Objective To compare the influence of postoperative pelvic floor function after different surgical procedures of hysterectomy. Methods A total of 260 patients who underwent hysterectomy in Renmin hospital of Wuhan University from January 2012 to January 2014 were enrolled in the study, and divided into 5 groups by different surgical procedures, which were total abdominal hysterectomy (A-TH;46 cases), total laparoscopic hysterectomy (L-TH;59 cases), total vaginal hysterectomy (V-TH;42 cases), abdominal intrafascial hysterectomy (A-CISH;78 cases), laparoscopic intrafascial hysterectomy (L-CISH;35 cases). Pelvic examination, pelvic organ prolapse quantitation (POP-Q), test of pelvic muscle strength, pelvic floor distress inventory-short form 20 (PFDI-20) and the female sexual function index (FSFI) questionnaire were measured after 6 months and 12 months. Results The differences of pelvic organ prolapse incidence after 6 months, A-TH and A-CISH [7%(3/46) versus 3%(2/78)], A-TH and L-CISH [7%(3/46) versus 3% (1/35)] were statistically significance (all P＜0.05).POP-Q grade after 6 months between A-TH and A-CISH was statistically different in degree (P＜0.05). The differences of incidence of abnormal pelvic floor muscle fatigue after 6 months of A-TH and A-CISH [59% (27/46) versus 29% (23/78)], A-TH and L-CISH [59%(27/46) versus 26%(9/35)] were statistically significant (all P＜0.05), after 12 months the difference of L-TH and A-CISH [61% (36/59) versus 29%(23/78)] was statistically different (P＜0.05). The differences of incidence of abnormal pelvic floor muscle strength after 6 months of L-TH and A-CISH [53%(31/59) verus 24%(19/78)], V-TH and A-CISH [60%(25/42) verus 24%(19/78)], V-TH and L-CISH [60%(25/42) verus 23%(8/35)] were statistically significant (all P＜0.05);after 12 months the difference of V-TH and A-CISH [57% (24/42) versus 26% (20/78)] was statistically significant (P＜0.05). Stress urinary incontinence, abnormal bowel movements after 6 months and 12 months were no significant difference between groups (all P＞0.05), PFDI-20 total score was not statistically significant (P＞0.05). FSFI total score after 6 months and 12 months in A-TH and A-CISH, L-TH and A-CISH, A-CISH and L-CISH were statistically significant (all P＜0.05). Conclusion The influences of different surgical procedures to pelvic floor function are no statistical difference; as to the surgical resection of hysterectomy, intrafascia hysterectomy compared with extrafascia hysterectomy, the former is more helpful to the protection of the structure and function of the pelvic floor.

Objective:To analyze the association between thrombocytopenia and clinical manifestations in patients with antiphospholipid syndrome (APS), and the significance of adding thrombocytopenia to the classification criteria of APS.Methods:One hundred and sixty one APS patients admitted to Peking University People's Hospital from January 2003 to August 2017 were retrospectively analyzed. Clinical and laboratory data were compared between patients with and without thrombocytopenia. Chi-square test, Fisher's exact test and t test were used for statistical analysis. Results:Among 161 APS patients, 48 patients (29.8%) were primary APS and 113 patients (70.2%) were secondary APS. Ninety-one patients (56.5%) experienced thrombocytopenia, while 62 patients (38.5%) had thrombocytopenia as the initial symptom. Among primary APS patients, compared with patients without thrombocytopenia, the prevalence of thrombosis was significantly lower in patients with thrombocytopenia (40.0% vs 69.6%, χ2=4.218, P=0.040), especially venous thrombosis (20.0% vs 47.8%, χ2=4.174, P=0.041). Among secondary APS patients, compared with patients without thrombocyt-openia, the prevalence of thrombosis, arterial thrombosis (21.2% vs 42.6%, χ2=5.944, P=0.015) and venous thrombosis (22.7% vs 51.1%, χ2=9.753, P=0.002) was significantly lower in patients with thrombocytopenia (43.9% vs 80.9%, χ2=15.496, P<0.01). As for laboratory findings, primary APS patients with thrombocytopenia showed a higher proportion of positive aCL findings (80.0% vs 52.2%, χ2=4.174, P=0.041), while secondary APS patients with thrombocytopenia experienced more leukopenia (25.8% vs 10.6%, χ2=4.002, P=0.045), lower complement C3 levels (78.7% vs 44.4%, χ2=13.205, P<0.01) and complement C4 levels (74.6% vs 46.7%, χ2=8.485, P=0.004). The proportion of patients fulfilling 1988, 1989, 1999 and 2006 APS classification criteria in our cohort was 88.2%, 87.0%, 64.0% and 70.8%, respectively. Inclusion of thrombocytopenia into 2006 criteria improved the proportion to 96.3%. Conclusion:The prevalence of thrombosis in APS patients with thrombocytopenia is significantly low. Thrombocytopenia is an important clinical manifestation of APS which can improve the diagnostic accuracy of APS.

Nonalcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver dysfunction and has complex pathogenesis and progression. With in-depth studies in recent years, the theory of “two hits” has gradually been replaced by the theory of “multiple hits”. The theory of “multiple hits” including the neuroendocrine immune inflammatory network suggests that various factors participate in the progression of NAFLD, such as insulin resistance, adipose tissue dysfunction, mitochondrial dysfunction, endoplasmic reticulum stress, inflammatory activation, fatty acids, gut microbiota, iron overload, dietary factors, genetic factors, and epigenetic factors. With reference to the research advances in recent years, this article reviews the pathogenesis of NAFLD from the aspects of genetic and epigenetic factors, gut microbiota, intrahepatic immune cells, and aquaporin.

PURPOSE: Cathepsin K is a potent collagenase implicated in human and animal atherosclerosis-based vascular remodeling. This study examined the hypothesis that serum CatK is associated with the prevalence of coronary artery disease (CAD). MATERIALS AND METHODS: Between January 2011 and December 2012, 256 consecutive subjects were enrolled from among patients who underwent coronary angiography and percutaneous coronary intervention treatment. A total of 129 age-matched subjects served as controls. RESULTS: The subjects' serum cathepsin K and high sensitive C-reactive protein (hs-CRP) and high-density lipoprotein cholesterol were measured. The patients with CAD had significantly higher serum cathepsin K levels compared to the controls (130.8+/-25.5 ng/mL vs. 86.9+/-25.5 ng/mL, p<0.001), and the patients with acute coronary syndrome had significantly higher serum cathepsin K levels compared to those with stable angina pectoris (137.1+/-26.9 ng/mL vs. 102.6+/-12.9 ng/mL, p<0.001). A linear regression analysis showed that overall, the cathepsin K levels were inversely correlated with the high-density lipoprotein levels (r=-0.29, p<0.01) and positively with hs-CRP levels (r=0.32, p<0.01). Multiple logistic regression analyses shows that cathepsin K levels were independent predictors of CAD (odds ratio, 1.76; 95% confidence interval, 1.12 to 1.56; p<0.01). CONCLUSION: These data indicated that elevated levels of cathepsin K are closely associated with the presence of CAD and that circulating cathepsin K serves a useful biomarker for CAD.
Aged ; Biological Markers/blood ; C-Reactive Protein/metabolism ; Cathepsin K/*blood ; Coronary Artery Disease/*blood/metabolism ; Female ; Humans ; Male ; Middle Aged

PURPOSE: Cathepsin K is a potent collagenase implicated in human and animal atherosclerosis-based vascular remodeling. This study examined the hypothesis that serum CatK is associated with the prevalence of coronary artery disease (CAD). MATERIALS AND METHODS: Between January 2011 and December 2012, 256 consecutive subjects were enrolled from among patients who underwent coronary angiography and percutaneous coronary intervention treatment. A total of 129 age-matched subjects served as controls. RESULTS: The subjects' serum cathepsin K and high sensitive C-reactive protein (hs-CRP) and high-density lipoprotein cholesterol were measured. The patients with CAD had significantly higher serum cathepsin K levels compared to the controls (130.8+/-25.5 ng/mL vs. 86.9+/-25.5 ng/mL, p<0.001), and the patients with acute coronary syndrome had significantly higher serum cathepsin K levels compared to those with stable angina pectoris (137.1+/-26.9 ng/mL vs. 102.6+/-12.9 ng/mL, p<0.001). A linear regression analysis showed that overall, the cathepsin K levels were inversely correlated with the high-density lipoprotein levels (r=-0.29, p<0.01) and positively with hs-CRP levels (r=0.32, p<0.01). Multiple logistic regression analyses shows that cathepsin K levels were independent predictors of CAD (odds ratio, 1.76; 95% confidence interval, 1.12 to 1.56; p<0.01). CONCLUSION: These data indicated that elevated levels of cathepsin K are closely associated with the presence of CAD and that circulating cathepsin K serves a useful biomarker for CAD.
Aged ; Biological Markers/blood ; C-Reactive Protein/metabolism ; Cathepsin K/*blood ; Coronary Artery Disease/*blood/metabolism ; Female ; Humans ; Male ; Middle Aged