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Background The S5-methylation test, as an alternative classifier to cytology and HPV16/18 genotyping to triage cervical squamous intraepithelial lesions, has not been widely validated in Asian countries. Herein, we compared S5 methylation to HPV16/18 and cytology to detect cervical high-grade squamous intraepithelial lesion (HSIL) in a screening population who with either HPV infection or abnormal cytology results or both of them, derived from a multi-central clinical trial of 2246 Chinese participants. We matched all ≥ HSIL + cases (n = 468) with ≤LSIL controls (n = 468) to analyze the effectiveness of methylation. Methylation of S5 was quantified by pyrosequencing, blinded to cytology, histological and initial HPV results.Results The S5 methylation could distinguish women with ≥ HSIL + from women with ≤LSIL at a high area under the curve (AUC) of 0.80 (95% CI 0.74–0.85). The sensitivity of S5 methylation (at 2.85 cutoff) for ≥ HSIL + was 76.1% (95% confidence interval [CI] 71.7–79.2) was higher than HPV16/18 sensitivity (64.9%, 95% CI 58.3–71.7, P = 0.039) or cytology (48.9%, 95% CI 42.8–53.2, P < 0.001). At this cutoff, the specificity of S5 for ≥ HSIL + was (79.9%, 95% CI 76.2–84.9), higher than HPV16/18 (44.8%, 95% CI 40.1–49.4, P < 0.001) and cytology (54.6%, 95%CI 50.7–57.9, P < 0.001). In addition, S5 methylation could provide predictive information about progression in specific population in follow-up period.Conclusion S5 methylation classifier with high sensitivity and specificity exceeded HPV16/18 or cytology for detecting women with ≥ HSIL + in a screening Chinese population with HPV infection and/or abnormal cytology results. Furthermore, S5 methylation is a potential classifier for predicting progression.

Summary: Natural orifice transluminal endoscopic surgery (NOTES) is a significant innovation in the field of minimally invasive surgery. Transvaginal NOTES has gained the most popularity than other transluminal natural orifices such as mouth, rectum, urinary tract or vagina. Since vNOTES is introduced, many surgeons have developed the technique in various gynecologic surgeries. The aim is to collect the growing evidences of vNOTES in gynecological surgeries and highlight vNOTES with an acceptable safety profile. In the present literature review, the search was carried out using the PubMed database with the following keywords: “natural orifice transluminal endoscopic surgery”, “NOTES”, “natural orifice” and “gynecologic surgery”. The current status of vNOTES in gynecologic surgeries was investigated. A total of 33 studies with 628 cases were included in the review. Our outcomes showed that vNOTES had been performed successfully in a series of surgical procedures including salpingectomy, ovarian cystectomy, myomectomy, hysterectomy, lymphadenectomy and sacrocolpopexy. Advances in technology have improved the feasibility of vNOTES as a treatment option for gynecologic surgeries. When the technical limitations are overcome, wide application of vNOTES is expected to increase. Further prospective and comparative studies are needed to clarify the application of the techniques in gynecologic surgeries. Keywords: Minimally invasive surgery, Natural orifice transluminal surgery, Transvaginal route, Gynecologic surgery

Background. Although the tumorigenesis of cervical cancer (CC) has been widely investigated and recognized, the study of the systematic impact of histone deacetylase 10 (HDAC10), microRNA, and downstream molecular mechanisms in CC is still limited. Herein, cervical cancer, precancer lesions, and normal cervical tissues were collected to test the expression level of HDAC10, miR-223, and EPB41L3. The mechanism of HDAC10, miR-223, and EPB41L3 was interpreted in cervical cancer cells after HDAC10, miR-223, or EPB41L3 expression was altered. Results. HDAC10 was poorly expressed in cervical cancer and precancer lesions, while miR-223 was highly expressed in cervical cancer. HDAC10 bound to miR-223, and miR-223 targeted EPB41L3. HDAC10 depressed the invasion property and tumorigenesis of cervical cancer via downregulating miR-223 and subsequently targeting EPB41L3. Conclusion. The study clarifies that HDAC10 inhibits cervical cancer by downregulating miR-223 and subsequently targeting EPB41L3 expression, which might provide a new insight for management upon cervical cancer and precancer lesions.

Objective: To establish the messenger RNA (mRNA) and long non-coding RNA (lncRNA) expression profiles in ectopic and eutopic endometrium and provide novel insights into endometriosis. Methods: The mRNA and lncRNA expression profiles were tested using high-throughput sequencing technology in ectopic and eutopic endometrium with endometriosis and normal endometrium without endometriosis. The potential targeted lncRNAs were annotated by analyzing the correlation between lncRNA and mRNA expression to better understand the pathogenesis of endometriosis. Results: In ectopic compared with normal endometrium, a total of 2,188 mRNAs and 1,200 lncRNAs were differentially expressed with a fold-change (FC) ≥2.5. In eutopic compared with normal endometrium, a total of 2,324 mRNAs and 695 lncRNAs were differentially expressed with an FC ≥1.5. In ectopic compared with eutopic endometrium, a total of 2,223 mRNAs and 511 lncRNAs were differentially expressed with an FC ≥2. Bioinformatic analysis indicated that the differentially expressed mRNAs were enriched in the biological processes and signaling pathways involved in endometriosis. In addition, we constructed a gene coexpression network based on the dysregulated lncRNAs in both ectopic endometrium and eutopic endometrium, combined with their coexpressed mRNAs to simulate the complex interactions. Conclusions: This study describes the first-to-integrate analysis of the differential expression profiles of mRNAs and lncRNAs, including analyses between ectopic and normal endometrium, eutopic and normal endometrium, and ectopic and eutopic endometrium, which provides new insights to investigate the pathogenesis of endometriosis and explore novel diagnostic biomarkers and therapeutic targets.

Background and objectives This study is aimed to investigate the possibility of preoperative oral oil administration in displaying the chylous tubes and preventing chylous leakage in laparoscopic para-aortic lymphadenectomy. Materials and methods In this retrospective nonrandomized study, of the 30 patients with gynecological malignancies who had indications for laparoscopic para-aortic lymphadenectomy up to renal vessels, 15 were administered preoperative oral oil (oil a administration) (control group) at our hospital between September 2017 and June 2018. The chylous tube displaying rates, incidences of chylous leakage, and other perioperative data of the two groups were compared. Results Successful display of chylous tubes was observed in 93.3% (14/15) patients in the oil administration group. The chylous leakage was zero in the oil administration group, and 33.3% (5/15) in the control group. The postoperative drainage duration (4.1 ± 1.0 days vs 7.6 ± 1.4 days, P = 0.000), somatostatin application time (0 day vs 5.9 ± 0.8 days), and postoperative hospital stay (6.0 ± 2.3 days vs 9.1 ± 2.1 days, P = 0.001) were significantly shorter in the oil administration group. The total cost is lower in the oil administration group (4972.52 ± 80.54 dollars vs 6260.80 ± 484.47 dollars, P = 0.000). Conclusions Preoperative oil administration is a feasible and effective method to display the chylous tubes and to prevent the chylous leakage in para-aortic lymphadenectomy.

Introduction For the prediction of endometriosis associated ovarian carcinoma (EAOC), the risk factors for malignant ovarian endometriosis (MOE) were explored. Material and methods A group of 104 EAOC patients was compared with a group of 104 ovarian endometrial cyst patients. Using single and multivariate risk analysis of EAOC by calculating the area under the curve (AUC) of receiver-operator characteristics (ROC) curves, risks of MOE transformation were calculated for various burdens of risk factors. Results The age range of 85 EAOC patients (81.73% of EAOC patients) was from 40 to 60 years old, as menopause occurs most frequently in this age range. From single factor ROC curve analysis, if disease duration/age/menopause/times of pregnancy/multiple foci of endometriosis index AUC were above 0.70, this suggested that the above indicators were predictive of MOE. Times of pregnancy/tumour size/myoma of uterus/multiple foci of endometriosis were taken as the independent risk factors of MOE. Using logistic regression, the AUC of 0.89 (95% confidence interval [CI]: 0.84-0.94) was statistically significant (p < 0.001), illustrating the predictive power of this model. Conclusions Times of pregnancy/BMI/irregular vaginal bleeding/thyroid disease/myoma of uterus/tumour serious fixation index indicate higher risk of MOE; age/tumour size/menopause/disease duration/ dysmenorrhea/multiple foci of endometriosis suggest lower risk of MOE. Therefore, in patients with endometriosis, malignant transformation could be predicted early.

Antisense non-coding RNA in the INK4 locus (ANRIL) has been implicated in a variety of cancers. In the present study, we evaluated ANRIL expression in epithelial ovarian cancer (EOC) and defined its clinical implications and biological functions. ANRIL was overexpressed in EOC tissues relative to normal controls. Overexpression correlated with advanced International Federation of Gynecologists and Obstetricians stage and high histological grade. Multivariate analysis indicated that ANRIL is an independent prognostic factor for overall survival in EOC. Gain- and loss-of-function experiments demonstrated that ANRIL promotes EOC cell proliferation both in vitro and in vivo. The proliferative effect was linked to the promotion of cell cycle progression and inhibition of apoptosis and senescence. Down-regulation of P15INK4B and up-regulation of Bcl-2 by ANRIL may partially explain ANRIL-induced EOC cell proliferation. This study is the first to establish that ANRIL promotes EOC progression and is a potential prognostic biomarker.

Objective: The aim of the present study was to evaluate the feasibility and safety of laparoscopic surgery for endometrial cancer in aged patients and show the experiences of laparoscopic surgery for elderly endometrial cancer patients in Eastern China. Materials and Methods: A total of 211 patients (≥60 years) with endometrial carcinoma treated with surgery were retrospectively analyzed, including 104 patients who underwent laparoscopic surgery, and 107 who underwent laparotomy. Results: The operation time was similar in both groups (192.9 vs. 185.5 min, P = 0.722). For all cases, the estimated blood loss was less in the laparoscopic group relative to that of in the open group (227.5 vs. 382.6 ml, P = 0.000). There was no difference in the complication rate between the two groups (21.2% vs. 29.0%, P = 0.191). Overall, right pelvic and periaortic lymph node dissections were similar for the laparoscopic and laparotomy groups, but the former procedure dissected more left pelvic lymph nodes than that of in laparotomy (13.3 vs. 7.2 nodes, P = 0.038). The hospital stay was shorter after laparoscopic surgery than that of after laparotomy (7 vs. 10.5 days, P = 0.000). The recurrence rate was similar in the two groups (7.7% vs. 10.3%, P = 0.511). Conclusions: Laparoscopy could be a safe alternative to laparotomy for endometrial cancer in aged patients.

To investigate which clinical characteristics will influence the pregnancy rate and live birth rate after myomectomy.Data of clinical characteristics and reproductive outcome from 471 patients who wished to conceive and who underwent abdominal or laparoscopic myomectomy in the Obstetrics and Gynecology Hospital of Fudan University from January 2008 to June 2012 were retrospectively analyzed.Average age in the pregnancy group (30.0±3.7 years) and the nonpregnancy group (31.2±4.1 years) was statistically different (P=.000). The diameter of the biggest myoma had a positive relationship with the pregnancy rate when it was10 cm (rs=0.095, P=.039). Abortions before myomectomy, operation type, number, location, and classification of myomas, uterine cavity penetration, and uterine volume seemed not to influence the pregnancy rate (P.05). The location of the myoma may influence the live birth rate after myomectomy (rs=0.198, P=.002). Anterior and posterior myomas were associated with higher live birth rates than other locations (P=.001). The average interval between myomectomy and pregnancy was 16.0±8.7 months, and there was no difference between the abdominal (17.2±8.6 months) and laparoscopic (15.2±8.8 months) groups (P=.102). The interval in the live birth group was 15.0±8.4 months, and that in the non-live birth group was 18.9±9.3 months; the difference was significant (P=.005).Patients' age, myoma size and location, and interval between myomectomy and pregnancy may influence the pregnancy rate and live birth rate after myomectomy.

This study investigates whether goserelin can inhibit ovarian cancer proliferation and protect ovarian function from cisplatin (CDDP). We evaluated proliferation and AKT phosphorylation in goserelin-treated ES-2 and SKOV3-ip ovarian cancer cells. Anti-Müllerian hormone (AMH) in human granulosa cells (hGCs) cotreated with goserelin and CDDP was measured by ELISA. Tumour volumes, Ki-67 expression, estrus, follicles, ovarian volumes, and serum AMH were compared in nude mice bearing transplanted tumours treated with goserelin and/or CDDP. Our results showed that goserelin inhibited cellular proliferation and AKT phosphorylation in vitro, and inhibited tumour growth and Ki-67 expression in vivo. Goserelin and CDDP cotreatment decreased the estrus cycles of the nude mice and prolonged estrus duration. Goserelin abrogated the CDDP-induced down-regulation of primary and preantral follicle percentage and ovarian volume. Goserelin increased AMH secretion in vitro and in vivo. In conclusion, goserelin inhibited ovarian cancer proliferation and simultaneously protected ovarian function from CDDP.

The objective of this case study is to present our experience of a surgical approach for vaginal agenesis using an acellular porcine small intestinal submucosa (SIS) graft. The present report involved 2 patients diagnosed as having vaginal agenesis due to Meyer-von-Rokitansky-Küster-Hauser syndrome. The operation procedure involved the creation of a neovaginal tunnel and then a mold wrapped with the SIS graft was placed in the neovagina. The duration of surgery was less than 45 min with minimal blood loss and no operative and postoperative complications. Epithelialization of the neovagina was achieved within 2 months after surgery. The neovagina created with this procedure was the same as that of a normal adult vagina histologically and physiologically. In conclusion, the creation of a neovagina using a SIS graft resulted in a favorable outcome and this approach may be a potential alternative to the management of vaginal agenesis.

FSH may increase the risk of ovarian malignancy and play a key role in ovarian carcinogenesis, although the mechanism(s) are undefined. HMGA2 overexpression has been observed to be an early genetic event in tumorigenesis. The present study was designed to investigate the effect of FSH on let-7, HMGA2 and p53 expression in normal fimbrial epithelial cells of ovarian high-grade serous carcinomas (HGSCs). A primary human Fallopian tube (FT) fimbrial epithelium ex vivo culture system of low-grade serous carcinomas (LGSCs) and HGSCs was established. The levels of HMGA2, let-7, p53 and FSHR were evaluated by western blotting and reverse transcription (RT)-PCR. Treatment with FSH significantly increased HMGA2 expression in a time-dependent manner and the let-7 expression levels decreased gradually over time in the normal fimbrial epithelial cells of HGSCs. However, we did not observe similar results in LGSCs. In addition, knockdown of let-7 suppressed HMGA2 expression. p53 was not detected in the normal fimbrial epithelial cells before or after FSH administration. Our results indicate that FSH increases the expression of HMGA2 by downregulating the expression of let-7 in normal fimbrial epithelial cells of HGSCs, but no occurrence of p53 mutation. The susceptibility of fimbria to FSH in HGSCs compared with those in LGSCs is different.

Objective: Herein we described our experience with laparoendoscopic single site mymectomy (LESS-M) without the use of a single port access device and compared the clinical outcomes between LESS-M and conventional laparoscopic mymectomy (LM). Methods: From January 2012 to December 2014, 32 patients with leiomyomas underwent LESS-M in our hospital were enrolled in this prospective observational case-control study, and were 1:1 matched and compared with 32 patients who underwent LM by the same operative team for leimyomas of similar size and location. Patients and surgical data, and follow-up information were analyzed. Results: The operating time in the LESS-M group was significantly longer than that in the LM group (98 ± 9 min vs 56 ± 7 min, P=0.000), but the patients returned to work significantly earlier (2.9 ± 0.5 week vs 3.7 ± 1.1, P=0.001), and the cosmetic satisfaction score was significantly higher (9.3 ± 0.6 vs 8.4 ± 0.7, P=0.000). There was no significant difference of the mean intraoperative blood loss, hemoglobin change, return of bowel activity, postoperative fever, operation cost and total cost between the two groups. Conclusion: LESS-M is a feasible, safe, and efficacious procedure with shorter recovery and increased cosmetic satisfaction in selected patients with leiomyoma, and it can be cost-effectively performed without the need for a single port access device.

Background Chemokines play an important role in the pathogenesis of endometriosis. In the present study, the transcription of 18 chemokine receptors in eutopic endometrium and ectopic tissue with endometriosis was first analysed by RT-PCR. Dioxin, an air pollutant, and estrogen are reported to be associated with endometriosis. The regulatory mechanisms of dioxin and estrogen in the expression of CXCR1/IL-8 in the corresponding cells will help in elucidating roles of the chemokine in the aetiology of endometriosis. Methods and results CXCR1, a type of chemokine receptor, was over-expressed in endometriotic tissue. The high translation of the receptor and its ligand, interleukin (IL-8), in endometriotic tissue was then demonstrated by immunochemistry. Estradiol and 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) alone inhibited expression of CXCR1, whereas the combination of estradiol with TCDD up-regulated the expression. TCDD promoted IL-8 secretion by human pelvic mesothelial cells (HPMC), and 17beta-estradiol magnified the stimulatory effect. Both 17beta-estradiol and TCDD alone inhibited IL-8 secretion of U937 (a cell line of monocyte), but combination of 17beta-estradiol and TCDD had no further inhibitory effect. The co-culture of endometrial stromal cells (ESC) with HPMC produced more IL-8 than respective or total production of either of the cells alone, and estradiol played a synergistic stimulatory role with TCDD in IL-8 secretion of the co-culture. Interaction of HPMC and the monocytes significantly stimulated IL-8 secretion, suggesting a main resource of IL-8 in peritoneal cavity with endometriosis. TCDD promoted IL-8 secretion by HPMC-U937 co-culture, but exerted a contrary effect for IL-8 secretion when combined with estradiol. Conclusion Estradiol and TCDD in the peritoneal cavity can lead to a persistent and serious inflammation, which gives a new insight into the interactions of estrogen and TCDD in endometriosis.

To investigate the influence of gonadotropin-releasing hormone (GnRH) analogues on ovarian cancer and ovarian function in vivo.ES-2 cells were cultured and xenotransplanted into 36 nude mice, which were divided into 6 groups: normal saline (NS) group: NS 0.1 ml/day subcutaneous injection, and then NS 0.2 ml/week peritoneal injection; cisplatin (DDP) group: NS 0.1 ml/day subcutaneous injection, and then DDP 5 mg/kg (diluted to 0.2 ml) per week peritoneal injection; goserelin group: 100 µg goserelin (diluted to 0.1 ml) per day subcutaneous injection, and then NS 0.2 ml/week peritoneal injection; goserelin + DDP group: 100 µg goserelin (diluted to 0.1 ml) per day subcutaneous injection, and DDP 5 mg/kg (diluted to 0.2 ml) per week peritoneal injection; cetrorelix group:100 µg cetrorelix (diluted to 0.1 ml) per day subcutaneous injection and NS 0.2 ml/week peritoneal injection; cetrorelix + DDP group: 100 µg cetrorelix (diluted to 0.1 ml) per day subcutaneous injection and DDP 5 mg/kg (diluted to 0.2 ml) per week peritoneal injection. All the peritoneal injection started from subcutaneous injection one week later. To compare the weight of nude mice, the volumes of transplanted tumors, the expression of Ki-67 antigen in transplanted tumors, the estrus, the ratio of atretic follicles, the ratio of primary and preantral follicles, the levels of serum anti-Mullerian hormone (AMH), follicle-stimulating hormone (FSH), estradio (E(2)) and progesterone (P) in each group.There were no significant difference in the weight of nude mice among 6 groups (P0.05), which on day 29 in NS group was (19.8 ± 2.2) g, DDP group (20.5 ± 1.4) g, gosereline group (19.6 ± 0.9) g, goserelin + DDP group (19.7 ± 1.6) g, cetrorelix group (20.7 ± 2.2) g, and cetrorelix + DDP group (19.0 ± 1.7) g. The tumor volumes of different groups on the 12(th) day: NS group (241 ± 179) mm(3), DDP group (78 ± 20) mm(3), gosereline group (78 ± 55) mm(3), goserelin + DDP group (64 ± 48) mm(3), cetrorelix group (78 ± 64) mm(3), or cetrorelix + DDP group (70 ± 19) mm(3), in which there were significant difference between NS group and the other groups (P0.05); and the same result was obtained on day 15, 19, 22, 26 and 29 (P0.05). The expression of Ki-67 in NS group was (33 ± 10)%, in which it was higher than those in DDP group 3.5%, goserelin group 8.8%, goserelin + DDP group 1.5%, cetrorelix group (23 ± 11)%, or cetrorelix + DDP group (8 ± 6)% (P0.05). The ratio of primary and preantral follicles in goserelin group was (71.5 ± 8.1)%, in goserelin + DDP group was (62.4 ± 4.1)%, in cetrorelix group was (71.2 ± 7.4)%, and in cetrorelix + DDP group was (63.8 ± 3.1)%, in which they were much higher than that in DDP group (47.0 ± 4.8)% (P0.05). The level of AMH in goserelin group was (98 ± 27) ng/ml, which was much higher than that in NS group (66.2 ± 17.4) ng/ml (P0.05), while there were no difference in the levels of FSH, E(2) or P among different groups (P0.05).GnRH analogues could inhibit the growth of transplanted tumors in nude mice, meanwhile increase the secretion of AMH, decrease the frequencies and prolong the lasting time of estrus, decrease the ratio of atretic follicles, raise the ratio of primary and preantral follicles, which may be protect the ovarian function of nude mice.

To evaluate clinical efficiency and quality-of-life outcomes in treatment of severe pelvic organ prolapse by the "Xiehe" pelvic floor reconstruction surgery.From Jun. 2006 to Dec. 2008, 277 severe pelvic organ prolapse patients with stage III to IV from 8 hospitals in China were enrolled in this prospective study. Pelvic organ prolapse quantitative examination (POP-Q) and anatomic improvement in these patients after surgery were analyzed in this interim study. Comparisons of pelvic floor impact questionnaire-short form 7 (PFIQ-7) and pelvic floor distress inventory-short form 20 (PFDI-20) in these patients before and after surgery was used to evaluate quality of life. Comparison of pelvic organ prolapse-urinary incontinence sexual questionnaire (PISQ) in these patients before and after surgery was used to evaluate quality of sexual life.With a median follow-up of 14.0 months (6 - 28 months), twenty-three patients showed recurrent prolapse (8.3%, 23/277), and anatomical success (stage 2 in the treated compartment) was 91.7% (254/277). In this series, mesh exposure or erosion rate was 6.9% (19/277). The postoperative de novo stress incontinence rate was 6.5% (18/277). The scores for PFIQ-7 and PFDI-20, and its subscales were significantly improved, the scores of before treatment were lower than those after treatment (P0.01). And there was no significant difference in the average score of PISQ before and after the surgery (76.6 ± 15.4 versus 75.5 ± 14.5 versus 73.6 ± 12.6, P0.05), but the rate of de novo dyspareunia was 11% (9/80)."Xiehe" pelvic floor reconstruction surgery was safe and efficacy in treatment of pelvic organ prolapse. It could improve quality of life remarkably with less cost when compared with the traditional total pelvic floor reconstruction surgery.

To investigate clinical significance and application of modified pelvic floor reconstruction developed by Peking Union Medical College Hospital (MPFR) in treatment of severe pelvic organ prolapse (POP) by comparing the effectiveness, quality of postoperative sexual life, life satisfaction and risk factors for POP recurrence with the following two surgical procedures: traditional total vaginal hysterectomy with anterior-posterior colporrhaphy (TVH-APC) and total vaginal hysterectomy with lateral colporrhaphy and sacrospinous ligament fixation and vaginal bridge repair and episiotomy (TVH-LC-SSLF-VBR-EP).Totally 173 patients with severe POP and at least two compartments defects of pelvic floor underwent surgeries in the study, 86 patients (group A) were treated by MPFR with polypropylene mesh application, 58 (group B) were treated by TVH-APC, and 29 patients (group C) were treated by TVH-LC-SSLF-VBR-EP. Peri-operative data and outcomes of postoperative courses at 6, 12, 18 months were collected and analyzed, in the meantime, the risk factors of recurrence were studied.(1) No statistical difference was observed among the above 3 groups in terms of length of operation, amount of blood loss, length of hospital stay, and morbidity after surgery (P0.05). (2) Cost hospitalization was (11 448 ± 3049) Yuan in group A, which was significantly higher than (7262 ± 1607) Yuan in group B and (7140 ± 1817) Yuan in group C (P0.05). (3) The length of vaginal cuff of (7.5 ± 1.4) cm in group A and (5.6 ± 1.1) cm in group C were significantly longer than (7.1 ± 0.6) cm in group B (P0.05). The width of vaginal cuff of (4.3 ± 0.3) cm in group A was larger than (3.4 ± 0.3) cm in group B and (3.3 ± 0.4) cm in group C (P0.05). (4) The recurrence rate at 12 months after surgery was 12.8% (11/86) in group A, which was similar with 17.2% (5/29) in group C (P0.05) and significantly less than 36.2% (21/58) in group B (P0.05). The rate of active sexual life of 16.3% (14/86) in group A was significantly higher than 1.7% (1/58) in group B and 0 in group C (P0.05). The index of life quality improvement at 12 months after surgery was 48 ± 12 in group A, which was no less than 53 ± 16 in group C (P0.05) and higher than 27 ± 9 in group B (P0.05). (5) Mesh rejection was observed in 6 patients in group A within 3 months after surgery, while the posterior vaginal wall was exclusively involved. No difference was found in urinary retention or urinary incontinence among three groups (P0.05). (6) The severe degree of POP, type of surgical procedure (TVT-APC), anterior compartment defect of pelvic floor, and early days of performing pelvic floor reconstruction surgeries were high risk factors for POP recurrence (P0.05).MPFR has a better curative effect and lower recurrence rate on patients with POP. It can help patients regain integrity of anatomical structure and functions of pelvic floor. TVH-LC-SSLF-VBR-EP is also effective.

To investigate the clinical manifestation, diagnosis, therapies and medical economics of cesarean scar pregnancy (CSP).From Jan. 2005 to Dec. 2008, 96 patients with CSP treated in Obstetrics and Gynecology Hospital of Fudan University were studied retrospectively. Those cases were divided into 3 groups. Thirty-three patients were treated with methotrexate (MTX) 50 mg/m(2) intravenously guttae in group A. Among that 18 cases were treated with MTX, after 5-10 days they underwent dilation and curettage of uterus; 15 cases were given by dilation and curettage first if the level of serum human chorionic gonadotrophin-β (β-hCG) descent less than 30% in every 48 hours for 3 times after curettage, then MTX (50 mg/m(2)) intravenously guttae. Sixty patients were treated with MTX 100 mg bilateral uterine artery injection and embolization in group B. After 2 days, they underwent curettage. Group C: 3 patients were treated with laparotomy lesion excision. The following clinical parameters were compared, including blood loss (M), lesion diameter (x(-) ± s), blood β-hCG level (M) before treatment, the number of cases with myometrial thickness anterior to the CSP ≤ 3 mm, the resistant index (RI) ≤ 0.5, expense (x(-) ± s), hospital days (x(-) ± s) in those 3 groups. The correlation of blood loss with lesion diameter and blood β-hCG level was studied.(1) Clinical manifestation: bleeding loss were 20 ml in MTX + curettage of group A, 10 ml in curettage + MTX of group A, 12 ml in group B and 200 ml in group C. The volume of bleeding loss in group C was significantly higher than those in group A or group B (P0.01). The lesion diameter were (23 ± 15) mm in curettage + MTX of group A and (30 ± 14) mm of group B, which were higher than (16 ± 8) mm of MTX + curettage of group A (P0.01). The lesion diameter of (52 ± 7) mm in group C were significantly bigger than those in the other groups (P0.01). The level of blood β-hCG levels were 21 592 U/L in MTX + curettage of group A, 979 U/L in curettage + MTX of group A, which reach statistical difference (P0.05). The level of blood β-hCG levels were 11 312 U/L in group B and 101 U/L in group C. Among 28 cases with RI ≤ 0.5, there was 8 cases in group A (24%, 8/33), 18 cases in group B (30%, 18/60) and 2 cases in group C (2/3). Among 23 cases with myometrial thickness anterior to the CSP ≤ 3 mm, there was 21 cases in group B (35%, 21/60), which were significantly higher than 2 in group A (6%, 2/33) and none in group C (P0.05). The expense were (5578 ± 3679) yuan in MTX + curettage of group A and (5346 ± 2765) yuan in curettage + MTX of group, which did not reach statistical difference (P0.05). The expense were (7860 ± 2104) yuan in group B, which were significantly higher than those in group A and (5004 ± 421) yuan in group C (P0.05). The hospital days were (15 ± 8) days and (19 ± 14) days of group A, (16 ± 10) days in group B and (17 ± 8) days in group C, there was no significant difference among those treatments (P0.05). (2) Correlation: there was positive correlation between bleeding loss and lesion diameter (r = 0.31, P0.05) or blood β-hCG level (r = 0.35, P0.05).MTX intravenously guttae, MTX uterine artery injection and embolization, and laparotomy lesion excision were all properly used in treatment of CSP. MTX uterine artery injection and embolization was recommended for those with big lesion, high β-hCG level, less myometrial thickness anterior to the CSP or plentiful blood supply of the lesion but the expense might be high.

To compare clinical effect of gonadotropin releasing hormone agonist (GnRH-a) alone and GnRH-a combined with low-dose dydrogesteronea and estradiol valerate on sex hormone, hypoestrogenic symptoms, quality of life and bone mineral density (BMD) in treatment of endometriosis.Seventy patients with moderate or severe endometriosis, who were diagnosed by laparotomy or laparoscopic surgery within two months, were randomly assigned into two groups. 35 patients in GnRH-a group were treated by goserelin (3.6 mg) for three months, and 35 patients in add-back group were treated by goserelin (3.6 mg) combined with estradiol valerate 0.5 mg and dydrogesteronea 5 mg daily. Before and after the treatment, clinical parameters were recorded and analyzed, including visual analog scale (VAS), medical outcomes survey short form 36 (SF-36), Kupperman menopausal index (KMI), BMD, the serum level of follicle stimulating hormone (FSH), estradiol (E2) and bone gla-protein (BGP). The first menstruation and VAS were also followed up after treatment.Every 3 cases in two groups lost follow-up. (1) Reproductive hormone: the level of E2 in add-back group [(94+/-71) pmol/L] was significantly higher than (54+/-52) pmol/L in GnRH-a group (P0.01). The level of FSH in add-back group [(3.0+/-1.9) U/L] was significantly lower than (5.7+/-2.9) U/L in GnRH-a group (P0.05). (2) VAS: after treatment, VAS in both group decreased significantly when compared with that before treatment (P0.05), and remained until menstruated. (3) KMI: KMI in add back-group (10+/-8)was significantly lower than (14+/-6) in GnRH-a group (P0.05). (4) BMD: compared with that before treatment, BMD decreased significantly after treatment in GnRH-a group (P0.05), no remarkable difference of BMD was observed before and after treatment in add-back group. Before treatment, serum BGP in both groups did not show statistical difference. After treatment, the level of BGP in GnRH-a group [(7932+/-5206) ng/L] was significantly higher than (5419+/-2917) ng/L in add-back group (P0.05).GnRH-a combined with estrogen-progesterone regimen could relieve pain from endometriosis as effectively as GnRH-a alone and reduce hypoestrogenic symptoms and bone loss. Therefore, it is a safe and effective treatment.

To investigate the regulatory effect of ligustrazine and Radix Astragalus (Chinese drugs for supplementing qi and activating blood circulation) on uterine mucosa stromal cyto-chemotactic factor RANTES and receptor CCR5 expression.The eutopic and ectopic endometrial stromal cells (EMSC) isolated and purified from 10 patients with ovarian endometrial cyst were selected as the experimental group, while those from 10 patients with benign lesion were selected as the control group. After they were intervened by different factors, including astragalus injection (AI), ligustrazine injection (LI), AI + LI, and Danazol, the expression levels of RANTES and CCR5 in the cells were detected by ELISA and RT-PCR.RANTES expressions in eutopic and ectopic EMSC were different insignificantly (P0.05). The ectopic EMSC RANTES expression was 13.602 +/- 3.358 ng/L and eutopic EMSC RANTES was 12.850 +/- 7.997 ng/L in the positive control group, which was significantly higher than that in the negative control group (both being 0.027 +/- 0.016 ng/L, P0.05), and the ectopic EMSC expressions after intervened with Chinese drugs were significantly lower than that in the positive control group (P0.05). CCR5 expression in ectopic EMSC was 0.759 +/- 0.039 ng/L, which was higher than that in eutopic EMSC (0.249 +/- 0.026 ng/L, P0.05). Ectopic EMSC CCR5 expression was higher in the positive control group than that in the negative control group (0.759 +/- 0.039 ng/L vs 0.478 +/- 0.094 ng/L, P0.05). Similar situation also was shown between the positive and negative control groups in terms of eutopic EMSC CCR5 expression (0.249 +/- 0.026 ng/L vs 0.131 +/- 0.021 ng/L, P0.01), and the expression was significantly lower in all the Chinese drugs treated EMSC groups as compared with that in the positive control group (P0.01).CCR5 expression was higher in ectopic EMSC than that in eutopic EMSC. Ligustrazine and Radix Astragalus could down-regulate the auto-secretion of RANTES and CCR5 in patients with endometriosis.

To evaluate the role of androgen and its receptor in the pathogenesis of prolapse of pelvic floor.Specimens of right cardinal ligament and vaginal wall were collected from 38 patients with prolapse, aged (64 +/- 3) (45 - 79), all menopausal, and 23 women, aged (50 +/- 2)(45-57), with obstetric or gynecologic diseases other than prolapse (as controls), all undergoing total hysterectomy. The 38 prolapse patients were divided into 2 groups: Groupor = 60, aged (66 +/- 6), and Group60, aged (52 +/- 5). Western blotting and immunohistochemistry were used to detect the expression of androgen receptor (AR) in the tissues. Peripheral blood samples were collected from all patients to examine the levels of serum testosterone and sex hormone binding globulin (SHBG) by chemiluminescent labeling.There were no significant differences in the serum concentrations of testosterone and SHBG between the prolapse and the control groups. The AR positive rates in the cardinal ligament and vaginal wall tissues of the prolapse patients agedor = 60 were (49 +/- 15)% and (49 +/- 10)% respectively, both not significantly different from those of the control group [(43 +/- 15)% and (42 +/- 3)% respectively, both P0.05]. ears, The AR expression rates in the tissues of cardinal ligament and vaginal wall of the prolapse patients were (42 +/- 3)% and (43 +/- 15)% respectively, both significantly higher than those of the control group [(29 +/- 7)% and (29 +/- 6)% respectively, both P0.001]. Western blotting showed that the positive rate of the AR with the relative molecular weight of 45 000 in the cardinal ligament of the prolapse group was 4.41%, significantly higher than that of the control group (2.1%, P = 0.02), however, the positive rate of the AR with the relative molecular weight of 45 000 in the vaginal wall tissue of the prolapse group was 3.34%, not significantly different from that of the control group (2.28%, P = 0.2). There were no significant differences in the in the straps of 110 000 and 90 000 detected by C-terminal polyantibodies of AR in the cardinal ligament and vaginal wall tissues between the prolapse patients and the control group (both P0.05).The increasing expression of AR in the tissue of vaginal wall and cardinal ligament of the prolapse patients with pelvic floor dysfunction may play an important role in the etiology of pelvic floor dysfunction.

To assess the estrogen and progestin's effect on protein expression of metastasis repression gene nm23-H1 via regulation of phosphorylation signaling in epithelial ovarian cancer cell line ES-2.Ovarian clear cell adenocarcinom cell line ES-2 was treated by different doses of 17beta-estradiol (estrogen), medroxyprogestogen (progestin) and dimethyl sulfoxide (control group), and then the following experiments were conducted. (1) Change of the cell migration capacity after treatment with estrogen and progestin for 24 and 48 hours was measured by in vitro wound healing assay. (2) Transwell experiments were used to detect the ability of cell invasion, which was also used to inhibit the phosphorylation of protein kinase B (AKT) pathway with estrogen and progestin. (3) Change of nm23-H1, AKT and phosphorylated protein kinase B (pAKT) protein level of ES-2 cells after treated with estrogen and progestin was detected by western blot. (4) Cells were transfected with the small interfering RNA (siRNA) expression vector targeting AKT. The efficiency of cells transfected was calculated according to the number of cells with green fluorescent produced by cells transfected. Change of nm23-H1 expression was assessed.ES-2 cells treated with estrogen, progestin or vehicle all migrated into the wound surface after 24 and 48 hours. The migration of the cells treated with estrogen was (1.39 +/- 0.08) mm, significantly elevated (P = 0.029), and that of the cells treated with progestin was (1.96 +/- 0.07) mm, significantly decreased compared with cells treated with vehicle (P = 0.014). The cells were cultured in transwell after 24 hours. The invasion of the cells treated with estrogen was 119 +/- 13, significantly elevated (P = 0.015), and that of the cells treated with progestin was 78 +/- 8, significantly decreased compared with cells treated with vehicle (P = 0.006). Western blot results showed that 17beta-estradiol decreased nm23-H1 expression, and both effects were dose and time dependent (P = 0.020, P = 0.001). Progestin increased nm23-H1 expression in ES-2 cells, and both effects were dose and time dependent (P = 0.003, P = 0.002). 17beta-Estradiol elevated the expression of pAKT, which was also dose and time dependent (P = 0.001, P = 0.007), while progestin repressed pAKT expression which was also dose and time dependent (P = 0.012, P = 0.039). When cells were transfected with the siRNA expression vector targeting AKT, the effects of estrogen and progestin on nm23-H1 expression were both attenuated.Estrogen downregulates the expression of nm23-H1 via activation of the phosphorylation signaling, thus participated in the regulation of invasion and metastasis of epithelial ovarian cancer cells. Progestin upregulates the expression of nm23-H1, and might repress invasion and metastasis of tumor cells.

To evaluate the therapeutic efficacies of preserving fertility treatment in patients with early cervical cancer.Sixteen patients with early cervical cancer treated by laparoscopic vaginal radical trachelectomy and pre- or postoperative chemotherapy were analyzed retrospectively, focusing on the treatment indication and management of high risk patients.The median age was 29 years (range 26 to 34 years). Eleven were nulligravida and 4 multipara. All patients had a desire to maintain fertility. For clinical stage, 2 were stage Ia2, 13 stage Ib1 and 1 stage Ib2. Fifteen patients had squamous cell carcinoma and 1 had adenosquamous cell carcinoma. Mean operative time was 3 hours and 12 minutes, and mean blood loss was 320 ml. There were no intra- or postoperative complications. With mean follow-up time of 13 months, one patient had recurrence (6%), and no one became pregnant.It is possible to preserve fertility in the treatment of patients with early cervical cancer, but treatment indication should be considered carefully. The management of high risk patients should be investigated extensively.

To evaluate the laparoscopic operation for early ovarian malignant tumor with low risk.Ten patients with ovarian malignant tumor who underwent laparoscopic total hysterectomy, pelvic lymph nodes dissection, bilateral adnexectomy, ovarian aortic and vein high ligation, omentectomy, and additional appendectomy. Eleven patients with the same diagnosis who underwent operation by laparotomy were served as control group. The operation time, intraoperative blood loss, number of pelvic lymph nodes excised, and postoperative recovery were analyzed retrospectively.Frozen section method during operation proved the diagnosis of ovarian malignant tumor and cytological examination proved a negative result of the peritoneal irrigation liquid. The operation time was 298 min +/- 60 min for the laparoscopy group and 182 min +/- 43 min for the laparotomy group (P0.05). The intraoperative blood loss was 280 ml +/- 156 ml for the laparoscopy group and 346 ml +/- 170 ml for the laparotomy group (P0.05). The number of pelvic lymph node resected was 25 +/- 5 and 27 +/- 7 for the laparoscopy group and laparotomy group respectively (P0.05). The postoperative illness rate was 20.0% and 72.7% for the laparoscopy group and laparotomy group respectively (P0.01). Seven patients and 1 case in the laparoscopy group and laparotomy group left their beds 48 hours after operation (P0.05). The right obtuator nerve was injured and was sutured on 1 patient in the laparoscopy group.The whole procedure of total hysterectomy, bilateral adnexectomy, pelvic lymph node dissection, ovarian aortic and vein high ligation, omentectomy, and additional appendectomy may be performed under laparoscope in the treatment of early stage ovarian malignant tumor with lower risk. The laparoscopic operation has the advantage of less intraoperative bleeding, less morbidity and rapid recovery.

To investigate the role of laparoscopy in diagnosis and treatment of infertile women with endometriosis.Totally 314 infertile cases were diagnosed as having endometriosis by laparoscopy, and 58, 173, 68 and 15 cases were assigned to stage I, II, III and IV groups respectively according to the revised classification American Fertility Society (r-AFS). Laparoscopic treatment included excision of ovarian endometriosis lesions, lysis of adhesions, endocoagulation of pelvic endometriosis lesions with controlled heating (100 degrees C) and lavaging of the peritoneal cavity. The duration of follow-up after laparoscopic surgery was censored at 36 weeks. Women who became pregnant were followed up to 20 weeks' gestation. The U and chi(2) tests were used to determine significance of difference in the rate of pregnancy and spontaneous abortion between all clinical stages.Of all the 314 cases, 254 became pregnant within 36 weeks after surgery. The cumulative numbers of pregnancy were 50 (86.2%, 50/58), 141 (81.5%, 141/173), 52 (76.5%, 52/68) and 11 (73.3%, 11/15) in stage I-IV groups respectively. The accumulative pregnancy rates were, however, not significantly different among stages I-IV (P0.05). The accumulative pregnancy rate within 24 weeks after surgery (93.7%, 238/254) was higher than that within 25 - 36 weeks after surgery (6.3%, 16/254). Of 254 cases who were pregnant, 12 had miscarriage. There was no significant difference of miscarriage rate between all stages (P0.05). While the rate of miscarriage was higher within 12 weeks of gestation (83.3%, 10/12) than that of after 12 weeks of gestation (P0.05).Early lesions of endometriosis and pelvic factors for infertility can be found by laparoscopy. And pregnancy rate of endometriosis-associated infertility can be improved by laparoscopic surgery. To clean the menstrual blood pool and ablate peritoneal lesion with endocoagulation as completely as possible have significant importance for enhancement of fecundity in infertile women with endometriosis, especially for stage I-II cases.