Infertility in developing countries is important but neglected, while the issues of population growth control have been paid much attention. Female infertility rates in African countries were about 30 percent, which were three times higher than those of industrialized countries. It was reported that the most common cause of infertility was tubal dysfunction due to sexually transmitted infections, unhygienic delivery management, and unsafe abortion. The second common causes were male factors, which had been underestimated in developing countries. Thus, women were always blamed and often abused by their husbands and in-laws. Furthermore, infertile couples suffered from social discrimination and economic disadvantages.
 Infertilities were often treated without appropriate examinations of both husbands and wives. Inexpensive treatments were commonly applied: e.g., treatment of sexually transmitted infections, encouraging timing intercourse, hormonal therapies. Assisted reproductive technology (ART) would be effective in developing countries where main causes of infertility were tubal dysfunction and male factors. ART has been performed in urban areas in some developing countries. However, it is difficult to promote ART in developing countries, because of high costs and lack of sufficient technical and ethical regulations. To decrease the burden of infertility in developing countries, first, both developing and industrialized countries have to recognize the significance of the issue. Then, it is needed to evaluate accurate rates of infertility, causes of infertility, and effectiveness of current treatment, so that the countries could develop prioritized strategies and interventions.
 Infertility rates could be decreased with relatively low cost through building a system of proper diagnosis and treatment. International assistance might be required to negotiate the drug prices and to establish technical and ethical review mechanisms, which are the prerequisites of promoting ART. It is also important to provide people with knowledge and information regarding infertility, their causes and treatment.

Polysaccharide sulfate (PSS) is a new type of antiatherosclerotic medicine for its effects of anticoagulation, anti-thrombosis and modulation of dyslipidemia. However, it is still uncertain whether PSS could modulate the diabetic dyslipidemia or not. Here, the rat model of diabetic dyslipidemia was developed and the effects of PSS on glucose and lipid levels were investigated in this animal model. Wistar rats were iv injected with streptozotocin 20 mg·kg-1 after feeding with high fat diet for one and a half month. Then, rats received orally PSS (30, 90, and 180 mg·kg-1) for 1 month. After oral treatment with PSS (90 and 180 mg·kg-1) for 1 month, the levels of triglyceride (TG), total cholesterol (TC), low density lipoprotein-cholesterol (LDL-C) were significantly reduced and the level of high density lipoprotein-cholesterol (HDL-C) increased, compared with diabetic control rats. Moreover, PSS (30, 90, and 180 mg·kg-1) had a tendency to reduce glucose and insulin levels, and significantly increased insulin sensitivity index. Our results suggest that PSS could improve insulin sensitivity and relieve dyslipidemia in diabetic dyslipidemic rats.

We report 2 patients with unilateral pulmonary edema after heart surgery who were successfully treated using venovenous extracorporeal membrane oxygenation (VV ECMO). Case 1 : A 35-year-old woman presented with dyspnea. Echocardiography showed severe mitral regurgitation (MR) and tricuspid regurgitation (TR) and therefore, mitral valve plasty (MVP) and tricuspid annular plasty (TAP) were performed via right thoracotomy. After weaning from cardiopulmonary bypass, respiratory failure occurred with expectoration of foamy sputum and it was difficult to maintain oxygenation. Therefore, we performed VV ECMO to maintain oxygenation. A chest X-ray film after surgery showed ipsilateral pulmonary edema. After weaning from VV ECMO, deep venous thrombosis occurred and therefore we inserted an IVC filter. Case 2 : A 67-year-old man, who had previously received aortic valve replacement experienced dyspnea and visited our hospital. Echocardiography showed an aortic root abscess, and therefore Bentall operation was performed. After weaning from cardiopulmonary bypass, oxygenation was difficult to maintain, and therefore we performed VV ECMO. A chest X-ray film post operatively showed right ipsilateral pulmonary edema. The patient was weaned from VV ECMO 5 days post operatively and was discharged 60 days post operatively. We believe that VV ECMO can be beneficial for patients with respiratory failure after heart surgery, but complications related to this approach such as DVT should also be considered.

Objective: To determine the association between health-related quality of life (HRQOL) and neck pain, kinesiophobia, and modalities of physical activity in individuals with postoperative degenerative cervical myelopathy and radiculopathy (DCM/R) because postoperative pain after cervical spine surgery is likely to persist, causing kinesiophobia and avoidance of physical activity. Methods: A questionnaire was distributed to 280 individuals with DCM/R. The questionnaire comprised the following four items: HRQOL (EuroQol 5-dimensions 5-level), neck pain (numerical rating scale [NRS]), kinesiophobia (11-item Tampa Scale for Kinesiophobia [TSK-11]), and physical activity (paid work, light exercise, walking, strength training, and gardening). Hierarchical multiple regression analysis was performed using the NRS, TSK-11, and physical activity as independent variables. Results: In total, 126 individuals provided analyzable responses (45.0%). After including the NRS score as an independent variable to the multiple regression equation for participants’ background, the independent rate of the regression equation significantly improved by only 4.1% (R2=0.153). The addition of the TSK-11 score significantly improved this effect by 11.1% (R2=0.264). Finally, the addition of physical activity also significantly improved the explanatory rate by 9.9% (R2=0.363). Conclusion Neck pain, kinesiophobia, and physical activity (specifically paid work and walking) were independently associated with HRQOL in individuals with postoperative DCM/R.

Background : The effects of rehabilitation on hemodialysis patients are unknown. We assessed the effects and investigated the association between rehabilitation treatment effects and all-cause mortality. Methods : This prospective cohort study included 120 patients on maintenance hemodialysis. ADL was assessed using the Functional Independence Measure (FIM) score (total points, 126), which comprises 13 motor items (total points, 91) and five cognitive items (total points, 35). A survival curve was constructed using the Kaplan-Meier analysis and stratified into an increase or no-increase of the FIM score. Multivariable logistic regression analysis was used to determine factors associated with the effects of rehabilitation. Discriminative sensitivity of FIM cognitive items for an increase in total FIM was estimated using the area under the receiver operating characteristic (AuROC) curve. Results : The average total FIM score increased from 64.2±3.6 to 75.8±3.0, and the increase in FIM motor and cognitive items was 11.0±1.3 and 0.5±0.6, respectively. The cumulative survival rate within 2.5 years was significantly higher in the FIM increase group than that in the FIM no-increase group. FIM cognitive items and anemia were significantly associated with rehabilitation effects, and AuROC showed that a cutoff of 34 points in cognitive FIM had moderate discriminative sensitivity for a total FIM increase (AuC, 0.719 ; p<0.0008). Conclusions : Rehabilitating hemodialysis patients improved their FIM score (particularly the motor items), and a higher FIM score resulted in a better prognosis. The effectiveness of rehabilitation depends on maintaining a perfect FIM cognitive score.

Polysaccharide sulfate (PSS) is a new type of antiatherosclerotic medicine for its effects of anticoagulation, anti-thrombosis and modulation of dyslipidemia. However, it is still uncertain whether PSS could modulate the diabetic dyslipidemia or not. Here, the rat model of diabetic dyslipidemia was developed and the effects of PSS on glucose and lipid levels were investigated in this animal model. Wistar rats were iv injected with streptozotocin 20 mg x kg(-1) after feeding with high fat diet for one and a half month. Then, rats received orally PSS (30, 90, and 180 mg x kg(-1)) for 1 month. After oral treatment with PSS (90 and 180 mg x kg(-1)) for 1 month, the levels of triglyceride (TG), total cholesterol (TC), low density lipoprotein-cholesterol (LDL-C) were significantly reduced and the level of high density lipoprotein-cholesterol (HDL-C) increased, compared with diabetic control rats. Moreover, PSS (30, 90, and 180 mg x kg(-1)) had a tendency to reduce glucose and insulin levels, and significantly increased insulin sensitivity index. Our results suggest that PSS could improve insulin sensitivity and relieve dyslipidemia in diabetic dyslipidemic rats.
Administration, Oral ; Animals ; Blood Glucose ; metabolism ; Cholesterol, HDL ; blood ; Cholesterol, LDL ; blood ; Diabetes Mellitus, Experimental ; blood ; chemically induced ; complications ; Dyslipidemias ; blood ; etiology ; Hypolipidemic Agents ; administration & dosage ; pharmacology ; Insulin ; blood ; Insulin Resistance ; Male ; Polysaccharides ; administration & dosage ; pharmacology ; Random Allocation ; Rats ; Rats, Wistar ; Streptozocin ; Sulfates ; administration & dosage ; pharmacology ; Triglycerides ; blood

Introduction: As the average life expectancy is increasing, the number of patients aged >100 years who have fragility fractures will increase in the future. In female patients, the incidence of open fractures increases with age.Case Presentation: We present the case of a 102-year-old woman with open tibial and fibular diaphyseal fractures (Gustilo-Anderson classification type IIIb) treated with temporary external fixation, advancement flap, and negative pressure wound therapy in the first-stage surgery and treatment, and open reduction and internal fixation with skin grafting in the second-stage surgery. Open wound and bone healing were attained.Conclusion: Surgery should not be denied on the basis of age alone. Medical evaluation should focus on identifying risk factors, assessing risk in detail, optimizing status, predicting complications, and making the appropriate surgical plan for the patient status. Moreover, in the present case, meticulous postoperative management was the main reason for the successful surgical treatment.

Multiple primary malignant neoplasms (MPMNs) are rarely reported and it is important to give early diagnosis and proper therapy for these patients. Here reported a case of 62-year-old man with concomitant three early stage cancer lesions in upper gastrointestinal tract, all of which were detected by endoscopy. The first one was an IIc-type lesion at angular part of stomach under endoscopy, which was histologically confirmed to be a mucosal well-differentiated adenocarcinoma. The patient underwent a standard radical gastrectomy for the lesion after the failure of endoscopic treatment. The other two neoplasms were observed during follow-up and were indicated as early stage lesions by synthesizing information from endoscopy, endoscopic ultrasonography, computed tomography and biopsy. One displayed as a hyperemic patch (3 cm×4 cm in size) located at the part of esophagus 27 cm away from the incisor teeth and was proved to be moderately differentiated squamous cancer by histopathological examination. The other was an IIc-type lesion (3.0 cm×3.5 cm in size) located at the part of esophagus 36 cm away from the incisor teeth, and the biopsy result showed a poorly differentiated squamous carcinoma. Both the two lesions were treated with radical radiation because the patient refused surgery management. No recurrence of former lesions or occurrence of novel lesions were observed during post-treatment follow-up, suggesting radical radiation might be effective for this patient.
Gastrointestinal Neoplasms ; diagnosis ; Humans ; Male ; Middle Aged ; Neoplasms, Multiple Primary ; diagnosis ; Upper Gastrointestinal Tract ; pathology

Prolonged air leakage is a major cause of morbidity in pneumothorax. When conservative management is not effective, surgery should be performed. However, surgery is not appropriate in patients with low pulmonary function. In these patients, occlusion of the airway with endobronchial blockers may be attempted under bronchoscopy. We treated two patients with prolonged air leakage using endobronchial Watanabe spigots under fibrobronchoscopy.
Bronchoscopy ; Emphysema ; Endoscopy ; Humans ; Pneumothorax ; Pulmonary Emphysema

Prolonged air leakage is a major cause of morbidity in pneumothorax. When conservative management is not effective, surgery should be performed. However, surgery is not appropriate in patients with low pulmonary function. In these patients, occlusion of the airway with endobronchial blockers may be attempted under bronchoscopy. We treated two patients with prolonged air leakage using endobronchial Watanabe spigots under fibrobronchoscopy.
Bronchoscopy ; Emphysema ; Endoscopy ; Humans ; Pneumothorax ; Pulmonary Emphysema