Clinical analysis of modified laparoscopic sacrocolpopexy in the treatment of pelvic organ prolapse / 中国实用妇科与产科杂志

OBJECTIVE: To explore clinical effectiveness of modified laparoscopic sacrocolpopexy by using double-mesh in the treatment of pelvic organ prolapse.METHODS: A retrospective analysis was conducted in 61 patients with pelvic organ prolapse who received LSC from September 1,2012 to September 30,2017.Among 61 patients,32 cases received modified LSC(modified group)and 29 cases received traditional Y-mesh LSC(traditional group).The intraoperative and postoperative parameters were compared between the two groups and the improvement in subjective symptoms was evaluated by using the simple questionnaire(PFIQ-7)and subjective cure rate was assessed.RESULTS: The difference was of statistical significance in operation time[(127.34+7.88)min vs.(143.28+15.38)min]between the modified group and the traditional group(P0.05).The median follow-up time of 61 patients was 28 months.In the modified group and traditional group,the objective cure rates were 96.86% and 89.65%,respectively.After operation each indicator point was recovered anatomically according to POP-Q,and there was statistical difference compared with before operation.The score of postoperative PFIQ-7 was obviously reduced compared to the preoperative parameter.The subjective cure rates of the modified group and traditional group were 100% and 94.74%,respectively.There was no new complications occurring in the modified group.There were 3 cases of postoperative mesh exposure in the traditional group.The symptoms of urinary incontinence disappeared after TVT-O in both groups.Two new cases of urinary incontinence occured in both groups after surgery.CONCLUSION: Both of the two operations for pelvic organ prolapse are safe and effective.The modified LSC is an alternative surgical option for ptatients with pelvic organ prolapse because of its advantages,such as simpler operation,shorter operation time,and fewer longterm complications.

Investigation of awareness of menopausal hormone therapy among medical staff in Zhujiang Hospital of Southern Medical University / 解放军医学杂志

Objective To investigate the awareness and attitude towards menopause and menopausal hormone therapy (MHT) among the medical staff of Zhujiang Hospital of Southern Medical University.Methods A self-designed questionnaire related to menopause and MHT was conducted among 1143 medical staffs in Zhujiang Hospital of Southern Medical University.Results The best-known symptoms,in sequences,were dysphoria and depression (90.6％),sleep disorders (81.5％),hot flashes and night sweating (69.4％),dizziness and palpitation (59.3％),and paresthesia (50.3％).Of 1143 respondents,42.1％(481) knew about MHT,and 62％(709) considered that MHT is necessary for symptomatic menopausal women.Significant differences existed in attitudes towards MHT between different titles and departments (P=0.027,P=0.000).Fifty-seven percent (651) of medical staff expressed concern about the side effects of MHT and had scruples about its use,73.1％(836) believed that MHT can improve menopausal symptoms,while 54.5％(623) believed MHT can prevent and treat osteoporosis.Conclusions The awareness rate on menopause and MHT is relatively low among the medical personnel of Zhujiang Hospital of Southern Medical University.There exist differences in attitudes towards menopause and MHT among different departments,doctors and nurses,and different titles.

Effect of allogeneic adipose derived mesenchymal stem cells on regulatory T cells in peripheral blood of patients with premature ovarian failure / 解放军医学杂志

Objective To investigate the effect of allogeneic adipose derived mesenchymal stem cells (hADSCs) on regulatory T cells (Tregs) in peripheral blood of patients with premature ovarian failure (POF).Methods hADSCs were isolated from adipose tissue using 0.1％ type Ⅰ collagenase digestion.Adipogenic,osteogenic differentiation and surface molecular characterization were also performed.Peripheral blood mononuclear cells (PBMCs) of POF patients were isolated by density gradient centrifugation.PBMCs were co-cultured with 1 × 104,2 × 104 and 1 × 105 hADSCs for 72 hours under the stimulation of phytohemagglutinin (PHA).The proliferation rate of lymphocytes was measured by CCK-8 method,the proportion of CD4+ CD25+ Foxp3+ Treg cells was measured by flow cytometry.Real-time fluorescent quantitative PCR was used to detect the mRNA level of Foxp3+.Results hADSCs were positive for CD90,CD105 and negative for CD34,CD45,and has adipogenic and osteogenic differentiation ability.The results of CCK-8 showed that hADSCs could significantly inhibit the proliferation of lymphocytes compared with that in control group (P＜0.001).Flow cytometry showed that hADSCs could promote the proliferation of CD4+ CD25+ Foxp3+ Treg cells (P＜0.05).The results of qPCR showed that Foxp3+ mRNA expression was obviously up-regulated in all experimental groups compared with that in control group (P＜0.001).Conclusion hADSCs can play an immune regulatory role and promote the proliferation of Tregs in peripheral blood of patients with premature ovarian failure.

Longitudinal analysis of vaginal microbiota in women with recurrent vulvovaginal candidiasis / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the vaginal flora in patients with recurrent vulvovaginal candidiasis (RVVC).</p><p><b>METHODS</b>Vaginal swabs were collected at different time points from 6 RVVC patients and 5 healthy women of child-bearing age. The dynamic changes, microbiota composition, alpha diversity and beta diversity in the two groups were assessed by analyzing the 16S rRNA V4 hypervariable region amplified from the total genomic DNA from the swabs.</p><p><b>RESULTS</b>Lactobacillus was the predominant species in healthy women with similar proportions of L.iners and L.crispatus; small proportions of Gardnerella, Prevotella and other genus were also detected. In some healthy women, the vaginal flora showed a high relative abundance of anaerobic bacteria such as Gardnerella, Prevotella, Atopobium, Sneathia. Compared with the healthy women, patients with RVVC showed a significantly reduced diversity of vaginal flora, where L.iners was the predominant species and the content of L.crispatus decreased significantly. In healthy women, the vaginal flora fluctuated with the menstrual cycle, and the fluctuation was the most prominent during menstruation; the dominant species either alternated regularly or maintain an absolute superiority in the menstrual cycle. The vaginal flora showed attenuated fluctuation in women with RVVC, were highly conserved within the menstrual cycle, and maintained a similar composition in the episodes and intermittent periods.</p><p><b>CONCLUSION</b>The vaginal flora of RVVC patients do not undergo regular variations with the menstrual cycle and shows a similar composition between the episodes and intermittent periods. Promoting the production of L.iners or inhibiting the colonization of L.crispatus to restore the composition of the vaginal flora may help in the treatment of RVVC.</p>

Clinical efficacy and safety of selective trans-cystic intra-operative cholangiography in primary suture following three-port laparoscopic common bile duct exploration / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Intra-operative cholangiography has been shown to be a sensitive and specific method of demonstrating bile duct stones. This study investigated the feasibility, safety, and clinical value of selective trans-cystic intra-operative cholangiography in primary suture following three-port laparoscopic common bile duct exploration, and identified the factors that positively predict the presence of common bile duct stones.</p><p><b>METHODS</b>From January 2008 to January 2011, 252 of 1013 patients undergoing laparoscopic cholecystectomy received selective trans-cystic intra-operative cholangiography and primary suture following three-port laparoscopic common bile duct exploration. Their clinical data were analyzed retrospectively.</p><p><b>RESULTS</b>All operations were successful and none was converted to open surgery. The intra-operative cholangiography time was (8.3 ± 2.5) minutes, and the operative duration was (105.4 ± 23.1) minutes. According to selective intra-operative cholangiography, the positive predictive values of current jaundice, small gallstones (< 0.5 cm) and dilated cystic duct (> 0.3 cm), dilated common bile duct (> 0.8 cm), history of jaundice or gallstone pancreatitis, abnormal liver function test, and preoperative demonstration of suspected common bile duct stones on imaging were 87%, 25%, 42%, 15%, 32%, and 75% for common bile duct stones, respectively. Patients with several factors suggestive of common bile duct stones yielded higher numbers of positive cholangiograms. Unexpected stones were found in 13 patients (5.2%) by intra-operative cholangiography. The post-operative hospital stay was (4.7 ± 2.2) days. Post-operative bile leakage occurred in two cases, and these patients recovered by simple drainage for 3 - 7 days without re-operation. Of the 761 patients who underwent laparoscopic cholecystectomy alone, 5 (0.7%) presented with a retained common bile duct stone requiring intervention. The median follow-up was 12 months, and only one patient who once suffered from bile leakage presented with obstructive jaundice due to bile duct stenosis 6 months postoperatively. The other patients recovered without any serious complications.</p><p><b>CONCLUSIONS</b>Selective intra-operative cholangiography yields acceptably high positive results. It is a safe, effective, and minimally invasive approach in patients with suspected choledocholithiasis and primary suture following three-port laparoscopic common bile duct exploration.</p>

Laparoendoscopic single-site surgery for gynecologic malignancy: the first report in China / 南方医科大学学报

<p><b>OBJECTIVE</b>To report the first case of laparoendoscopic single-site surgery (LESS) for gynecologic malignancy in China and discuss the application of LESS in minimally invasive gynecologic surgery.</p><p><b>METHODS</b>A 57-year-old postmenopausal woman presented with vaginal bleeding for 5 years and diagnostic curettage revealed endometrial cancer. Staged LESS for endometrial cancer was performed using a single multiple-channel port (Tri-port) inserted through a solitary 2.5 cm upper umbilicus incision.</p><p><b>RESULTS</b>The operation was completed successfully. The total operative time was 4.5 h, the duration of the LESS procedure was 4.0 h, and the establishment of the operative access took 1.0 h. No other port incision or transfer to open procedure was needed. The intraoperative blood loss was 100 ml. Bowel peristalsis and micturition recovered 2 days after the operation, and the peritoneal drainage tube was removed 4 days after the operation without vaginal bleeding. No obvious scar was left on the surface of umbilicus.</p><p><b>CONCLUSION</b>LESS can be a promising minimally invasive approach to effective management of benign and malignant gynecological diseases.</p>

Transumbilical laparoendoscopic single-site surgery-assisted vaginal hysterectomy: initial report in South China / 南方医科大学学报

<p><b>OBJECTIVE</b>To report the first case of transumbilical laparoendoscopic single-site surgery-assisted vaginal hysterectomy in South China, and discuss its feasibility and safety.</p><p><b>METHODS</b>A 42-year-old woman with multiple myoma of the uterus underwent laparoendoscopic single-site surgery-assisted vaginal hysterectomy performed using a single multiple-channel port inserted through a solitary 2 cm upper umbilicus incision.</p><p><b>RESULTS</b>The total operative time was 3 h, and duration of the laparoendoscopic procedure was 2 h. The surgery was completed uneventfully without an additional port incision or transfer to open surgery. The intraoperative blood loss was 100 ml. Bowel peristalsis was recovered 3 days after the operation. The vaginal stump and abdominal incision healed smoothly without occurrence of vaginal bleeding.</p><p><b>CONCLUSION</b>With the development of surgical instruments and improvement of the surgeons' skills, laparoendoscopic single-site surgery, due to its invasiveness, can be a promising approach to the management of gynecological disease including gynecological malignant tumors.</p>

Establish a gemcitabine-resistant pancreatic cancer cell line SW1990/GZ and research the relationship between SW1990/GZ and pancreatic cancer stem cell / 中华外科杂志

<p><b>OBJECTIVES</b>To establish a gemcitabine-resistant pancreatic cancer cell line SW1990/GZ, and to explore the relationship between drug-resistant cell line SW1990/GZ and pancreatic cancer stem cell.</p><p><b>METHODS</b>Gemcitabine-resistant pancreatic cancer cell line SW1990/GZ was obtained by treating parental cell line SW1990 in vitro with increasing dosage of gemcitabine in culture medium intermittently for 24 weeks. Stable cultures were obtained which were 77.2-fold increased in resistance relative to parental cells. Gene expressions of ABCB1/MDR1, ABCC1/MRP and ABCG2/BCRP were determined by real-time PCR. Tumorigenic potential was performed by nude mice xenograft transplant experiments. Side population analysis and CD24CD44 positive cells explore were determined by flow cytometry to examine cancer stem cell proportion.</p><p><b>RESULTS</b>Gemcitabine-resistant cell line SW1990/GZ underwent obvious morphological and functional changes. Compared with the parental cell line, SW1990/GZ cell was small and turned into round shape. SW1990/GZ had a higher gene expression level of ABCB1/MDR1, ABCC1/MRP and ABCG2/BCRP than SW1990 (P < 0.01). Nude mice xenograft transplant experiments showed that only 1 × 10(5) SW1990/GZ cells were sufficient for tumor formation, whereas an injection of 1 × 10(5) SW1990 cells did not initiate tumors. Flow cytometry analysis showed that SP proportion in SW1990/GZ was (11.0 ± 1.0)%, whereas in parental SW1990 it was (4.6 ± 0.9)%, CD44CD24 positive cells was (8.73 ± 0.81)% in SW1990/GZ, whereas (1.1 ± 0.4)% in SW1990.</p><p><b>CONCLUSIONS</b>Gemcitabine-resistant cell line SW1990/GZ has a higher proportion of pancreatic cancer stem cells compared to its parental cell line SW1990. CD44 is mainly responsible for acquired drug resistance, which can be a potential target to overcome acquired drug resistance in pancreatic cancer.</p>

Laparoscopic gastric resection in 50 cases of gastric benign diseases / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the feasibility, effect, and clinic value of total laparoscopic gastric resection in patients with benign gastric disease.</p><p><b>METHODS</b>The clinical materials of 50 cases underwent total laparoscopic gastric resection (LG group) and 104 cases open surgery (OG group) between January 2002 and June 2006 were compared. The operation time, intraoperative blood loss, mean time of stay in hospital and postoperative complications were studied.</p><p><b>RESULTS</b>All operations in LG group were successfully preformed with laparoscopic technique, and the mean operation time was 105 min, mean intraoperative blood loss was 50 ml, and mean hospital stay was 7 days. Incisional wound infection occurred in 2 cases and no serious complications occurred in this group. In OG group, the mean operation time was 118 min, mean intraoperative blood loss was 108 ml, and mean hospital stay was 12 days. Wound infection occurred in 7 cases, disorder of gastric emptying was found in 3 cases, fistula of anastomotic stoma happened in 1 case and bowel obstruction occurred in 1 case. There was significant difference in operation blood loss and hospital stay between the two groups (P < 0.05).</p><p><b>CONCLUSIONS</b>Laparoscopic gastric resection is a safe and feasible minimally-invasive surgery, it brings less pain, less bleeding, shorter hospital stay.</p>

Study on esophageal motor function against reflux after esophagogastric anastomosis with mucosal valve / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To find an effective operative procedure against reflux after esophagogastric anastomosis with mucosal valve.</p><p><b>METHODS</b>Four hundred and sixty-four patients with esophageal or cardiac cancer were randomly divided into three groups according to anastomosis modes. Group A underwent esophagogastric anastomosis with mucosal valve (175 cases), group B with mechanical stapler (151 cases) and group C one layer anastomosis with handcraft suture (138 cases). The gastroesophageal reflux index (GERI) was examined by isotope,and 24 h esophageal pH was also monitored. The esophageal motor function was compared among three groups.</p><p><b>RESULTS</b>The reflux rates were 0, 33.3%, and 6.7% in group A, B, C respectively. The esophageal motor function and the 24 h esophageal pH monitoring indicated that the various indexes were approaching to the normal level in group A, but the various indexes in group B and C were significantly different from the normal values (P< 0.05).</p><p><b>CONCLUSION</b>The esophagogastric anastomosis with mucosal valve has better antireflux effect and can prevent the reflux esophagitis after esophageal or cardiac cancer eradication.</p>