Mechanical study of alisol B 23-acetate on methionine and choline deficient diet-induced nonalcoholic steatohepatitis based on untargeted metabolomics.

Alisol B 23-acetate (AB23A) has been demonstrated to have beneficial effects on nonalcoholic steatohepatitis (NASH). However, the mechanisms of AB23A on NASH remain unclear. This study aimed to investigate the mechanisms underlying the metabolic regulatory effects of AB23A on NASH. We used AB23A to treat mice with NASH, which was induced by a methionine and choline deficient (MCD) diet. We initially investigated therapeutic effect and resistance to oxidation and inflammation of AB23A on NASH. Subsequently, we performed untargeted metabolomic analyses and relative validation assessments to evaluate the metabolic regulatory effects of AB23A. AB23A reduced lipid accumulation, ameliorated oxidative stress and decreased pro-inflammatory cytokines in the liver. Untargeted metabolomic analysis found that AB23A altered the metabolites of liver. A total of 55 differential metabolites and three common changed pathways were screened among the control, model and AB23A treatment groups. Further tests validated the effects of AB23A on modulating common changed pathway-involved factors. AB23A treatment can ameliorate NASH by inhibiting oxidative stress and inflammation. The mechanism of AB23A on NASH may be related to the regulation of alanine, aspartate and glutamate metabolism, d-glutamine and d-glutamate metabolism, and arginine biosynthesis pathways.

Synergy effects of Methylomonas koyamae and Hyphomicrobium methylovorum under methanethiol stress.

Methanotrophs are able to metabolize volatile organic sulfur compounds (VOSCs), excrete organic carbon during CH4 oxidation, and influence microbial community structure and function of the ecosystem. In return, microbial community structure and environmental factors can affect the growth metabolism of methanotrophs. In this study, Methylomonas koyamae and Hyphomicrobium methylovorum were used for model organisms, and methanethiol (MT) was chosen for a typical VOSC to investigate the synergy effects under VOSC stress. The results showed that when Hyphomicrobium methylovorum was co-cultured with Methylomonas koyamae in the medium with CH4 used as the carbon source, the co-culture had better MT tolerance relative to Methylomonas koyamae and oxidized all CH4 within 120 h, even at the initial MT concentration of 2000 mg m-3. The optimal co-culture ratios of Methylomonas koyamae to Hyphomicrobium methylovorum were 4:1-12:1. Although MT could be converted spontaneously to dimethyl disulfide (DMDS), H2S, and CS2 in air, faster losses of MT, DMDS, H2S, and CS2 were observed in each strain mono-culture and the co-culture. Compared with Hyphomicrobium methylovorum, MT was degraded more quickly in the Methylomonas koyamae culture. During the co-culture, the CH4 oxidation process of Methylomonas koyamae could provide carbon and energy sources for the growth of Hyphomicrobium methylovorum, while Hyphomicrobium methylovorum oxidized MT to help Methylomonas koyamae detoxify. These findings are helpful to understand the synergy effects of Methylomonas koyamae and Hyphomicrobium methylovorum under MT stress and enrich the role of methanotrophs in the sulfur biogeochemical cycle. KEY POINTS: • The co-culture of Methylomonas and Hyphomicrobium has better tolerance to CH3SH. • Methylomonas can provide carbon sources for the growth of Hyphomicrobium. • The co-culture of Methylomonas and Hyphomicrobium enhances the removal of CH4 and CH3SH.

The first two cases of transcatheter mitral valve repair with ARTO system in Asia.

BACKGROUND: MAVERIC (Mitral Valve Repair Clinical Trial) validates the safety and efficacy of the ARTO system. We here report the first two successful cases of utilizing the ARTO system in patients with symptomatic heart failure (HF) with functional mitral regurgitation (FMR) in Asia. METHODS: Two patients, aged 70 and 63, had severe HF with FMR. Transesophageal echocardiography confirmed that the left ventricular ejection fractions were less than 50% with severe mitral regurgitation (MR) in both patients. Optimizing drug treatment could not mitigate their symptoms. Therefore, we used the ARTO system to repair the mitral valve for these patients on March 5 and 6, 2019, respectively. RESULTS: Mitral valve repairs using the ARTO system were successfully performed under general anaesthesia for these two patients. MR was decreased immediately after the procedures in both patients. The 30-day and 3-month transthoracic echocardiography (TTE) revealed a moderate to severe MR in both patients, and the New York Heart Association (NYHA) scales were also partially improved. CONCLUSION: The first two cases in Asia indicate that the ARTO system is feasible for patients with heart failure with FMR, and the patient selection appears to be crucial.

Assessment of the major odor contributors and health risks of volatile compounds in three disposal technologies for municipal solid waste.

Gaseous emissions from municipal solid waste (MSW) disposal plants pose serious odor pollution and health risks. In this study, the emission of volatile organic compounds and carbon disulfide was compared in the main processing units of three disposal methods, i.e., landfilling, eco-mechanical biological treatment (EMBT) and anaerobic fermentation in a MSW disposal plant. Among the detected volatile compounds (VCs), the top ten odor compounds were methanethiol, dimethyl sulfide, dimethyl disulfide, carbon disulfide, styrene, m-xylene, 4-ethyltoluene, ethylbenzene, 2-hexyl ketone and n-hexane in the MSW disposal plant. Sulfur compounds were the main source of odor at the majority of sampling sites, and aromatic compounds were the dominant odor substrates at the tipping unit and sorting system of EMBT, while 2-hexanone was the major odor substrate at the tipping unit (AT) and sorting system (AS) of anaerobic fermentation and the landfill working surface. At AS and AT, the lifetime cancer risk values for 1,2-dichloroethane and trichloroethylene exceeded the carcinogenic risk value (>1.0E-04), and the hazard index values of naphthalene, trichloroethylene and acrolein all exceeded the acceptable level (>1). Therefore, special attention should be paid to VC emissions from MSW disposal facilities, and protection measures should be adopted for on-site workers to minimize health risks.

[Expression and Regulatory Effect of miR-30b on Dynamin in Cochlear Hair Cells].

OBJECTIVE: To determine the expression of miR-30b in hair cells of mice,and its regulatory effect on the target gene DNM1 and expression of Dynamin,the key protein of synaptic endocytosis in inner hair cells. METHODS: The basilar membrane of cochlear in adult C57 mice was obtained. The expression of miR-30b in the hair cells was detected by in situ hybridization. Luciferase vector was constructed and transfected into 293T cells with miR-30b. Changes in luciferase activity were measured to verify whether DNM1 was the target gene of miR-30b. Adeno-associated virus carrying miR-30b were micro-injected into cochlear via the round window membrane. mRNA expressions of DNM1 and miR-30b were detected by RT-PCR 14 days later. The expression of Dynamin was detected by Western blot. RESULTS: miR-30b expressed in the inner and outer hair cells scattered in the region of the nucleus and cytoplasm. miR-30b reduced luciferase activity from the reporter vector containing DNM11 (P<0.05),but not in its mutants. Increased expressions of miR-30b and decreased mRNA expressions of DNM1 and Dynamin were observed following transfection of AAV-miR-30b. CONCLUSION: miR-30b expresses in inner and outer hair cells,which is consistent with the morphological orientation of dynamin. miR-30b inhibits the expression of Dynamin by targeting DNM11 gene.

Conversion of sulfur compounds and microbial community in anaerobic treatment of fish and pork waste.

Volatile sulfur compounds (VSCs) are not only the main source of malodor in anaerobic treatment of organic waste, but also pose a threat to human health. In this study, VSCs production and microbial community was investigated during the anaerobic degradation of fish and pork waste. The results showed that after the operation of 245 days, 94.5% and 76.2% of sulfur compounds in the fish and pork waste was converted into VSCs. Among the detected VSCs including H2S, carbon disulfide, methanethiol, ethanethiol, dimethyl sulfide, dimethyl disulfide and dimethyl trisulfide, methanethiol was the major component with the maximum concentration of 4.54% and 3.28% in the fish and pork waste, respectively. The conversion of sulfur compounds including total sulfur, SO42--S, S2-, methionine and cysteine followed the first-order kinetics. Miseq sequencing analysis showed that Acinetobacter, Clostridium, Proteus, Thiobacillus, Hyphomicrobium and Pseudomonas were the main known sulfur-metabolizing microorganisms in the fish and pork waste. The C/N value had most significant influence on the microbial community in the fish and pork waste. A main conversion of sulfur compounds with CH3SH as the key intermediate was firstly hypothesized during the anaerobic degradation of fish and pork waste. These findings are helpful to understand the conversion of sulfur compounds and to develop techniques to control ordor pollution in the anaerobic treatment of organic waste.

[Effect of atopy on serum glucocorticoid receptor levels in children with bronchiolitis].

OBJECTIVE: To investigate the effect of atopy on the expression of glucocorticoid receptors in children with bronchiolitis. METHODS: ELISA was used to measure the changes in the serum levels of glucocorticoid receptor α (GRα) and glucocorticoid receptor ß (GRß) in the bronchiolitis group (77 children, including 34 children with atopy) and pneumonia group (68 children). Thirty-eight children who were prepared to undergo surgeries for non-infectious diseases and had no atopy or family history of allergic diseases were enrolled as the control group. RESULTS: The bronchiolitis group and the pneumonia group had significant increases in the serum levels of GRα and GRß compared with the control group (P<0.01), and the bronchiolitis group had significant increases in these levels compared with the pneumonia group (P<0.01). Compared with the control group and the pneumonia group, the bronchiolitis group had a significant increase in the GRα/GRß ratio (P<0.01). Compared with the control group, the children with or without atopy in the bronchiolitis group had significant increases in the serum levels of GRα and GRß (P<0.01). The non-atopic children in the bronchiolitis group had a significant increase in the serum level of GRß compared with the atopic children (P<0.01). The atopic children in the bronchiolitis group had a significant increase in the GRα/GRß ratio compared with the control group and non-atopic children in the bronchiolitis group (P<0.01). CONCLUSIONS: Children with bronchiolitis have increased serum levels of GRα and GRß. The children with atopy have an increased GRα/GRß ratio, suggesting that the atopic children with bronchiolitis are highly sensitive to glucocorticoids.

Fertility-Preserving Treatments in Patients with Gynecological Cancers: Chinese Experience and Literature Review.

We conducted a retrospectively reviewed of the literature published of patients underwent fertility-preserving treatments for cervical, endometrial and ovarian cancers using the WANFANG database in Chinese. A majority were retrospective studies and case reports. With cervical cancer, radical trachelectomy(RT) in combination with pelvic lymphadenectomy could preserve the fertility of patients with early stage IA1-IB1 cancers, Tumor size≤2 cm should be emphasized as the indication of RT in considering of the higher recurrent rate in patients with tumor size>2 cm. For endometrial cancers, there is much experience on it. Given accurate pretreatment assessment, hormonal therapy is feasible management option to preserve fertility in young patients with early stage lesions that limited to the endometrium and well differentiated. High dose progestin have been applied, oral medroxyprogesterone acetate (MPA), 250-500 mg/day, megestrol acetate 160-480 mg/day. Other therapies that have been used in a limited number of cases include GnRH analog, intrauterine devices (IUDS) containing progestogen, usually combination of these therapies. All patients should be followed up by ultrasound and/or MRI evaluation, and endometrial curettage at intervals of 3 months. With ovarian cancer, in China, fertility- preserving surgery in patients with stage IA (grade G1) of epithelial ovarian tumor and patients with germ cell tumor and borderline ovarian tumor have been successfully performed.

[Treating chronic persistent bronchial asthma children with abnormal myocardial enzyme spectrum by Yupingfeng powder: an efficacy observation].

OBJECTIVE: To observe the clinical efficacy of treating chronic persistent bronchial asthma (CPBA) children with abnormal myocardial enzyme spectrum (AMES) by Yupingfeng Powder (YP) combined routine therapy. METHODS: From January 2010 to December 2012, 156 CPBA children patients with AMES were randomly assigned to the treatment group (80 cases) and the control group (76 cases). All patients received routine treatment (inhaled corticosteroids and/or leukotriene regulator). Besides, those in the treatment group took YP. The treatment duration was 3 months. The scores of children asthma control test (C-ACT), pulmonary function (FEV,% and PEF%), myocardial enzyme spectrum were observed before and after treatment, and 3 months before and after treatment. The myocardial enzyme spectrum of 40 healthy children at the baby clinics during the same period were recruited as the control. RESULTS: Compared with the control group, creatine kinase isoenzyme (CK-MB), creatine kinase(CK), and lactate dehydrogenase (LDH) increased in the two treatment groups (P <0.01), but there was no statistical difference in AST (P >0.05). Compared with before treatment in the same group, CK-MB, CK, LDH, and AST decreased in the treatment group after treatment and 3 months after treatment (P <0.01). CK-MB, CK, LDH, and AST decreased in the control group 3 months after treatment (P <0.01, P <0.05).Compared with after treatment, CK decreased in the control group 3 months after treatment (P <0.01). C-ACT score, FEV(1),%, and PEF% all increased in the two groups after treatment and 3 months after treatment (P <0.01, P <0.05). Compared with after treatment in the same group, CK decreased in the control group 3 months after treatment (P <0. 01). Compared with the control group in the same period, post-treatment CK-MB and CK decreased (P <0. 01, P <0. 05), while post-treatment C-ACT score, FEV, %, and PEF% increased (P <0.05) in the treatment group (P <0.05). CONCLUSION: YP could strengthen specific and non-specific immunity of the organism, and improve clinical symptoms and the level of myocardial enzyme spectrum.

Factors Associated with Performance-based Physical Function of Older Veterans of the PLAAF: A Pilot Study.

[Purpose] This study investigated the factors associated with performance-based physical function of older veterans of the People's Liberation Army Air Force of China (PLAAF). [Subjects and Methods] A cross-sectional survey of 146 older veterans of the PLAAF was carried out. Their physical function was measured using the Chinese Mini-Physical Performance Testing (CM-PPT). The demographics and health status (including physical measures, blood chemical tests, chronic diseases, and number of morbidities) were collected from health examination reports and computer records of case history. Cognition was measured using the Mini-Mental Status Examination (MMSE). [Results] In multiple linear regressions, age, MMSE, Parkinsonism, and chronic obstructive pulmonary disease were independently associated with CM-PPT, while previous stroke and albumin level reached borderline statistical significance. The association between the number of morbidities and CM-PPT was significant after adjustment for MMSE and demographics. The CM-PPT of low (0 or 1), medium (2 to 4) and high count (5 or more) morbidities were 11.3±3.9, 10.2±4.1, 6.1±3.8 respectively, and the difference among these three groups was significant. [Conclusion] Some modified conditions and the number of chronic diseases might be associated with the physical function of older veterans of the PLAAF.

[Cadmium and selected heavy metals in soils of Jianping area in Wushan County, the Three Gorges region: distribution and source recognition].

Abnormally high cadmium (Cd) concentrations were existed in soils of Jianping area in the Three Gorges region, but little information is available about the geochemical distribution of Cd and source identification. In the present paper, total contents of Cd and other selected heavy metal elements, the characteristics of soil, the contents of Cd in typical soil profiles, and chemical forms of Cd in selected soils were studied. The correlation analysis, the principal component analysis, and the comparison between different soil types were conducted. The concentration distribution of Cd and selected elements in local soils was investigated and their sources were identified. The results showed that Cd in local rocks, coal and coal wastes ranged from 0.22-101 mg x kg(-1), 0.42-42 mg x kg(-1) in the arable topsoil, and 0. 12-8.5 mg x kg(-1) in natural soils. The soils were also rich in other elements such as V, Cr, Ni and Zn. The weak acid fraction of Cd accounted for 17%-35% of total contents. This study demonstrated that soils from the Jianping area of Wushan County had a serious Cd pollution, and both local rocks and soils display a significant geochemical interrelation. Cd particularly accumulates in the topsoil, and it is mainly derived from the geogenic source. Human such as the historical coal mining may overload Cd in the soils. The local soils had a high portion of bioavailable Cd, through which Cd may easily transfer to and accumulate in the local crops growing in the Cd-rich soils and cause potential health risk to local residents.

[Regulation of claudin-4 gene expression in endometrial adenocarcinoma Ishikawa cell line by progesterone].

OBJECTIVE: To explore the regulation of claudin-4 expression in endometrial adenocarcinoma cell lines by progesterone. METHODS: Ishikawa cells were treated with various concentrations of megestrol acetate (MA: 2, 5, 10, 15, 20 mg/L). After cultured for 24, 48 and 72 hours, cells growth were measured by methyl thiazolyl tetrazolium (MTT). The group of Ishikawa cells incubated with MA at the 50% inhibitory concentration (IC(50)) was selected for cell apoptosis assay by using transmission electron microscopy and flow cytometry method. Real-time PCR and western blot were used for detecting the mRNA and protein expression levels of claudin-4. The localization of claudin-4 was examined by immunofluorescent staining. RESULTS: The inhibitory effects of megestrol acetate on the growth of Ishikawa cells were dose-dependent and time-dependent. IC(50) of MA on Ishikawa cells was 15 mg/L after incubated for 72 hours. After MA treatment, Ishikawa cells showed shrinkage, nuclear chromatin condensation, fractures of nuclear membrane and endoplasmic reticulum expansion, even round apoptotic bodies were found. The apoptosis rate of cells before MA treatment was (0.076 ± 0.024)%, and the rate was (3.934 ± 0.816)% by MA treated for 72 hours, in which there were signicant difference (P < 0.05). The relative quantification of claudin-4 mRNA and protein of the cells before MA treatment were 0.64 ± 0.20 and 0.94 ± 0.18, while they were 0.47 ± 0.15 and 0.62 ± 0.15 after MA treated. The expression of claudin-4 was significantly decreased after MA treatment (P < 0.05). The localization of claudin-4 transferred from cytomembrane to cytoplasm and nucleus after MA treatment. CONCLUSIONS: MA could inhibite the growth of Ishikawa cells, in which the mechanism may be decrease the expression of claudin-4 and the apoptosis of cells. The distribution change of claudin-4 may be related to the anti-cancer effect of progesterone.

[Relationship between serum S100B protein level and brain damage in preterm infants].

OBJECTIVE: To study changes of serum S100B protein level in preterm infants with brain damage and its role. METHODS: Forty-seven preterm infants were classified into 3 groups based on the results of brain ultrasound and MRI: brain white matter damage (WMD; n=13), brain but not white matter damage (non-WMD; n=14) and control (no brain damage; n=20). Blood samples were collected within 24 hrs, 72 hrs and 7 days after birth. S100B protein level was measured using ELISA. RESULTS: Serum levels of S100B in the WMD and non-WMD groups were significantly higher than in the control group within 24 hours, 72 hours and 7 days after birth (P<0.05). More increased serum S100B levels were observed in the WMD group compared with the non-WMD group (P<0.05). CONCLUSIONS: Serum S100B protein level increases in preterm infants with brain damage within 7 days after birth, suggesting that it may be used as an early sensitive marker for the diagnosis of brain damage, especially WMD.

[Combined use of tandem mass spectrometry with urine gas chromatography/mass spectrometry is useful for diagnosis of inborn errors of metabolism in children].

OBJECTIVE: Many inborn errors of metabolism have similar presenting clinical manifestations, making early diagnosis difficult. We report our experience with tandem mass spectrometry combined with urine gas chromatography/mass spectrometry as a means of definitively diagnosing inborn errors of metabolism. METHODS: One hundred and thirty-two children with suspected inborn errors of metabolism but without specific clinical manifestations, admitted to the Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine between June 1, 2003 and September 30, 2006, were studied. Children received routine biochemical examinations, as well as mass spectrometry and gas chromatography-mass spectrometry. RESULTS: Fifteen cases (11.5%) were confirmed as having inborn errors of metabolism, including 6 cases of methylmalonic acidemia, 2 of propionic academia, 2 of Type II citrullinemia, 1 of biotinidase deficiency, 1 of tyrosinemia, 1 of maple syrup urine disease, 1 of omithine transcarbamylase deficiency and 1 of very long chain Acyl CoA dehydrogenase deficiency. CONCLUSIONS: The combined use of tandem mass spectrometry with urine gas chromatography mass spectrometry is useful for early diagnosis of inborn errors of metabolism in children with suspected inborn errors of metabolism but without specific clinical manifestations.

[Relationship between pain symptoms and clinico-pathological features of pelvic endometriosis].

OBJECTIVE: To study the relationship between pain symptoms and the clinico-pathological features of pelvic endometriosis (EM). METHODS: One hundred thirty patients with laparoscopic diagnosis of EM were studied retrospectively and the relationship between pain symptoms including dysmenorrhea, chronic pelvic pain (CPP), dyspareunia and dyschezia and the anatomical features of pelvic endometriosis were evaluated. RESULTS: One hundred (76.9%) patients with pain symptoms and 30 (23.1%) without were included in this study. The number of patients with mild, moderate and severe dysmenorrhoea was 27 (20.8%), 41 (31.5%), and 32 (24.6%), respectively. Patients with dyspareunia, CPP and dyschezia were 46 (35.4%), 45 (34.6%) and 67 (51.5%), respectively. Compared with patients without dysmenorrhea, the proportion of deep utero-sacral nodules (45.0% vs 13.3%, P=0.00), recto-vaginal nodules (16.0% vs 0, P=0.01), complete obliteration of cul-de sac (41.0% vs 10.0%, P=0.00), and lesions of DIE (51.0% vs 16.7%, P=0.00) was significantly increased in patients with dysmenorrhea. The severity of dysmenorrhea was positively correlated with nodules in uterosacral ligaments (P=0.005, r=0.302), and invasive depth of uterosacral ligaments (P=0.016, OR=5.085). Among patients with endometrioma, significantly more moderate to severe adhesions were found in patients with dysmenorrhea, compared with those patients without dysmenorrhea (29.1% vs 8.3%, P=0.029). Patients with CPP had more nodules in the utero-sacral ligaments (51.1% vs 30.6%, P=0.018) and DIE lesions (57.8% vs 35.3%, P=0.011), compared with those without. More nodules in the utero-sacral ligaments (46.3% vs 28.6%, P=0.028), recto-vaginal nodules (19.4% vs 4.8%, P=0.01), complete obliteration of cul-de sac (44.8% vs 22.2%, P=0.005) and DIE lesions (53.7% vs 31.7%, P=0.01) were found in patients with dyschezia, compared with those without. Nodules in the recto-vaginal pouch were an independent risk factor of dyspareunia. CONCLUSION: Pain symptoms including dysmenorrhea, dyspareunia, chronic pelvic pain, and dyschezia are remarkably related to endometriotic nodules at the posterior part of the pelvis or those with deep invasions.

[Visual and histologic analysis of laparoscopic diagnosis of endometriosis].

OBJECTIVE: To determine the characteristics of anatomical distribution of pelvic endometriosis and the correlation between visual and histologic findings of endometriosis at laparoscopy. METHODS: A prospective study of 62 patients undergoing laparoscopy for the pelvic pain, infertility and/or pelvic masses was carried out. All lesions with the diagnosis of endometriosis laparoscopically were excised and examined pathologically. Normal-appearing peritoneal biopsies were obtained randomly. All lesions were identified by anatomical site and color of the foci. The positive predictive value (PPV), sensitivity, negative predictive value (NPV), and specificity were determined for visually identified endometriosis versus the histologic findings. RESULTS: Totally, 219 peritoneal endometriotic lesions, 54 normal peritoneal biopsies, and 71 ovarian endometriotic cysts were obtained. Peritoneal lesions tended to locate in posterior part of the pelvis (80.8%, 177/219) and in left (58.0%, 127/219) with most in black (39.2%). The PPV was 67.6%; sensitivity, 93.7%; NPV, 81.4%; and specificity, 38.3% for visual versus histologic diagnosis of peritoneal endometriosis. Lesions in black or from sacral ligaments were confirmed histologically in 94.2% and 84.7% respectively, and 80.3% (57/71) of ovarian endometriotic cysts diagnosed by laparoscopy were confirmed histologically with 43.6% in the left, 27.3% in the right; and 29.1% (16/55) in both sides of the ovary. In addition, 18.5% (10/54) of normal-appearing peritoneal biopsy were identified as endometriosis by pathological examination. Laparoscopy was confirmed to be in 100% diagnostic accordance with pathology for patients with endometriosis. CONCLUSIONS: Our study showed asymmetrical distribution of pelvic endometriosis. Peritoneal lesions in black or from sacral ligament are more likely to be histologically confirmed, and microscopic lesions are not a rare phenomenon of endometriosis.

[Correlative factors analysis of recurrence of endometriosis after conservative surgery].

OBJECTIVE: To determine the correlative factors with recurrence of endometriosis after conservative surgery. METHODS: A cohort study was performed on 285 patients who had a minimum of 36 months of follow-up after conservative surgery for endometriosis. All patients underwent clinical interview, physical examination and ultrasonography. The factors measured included: age at surgery, age at onset of disease, gravidity, parity, tenderness nodule at cul-de-sac (yes/no), uterus mobility (movable/fixed), serum CA(125) level, type of operation (laparoscopy/laparotomy), history of operation for endometriosis (yes/no), side of endometrioma (left/right/bilateral), intraoperative revised classification American Fertility Society (r-AFS) scores, post-operative r-AFS scores, highest post-operative temperature, post-operative adjuvant therapy, post-operative gravidity and parity. The recurrent rate and its predictive factors were evaluated and the univariate, multivariate COX regression and Kaplan-Meier analyses were performed to determine the predictive factors for recurrence of endometriosis. RESULTS: The related factors and their odds ratio (OR) by univariate analysis were as follows: history of endometriosis surgery, 13.630 (P < 0.01); nodules with tenderness at cul-de-sac, 6.133 (P < 0.01); post-operative administration of clomiphene, 5.173 (P < 0.01); left endometrioma, 4.503 (P < 0.01); bilateral endometrioma, 3.709 (P < 0.01); post-operative r-AFS scores, 1.831 (P < 0.01); post-operative gravidity, 0.392 (P < 0.05); post-operative administration of progesterone for 6 months, 0.472 (P < 0.01); laparoscopic surgery, 0.567 (P < 0.05); pre-operative parity, 0.640 (P < 0.05); pre-operative gravidity, 0.759 (P < 0.05); age at onset of disease, 0.912 (P < 0.01) and age at surgery, 0.932 (P < 0.05). Meanwhile, the related factors and their odds ratio (OR) by multivariate COX analysis were as follows: history of endometriosis surgery, 8.219 (P < 0.01); bilateral endometrioma, 6.369 (P < 0.01); left endometrioma, 2.682 (P < 0.05); tenderness nodules at cul-de-sac, 2.154 (P < 0.05); post-operative administration of clomiphene, 1.860 (P < 0.05); post-operative r-AFS scores, 1.188 (P < 0.01); post-operative gravidity, 0.253 (P < 0.01); post-operative administration of progesterone for 6 months, 0.518 (P < 0.05); age at surgery, 0.937 (P < 0.01). CONCLUSIONS: The risk factors for recurrence of endometriosis include a history of endometriosis surgery, bilateral endometrioma, left endometrioma, tenderness nodules at cul-de-sac, post-operative administration of clomiphene, post-operative r-AFS scores,whereas the protective factors include the post-operative gravidity, post-operative adjuvant therapy and age at surgery.

[Effect of different surgical approaches on quality of life and cost-consequence].

OBJECTIVE: To evaluate the effects of total abdominal hysterectomy (TAH), laparoscopic hysterectomy (LH) and transvaginal hysterectomy (TVH) on quality of life, cost and health care utilization. METHODS: A study of women who underwent elective hysterectomy was performed to assess the effect of operations on quality of life using WHO quality of life-bref before operation, at the 4th, 14th and 28th day after operation, respectively. The data of total cost and health care utilization were also analyzed. RESULTS: The score of quality of life at the 4th day after operation in TVH patients was significantly higher than that in TAH patients (93 +/- 6 vs 81 +/- 11, P < 0.01). There was no significant difference in this score between TVH and LH, and between LH and TAH patients. However, at the 14th and 28th after operation, the scores in both TVH and LH patients were significantly higher than that in TAH patients (95 +/- 7 and 96 +/- 7 vs 85 +/- 9, P < 0.001 and 0.001; 96 +/- 10 and 98 +/- 7 vs 87 +/- 10, P < 0.01). There was no significant difference in the total costs among three groups. The better health care utilization was in LH and TVH patients, and the worse in TAH patients. CONCLUSIONS: The effect of LH and TVH on quality of life and health economics is similar, and appears to be superior than that of TAH.

[Clinical characteristics of abdominal wall endometrioma and its recurrence-related factors].

OBJECTIVE: To analyze the clinical characteristics, and treatment, recurrence-related factors of abdominal wall endometriomas (AWE). METHODS: Fifty-seven cases of AWE treated at Peking Union Medical College Hospital from 1983 to 2002 were reviewed. RESULTS: The incidence of AWE was 1.04% (57/5478) in patients with endometriosis after surgical treatment. It was 0.046% in patients undergoing cesarean section in the same period. Of 57 cases with AWE, 56 had low-abdominal operation previously and one was primary umbilicus endometrioma. Fifty-five cases of AWE were secondary to cesarean section. The latent period of AWE was positively correlated to patient's age at onset (P < 0.001). Fifty-five cases received surgical treatment while 2 were given medical treatment. Follow-up duration was 1.1 - 235 months. Five cases recurred and one was transformed to malignancy. The recurrence was correlated to the size and depth of the lesions. CONCLUSIONS: AWE could be diagnosed prior to operation according to its typical clinical manifestations. Ultrasonic examination may be valuable for the diagnosis of atypical cases. Surgical treatment is effective. A complete excision with clear margin is very important to prevent recurrence.