of sediment movement in the SlavíčRiver catchment.However,the modelling provided valuable information about high sediment connectivity despite different recent land use conditions(highly forested area of the catchment)than those in historical times from the 16th to 19th centuries when the SlavíčRiver catchment was highly deforested and sediment connectivity was probably higher.The analysis of anthropogenic interventions,field mapping,grain size of bed sediments and stream power analysis revealed more deceleration of sediment movement through the catchment,decreased sediment connectivity with bed erosion,and gradual river channel process transformation in some reaches.Field mapping has identified various natural formations and human-induced changes impacting the longitudinal and lateral connectivity in the SlavíčRiver.For instance,embankments along 48%of the river's length,both on the right and left banks,significantly hinder lateral sediment supply to the channel.Stream power index analysis indicates increased energy levels in the flowing water in the river's upper reaches(up to 404.8 W m^(-2)).This high energy is also observed in certain downstream sections(up to 337.6 W m^(-2)),where it is influenced by human activities.These conditions lead to intensified erosion processes,playing a crucial role in sediment connectivity.Similar observations were described in recent studies that pointed out the long-term human interventions on many streams draining European mountains,where a decrease in sediment connectivity in these streams is linked with sediment deficits and the transformation of processes forming channels.展开更多
Objective:To explore the clinical benefits achieved by implementing the operating room nursing cooperation path for patients undergoing laparoscopic hysterectomy.Methods:64 laparoscopic hysterectomy cases were divided...Objective:To explore the clinical benefits achieved by implementing the operating room nursing cooperation path for patients undergoing laparoscopic hysterectomy.Methods:64 laparoscopic hysterectomy cases were divided into groups according to the order of admission.The control group received routine perioperative care.The observation group implemented the nursing cooperation path in the operating room on the same basis as the control group.The two groups’physiological responses,stimulus indicators,anxiety,and complication rates were compared.Results:The heart rate,blood pressure 0.5 hours after surgery,anxiety scores 1 day before and 3 days after surgery,and the total number of complications in the observation group were all lower than those in the control group(P<0.05).Conclusion:The development of a nursing cooperation path in the operating room can help patients undergoing laparoscopic hysterectomy reduce heart rate,blood pressure,stress responses,and the risk of complications,and is worthy of promotion.展开更多
文摘Introduction: Hysterectomy is a surgical procedure involving partial or total removal of the uterus. It is the most common gynaecological surgery in the world. Objective: To describe the epidemio-clinical and prognostic aspects of gynaecological hysterectomies. Patients and methods: This was an 18-month retrospective prospective descriptive study with a six-month follow-up period from 1 December 2020 to 31 May 2022 carried out in the gynaecology department of the Segou regional hospital. Results: Fifty-six (56) hysterectomies were performed out of 118 gynaecological surgical procedures (47.45%). The mean age was 47 ± 11.77 years. Large multiparous women were the most common (50%), with an average parity of 4.58. The main indications were uterine fibroids (30.4%), precancerous lesions of the cervix (17.85%) and uterine prolapse (17.85%). The abdominal route was the most commonly used surgical route (82.14%). Hysterectomy was total in 100% of cases and associated with bilateral adnexectomy in 48.2% of cases. The intra- and post-operative prognosis was satisfactory in 94.6% of cases. No deaths were recorded. The average length of stay was 3.28 days, irrespective of the surgical approach. Three cases of dyspareunia were noted among those who had resumed sexual activity.
基金Supported by Qiandongnan Prefecture Science and Technology Support Plan,No.[2021]11Training of High Level Innovative Talents in Guizhou Province,No.[2022]201701。
文摘BACKGROUND Postpartum hemorrhage(PPH)is a leading cause of maternal mortality,and hysterectomy is an important intervention for managing intractable PPH.Accurately predicting the need for hysterectomy and taking proactive emergency measures is crucial for reducing mortality rates.AIM To develop a risk prediction model for PPH requiring hysterectomy in the ethnic minority regions of Qiandongnan,China,to help guide clinical decision-making.METHODS The study included 23490 patients,with 1050 having experienced PPH and 74 who underwent hysterectomies.The independent risk factors closely associated with the necessity for hysterectomy were analyzed to construct a risk prediction model,and its predictive efficacy was subsequently evaluated.RESULTS The proportion of hysterectomies among the included patients was 0.32%(74/23490),representing 7.05%(74/1050)of PPH cases.The number of deliveries,history of cesarean section,placenta previa,uterine atony,and placenta accreta were identified in this population as independent risk factors for requiring a hysterectomy.Receiver operating characteristic curve analysis of the prediction model showed an area under the curve of 0.953(95%confidence interval:0.928-0.978)with a sensitivity of 90.50%and a specificity of 90.70%.CONCLUSION The model demonstrates excellent predictive power and is effective in guiding clinical decisions regarding PPH in the ethnic minority regions of Qiandongnan,China.
文摘Background: Cervical cancer (CC) is one of the most frequent cancers and the leading cause of death from gynecological cancer in Low and middle income countries, Cameroon inclusive. Surgery is the primary treatment modality when the disease is diagnosed at early stage. Radical hysterectomy in cervical cancer has not been evaluated in recent years in Cameroon. The purpose of this study is thus to evaluate the epidemiological and clinical features and short term outcomes of patients who underwent surgery. Patients and methods: This retrospective study was conducted at the Douala Gynaeco-obstetric and Pediatric Hospital and the Douala General Hospital. Cervical cancer patients who underwent Radical hysterectomy between January 2015 and December 2020 were included. A pre-established data collection tool was used to record socio-demographic, clinical and outcomes information from patients’ files;additional outcome information was obtained from phone calls. Descriptive analysis was done using the SPSS version 26. Bivariate analysis was used to determine associations between disease and patients characteristics and occurrence of adverse postoperative outcome. P value of 0.05 was considered. Results: Sixty one patients were enrolled. Their ages ranged from 33 to 74 years with a mean age of 51.95 ± 10.29 years. Over 85% of women were married, 65.57% were unemployed and 86.88% were multiparous. Only 28% had never done cervical cancer screening. Most patients had stage IB1 to IB2 stage disease (57.1%). Less than 9% underwent radical hysterectomy and 8 of those (13.11%) suffered intraoperative complications. Twenty-five patients (40.98%) presented immediate and short term complications. There was no significant association between the disease or patients’ characteristics and adverse outcomes. Conclusion: Cervical cancer patients are relatively young in our settings and only 9% of them reach the hospital at early stage. Postoperative adverse outcomes rate is higher than that reported in the literature. Sensitization on screening and awareness of early symptoms can reverse the situation.
文摘Introduction: Emergency obstetric hysterectomy (EOH) is a lifesaving procedure that is performed as a last resort in cases of severe postpartum haemorrhage. Objective: The objective of this study was to determine the incidence, socio-demographic profile of patients, indications, management and maternal-fetal outcomes of EOH in a maternity hospital with limited resources in Niger. Methodology: This was an eight-year retrospective cohort study involving the analysis of medical records from patients who underwent emergency obstetric hysterectomies between 1 January 2015 and 31 December 2022 at the Mother and Child Health Centre (MCHC) in Maradi, Niger. The epidemiological data, indications, and outcomes of EOH were collated and subjected to analysis using the statistical software package SPSS 21.0. Comparisons were made using the Chi-squared test. A p-value of less than 0.05 was considered statistically significant. Results: During the study period, 239 cases of emergency obstetric hysterectomy were recorded out of 269,710 deliveries, representing a frequency of 0.89%. The mean age of the patients was 32.41 years (range: 17 - 50 years). The patients were identified as married (239 cases, 100%), unemployed (228 cases, 95.4%), and not attending school (215 cases, 90%). The largest number of cases were observed in large multiparous women (i.e., those with more than five children), representing 58.6% of the total number of cases (140 patients). The average parity among this group was 6.15 children. The majority of patients (229 patients, 95.82%) had undergone in utero transfer, with 169 patients (70.71%), originating from peripheral maternity units in the Maradi region. Upon admission, 116 patients (48.53%) exhibited active genital haemorrhage, while 58 patients (24.26%) were in shock. The primary indications for hysterectomy were uterine rupture (153 patients, 64%), uterine atony (77 patients, 32.2%), and placental accreta (six patients, 2.5%). Hysterectomy was performed by an obstetric gynaecologist (230 patients, 96.2%), an obstetric gynaecology resident (six patients, 2.5%), or a general practitioner with district surgical expertise (three patients, 1.3%). In the majority of cases (180 patients, 75.3%), total hysterectomy was performed. The incidence of maternal mortality (26 patients, 10.9%), and perinatal mortality (223 newborns, 93.4%) was notably elevated in our series. Conclusion: Our findings are in close alignment with those previously documented in the literature. The practice of emergency obstetric hysterectomy is a common occurrence in our region. It is considered a last resort when conservative procedures have failed or are not an option. Improved obstetric management would result in a reduction in the number of cases of haemostatic hysterectomy. The availability of blood products is expected to improve maternal prognosis.
文摘Industrial activities such as smelting emissions,mineral combustion and industrial wastewater discharge might lead to copper pollution in the environment.This kind of copper pollution has harmful effects on aquatic o rganisms,plants and animals through direct or indirect exposure.However,the current understanding of the toxicity of copper is rather limited.Copper overload can perturb intracellular homeostasis and induce oxidative stress and e ven cell death.Recently,cuproptosis has been identified as a copper-dependent form of cell death induced by o xidative stress in mitochondria.We uncover here that zinc transporter 1(ZNT1)is an important regulator involved in cuproptosis.Firstly,we established the copper overload-induced cell death model with the overexpression of copper importer SLC31A1 in HeLa cells.Using this model,we conducted unbiased genome-wide CRISPR-Cas9 screens in cells treated with copper.Our results revealed a significant enrichment of ZNT1 gene in both library A and library B plasmids.Knocking out of ZNT1 in HeLa cells notably prevented cuproptosis.Subsequent knockout of metal transcription factor 1(MTF1)in ZNT1-deficient cells nearly abolished their ability to resist copper-induced cell death.However,overexpression of metallothionein 1X(MT1X)in the double-knockout cells could p artially restored the resistance to cuproptosis by loss of MTF1.Mechanistically,knockout of ZNT1 could promote MT1X expression by activating MTF1.As a consequence,the interaction between MT1X and copper was e nhanced,reducing the flow of copper into mitochondria and eliminating mitochondria damage.Taken together,this study reveals the important role of ZNT1 in cuproptosis and shows MTF1-MT1X axis mediated resistance to c uproptosis.Moreover,our study will help to understand the regulatory mechanism of cellular and systemic copper homeostasis under copper overload,and present insights into novel treatments for damages caused by both genetic copper overload diseases and environmental copper contamination.
基金supported by an internal grant of the University of Ostrava[SGS10/PřF/2021-Specificity of fluvial landscape in the context of historical and future changes].
文摘Mountain streams act as conveyors of sediments within the river continuum,where the physical transport of sediments between river reaches through the catchment or between individual parts(e.g.,between hillslopes and channels)of the catchment is assumed.This study focused on sediment connectivity analysis in the SlavíčRiver catchment in the MoravskoslezskéBeskydy Mts in the eastern part of the Czech Republic.The connectivity index and connectivity index target modelling were combined with an analysis of anthropogenic interventions.Additionally,field mapping,grain size of bed sediments and stream power analysis were used to obtain information about connectivity in the catchment.Based on the analysis and obtained results,terrain topography is the current main driving factor affecting the connectivity of sediment movement in the SlavíčRiver catchment.However,the modelling provided valuable information about high sediment connectivity despite different recent land use conditions(highly forested area of the catchment)than those in historical times from the 16th to 19th centuries when the SlavíčRiver catchment was highly deforested and sediment connectivity was probably higher.The analysis of anthropogenic interventions,field mapping,grain size of bed sediments and stream power analysis revealed more deceleration of sediment movement through the catchment,decreased sediment connectivity with bed erosion,and gradual river channel process transformation in some reaches.Field mapping has identified various natural formations and human-induced changes impacting the longitudinal and lateral connectivity in the SlavíčRiver.For instance,embankments along 48%of the river's length,both on the right and left banks,significantly hinder lateral sediment supply to the channel.Stream power index analysis indicates increased energy levels in the flowing water in the river's upper reaches(up to 404.8 W m^(-2)).This high energy is also observed in certain downstream sections(up to 337.6 W m^(-2)),where it is influenced by human activities.These conditions lead to intensified erosion processes,playing a crucial role in sediment connectivity.Similar observations were described in recent studies that pointed out the long-term human interventions on many streams draining European mountains,where a decrease in sediment connectivity in these streams is linked with sediment deficits and the transformation of processes forming channels.
文摘Objective:To explore the clinical benefits achieved by implementing the operating room nursing cooperation path for patients undergoing laparoscopic hysterectomy.Methods:64 laparoscopic hysterectomy cases were divided into groups according to the order of admission.The control group received routine perioperative care.The observation group implemented the nursing cooperation path in the operating room on the same basis as the control group.The two groups’physiological responses,stimulus indicators,anxiety,and complication rates were compared.Results:The heart rate,blood pressure 0.5 hours after surgery,anxiety scores 1 day before and 3 days after surgery,and the total number of complications in the observation group were all lower than those in the control group(P<0.05).Conclusion:The development of a nursing cooperation path in the operating room can help patients undergoing laparoscopic hysterectomy reduce heart rate,blood pressure,stress responses,and the risk of complications,and is worthy of promotion.