Imperforate hymen (IH) is an uncommon congenital anomaly of the female genital tract, with the hymen completely obstructing the vaginal opening. Despite the simple diagnosis and treatment of IH, missed or delayed diagnosis is often a clinical problem owing to its low incidence, nonspecific symptoms, or insufficient physical examination. The aim of this study is to identify the characteristics, clinical presentations, treatment modalities, and outcomes of imperforate hymen patients. In this study, a literature search of PubMed databases was performed for sources published up to 3 July 2018 for English-language studies with the term “imperforate hymen”. The literature review identified 251 citations and 155 articles (143 case reports, 12 case series) containing 253 patients who were finally included (two papers were not written in English). Among 236 postnatal patients, the mean age of the patients was 10.7 ± 4.7 years. Abdominal pain (54.2%), urinary retention (20.3%), abnormal menstruation (14.0%), dysuria (9.7%), increased urinary frequency (5.1%), severe presentation of renal failure (n = 5, 2.1%), and urinary tract infection (n = 1, 0.4%) were presented. Most patients diagnosed with the condition underwent surgical treatment (83.5%), most of whom were treated via a hymenotomy (35.2%) and hymenectomy (36.4%), and the use of prophylactic antibiotics were only used in 7 patients. There were no differences in outcomes between two surgical methods. In addition, 141 (59.7%) patients showed improvement and 5 deceased patients were not related to IH or the operation itself; Complications, such as vaginal adhesion, were only noted in 6.6% of patients. In addition, among 17 cases of newborns with a diagnosis of IH before birth, hymenectomy (n = 5, 29.4%) and hymenotomy (n = 9, 52.9%) were the main treatment modalities and showed improved prognosis in 52.9% of newborns. Because IH diagnosis is easy and postsurgical prognosis is good, clinicians should carefully examine every female patient at birth. IH should be considered regarding adolescent girls with abdominal pain, lower back pain, or urinary retention, and perform appropriate physical examinations of the genital introitus. In addition, accurate diagnosis as IH, not misdiagnosing as vaginal septum or agenesis, is important to prevent severe complications such as stricture and ascending infection.

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Chemical modification of titanium/titanium oxide (Ti/TiO 2 ) substrates has recently gained a great deal of attention because of the applications of Ti/TiO 2 -based materials to biomedical areas. The reported modification methods generally involve passive coating of Ti/TiO 2 substrates with protein-resistant materials, and poly(ethylene glycol) (PEG) has proven advantageous for bestowing a nonbiofouling property on the surface of Ti/TiO 2 . However, the wider applications of Ti/TiO 2 -based materials to biomedical areas will require the introduction of biologically active moieties onto Ti/TiO 2 , in addition to nonbiofouling property. In this work, we therefore utilized surface-initiated polymerization to coat the Ti/TiO 2 substrates with polymers presenting the nonbiofouling PEG moiety and subsequently conjugated biologically active compounds to the PEG-presenting, polymeric films. Specifically, a Ti/TiO 2 surface was chemically modified to present an initiator for atom transfer radical polymerization, and poly(ethylene glycol) methacrylate (PEGMA) was polymerized from the surface. After activation of hydroxyl groups of poly(PEGMA) (pPEGMA) with N,N'-disuccinimidyl carbonate, biotin, a model compound, was conjugated to the pPEGMA films. The reactions were confirmed by infrared spectroscopy, X-ray photoelectron spectroscopy, contact angle goniometry, and ellipsometry. The biospecific binding of target proteins was also utilized to generate micropatterns of proteins on the Ti/TiO 2 surface.

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