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OBJECTIVE To investigate the feasibility, efficacy and safety of ultrasound-guided high-intensity focused ultrasound (HIFU) ablation for treating the broad ligament uterine fibroid (BLUF). METHODS A total of 236 patients with symptomatic uterine fibroids were enrolled and treated with JC-200 extracorporeal ultrasound-guided HIFU under conscious sedation between January 2017 and December 2018. Of them, data of 12 patients with 13 broad ligament fibroids were retrospectively analyzed. The patients' mean age was 38.6 ± 6.3 years. The focused ultrasound target was deployed and moved from the deeper layer to the superficial layer of BLUFs. All patients underwent contrast-enhanced MRI (CE-MRI) before, immediate post-operation, and six months after the HIFU ablation procedure. The fibroid size, non-perfusion volume (NPV) ratio, the reduction of fibroid volumes, adverse events, symptom changes, and abnormal MRI findings associated with the HIFU treatment were analyzed. RESULTS Ultrasound-guided HIFU ablation in the twelve patients was technically successful with one session treatment. The mean longest diameter of BLUFs was 6.2 ± 2.3 cm. The mean NPV ratio of fibroids was 84.08%± 9.4%. After HIFU ablation, lower abdominal pain occurred in 7 cases, sacrococcygeal pain in 3 cases, and mild skin pain in 6 cases. There were no severe adverse events and complications associated with the treatment. At 6 months post-treatment follow-up, the mean fibroid volume decreased by 56.2%± 9.0% (p

High Intensity Focused Ultrasound ablation therapy for fibroids and adenomyoma has been increasingly applied in Gynecology. It is now considered a safe surgery with effectiveness compatible to open or laparoscopic myomectomy. However, to further minimize its potential risks of skin burn to the buttocks and nerve injury, this paper studied the skin temperature changes as monitored by infrared thermography in an attempt to identify the risks during HIFU treatment. Although the infrared imaging technology is safe and feasible to monitor the skin temperature changes during HIFU ablation, there isn’t enough conclusive evidence to prove it can be used to avoid skin burn at the buttock or nerve injury.

Vulvar intraepithelial neoplasia is a premalignant skin lesion of the vulva that often presents with severe vulvar pruritus, pain, and psychosexual disorders. The technology of non-invasive focused ultrasound surgery has improved over the years. Today its potential to treat these irritating diseases noninvasively is a relatively new area of clinical research interest. Increasing studies in China revealed that FUS treatment is effective and safe. This paper describes the preparation, technique, postoperative care, and results of this focused ultrasound surgery for treating vulvar non-neoplastic epithelial disease. Therefore it could be a future alternative treatment for benign vulvar diseases, replacing many invasive surgical treatments.

BackgroundAdvanced Head and Neck Squamous Cell Cancer (HNSCC) is associated with a poor prognosis, and biomarkers that predict response to treatment are highly desirable. The primary aim was to predict Progression Free Survival (PFS) with a multivariate risk prediction model.MethodsBlood samples from 56 HNSCC patients were prospectively obtained within a Phase 2 clinical trial (NCT02633800), before and after the first treatment cycle of platinum-based chemotherapy, to identify biological covariates predictive of outcome. A total of 42 baseline covariates were derived pre-treatment, which were combined with 29 covariates after one cycle of treatment. These covariates were ranked and selected by Bayesian multivariate regression to form risk scores to predict PFS, producing “baseline” and “combined” risk prediction models respectively.ResultsThe baseline model comprised of CD33+CD14+ monocytes, Double Negative B cells and age, in a weighted risk signature which predicted PFS with a concordance index (C-index) of 0.661. The combined model composed of baseline CD33+CD14+ monocytes, baseline Tregs, after-treatment changes in CD8 effector memory T cells, CD8 Central memory T cells and CD3 T Cells, along with the hypopharyngeal primary tumor subsite. This weighted risk signature exhibited an improved C-index of 0.757. There was concordance between levels of CD33+CD14+ myeloid cells in tumor tissue, as demonstrated by imaging mass cytometry, and peripheral blood in the same patients. This monocyte subpopulation also had univariate predictive value (log-rank p value = 0.03) but the C-index was inferior to the combined signature.ConclusionsThis immune-based combined multimodality signature, obtained through longitudinal peripheral blood monitoring, presents a novel means of predicting response early on during the treatment course.FundingDaiichi Sankyo Inc, Cancer Research UK, EU IMI2 IMMUCAN, UK Medical Research Council, European Research Council (335326), National Institute for Health Research and The Institute of Cancer Research.

Uterine lipoleiomyoma is a rare benign tumor of the uterus. Imaging has an important role in determining its intrauterine location and fatty nature. The diagnosis in this lady was made only by chance pathological findings postoperatively. This tumor has been reported because of its rarity. Our aim to present this case is to raise clinical awareness of this tumor, then conservative treatment or noninvasive surgery can be offered.

We come to realize the importance of “telehealth” during the current COVID-19 pandemic. Telehealth can be defined as providing health care, including preventive, diagnostic, and treatment services, by using information and communication technologies such as videoconferencing, electronic messaging, and telephone calls (1). With the rapid development of new treatment technology, communication, and fast speed networks, not only telehealth can provide medical services closer to home, but it also should provide the doctors and patients with additional benefits of safety, effectiveness, and satisfaction. HIFU is a new non-invasive ablation treatment for many solid tumors. This paper illustrates how the potential practice of HIFU ablation for fibroids can be modified to make it suitable for doctors in their HIFU training for treatment of fibroids and adenomyosis and for patients who need surgery using this new telehealth development.

Any surgical procedure has potential complications. Abdominal and laparoscopic surgery may have heavy bleeding at operation, infection, poor wound healing, pelvic adhesion, ureter or bladder injury, bowel injury, and many others. HIFU ablation involves no wound, no bleeding, and is a type of noninvasive treatment. Complications are extremely low. However, organs and tissues close to the uterus include the bowel, bladder, nerves, and sacral bone, as well as the skin of the lower abdomen, may be within the acoustic pathway during the HIFU ablation procedure. Therefore, there is a potential for thermal injuries to these organs or tissues within the pathway, causing bowel perforation, bladder injury, nerve injury, bone damage, or skin burn. However, these are infrequent complications of HIFU treatment. As reported in the literature, skin burn incidence is about 0.2–0.5% [1], and the nerve injury, though reported in the early stage of HIFU ablation development, is now even much lower. Up to 99% of HIFU induced adverse events were mild and not requiring any special treatment [2]. From the literature, the severity of adverse effects was reported according to the SIR classification system for complications by outcome: (a) Class A: no therapy, no consequence; (b) Class B: nominal therapy, no consequence; (c) Class C: require therapy, minor hospitalization ( 48 h); (e) Class E: permanent adverse sequelae; (f) Class F: death. Class A and B were considered minor complications in this classification system; Class C, Class D, Class E, and Class F were considered major complications [3]. Although there were case reports of major adverse effects, including skin burn, bowel injury, acute renal failure, deep vein thrombosis, pubic symphysis injury, in the early literature. From a multicenter study with large data analysis, the complication rate during and after the HIFU ablation is mild in Class A and Class B. The complications were also much lower than laparoscopic surgery and conventional open surgery [4]. The major adverse events in Class C and D categories were only 0.38% [2].

Some evidence showed that uterine fibroids might adversely affect fertility, causing 1–2.4% of infertility in patients [1]. Uterine fibroids may cause fertility, pregnancy, and labor complications such as miscarriage, preterm labor, obstructed labor, or postpartum bleeding. The impact of HIFU ablation on patients’ fertility and pregnancy outcome becomes a topic of interest because HIFU ablation is currently used as a new technology for treating fibroids and adenomyosis.

Sedation reduces irritability or agitation by administering sedative drugs; generally, it is used in a medical procedure or diagnostic procedure. Sedation can be classified into four stages: mild sedation (anxiety); moderate sedation (conscious sedation); deep sedation; and general anesthesia. Table 2.1 showed the Ramsay sedation score most commonly used to define sedation [1]. Most HIFU ablation of uterine fibroids and adenomyosis in gynecology is performed under conscious sedation with analgesia.

At present, the commonly used diagnostic examination of fibroids and adenomyosis are MRI and ultrasound imaging.

Selective ablation of endometriotic lesions in the myometrium reduces the extent and sizes of adenomyosis lesions and limits the ectopic endometrial functions and growth. Eventually, it may achieve the purpose of improving symptoms.

Adenomyosis is due to the invasion or presence of endometrial glands in the uterine myometrium accompanied by hyperplasia and hypertrophy of the surrounding muscle cells, forming diffuse or focal lesions. Adenomyosis occurs most often in women between the ages of 30 and 50, but it can also be in younger women who have not had children. The incidence of adenomyosis is about 20–30% of reproductive-aged women, but this varies according to the particular population [1]. Recently, there appears to have a significant increase in the incidence and younger age patients. Thirty-five percent of patients are without symptoms, 15–30% associated with pelvic endometriosis, and 50% with uterine fibroids. The pathogenesis of adenomyosis is unknown, but in some patients, there is a belief that any intrauterine manipulations such as surgical termination of pregnancy can damage the endometrium’s basal layer, causing the endometrial gland to invade into the myometrium thus increasing the extent and severity of adenomyosis. Adenomyosis can then lead to dysmenorrhea and increased menstrual flow, infertility, and other related symptoms [2]. This disease seriously affects women’s physical and mental health.

Uterine fibroids are common benign uterine tumors in women of childbearing age, with an incidence ranging from 20 to 40% [1]. They mainly develop from uterine smooth muscle cell proliferation, including a small amount of fibrous connective tissues. The medical terminology is “uterine leiomyoma,” but the condition is commonly known as uterine fibroids by the lay public.

HIFU treatment is a revolutionary treatment and utterly different from traditional surgery. Many people, including doctors, still do not understand how HIFU works. Hopefully, after reading this book, the clinical applications of this HIFU ablation in obstetrics and gynecology can now be recognized. This chapter will also help elaborate on some HIFU treatment issues that even those who have learned HIFU ablation may be confused.

Applications of HIFU ablation have been reported to treat placenta accreta, abdominal wall endometriotic lesions, and cesarean scar pregnancy. HIFU ablation is a new treatment for these conditions that may require more evidence to prove its safety and effectiveness. These treatments are elaborated and described in this chapter as follow

Street navigation has always been a challenge for the visually impaired people. Even with rapidly advancing technology and increasingly accessible hardware like smartphones, environmental traversal is still a huge challenge for them to have normal social activities such as meeting friends in a local neighborhood. This paper considers an intelligent method for a more accurate estimation of the users’ true location through adapting the particle filter algorithm with the sensed data provided by smartphones. The evaluation results clearly revealed that our proposed method can be a better alternative without any extra hardware. More importantly, it can enhance the navigational accuracy in the context of street navigation for the visually impaired. There are many possible directions for future investigations including how to extend our method for the elderly and other minority groups.

While ultrasound is most widely known for its use in diagnostic imaging, the energy carried by ultrasound waves can be utilized to influence cell function and drug delivery. Consequently, our ability to use ultrasound energy at a given intensity unlocks the opportunity to use the ultrasound for therapeutic applications. Indeed, in the last decade ultrasound-based therapies have emerged with promising treatment modalities for several medical conditions. More recently, ultrasound in combination with nanomedicines, i.e., nanoparticles, has been shown to have substantial potential to enhance the efficacy of many treatments including cancer, Alzheimer disease or osteoarthritis. The concept of ultrasound combined with drug delivery is still in its infancy and more research is needed to unfold the mechanisms and interactions of ultrasound with different nanoparticles types and with various cell types. Here we present the state-of-art in ultrasound and ultrasound-assisted drug delivery with a particular focus on cancer treatments. Notably, this review discusses the application of high intensity focus ultrasound for non-invasive tumor ablation and immunomodulatory effects of ultrasound, as well as the efficacy of nanoparticle-enhanced ultrasound therapies for different medical conditions. Furthermore, this review presents safety considerations related to ultrasound technology and gives recommendations in the context of system design and operation.

This paper reflects a Hong Kong doctors group's journey to learn the high-intensity focused ultrasound (HIFU) ablation treatment for gynecological diseases in China. The procedures of HIFU ablation for fibroids, adenomyosis, and other gynecological diseases are described. After completing our training, the authors applied the HIFU ablation techniques they have learned to establish an outpatient HIFU clinic and provided HIFU ablation treatment in Hong Kong. This paper describes their early experience in providing HIFU services.

Noninvasive high-intensity focused ultrasound (HIFU) surgery has become a popular surgical treatment for fibroids, adenomyosis, and various gynecological diseases in China and many countries. While traditional theater designs in hospitals are standardized and easily available for reference, an outpatient HIFU theater design is not yet available in the literature or is nonexistent. The authors presented the design and setup of an ultrasound-guided HIFU center in Hong Kong and listed the space and safety requirements and special features of their HIFU theater. Despite its limited space, the HIFU surgery center has made available a nursing station, a changing room, and an observation/recovery room. A room for learning HIFU treatment and viewing is also available without any intrusion of patient's privacy during treatment. The article concluded that because the space requirements for a HIFU theater were much reduced, the cost of the HIFU theater setup would be much cost-effective. Finally, its relaxing lighting environment was totally different and impossible to be installed in a traditional operating theater in a hospital.

This paper presents the case of a postmenopausal woman with a rare florid cystic endosalpingiosis presenting as an ovarian cyst, together with cystic lesions in the pelvis. She had chronic pelvic pain and ultrasound-diagnosed cystic lesions in the pelvis. Surgical laparoscopic management was planned and executed successfully with the condition being diagnosed at the time of surgery and confirmed by histologic analysis. We herein describe the surgical technique used to excise these lesions and present a discussion about the possible implications endosalpingiosis has regarding high-grade serous neoplasms and the tubal origin of these malignancies.

Highlights • A case of acute bowel obstruction caused by the use of barbed suture in laparoscopic myomectomy. • Bowel complications associated with barbed suture were seldom reported despite it is increasingly used in surgery today. • Some recommendations arising from this case may help to avoid or reduce this complication. • A high index of suspicion is necessary in making an early diagnosis and prompt action should be taken to alleviate major bowel complications due to barbed suture., Myomectomy is commonly performed for symptomatic fibroids in women who wish to conserve fertility. Laparoscopic myomectomy provides advantages as a minimally invasive procedure. To facilitate the closure of the uterine wound after enucleation of the fibroid, barbed sutures have been introduced as they can shorten the operative time and reduce the amount of bleeding. However, the use of barbed suture is not without risk. There were a few reports on the risks of barbed sutures in the literature. We report herein a case of acute abdomen because of small bowel entrapment and obstruction following the use of barbed suture in laparoscopic myomectomy. Surgeons using barbed suture in myomectomy should be vigilant on the possibility of this bowel complication whenever adverse clinical situation arises as the outcome could be serious if the condition was left unchecked.

Cancer cells tend to metastasize first to tumor-draining lymph nodes, but the mechanisms mediating cancer cell invasion into the lymphatic vasculature remain little understood. Here, we show that in the human breast tumor microenvironment (TME), the presence of increased numbers of RORγt+ group 3 innate lymphoid cells (ILC3) correlates with an increased likelihood of lymph node metastasis. In a preclinical mouse model of breast cancer, CCL21-mediated recruitment of ILC3 to tumors stimulated the production of the CXCL13 by TME stromal cells, which in turn promoted ILC3–stromal interactions and production of the cancer cell motile factor RANKL. Depleting ILC3 or neutralizing CCL21, CXCL13, or RANKL was sufficient to decrease lymph node metastasis. Our findings establish a role for RORγt+ILC3 in promoting lymphatic metastasis by modulating the local chemokine milieu of cancer cells in the TME. Cancer Res; 77(5); 1083–96. ©2017 AACR.

Aim: The aim of this study was to identify factors influencing the choice between different approaches in hysterectomy for uterine fibroids. Methods: A cross-sectional study was conducted involving 285 women who had undergone hysterectomy for uterine fibroids at the Liverpool Hospital, New South Wales, Australia. Results: This study shows that several factors influenced the choice of hysterectomy approach. First, concomitant adnexal surgery increased the likelihood of undergoing an abdominal hysterectomy rather than either a vaginal or a laparoscopic hysterectomy by 10- and fivefold (both p 280 g) had a 20 (p

Objective To demonstrate the technique and clinical safety of primary entry of an optically guided entry approach in laparoscopic surgery. Materials The clinical data from a personal series of 821 consecutive cases of laparoscopic surgery were used. Methods The technique of an optically guided primary entry using an Endopath Xcel trocar was described. Results There was no bowel, vascular, or visceral complication in this series. This entry approach was also safe in those with high surgical risks, for example, high body mass index, multiple previous abdominal surgeries and previous laparotomy. There was no failed entry, no extraperitoneal insufflation, no wound infection and wound hernia. Conclusion In this personal series, the findings demonstrated the safety and feasibility of an optically guided entry technique in laparoscopic surgeries.

Inguinal endometriosis can present as a rare tumor when it occurs outside the abdomen and pelvis. We present a patient with a painful tumor in the right inguinal region, where its diagnosis was made before the operation. This enabled a conservative excisional surgery to be performed. The literature is reviewed and the diagnosis as well as management are discussed.

Objective To study the feasibility and result of LAVH performed in virgins and nulliparae. Study design Retrospective review of 297 consecutive cases of LAVH using the Biswas Uterine Vaginal Elevator (BUVE) in a private hospital in Hong Kong for benign gynaecological conditions between July 2006 and February 2009. Variables analysed included patient demographics, operative times, uterine weight, hospital stay, intraoperative blood loss, and operative complications. Patients who were virgins and nulliparae were compared to each other and to a control group of patients receiving LAVH during the same period of time. Results All 297 cases of LAVH were successfully performed without any conversion. Ninety-seven LAVHs were performed on 31 virgins and 66 nulliparae, while 200 LAVHs were performed on parous patients during the same study period. The uterine sizes in the virgin group were significantly larger than those in the other two groups. The operation times in the virgin and nullipara groups were significantly longer than those in the control group. The complication rates of LAVH in these three groups were 6.4%, 12.1% and 3% in the virgin, nulliparous and control groups respectively. The overall complication rate of this series was low at 5.3%. Conclusions LAVH is feasible with acceptable safety in virgins and nulliparae in spite of their narrow and tight vaginas.

This paper describes the development of a Chinese Acupuncture Expert System (CAES) that will assist the learning and practice of medical acupuncture. This was the development of a Chinese Acupuncture Expert System which incorporated eight functional modules. These modules were 1) Add Patient Record subsystem; 2) Diagnosis subsystem ; 3) Acupuncture Prescription subsystem ; 4) Needle Insertion Position Animation subsystem ; 5) Acupuncture Points Usage Statistic subsystem ; 6) History Query subsystem; 7) Acupuncture Points Query subsystem and 8) Diagnosis Remarks and Diagnosis Record Save subsystem. Two databases were built--Patient Record database and Diagnosis (Acupuncture) Knowledge database. All the Traditional Chinese Medicine (TCM) knowledge and acupuncture treatment prescriptions were extracted from officially used TCM textbooks and received guidiance and expert advice from two acupuncturists working in this project. A Chinese Acupuncture Expert System (CAES) was built, which after the input from users of any Chinese disease symptoms and signs, it can provide a list of related TCM syndrome diagnoses based on the patients' disease symptoms and signs, and at the same time it can offer advice of the appropriate Chinese acupuncture treatment to the users. CAES also provided text descriptions and acupuncture animations showing the acupoint locations and the direction and depth of the needle insertion technique. Therefore users can easily learn acupuncture and practice it. This new acupuncture expert system will hopefully provide an easy way for users to learn and practice Chinese Acupuncture and establish its usefulness after it was fully evaluated.

Aim: To explore and compare the features of menstruation, perception and management of menstrual pain between two cohorts of Australian and Chinese women. Methods: A pilot comparison study was carried out using modified valid menstrual questionnaires. The study included 120 Australian women and 122 Chinese women aged from 18 to 45 years with primary dysmenorrhea. Results: Australian women rated menstrual pain as more intense than Chinese women (8.5 ± 1.5 on a 10-point pain scale vs 7.3 ± 1.8, P

Cervical endometriosis is uncommon and usually an incidental or retrospective finding on histopathology reports. It can be asymptomatic or present with a diverse range of persistent symptoms and even life-threatening hemorrhage. The condition can be managed expectantly in asymptomatic patients, however persistent symptoms may warrant surgery. We encountered four cases of histologically proven cervical endometriosis at our tertiary hospital in New South Wales, Australia. All our patients had different symptoms, presentations and indications for their surgery leading to their diagnosis. This review is to report these cases followed by discussion with a review of the literature.

6043Background: The use of patritumab (Daiichi Sankyo), an internalizing anti-HER3 monoclonal antibody, in combination with cetuximab and cisplatin was investigated in a cohort of patients with R/M...

Four babies with congenital listeriosis were diagnosed in the Prince of Wales Hospital in Hong Kong in 1990-1991. Two died in the early neonatal period. The remaining 2 survived and recovered with no sequelae. The clinical and pathological features of these babies, together with those reported in the recent literature are highlighted so as to raise a high index of suspicion toward this disease and hopefully prompt treatment can be offered.

The aim of this article is to introduce an electrical bioimpedance device that uses an old and little-known impedance measuring technique to study the impedance of the meridian and nonmeridian tissue segments.Three (3) pilot experimental studies involving both a tissue phantom (a cucumber) and 3 human subjects were performed using this BIRD-I (Bioimpedance Research Device) device. This device consists of a Fluke RCL meter, a multiplexer box, a laptop computer, and a medical-grade isolation transformer. Segment and surface sheath (or local) impedances were estimated using formulae first published in the 1930s, in an approach that differs from that of the standard four-electrode technique used in most meridian studies to date.Our study found that, when using a quasilinear four-electrode arrangement, the reference electrodes should be positioned at least 10 cm from the test electrodes to ensure that the segment (or core) impedance estimation is not affected by the proximity of the reference electrodes. A tissue phantom was used to determine the repeatability of segment (core) impedance measurement by the device. An applied frequency of 100 kHz was found to produce the best repeatability among the various frequencies tested. In another preliminary study, with a segment of the triple energizer meridian on the lower arm selected as reference segment, core resistance-based profiles around the lower arm showed three of the other five meridians to exist as local resistance minima relative to neighboring nonmeridian segments. The profiles of the 2 subjects tested were very similar, suggesting that the results are unlikely to be spurious.In electrical bioimpedance studies, it is recommended that the measuring technique and device be clearly defined and standardized to provide optimal working conditions. In our study using the BIRD I device, we defined our standard experimental conditions as a test frequency of 100 kHz and the position of the reference electrodes of at least 10 cm from the test electrodes. Our device has demonstrated potential for use in quantifying the degree of electrical interconnection between any two surface-defined test meridian or nonmeridian segments. Issues arising from use of this device and the measurement Horton and van Ravenswaay technique were also presented.

To evaluate the prevalence and risk factors of urge urinary incontinence (UUI) in Chinese adult women. A cross-sectional study using the multistaged random sampling method. Twenty thousand Chinese women aged ≥20 years were interviewed. Of the women aged 20–99 years, the prevalence of UUI was 2.6%, which increased with age. Age, waist circumstance, constipation, chronic pelvic pain, history of gynecological diseases, and menopausal status were independent risk factors of UUI. Women aged 60 or above were 2.329 times more likely to suffer UUI as compared to women aged 20–40. Women in perimenopausal or postmenopausal status were, respectively, 1.766 or 2.285 times more likely to suffer UUI as compared to women in normal menstruation. However, parity and mode of delivery were not risk factors. The prevalence of UUI is 2.6% among Chinese adult women. Age is a major independent risk factor of UUI.

Study Objective To assess the appearance of the endometrial cavity after microwave endometrial ablation. Design Prospective observational study. Setting GuangDong Women's and Children's Hospital, GuangDong, China. Patients A total of 349 patients who underwent microwave endometrial ablation from January 2000 through August 2008 were followed up for 1 month to 8 years. At follow-up in 2007 and 2008, patients were advised of this clinical study and were randomly selected for participation if they agreed to undergo outpatient hysteroscopy to assess the uterine cavity during follow-up visits. Fifty three patients (median [range] age, 43.1 [33–53] years) were recruited into the study at the time of endometrial ablation. Intervention Outpatient hysteroscopy. Main Results Within the first 3 months after ablation, outpatient hysteroscopy revealed varying amounts of necrotic tissue from the endometrium and superficial myometrium of the uterus. Six months postablation, a granulomatous reaction and fibrosis were present. A fibrotic cavity was also evident, and menstrual flow was reduced or had ceased. One year after ablation, hysteroscopy demonstrated a fibrotic cavity with myofibrous scars. Most patients developed amenorrhea at this time. Two years or more postablation, a second hysteroscopy demonstrated various types of intrauterine adhesions in 28 of the 53 women (52.8%). A cervical adhesion was observed in 1 patient (1.9%), focal adhesions in the fundal area in 12 (22.6%), a narrowed and scarred uterine cavity with bilateral stenotic tubal ostia in 11 (20.7%), and complete obliteration of the cavity in 4 (7.5%). Of these 28 women, 22 had amenorrhea, 3 had vaginal spotting during menstruation, and 2 had hypomenorrhea. Of those without intrauterine adhesions, only 5 had amenorrhea, 10 had vaginal spotting, and 8 had hypomenorrhea. Conclusion The hysteroscopic appearance of the uterine cavity after microwave endometrial ablation varies considerably. In this study, the menstrual outcome was correlated with postablation uterine cavity appearance.

Objectives To determine the prevalence and risk factors for mixed urinary incontinence (MUI) among Chinese women. Method In this cross-sectional survey study we analyzed the answers to a modified Bristol Female Lower Urinary Tract Symptoms questionnaire provided by 19 024 women older than 20 years and from 6 regions in China. Results The overall prevalence of MUI was 9.4%. The prevalence of MUI increased with age and reached 24.1% among women older than 70 years. Multivariable logistic regression analysis revealed that age, vaginal delivery, chronic constipation, pelvic organ prolapse, chronic pelvic pain, respiratory system disease, menstrual disorder, urinary system disease, alcohol consumption, pelvic surgery, obesity, and a low educational level were independent risk factors for MUI. Conclusion We found age, vaginal delivery, and chronic constipation to be the main risk factors for MUI among adult women in China.

This was a review of 512 consecutive cases of laparoscopic-assisted vaginal hysterectomy (LAVH) for benign gynecologic conditions with the Biswas uterovaginal elevator (BUVE) from February 2003 through June 2008. A single operator, using the BUVE and a standard surgical protocol, performed all hysterectomies. Variables analysis included patient demographics, operative times, uterine weight, hospital stay, intraoperative blood loss, and intraoperative and postoperative complications. LAVH was successfully performed for all patients. The median operative time was 62 [corrected] minutes, range 35 to 250 minutes. The median uterine weight was 231 [corrected] g (range 43-1690 g). The median estimated blood loss was 100 [corrected] mL (range 5-1600 mL). The median length of hospital stay was 1 [corrected] days (range 1-6 days). [corrected] No case sustained injury to the ureter or major vessels or required conversion. LAVH with the BUVE eliminates the need for laparotomy in performing hysterectomies for benign gynecologic disorders. The BUVE can achieve a full range of uterine manipulation. It allows safe and easy dissection of the bladder and precise colpotomy through simultaneous uterine elevation and delineation of vaginal fornices. Prevention of ureteric injury is made possible by moving the surgical field away from the ureter. The technique described can be used to handle a wide variety of diseases and situations and has been shown to be safe, fast, easy to learn, and reproducible and carries few complications.

Modern road safety management programs are required to meet a number of objectives within the overall goal of reducing accidents on the road network. One of these objectives is the identification of hazardous locations through network screening. Often screening is focused on specific accident types to be mitigated by specific programs, for example, red light cameras for reducing right-angle accidents at signalized intersections. Recent methods developed for network screening utilize safety performance functions and the empirical Bayes methodology to overcome limitations in existing methods such as ignoring regression to the mean in using accident counts or rates as a ranking measure. These newer methods often are referred to as screening for the potential for safety improvement (PSI). In one version of the PSI method, sites are ranked according to their expected accident frequency; in another, sites are ranked by the expected excess frequency measured as the difference between the expected accident frequency and that expected at similar sites. This study focuses on a relatively untested method that screens for high proportions of specific accident types by using estimates of the probability that a site's observed proportion of an accident type is truly above a given critical proportion. The impacts on the method of selection for the critical proportion are examined and the efficiency of this method is evaluated by comparing its application with that of the two PSI methods for a data set of stop-controlled intersections. Results indicate that screening for high proportions may be a reasonable alternative where PSI-type approaches are not possible.

The clinical awareness of Caesarean scar defect (CSD) as a cause of abnormal uterine bleeding and adverse obstetrical outcome is still lacking among gynaecologists and their patients. Patients with CSD are mostly asymptomatic, though the lesion may be associated with symptoms like abnormal uterine bleeding, pelvic pain, infertility, and adverse pregnancy outcome. This paper is to report two patients with incidental findings of CSD on ultrasound scanning and MRI and to discuss on their presentations, investigations, and dilemma on treatment options of this condition.

This study identified the influences of neonatal and maternal factors on premature birth and low birth weight in New South Wales, Australia. Bivariate and multivariate analyses were used to explore the association of selected neonatal and maternal characteristics with premature birth and low birth weight. The findings of this study showed that premature birth and low birth weight rate significantly varied by infant sex, maternal age, marital status, Aboriginality, parity, maternal smoking behaviour during pregnancy and maternal hypertension. First-born infants, and infants born to mothers aged less than 20 years, or who were single, separated/divorced, Aboriginal or who smoked during the pregnancy, were at increased risk of being premature or of low birth weight. This study also found that risk factors for premature births and low birth weight were similar in both singleton and multiple births. Gestational age was confirmed to be the single most important risk factor for low birth weight. The findings of this study suggest that in order to reduce the incidence of low birth weight and premature births, health improvement strategies should focus on antismoking campaigns during pregnancy and other healthcare programmes targeted at the socially disadvantaged populations identified in the study.

A retrospective review of women undergoing hysterectomy between May 1998 and April 2000 was performed. Multiple logistic regression analysis was used to identify factors influencing the choice of hysterectomy performed. Two independent factors, the surgeons' expertise and the concomitant adnexal surgery, had a strong influence on the decision-making process regarding type of hysterectomy Generalist gynaecologists tended to perform either an abdominal hysterectomy (AH) or a vaginal hysterectomy (VH) while non-generalist gynaecologists were more likely to perform laparoscopic hysterectomy (LH). Patients undergoing a hysterectomy along with adnexal surgery had a far greater chance of undergoing either an AH or a LH as opposed to a VH. In addition, patients who had bigger uterus were more likely to undergo an AH versus a VH as compared to those with a small uterus. Patients aged 50 or older had more chance of undergoing a VH than a LH.

Objective To analyze the clinical presentation of perineal endometriosis and evaluate its treatment. Methods Clinical data were analyzed from the records of 36 patients with perineal endometriosis who were operated on between 1983 and 2007 at Peking Union Medical College Hospital, and followed up for 0.5 to 14 years. Results The incidence of perineal endometriosis was 0.31% among the women with endometriosis treated surgically at the hospital. The latent period was between 4 months and 13 years. All patients had cyclical and painful lesions. Of the 36 patients, 5 (13.9%) also suffered from pelvic endometriosis. All patients without anal sphincter involvement were cured after complete surgical excision. In 7 patients who had anal sphincter involvement, disease recurred because of incomplete excision. Conclusion Perineal endometriosis can be diagnosed on the basis of clinical features and surgical excision is the treatment of choice. The recurrence rate of perineal endometriosis is related to sphincter involvement making preoperative evaluation of anal sphincter important.

Objective To assess the usefulness of workshops in basic laparoscopic skills in promoting the use of laparoscopy in gynaecological surgery. Design Prospective observational survey. Setting Department of Obstetrics and Gynaecology, Liverpool Hospital, Sydney, New South Wales and Department of Obstetrics and Gynaecology, Mercy Hospital, Melbourne, Victoria, Australia. Results Between 1993 and 1996 12 laparoscopic workshops have been conducted, with eight participants in each course. Of the participants, 82.5% were male, and 72.3% were over the age of 45 years. Out of 62 respondents to a questionnaire, 60 (96.8%) were performing more laparoscopic procedures after the course, with 38/62 (61.3%) performing more complex procedures. Conclusions Laparoscopic surgery does have a place in gynaecological practice, and laparoscopic workshops are useful for the introduction of laparoscopic techniques to the gynaecologist.

Background Historically, oestrogen and progesterone were each commonly used to save threatened pregnancies. In the 1940s it was postulated that their combined use would be synergistic and thereby led to the rationale of combined therapy for women who risked miscarriage. Objectives To determine the efficacy and safety of combined oestrogen and progesterone therapy to prevent miscarriage. Search methods We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (23 June 2013) CENTRAL (OVID) (The Cochrane Library 2013, Issue 6 of 12), MEDLINE (OVID) (1946 to June Week 2 2013), OLDMEDLINE (1946 to 1965), Embase (1974 to Week 25 2013), Embase Classic (1947 to 1973), CINAHL (1994 to 23 June 2013) and reference lists of retrieved studies. Selection criteria We included randomised controlled trials that assessed the effectiveness of combined oestrogen and progesterone for preventing miscarriage. We included one stratified randomised trial and one quasi-randomised trials. Cluster-randomised trials were eligible for inclusion but none were identified. We excluded studies published only as abstracts. We included studies that compared oestrogen and progesterone versus placebo or no intervention. Data collection and analysis Two review authors independently assessed trials for inclusion and assessed trial quality. Two review authors extracted data. Data were checked for accuracy. Main results Two trials (281 pregnancies and 282 fetuses) met our inclusion criteria. However, the two trials had significant clinical and methodological heterogeneity such that a meta-analysis combining trial data was considered inappropriate. One trial (involving 161 pregnancies) was based on women with a history of diabetes. It showed no statistically significant difference between using combined oestrogen and progestogen and using placebo for all our proposed primary outcomes, namely, miscarriage (risk ratio (RR) 0.95, 95% confidence interval (CI) 0.32 to 2.80), perinatal death (RR 0.94, 95% CI 0.53 to 1.69) and preterm birth (less than 34 weeks of gestation) (RR 0.91, 95% CI 0.80 to 1.04). In terms of this review's secondary outcomes, use of combined oestrogen and progestogen was associated with an increased risk of maternal cancer in the reproductive system (RR 6.65, 95% CI 1.56 to 28.29). However, for the outcome of cancer other than that of the reproductive system in mothers, there was no difference between groups. Similarly, there were no differences between the combined oestrogen and progestogen group versus placebo for other secondary outcomes reported: low birthweight of less than 2500 g, genital abnormalities in the offspring, abnormalities other than genital tract in the offspring, cancer in the reproductive system in the offspring, or cancer other than of the reproductive system in the offspring. The second study was based on pregnant women who had undergone in-vitro fertilisation (IVF). This study showed no difference in the rate of miscarriage between the combined oestrogen and progesterone group and the no treatment group (RR 0.66, 95% CI 0.23 to 1.85). The study did not report on this review's other primary outcomes (perinatal death or rates of preterm birth), nor on any of our proposed secondary outcomes. Authors' conclusions There is an insufficient evidence from randomised controlled trials to assess the use of combined oestrogen and progesterone for preventing miscarriages. We strongly recommend further research in this area.

Detection of human papillomavirus (HPV) was accomplished by utilizing polymerase chain reaction methods on cervical scrapes from a total of 488 Hong Kong Chinese women attending the colposcopy, general, and antenatal clinics. From colposcopy clinic, 10% of normal cervix, 31% of condyloma, 56, 50, and 57% of CIN I, CIN II, and CIN III, respectively, and 88% of squamous cell carcinoma contain HPV. The overall detection rate is 30%. The most prevalent type is 16. Four percent of scrapes from normal cervix of patients attending general gynecology clinic and none from antenatal clinic show HPV. The detection rate appears to be more related to the types of cervical lesions than to the age of the patients.