Volume 104 · Issue 39 · 2024

Chronic endometritis (CE) is an important factor leading to decreased endometrial receptivity, infertility, and repeated pregnancy loss; endometrial immune dysfunction, abnormal microbial flora, inflammatory status, and other factors play important roles in the occurrence and development of CE. Meanwhile, these factors are closely related to the pathophysiological mechanisms of common diseases that cause infertility, such as endometriosis, polycystic ovary syndrome, tubal diseases, and endometrial polyps. Through further development of high-quality prospective clinical research, microbiome and immunomics of CE and endometriosis,polycystic ovary syndrome and other diseases, to provide a new therapeutic idea for the treatment of refractory CE. In the course of clinical practice, the effective integration of the diagnosis and treatment principles of CE concomitant diseases in the treatment of CE is expected to provide a new choice for preventing the recurrence of CE.

Chronic endometritis (CE) is a persistent inflammation of the endometrium caused by microbial infection, which is characterized by the infiltration of plasma cells into the endometrial stromal area. CE emerges as a critical determinant in the etiology of female infertility and is closely associated with adverse pregnancy outcomes, such as recurrent spontaneous abortion and repeated implantation failure, imposing a heavy burden on patients and their families. However, current understanding of CE-induced infertility remains superficial, leading to delays and inconsistent approaches in the diagnosis and treatment of the condition. Emphasizing the diagnosis and treatment of CE can help improve women′s reproductive health, alleviate the economic and psychological pressures of patients and their families, resolve family conflicts and promote family and social harmony. This article provides an in-depth analysis of the diagnostic criteria and current application status of CE, its impact on endometrial receptivity and fallopian tubal function, as well as its interplay with other gynecological disorders. In alignment with clinical practice, we propose suggestions including enhancing the understanding of CE, strengthening publicity and education, standardizing the diagnostic process for CE, exploring the molecular mechanisms of CE and optimizing treatment strategies, in order to improve the comprehensive diagnosis and treatment strategies of CE-induced infertility and make greater contributions to the reproductive health of women in China.

Chronic endometritis (CE) refers to the persistent inflammation of endometrium and is closely associated with infertility. Recurrent pregnancy loss (RPL), which has complex etiological factors, is two or more pregnancy loss of a couple before 20 weeks. However, CE is found in approximately 30% RPL patients, indicating that the endometrial immune microenvironment disorder caused by CE may play important role in RPL. Therefore, we should pay high attention and give CE screening to the RPL patients. Due to the inconsistent diagnostic criteria of CE, the relationship between RPL and CE remains controversial. Antibiotic is the primary treatment of CE. Using the higher CE diagnosis value can ensure effective treatment to RPL patient, and avoid the abuse of antibiotic. The effective treatment of CE can improve the pregnant outcomes of RPL patient.

Scoliosis is a complex three-dimensional deformity of the spine that affects the growth of the spine in adolescent, leading to a heavy burden on families and society. According to the guidelines for the treatment of scoliosis, most adolescent idiopathic scoliosis (AIS) requires rehabilitative intervention. So far there has been a lack of scientific, evidence-based, and standardized rehabilitation assessment and treatment for AIS in China. Therefore, in order to promote the standardization of rehabilitation assessment and treatment for AIS, Chinese Society of Physical Medicine and Rehabilitation organized the domestic experts in multiple disciplines such as rehabilitation medicine, orthopedics, pediatric surgery, radiology, evidence-based medicine, etc., who has conformed to the principles of scientificity, safety, efficacy and advancement to propose the 19 recommendations of 8 categories using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) and Reporting Items for Practice Guidelines in Healthcare (RIGHT). Through the steps of literature search, evaluation, and establishment of direction and intensity of recommendation opinions, 19 recommendations were formed, involving AIS screening, assessment and treatment.

To compare the postoperative analgesic efficacy of ultrasound-guided infraspinatus-teres minor interfascial block and interscalene block in shoulder arthroscopic surgery.

A total of 74 patients undergoing shoulder arthroscopic surgery at the Affiliated Hospital of Jiaxing University from December 2023 to February 2024 were prospectively included, whose age ranged from 18 to 80 years and the American Society of Anesthesiologists (ASA) grade were Ⅰ-Ⅲ. Patients were divided into two groups using block randomization: infraspinatus-teres minor interfascial block group (observation group) and interscalene block group (control group), with 37 cases in each group. In the anesthesia preparation room, all patients received nerve blocks under ultrasound guidance with 20 ml of 0.375% ropivacaine. Patient-controlled intravenous analgesia (PCIA) was administered to all patients following surgery. The primary outcome was the area under the curve (AUC) of the numeric rating scale (NRS) for pain within 24 hours postoperatively. Secondary outcome measures included the highest NRS score within 48 hours postoperatively, the amount of sufentanil used via PCIA within 48 hours postoperatively, the incidence of rescue analgesia and rebound pain, QoR-40 scores, and the rate of postoperative nausea and vomiting within 24 hours. The non-inferiority margin for the AUC of NRS scores between the two types of regional nerve blocks was set at "2.6".

A total of 35 patients were included in the observation group [17 males, 18 females, aged (58.1±9.1) years], and 36 patients were included in the control group [12 males, 24 females, aged (57.0±9.8) years]. The AUC of the NRS scores at rest within 24 hours post-operation was 51.7±10.9 in the observation group and 62.6±13.6 in the control group. The difference in AUC between the two groups was -10.9 (95%CI:-16.8--5.1), with the upper limit of the 95%CI falling below the predefined non-inferiority margin of "2.6" (non-inferiority P<0.001). The highest NRS score [M (Q₁, Q₃)] within 48 hours post-surgery was 3 (3, 4) in the control group, which was significantly higher than the observation group′s score of 2 (2, 3) (P<0.001). During the postoperative period of 0-12 hours, the observation group received a median dose of 12 (10, 14) μg of sufentanil, which was significantly higher than the control group′s dose of 8 (6, 10) μg (P<0.001). During the postoperative period of 12-24 hours, the observation group received a median dose of 8 (8, 10) μg of sufentanil, which was significantly lower than the control group′s median dose of 12 (10, 14) μg (P<0.001). During the postoperative period of 24-48 hours, there was no statistically significant difference in the dose of sufentanil between the two groups of patients (P=0.548). In the observation group, the incidence of rescue analgesia within 48 hours postoperatively was 0 (0/35), which was lower than that of the control group at 22.2% (8/36) (P=0.010). The occurrence of rebound pain in the observation group was 0 (0/35), and the control group was 11.1% (4/36), no statistically significant difference was found between two groups (P=0.130). In the observation group, the QoR-40 score within 24 hours post-operation was 180.2±3.2, which was higher than the control group′s score of 175.8±4.7 (P<0.001). There was no statistically significant difference in the incidence of postoperative nausea and vomiting within 24 hours between the two groups (P=0.372).

Ultrasound-guided infraspinatus-teres minor interfascial block demonstrates a comparable analgesic effect to interscalene block in shoulder arthroscopic surgery within the first 24 hours postoperatively.

To analyze the clinical efficacy and its influencing factors of vedolizumab (VDZ) in the treatment of ulcerative colitis (UC).

The patients with moderately-to-severely active UC, who underwent VDZ treatment at the Second Affiliated Hospital of Wenzhou Medical University from November 2020 to November 2023 were retrospectively included. Based on whether 5-aminosalicylic acid (5-ASA) was used in combination with VDZ treatment, the patients were divided into combination group (received combination therapy of VDZ and 5-ASA) and monotherapy group (received monotherapy of VDZ). The clinical response rate and biological remission rate were analyzed at week 14. The clinical remission rate and mucosal healing rate were analyzed at week 38. The differences in efficacy of VDZ between the two groups were compared at week 14 and week 38, respectively. Multivariate logistic regression model was applied to analyze the influencing factors of clinical remission rate and mucosal healing rate in UC patients.

A total of 137 patients were included, including 74 males and 63 females, aged 18-76 (44±14) years old; Seventy-six cases in combination group and 61 cases in monotherapy group. At week 14 of VDZ treatment, the clinical response rate and biological remission rate were 79.6% (109/137) and 80.5% (33/41), respectively. At week 38, the clinical remission rate and mucosal healing rate were 78.8% (108/137) and 47.9% (57/119), respectively. There was no significant difference in clinical response rate and biological remission rate between combination group and monotherapy group at week 14 (both P>0.05). The clinical remission rate [85.5% (65/76) vs 70.5% (43/61), P=0.032] and mucosal healing rate [56.5% (39/69) vs 36.0% (18/50), P=0.027] were higher in combination group than those in monotherapy group at week 38. Multivariate logistic regression analysis showed that the combination therapy of VDZ and 5-ASA (OR=2.48, 95%CI: 1.02-6.03) and the clinical response at week 14 (OR=5.05, 95%CI: 1.98-12.85) were influencing factors of clinical remission rate of UC patients at week 38. Moreover, the baseline serum albumin (Alb) level ≥42.5 g/L was the influencing factor for the mucosal healing rate of UC patients at week 38 (OR=4.60, 95%CI: 2.06-10.24).

VDZ is effective in treating UC patients. Both the combination of 5-ASA and the clinical response at week 14 are the influencing factors of the clinical remission rate at week 38. In addition, the baseline serum Alb level ≥42.5 g/L is the influencing factor of the mucosal healing rate at week 38.

To compare the characteristics of high-resolution anorectal manometry (HR-ARM) in children with outlet obstructive constipation (OOC) in different age groups.

Retrospective inclusion of clinical data of functional constipation (FC) patients who underwent HR-ARM examination in the Department of Gastroenterology of Children′s Hospital Affiliated of Zhengzhou University from January 2019 to September 2023 was conducted. The patients were divided into low age group (4 years old≤age<6 years) and high age group (6 years old≤age≤15 years old) according to age. They were divided into OOC group (the pediatric patients with uncoordinated pelvic floor muscle contractions, insufficient rectal thrust during defecation, or insufficient relaxation of anal sphincter muscles during contraction) and non-OOC group based on HR-ARM results. The rectal motility [rectal resting pressure, maximum squeeze pressure (MSP), rectal pressure during force delivery, residual anal pressure, rectal anal pressure gradient], rectal sensory function (initial rectal sensory capacity threshold, initial fecal sensory capacity threshold, defecation distress capacity threshold, and maximum tolerance capacity threshold) and other indicators were compared between OOC group and non-OOC group in 2 age groups, respectively.

A total of 228 children with FC were included, including 146 males and 82 females, with an age [M (Q₁, Q₃)] of 7.5 (6.0, 9.7) years, including 54 in the low age group and 174 in the high age group. There were 131 cases in the OOC group and 97 cases in the non-OOC group. Compared with non OOC children (24 cases), there were no statistically significant differences in rectal resting pressure, anal sphincter resting pressure, MSP, rectal pressure during force delivery, initial rectal sensory capacity threshold, initial fecal sensory capacity threshold, defecation distress capacity threshold, and maximum tolerance capacity threshold among OOC children (30 cases) in the low age group (all P>0.05). In the high age group, the residual anal pressure of the OOC children (101 cases) was higher than that of the non-OOC children (73 cases) [102 (70, 113) vs 41 (24, 58) mmHg (1 mmHg=0.133 kPa), P<0.001], and the rectal anal pressure gradient was lower than that of the non-OOC children [-43 (-55, -23) vs 16 (9, 29) mmHg, P<0.001];The initial fecal sensory capacity threshold of the OOC children was higher than that of the non-OOC children [90 (54, 110) vs 60 (50, 91) ml, P=0.024].

Compared with non-OOC children in the same age group, OOC children aged 6 years and above have higher residual anal pressure and initial fecal sensory capacity threshold, and lower rectal anal pressure gradient. There is no statistically significant differences in the rectal sensory function in children under 6 years old with OOC.

The clinical data of 7 patients with anti-α-amino-3-hydroxy-5-methyl-4- isoxazolepropionic acid receptor (AMPAR) encephalitis admitted to the First Affiliated Hospital of Zhengzhou University from January 2015 to January 2024 were retrospectively collected, and 87 cases with complete literature data were included for summary analysis. Seven casess exhibited limbic encephalitis, including 3 with lung cancer and 1 with thymoma. All cases were treated with glucocorticoids and/or human immunoglobulin. Four cases with concurrent tumors were followed up for 1 to 25 months and all died. Among the 94 patients (7 admitted cases and 87 documented cases), there were 76 cases with tumor (80.9%), including 33 cases of thymoma (43.4%), 23 cases of lung cancer (30.3%), 9 cases of breast cancer (11.8%), and 6 cases of ovarian tumor (7.9%). The tumor was diagnosed in 13 cases (18.8%) before encephalitis, 40 cases (58.0%) within 1 month after encephalitis, 13 cases (18.8%) within 1-6 months, 2 case (2.9%) within 6-12 months, and 1 case (1.4%) after 1 year. Compared to the 18 patients without tumors who were followed up for>1 year, the 76 patients with tumors showed an increase in age and incidence of mental disorders (both P<0.05), while follow-up time and proportion of good prognosis were decreased (both P<0.05). Closely follow-up should be conducted within 1 year after anti-AMPAR encephalitis, especially in the lungs, thymus, breast, and ovaries. The prognosis of patients with tumors is poor, and older age and mental disorders may indicate the occurrence of tumors.

The patient, a 56-year-old male, was seen in the Department of Neurology of Peking Union Medical College Hospital in August 2023 due to dizziness and unstable gait. Physical examination revealed nystagmus, intentional tremor and staggering gait. Auxiliary examination revealed positive anti-metabolic glutamate receptor 1 (mGluR1) antibody in serum and cerebrospinal fluid. During the course of hormone shock, the patient developed chronic orthostatic tremor (tremor frequency<13 Hz), diagnosed as anti-mGluR1 encephalitis. At the beginning of the disease, clonazepam, gabapentin, medopa, debakin, perampanel, almar, trihexyphenidyl, etc. were successively applied to tremor, but the short-term effect was not good. Subsequent treatment with rituximab gradually relieved the tremor with the reduction of hormone dose. The natural progression of anti-mGluR1 encephalitis is not fully defined, but early diagnosis and timely immunotherapy may be important. Chronic orthostatic tremor may be related to autoimmune mechanisms, and the underlying cause should be actively sought.

Chronic endometritis (CE) is a persistent inflammation of the endometrium, which is often closely related to female infertility. At present, the diagnosis of CE is mainly carried out by histopathological examination, hysteroscopy and detection of pathogenic microorganisms. Despite this, there is no unified standard for the diagnosis of CE in the medical field. In recent years, as artificial intelligence (AI) enters a booming stage, AI technology plays an increasingly important role in the diagnosis and management of CE. The combination of AI technology and traditional CE diagnostic methods contributes to the rapid identification of CE features, thus improving the accuracy of diagnosis. In addition, AI technology can also build predictive models based on patient data, assess their risk of CE, and then achieve early intervention. With the continuous progress of technology, AI is expected to play a greater role in the prevention, diagnosis and treatment of CE, bringing better treatment results and quality of life for patients. Combined with the current research results at home and abroad, this paper summarizes the application status and existing problems of AI technology in the diagnosis and treatment of CE, in order to promote the in-depth development of AI in the field of CE.

Chronic endometritis (CE) is a chronic inflammatory disease characterized by infiltration of interstitial plasma cells in the endometrium, often associated with microbial infections. In recent years, the effect of CE on endometrial receptivity has attracted extensive attention in the field of reproductive medicine, particularly in patients with repeated implant failure (RIF). CE has become one of the important causes of RIF by changing the immune environment of the endometrium and reducing the success rate of embryo implantation. Although the current research has revealed the close relationship between CE and RIF, its specific mechanism of action still needs to be further explored. In future studies, unified diagnostic criteria, the development of personalized treatment options, and long-term follow-up of CE and relapse prevention strategies will be key research directions. Furthermore, exploring the molecular mechanisms underlying the effects of CE on endometrial receptivity, particularly its immunomodulatory and inflammation-mediated pathways, will provide important clues for the development of novel therapeutic strategies. This article systematically reviews the immunological basis of CE, diagnostic methods, pathological mechanisms associated with RIF, and current advances in the treatment of CE.

Alzheimer's disease (AD) is characterized by the deposition of beta amyloid (A β) in the brain. Recently, A β monoclonal antibodies have begun to be used in China, bringing hope to AD patients. Amyloid-related imaging abnormality (ARIA) is a common adverse reaction of A β monoclonal antibody therapy. It is an abnormal magnetic resonance manifestation of cerebral vascular origin, which affects the safety of A β monoclonal antibody therapy. At present, the understanding of the clinical, imaging manifestations and risk factors of ARIA is mainly based on the clinical trials of A β monoclonal antibody, but the mechanism of ARIA is unknown, and the monitoring and treatment methods have not yet reached a consensus. This review summarizes the mechanism, risk factors, clinical and imaging manifestations of ARIA, and discusses the methods of monitoring and dealing with ARIA, which provides reference for clinical practice.