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Study Objective To investigate the relationship between previous ipsilateral salpingectomy and interstitial pregnancy, and report on our experience of laparoscopic cornuostomy for interstitial pregnancy. Design A single-center, retrospective review. Setting A university-based hospital. Patients Patients who had a previous ipsilateral salpingectomy diagnosed with interstitial pregnancy and treated from July 2010 to September 2018. Interventions Laparoscopy or laparotomy as treatment for interstitial pregnancy following ipsilateral salpingectomy. Measurement and Main Results 414 cases of interstitial pregnancy were identified of which 46 (11.1%) were following ipsilateral salpingectomy; 20 of the 46 patients (43.5%) were pregnant by in vitro fertilization and embryo transfer. Ipsilateral salpingectomy was the result of ectopic pregnancy in 40 patients, hydrosalpinx in 5 patients, and torsion of ovarian tumor in 1 patient. The laparoscopic approach was used to treat 78.3% of patients with history of previous salpingectomy. Patients who underwent previous ipsilateral salpingectomy by laparoscopy had a shorter interval from salpingectomy to interstitial pregnancy (24 months vs. 60 months, p=.038) compared with patients who had ipsilateral salpingectomy managed by laparotomy. Laparoscopic cornuostomy was carried out in 38 cases (82.6%); 12 had fetal cardiac activity, 15 had ruptured, and 16 used prophylactic methotrexate (MTX) intraoperatively. Median size of the ectopic mass was 2.5 cm (1.0–5.0 cm). At the time of laparoscopic cornuostomy, more cases of interstitial pregnancies with intact ectopic mass cases were administered prophylactic MTX (81.3% vs. 45.5%, p =.043). Only 1 patient with a ruptured ectopic mass, high preoperative human chorionic gonadotropin levels, and not administered prophylactic MTX experienced persistent ectopic pregnancy (PEP) . Conclusions Patients with history of ipsilateral salpingectomy should be cautioned regarding the possibility of interstitial pregnancy. Laparoscopic cornuostomy appears to be an appropriate treatment for interstitial pregnancy in patients wishing to preserve fertility, and the use of concomitant prophylactic MTX may reduce the risk of PEP, especially in patients with ruptured masses and high human gonadotropin levels.

Nomograms are widely used as predictive tools to predict oncological outcomes intuitively and precisely. The aim of our study was to develop a nomogram for predicting overall survival (OS) of patients with early stage cervical cancer.In this retrospective study, the clinical, pathological, and hematological data and prognosis of 795 cervical cancer patients were investigated. We identified and incorporated independent significant prognostic factors for OS to develop a nomogram. The predictive accuracy and discriminative ability were measured by concordance index.By univariable analysis and subsequent multivariable analysis, we identified body mass index, albumin, platelet, leukocyte, tumor differentiation, and the status of the pelvic lymph node (PLN) (all P0.05) as independent prognostic factors. The concordance index of the nomogram integrating these 6 variables was 0.74. The calibration curves for probability of 3- and 5-year OS also demonstrated ideal agreement between nomogram prediction and actual observation.We developed a novel nomogram that can provide prediction of OS for patients with early stage cervical cancer individually. Furthermore, studies are required to validate whether it can be applied to other cohorts.

Decreased nitrous oxide (NO) levels are crucial factors in severe preeclampsia (sPE), and asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of NO synthetase. Steroid hormones are closely related to the vascular endothelium. This study determined the levels of and correlations between ADMA, estradiol (E2), and progesterone (Pg) in sPE to investigate the roles of these factors in this disease.Sixty-two sPE patients (sPE group) were divided into the sPE1 subgroup (28(+1)-32(+0) weeks of pregnancy), the sPE2 subgroup (32(+1)-36(+0) weeks), and the sPE3 subgroup (36(+1)-40(+0) weeks) and 75 normal pregnant women (NC group) were divided into the NC1 subgroup (28(+1)-32(+0) weeks of gestation), the NC2 subgroup (32(+1)-36(+0) weeks), and the NC3 subgroup (36(+1)-40(+0) weeks). Serum and placental ADMA levels were measured by enzyme-linked immunosorbent assay (ELISA), and serum E2 and Pg concentrations were determined by the chemilumineseent immunoassay (CLIA).ADMA concentrations in both the placenta and the maternal serum were significantly higher in the sPE group (p0.05). Higher ADMA contents were observed in the placenta relative to the maternal serum (p0.05). Serum E2 levels were significantly lower in the sPE group (p0.05). For Pg, the only significant difference was observed between the sPE1 and NC1 subgroups (p0.05). The Pg/E2 ratios in the sPE groups were significantly higher, with a significant high positive correlation between Pg/E2 ratios and serum ADMA levels.Increased serum levels of ADMA in sPE may result from increased secretion from the placenta, and the increased Pg/E2 ratio may play a role in the development of sPE by aggravating ADMA.

Inflammation contributes to development and progression in a variety of cancers, including cervical cancer. We developed a novel cervical cancer systemic inflammation score (CCSIS) based on the preoperative platelet-to-lymphocyte ratio (PLR) and serum albumin levels. A retrospective analysis of clinical data from 795 patients with operable cervical cancer was then conducted to investigate the prognostic value of CCSIS and its association with the patients' clinicopathological features, overall survival (OS), and disease-free survival (DFS). CCSIS was predictive of OS and DFS. High CCSIS was correlated with more advanced FIGO stages, poor tumor differentiation, and the presence of PLN and LVSI. Both albumin levels and the PLR were independent prognostic indicators for operable cervical cancer. The use of the CCSIS could improve risk stratification and traditional clinicopathological analysis in cervical cancer.

To explore the expression of astrocyte elevated gene-1 (AEG-1) in cervical cancer and analyze its correlation with microvascular density (MVD), nuclear factor kappaB (NF-kB p65) and vascular endothelial growth factor (VEGF).Immunohistochemical MaxVision method was adopted to detect the expression level of AEG-1, NF-kB p65 and VEGF in 45 samples of invading cervical cancer and 12 samples of cervicitis from The First Affiliated Hospital of Wenzhou Medical University. Tumor microvascular endothelial marker CD34 combined with Weidner was used to determine the MVD in cervical cancer tissue. The positive expression and staining conditions of AEG-1, NF-kB p65 and VEGF in cervical cancer tissues were observed under a light microscope. Correlations between expression of AEG-1 protein and those of NF-Kb p65 and VEGF, as well as MVD, were analyzed using Pearson correlation.The expression levels of AEG-1 were 0.186±0.043 in cervical cancer and 0.051±0.002 in chronic cervicitis (p0.01). Moreover, expression of AEG-1 was related to vascular invasion and lymphatic metastasis of cervical cancer (p0.01), but not with age of the patients, differentiation degree, tumour size, pathological type and parametrial infiltration (p0.05). Pearson correlation analysis showed that the expression of AEG-1 was linked with NF-kB p65 (r=0.501, p=0.000), VEGF (r=0.718, p=0.000) as well as MVD in cervical cancer tissue (r=0.815, p=0.000).AEG-1 is highly expressed in cervical cancer and promotes angiogenesis, which might be related to the fact that AEG-1 activating the signal pathway of NF-kB could up-regulate the level of VEGF expression.

A 46-year-old woman with Cushing's syndrome secondary to ectopic adrenocorticotropic hormone (ACTH) secretion caused by primary ovarian mature teratoma with carcinoid components was presented in our case. The patient manifested sustained hypercortisolemia without circadian rhythm and a lack of suppression of either low-dose dexamethasone suppression test (LDDST) or high-dose dexamethasone suppression test (HDDST). There was no evidence of a pituitary mass or secretion of other hormones. After careful clinical evaluation, no other tumor masses were found. Resection of the ovarian tumors led to sharp reduction of serum ACTH and cortisol concentrations. Immunohistochemistry showed positivity in CgA, Syn, CK, NSE. To the best of our knowledge, there are rare reports of an ACTH-secreting carcinoid components located in an ovarian mature teratoma, and bilateral ovarian mature teratoma makes it rarer.

The objective of this study was to explore the clinical significance of survivin expression in epithelial ovarian cancer (EOC) and the effect of survivin small hairpin RNA (shRNA) on survivin expression, apoptosis, and chemosensitivity in the human ovarian cancer cell line OVCAR3.A retrospective review of 90 consecutive EOC patients with a median follow-up time of 51 months was conducted. Survivin expression was examined by immunohistochemistry. OVCAR3 cells were transfected in vitro with survivin shRNA. Survivin mRNA expression levels were detected using reverse transcription-polymerase chain reaction. Flow cytometry was applied to determine survivin protein expression levels and cell apoptotic rates. The MTT method was used to examine the effects of survivin shRNA on chemosensitivity in OVCAR3 cells.Positive cytoplasmic expression of survivin was associated with advanced International Federation of Gynecology and Obstetrics (FIGO) stage, nonmucinous type, high grade, and recurrence. Positive survivin expression was also associated with platinum resistance (r = 0.306, P = 0.003). Statistical results indicated that FIGO stage (hazard rate = 1.649, P = 0.047) and cytoplasmic expression of survivin (hazard rate = 1.734, P = 0.010) were independent prognostic factors. Survivin mRNA and protein levels were lower in OVCAR3S (ovarian cancer cells transfected with a survivin recombinant vector) cells at 24 hours after transfection as compared with controls. The flow cytometric analysis revealed that survivin shRNA induced accumulation of cells in the G0/Gl phase, with a decrease in G2/M phase cells following 24 hours of culture as compared with a nontransfected group (P0.01). Furthermore, survivin shRNA increased the sensitivity of OVCAR3 cells to paclitaxel 15-fold (P0.05), whereas it had no significant effect on cisplatin (P0.05).In addition to FIGO stage, cytoplasmic survivin protein expression is an independent molecular marker for predicting EOC prognosis. Sequence-specific shRNA targeting survivin can effectively suppress survivin expression, enhance apoptosis, and increase the sensitivity of ovarian cancer cells to paclitaxel but not to cisplatin.

Objective To determine the efficacy of serum levels of cancer antigen 125 (CA125) and cancer antigen 19-9 (CA19-9), and the neutrophil-to-lymphocyte ratio (NLR) for diagnosis of mature cystic teratoma (MCT) with torsion. Methods A retrospective medical record review was conducted of data for women who had undergone surgery for ovarian MCT at the First Affiliated Hospital of Wenzhou Medical University, China, between January 1, 2008, and January 1, 2015. Patients with torsion and a control group who underwent surgery on the same days were identified. Clinical characteristics and the serum levels of CA125, CA19-9, and the NLR were assessed. Results The serum levels of CA125, CA19-9, and the NLR were higher in the torsion group (n=68) than in the control group (n=120; P≤0.001 for all). Receiver operating characteristic analysis indicated that the area under the curve for the combined use of CA125, CA19-9, and NLR was 0.978 (95% confidence interval 0.954–1.000; P

Ovarian cancer is recognized as one of the worst gynecologic malignancies associated with rapid metastasis and poor overall survival rate. The identified valuable molecular biomarkers criticize importance of timely diagnosis for ovarian cancer. Salusin-β levels are dramatically increased in women with polycystic ovarian syndrome. However, the roles of salusin-β in ovarian cancer have yet to be fully elucidated. A total of 57 paired ovarian cancer specimens and matched adjacent normal tissues were used to measure the salusin-β levels. The prognostic value of salusin-β for tumor progression and survival rate was investigated. The effects of salusin-β on ovarian cancer cell proliferation and epithelial-mesenchymal transition were also explored. The expression of salusin-β was significantly increased in ovarian cancer tissue specimens compared with matched normal adjacent tissue (P

Background Increased platelet has been identified as an independent and unfavorable prognostic indicator in various cancers including cervical cancer. In our study, the prognostic value of preoperative platelet count combining with FIGO (International Federation of Gynecology and Obstetrics) stage in patients with operable cervical cancer was investigated. Methods A large cohort study including 800 operable cervical cancer patients was conducted from May 2005 to December 2012. Cancer-related biomarkers such as platelet count, hematocrit, hemoglobin, RDW was evaluated together with FIGO staging system in stage IA1–IIA2 cervical cancer patients. The prediction validity of platelet together with FIGO stage was then evaluated by receiver operating characteristic (ROC) curve, and the areas under the curve (AUCs) were compared by Z test. Results Univariate cox proportional hazard analysis demonstrated that hematocrit, platelet count, hemoglobin, FIGO stage, tumor differentiation, PLN (pelvic lymph node metastasis), LVSI (vascular lymph node invasion) were associated with overall survival (OS) and disease free survival (DFS), instead of RDW (red cell distribution width), age and histological subtype. Multivariate analysis demonstrated that preoperative platelet and FIGO stage were independent predictors for OS and DFS in cervical cancer. Furthermore, significant improvements were found after the combination of platelet count and FIGO stage in predicting OS and DFS for cervical cancer patients ( P = 0.0128 and P = 0.0385, respectively). Conclusions Combination of platelet count and FIGO stage improved the prediction performance of FIGO staging and provide additional risk stratification for operable cervical cancer patients.

Aim: The aim of this study was to investigate histological and biomechanical properties of oviduct anastomosis with 2-octyl cyanoacrylate (OCA) in the rabbit. Material and Methods: Sixty female rabbits were randomly divided equally into three groups: A (control), B (traditional catgut suture), and C (non-suture technique using OCA). After suture or OCA anastomosis, gross examination (adhesion formation) and histopathology (hematoxylin–eosin), ultrastructure (transmission electron microscopy), and biomechanics (bursting pressure) on para-anastomotic site were investigated on oviduct taken at 1 (A1, B1, C1) and 4 (A2, B2, C2) weeks, respectively. Results: Adhesion score in group B was more severe than that in groups A and C at 1 and 4 weeks. Histopathology showed that acute endosalpingitis in group B was the most intense at 1 week, followed by significantly more tissue stimulation induced by catgut and foreign-body giant cells in group B than in group C at 4 weeks. Ultrastructural damage of ciliated cells was reversed partly (B2) and completely (C2) at 4 weeks. Bursting pressure in C1 was weaker than that in B1, followed by no significant difference at 4 weeks. Conclusion: Non-suture using OCA for oviduct anastomosis can be accepted as a new-perspective technique.

To evaluate the surgical, oncological outcome and prognostic factors of laparoscopic radical hysterectomy (LRH) and pelvic lymphadenectomy in patients with stage IB1 cervical cancer.Patients with IB1 cervical cancer undergoing LRH at the First People's Hospital of Foshan between January 2000 and March 2010 were enrolled in this study. Follow-up data were available.A total of 148 patients were identified. One case converted to laparotomy. Median number of resected pelvic lymph nodes was 23. Median blood loss was 250 mL and median operative time was 257 minutes. Intraoperative and postoperative complications occurred in 5.4% and 6.75% patients, respectively. Other medical problems included 47 cases (31.75%) of bladder dysfunction. Twenty-seven patients (18.24%) had microscopic nodal metastasis. A total of 37 patients received adjuvant therapy. After a median follow-up of 28 months, 21 patients had a recurrence. The overall 5-year survival rate is 82%. Univariate analysis showed the factors affecting the survival rate were nonsquamous histologic type, high grade, deep cervical stromal invasion, lymphovascular space invasion, and lymph node metastasis (P = 0.016, P = 0.045, P = 0.021, P = 0.038, and P =0.001). The Cox proportional hazards regression analysis indicated only lymph node metastasis (odds ratio = 6.293, P0.001) was an independent poor prognostic factor.Laparoscopic radical hysterectomy can be a safe alternative to abdominal RH for patients with IB1 cervical cancer. Lymph node metastasis was an independent poor prognostic factor.

The objective of this study was to determine the better method of myomectomy by comparing laparoscopic and open myomectomy for patients with fibroids with regard to operative parameters and outcomes. A systematic review was performed on published studies identified by the databases PubMed, EMBASE, the China Biological Medicine Datadase (CBMdisc), Ovid and the Cochrane Library, as well as cross-references. Randomized controlled trials on laparoscopic versus open myomectomy were assessed on operative parameters and outcomes. Six studies and 576 patients were studied. Analysis was performed using the statistical software Review Manager Version 4.2. The data available show that laparoscopic myomectomy was associated with less hemoglobin drop, reduced operative blood loss, more patients fully recuperated at day 15, diminished postoperative pain, and fewer overall complications but longer operation time. However, major complications, pregnancy and recurrence were comparable in the two groups. The data show that if performed by suitably specialized surgeons in selected patients, laparoscopic myomectomy is a better choice than open surgery.

Overexpression of ATP-binding cassette (ABC) transporters in cancer cells results in multidrug resistance (MDR), which is one of the major obstacles in the treatment of cancer patients. None of the strategies to overcome MDR has been successfully applied in the clinic until now. Plenty of evidence shows that some triterpenoids function as reversal agents of MDR for anticancer drug resistance treatment. Here, we review the latest findings of reversing cancer MDR with triterpenoids. Findings are summarized showing that triterpenoids are MDR modulators and potential chemosensitizers. Finally, we contemplate future prospects of modulating MDR in the clinic.

Objective To study the adverse biomechanical effects of methotrexate (MTX) on spontaneous tubal motility and on a widely distributed Cajal-like type of tubal interstitial cells (t-ICC) in rabbits. In our previous study, MTX was confirmed to cause acute endosalpingitis, and ultrastructural and steroid receptor damage in rat's endosalpinx in a dose-dependent manner. Design Differences in spontaneous tubal contractions and cellular distribution of t-ICC in isthmus were evaluated in response to MTX. Setting Medical school research laboratory. Animal(s) Twenty nonpregnant female New Zealand albino rabbits in estrus stage were divided equally into four groups. Intervention(s) Rabbits received IM MTX (1, 5, 10 mg/kg body weight) and controls received physiological saline. Main Outcome Measure(s) On day 7, in vitro motility studies measuring spontaneous tubal contractions were performed, and cellular distribution of t-ICC was determined by immunohistochemistry. Result(s) Methotrexate produced a concentration-dependent inhibition of spontaneous isthmus contractions (frequency in 5, 10 mg/kg groups, and amplitude in 1, 5, 10 mg/kg MTX groups). It decreased significantly compared with the control group. Meanwhile, MTX at 5, 10 mg/kg decreased the population of c-kit immunoreactive t-ICC significantly. Conclusion(s) The decreased t-ICC may contribute to the diminished tubal smooth muscle contractility caused by MTX as observed. Tubal interstitial cells might be new potential targets for a variety of dysfunctional tubal motility diseases.

Objectives Methotrexate (MTX) has been a prevalent drug in conservative treatment of unruptured tubal pregnancy for many years. However, few researchers have performed morphological and protein analysis simultaneously to evaluate the specific toxic effects of MTX on the fallopian tubes. The aim of this study was to investigate acute and long-term toxic effects of increasing doses of MTX on the fallopian tubes and a possible dose–effect relationship. We also discuss the potential implications for subsequent pregnancies. Study design At the 10th day and the 2nd and 3rd months after MTX treatment, a total of 108 females SD rats in estrus stage (27 rats in each group) were collected according to the dose of MTX i.p.: 1, 2, 5 mg/kg body weight in groups I, II and III respectively and physiological saline i.p. in group IV for control. Nine rats in each group were killed at each time point and tissues close to the ampulla of the fallopian tubes were dissected for HE staining and routine histological observation. Estrogen receptor (ER) and progesterone receptor (PR) expression was detected by immunohistochemistry and Western blot. Results Morphological observation showed acute endosalpingitis in group I, becoming more intense with increasing doses of MTX in groups II and III in a reversible mode. Expression of ER in the endosalpinx significantly decreased in parallel with increasing doses of MTX in a dose–effect manner, which was reversible in groups I and II and irreversible in group III. Furthermore, ER and PR could recover close to normal levels in groups I and II after the 3rd month, while they could not restore to normal in group III. Conclusions These results provide the first evidence that MTX (≥5 mg/kg) can induce long-term, irreversible damage to steroid hormone receptors in the fallopian tubes in a dose-dependent manner. We tentatively suggest that MTX should be used in a relatively small and safe range of dosage in order to avoid impairment and potential risk of subsequent tubal pregnancy or infertility.

There is no clear consensus on the advantages of laparoscopically assisted surgery (LAS) versus open surgery (OS) for endometrial cancer. The present study compared LAS versus OS for patients with endometrial cancer with regard to operative parameters and outcomes. A search of the PubMed, EMBASE, the China Biological Medicine Datadase (CBMdisc), Ovid, and the Cochrane Library identified four studies that met the inclusion criteria for data extraction. Estimates of effectiveness were performed using fixed- and random effects models. The effect was calculated as an odds ratio (OR) or weighted mean difference (WMD) with 95% confidence intervals (CIs). Level of significance was set at P< 0.05. Outcomes of 331 patients were studied. When randomized controlled trials were analyzed, OR for LAS was 0.34 (95% CI: 0.13, 0.89; P= 0.03) for postoperative complications and 0.14 (95% CI: 0.05, 0.39; P= 0.0002) for incidence of transfusion; and WMD for LAS was 263.58 mL (95% CI: 467.71, 59.45 mL; P= 0.01) for blood loss, 38.09 min (95% CI: 10.50, 65.68 min; P= 0.007) for operation time, and 3.35 days (95% CI: 3.84, 2.86 days; P< 0.00001) for hospital stay. There was no difference in patients in terms of recurrence and survival. The present study has shown that LAS was associated with fewer postoperative complications, lower incidence of transfusion, less blood loss, longer operation time, and shorter hospital stay. What's more, no significant difference was found in terms of recurrence and survival. When performed by suitably specialized surgeons in selected patients, it appears to be a better choice than OS.

Isolated superficial inguinal metastases without any extended intra-abdominal spread is a rare event in patients with ovarian carcinoma. Here we report an isolated superficial inguinal metastasis in a patient with primary ovarian cancer. A 54-year-old Chinese patient with primary ovarian cancer, had an isolated painless enlarged right groin swelling (3×2cm) as the only manifestation, preoperative pathology confirmed metastatic adenocarcinoma. Gynecologic examination, transvaginal ultrasonography of the abdominopelvic cavity revealed a 5-cm mixed, right adnexal mass. At exploratory laparotomy, there was little intra-abdominal tumor dissemination but 100 ml of faint yellow peritoneal fluid and a 5-cm right ovarian tumor with intact capsule. Staging operation was performed and postoperative pathology confirmed adenocarcinoma located within right ovarian, with no evidence of involvement of other sites. Then the patient received adjuvant chemotherapy for Stage IVB. Five years later, the patient is currently still alive without evidence of recurrent disease. This case indicate that ovarian carcinoma isn’t a disease localized only within the intra-peritoneal cavity, isolated superficial inguinal lymph node metastasis might occur in rare cases via potential lymphatic and (or) hematogenous route under special conditions. We propose the need to investigate the possible mechanisms, risk factors, metastatic patterns, the biology and natural history of such patients in a large-scale and multicenter analysis. Furthermore, efforts should be made for earlier and differential diagnosis and finally prolong survival time for such patients.