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Objective To evaluate the clinical effect after laparoscopic sacral colpopexy (LSC) of combined transabdominal-transvaginal approach on stage Ⅳpelvic organs prolapse (POP). Methods The clinical data of 65 patients undergoing LSC of combined transabdominal-transvaginal approach from January 1st, 2010 to July 30th, 2017 due to POP stage Ⅳ in First Affiliated Hospital of Guangzhou Medical University were retrospectively analyzed. Objective outcome was assessed by comparing preoperative and postoperative pelvic organ prolapse quantification (POP-Q) systems. Subjective effects were assessed by comparing pelvic floor distress inventory-short form 20 (PFDI-20), pelvic floor impact questionnaire short form (PFIQ-7), pelvic organ prolapse/urinary incontinence sexual questionnaire-12 (PISQ-12) and patient global impression of improvement (PGI-I). Results All 65 patients were successfully performed without any intraoperative complications. Fifty-three patients were followed in the clinic department and 12 were followed up by telephone. The follow-up duration was 6.1-80.3 months and the median follow-up duration was 24.5 months. The bleeding loss was 20-250 ml. Postoperative urethral catheter residence day was (2.5± 1.1) days, length of postoperative stay was (6.2±1.7) days. The postoperative POP-Q scores were compared with preoperative scores which had significantly improved except pb (all P<0.01). The objective cure rates of vaginal anterior wall, apical and posterior wall prolapse stageⅣwere 90% (47/52), 100% (23/23) and 95% (20/21).About PGI-I, except for 1 patient who chose"improvement", the other 64 patients (98%, 64/65) all chose"significant improvement". Furthermore, preoperative and postoperative PFDI-20, PFIQ-7, and PISQ-12 scores were all statistically significant (all P<0.01). Subjective efficacy was significant. Three cases (5%, 3/65) of postoperative fever occurred. Two cases (4%, 2/53) had mesh exposure. Six patients (11%, 6/53) had recurrence of postoperative prolapse. Five cases had recurrence of vaginal anterior wall prolapse and no reoperation was performed; 1 case was recurrence of posterior vaginal wall prolapse who diagnosed as vaginal posterior wall prolapse stage Ⅲ; no recurrence of apical prolapse. The rate of reoperation (including exposed-mesh removal and pelvic floor reconstruction surgery) was 5% (3/65). Conclusions The LSC of combined transabdominal-transvaginal approach has a high subjective efficacy rate. The objective cure rate in the case of apical prolapse stage Ⅳ is one hundred percent.The LSC of combined transabdominal-transvaginal approach has low mesh exposure, low postoperative infection and the reoperation rate, which is one of optional pelvic floor reconstruction surgery. However, there is still a risk of recurrence in patients with POP stageⅣwith severe bladder bulging.
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AIM:To observe the expression of angiogenesis factors in the myocardial tissue of streptozotocin-induced diabetic rats .METHODS:The diabetic rat model was induced by intraperitoneal injection of streptozotocin .After 12 weeks, the cardiac function was measured by MPA cardiac function analysis system .The myocardial collagen volume fraction ( CVF) was assessed by Masson staining .The capillary vessels was quantified as the ratio of capillary to myocyte (C/M) using CD31 immunostaining.The expression levels of vascular endothelial growth factor (VEGF), angiopoietin ( Ang)-1, endostatin and Ang-2 were observed by Western blotting .RESULTS:Compared with normal control group , the left ventricular end-diastolic pressure (LVEDP) was evidently increased (P0.05).CONCLUSION:Im-balances between the angiogenic factors (VEGF and Ang-1) and anti-angiogenic factors (endostatin) may play an impor-tant role in the pathogenesis of diabetic cardiomyopathy .
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Diabetic SD rats were established by injection of streptozotocin,and were divided into normal blood sugar control group(NC),diabetic control group(DM),and the insulin treatment group(IDM).12 weeks later,the maximum rates of increasing and decreasing pressure in left ventricle were both decreased in DM group(P＜ 0.05),and those in IDM group were higher than those in DM group(P＜0.05).Regional myocardial blood flow in DM group was lower than that in NC group [(3.39 ± 0.48 vs 3.90 ± 0.45) ml · g-1 · min-1,P＜ 0.05],and that in IDM group was higher than that in DM group [(4.46 ± 0.52 vs 3.39 ± 0.48) ml · g-1 · min-1,P＜0.05].The capillary density ratio in DM group was lower than that of NC group [0.429 ± 0.091 vs 0.545 ± 0.082,P＜0.05],but that in IDM group was higher than DM group [0.494 ± 0.076 vs 0.429 ± 0.091,P＜0.05].VEGF and Ang-1 expression in DM group were the highest in 3 groups (P＜0.05).Insulin therapy may improve the angiogenesis and myocardial blood flow in diabetic rats with cardiomyopathy.
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Objective To investigate the association of ERCC1 and BRCA1 gene expression with clinical features and sensitivity to platinum-containing chemotherapy in patients with ovarian epithelial carcinoma. Methods Primary ovarian epithelial carcinoma tissues were harvested from 48 patients receiving staging surgery or cytoreductive surgery. Expression of ERCC1 and BRCA1 in the tumor samples was detected by immunohistochemistry. Results ERCC1 expression was correlated with clinical stage(P﹤0. 05)but not with age,pathological type or degree of differentiation(P﹥0. 05). BRCA1 expression was not correlated with any of the clinicopathological features(P﹥0. 05);ERCC1 expression was significantly higher in drug-resistant tissues than in drug-sensitive samples(P﹤0. 05);The expression of ERCC1 and BRCA1 was positive in 89. 58%and 25. 00%of the samples,respectively. Conclusion ERCC1 gene expression is correlated with clinical stage but not with age,pathological type or degree of differentiation. BRCA1 gene expression is not correlated with clinicopathological features. ERCC1 has high positive expression in epithelial ovarian cancer and is correlated with sensitivity of platinum-containing adjuvant chemotherapy.
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Objective To investigate the β-tubulin Ⅲexpression in locally advanced cervical cancers and its significance in the neoadjuvant chemotherapy of cervical cancer .Methods Immunohistochemistry was used to detect the expression of β-tubulin Ⅲin tissue samples from 62 cases of locally advanced cervical cancer patients .Groups paclitaxel +cisplatin/carboplatin (TP) (34 pa-tients) underwent two cycles of TP chemotherapy ,while group 5-fluorouracil+cisplatin(PF) (28 patients) underwent two cycles of PF chemotherapy .Comprehensive analysis of β-tubulinⅢexpressions of TP and PF neoadjuvant chemotherapies revealed the efficien -cy and operation rate .Results The positive rate ofβ-tubulin Ⅲ was 62.90% in locally advanced cervical cancer .β-tubulin Ⅲ ex-pression was not correlated with clinicopathological features in locally advanced cervical cancer ( P >0.05 ) .β-tubulinⅢexpression was correlated with efficiency and operation rate with TP chemotherapy but not with PF chemotherapy .Conclusions In the neoadju-vant chemotherapy of locally advanced cervical cancers ,β-tubulinⅢexpression can be used as an important index to predict the effec-tive rate of combined chemotherapy containing paclitaxel and guide the patients to individual chemotherapy .
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Objective To study clinical curative effect and complications of modified laparoscopic sacral colpopexy and evaluate the efficacy and safety of this procedure in treatment of pelvic organ prolapse (POP).Methods From Jan.2008 to Sept.2012,66 patients who had undergone modified laparoscopic sacral colpopexy for POP in the first affiliated hospital of Guangzhou medical university were studied retrospectively.Primary outcomes were assessed with POP quantitation (POP-Q) system that was measured before or after operation respectively to evaluate the objective cure rate and recurrence rate.Secondary outcomes were measured by the pelvic floor distress inventory short form (PFDI-20) to evaluate the subjective cure rate,as well as to evaluate the improvement of postoperative lower urinary tract symptoms.Results Sixty-three patients were followed up for 6 to 57 months,and the median follow-up time was 16 months,the overall objective cure rate was 95％ (60/63).Postoperative each indicator point was reset anatomically according to POP-Q,the overall objective cure rate was 90％ (57/63),and the total recurrence rate was 10％ (6/63).The median postoperative vaginal length was slightly shortened than preoperative length[7.5 cm versus 8.0 cm,P ＜ 0.01]; the median score of postoperative PFDI-20 was obviously improved compared to the preoperative (21 versus 75 scores,P ＜ 0.05) ; there was no statistically significant difference in POP-Q staging and questionnaire score at more than 3 years,＞ 2-≤ 3 years,＞1-≤2 years,＜0.5-1 year after operation(P ＞0.05).Among 23 patients with stress urinary incontinence (SUI) and 5 patients with mixed urinary incontinence (MUI),15 cases underwent transvaginal tension free vaginal tape-obturator (TVT-O) procedure simultaneously,13 cases did not.The cure rate of SUI was 14/15 and 10/13,respectively.Conclusions Modified laparoscopic sacral colpopexy can not only reach the anatomical replacement stage but significantly improve the postoperative quality of life with high subjective and objective cure rate and few complications.The long-term curative effect is stable.
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Dyslipidemia is a well-established risk factor for atherosclerosis. Treating dyslipidemia in elderly patients requires specific knowledge and understanding of common dyslipidemias and the relative safety of various pharmacologic agents in the presence of possible multiple comorbidities. Lifestyle modification remains the first step in the treatment of dyslipidemia; however, it can be difficult to sustain and achieve acceptable compliance in the elderly and it is best used in combination with drug therapy. Statins are widely accepted as the first-line therapy. Several recent studies have demonstrated that statins are safe and effective in the elderly. However, it is important to note that there is very limited data regarding the effects of dyslipidemia treatment on morbidity and mortality in patients over 85 years of age. In summary, the clinicians must recognize that the presence of dyslipidemia in the elderly poses substantial risk of coronary events and stroke. The available evidence has demonstrated that in most elderly patients who are at increased risk for cardiovascular morbidity and mortality, treatment of dyslipidemia with appropriate therapy reduces the risk, and when used carefully with close monitoring for safety, the treatment is generally well tolerated. With increasing life expectancy, it is critical for physicians to recognize the importance of detection and treatment of dyslipidemia in the elderly.
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Objective To observe the effect of pressure-protective brace with pressure-sensitive device in the early stage rehabilitation training enhance bone healing, shorten the treatment course and reduce complications,a kind of independently developed pressure-protective brace with pressure-sensitive device was utilized with quantified discontinuous longitudinal stress stimulation under doctors' regulation according to procedure. Methods The pressure-protective brace with pressure sensitive device for rehabilitation training was developed in May 2008 ,and was applied in clinics during January 2009 to June 2010. Forty elder patients,with complete clinical data, underwent Dynamic Hip Screw (DHS) internal fixation of femoral intertrochanteric fracture were were enrolled into this study. These cases were assigned into experimental group and control group with 20 patients respectively. The patients of experimental group performed lower extremity rehabilitation training wearing the pressure-protective brace. The load training of lower extremities with double crutches was modulated by doctors through regulating the threshold value of pressure in different time and different condition after operation according to the prearranged rehabilitative plan of individuation. The controls were instructed to performed lower extremity rehabilitation training in traditional way. Both the clinical healing and bone union time in all cases were evaluated according to the uniform standard. Results Total 40 patients were followed up for 13.0 - 24. 0 weeks ( average, 17.6 weeks ). Clinical healing time was 7.0 - 12. 0 weeks ( average,9. 1 weeks ) and bone healing time was 12. 0 - 16.0 weeks(average,13. 7 weeks)in experimental group. While in control group,the clinic healing time and bone union time was 9. 0 - 13.0 weeks( average, 11.3 weeks) and 14. 0 -20. 0 weeks (average, 16. 6 weeks)respectively. The Independent T-test results showed that whether clinic healing time or bone healing time presented significant differences between experimental group and the controls( P＜0. 01 ). All of the fractures in these two groups were healed at the end time of follow up without adverse complications,including fracture displacement, implant break, implant loose and failure. Conclusion The pressure-protective brace with pressure sensitive device used for quantifying rehabilitation training can enhance bone union, shorten the treatment course and reduce complications. This method further proves that discontinuous compressive stress in a certain range can stimulate fracture healing.