Oncological Safety of Diagnostic Hysteroscopy for Apparent Early-Stage Type II Endometrial Cancer: A Multicenter Retrospective Cohort Study.

Objective: To study the oncological safety of diagnostic hysteroscopy for women with apparent early-stage type II endometrial cancer. Patients and Methods: A total of 429 women with presumed early-stage type II endometrial cancer were included. The 5-year disease-free survival (DFS) and overall survival (OS) were estimated and compared using the Kaplan-Meier method and the log-rank test among patients diagnosed by Dilation & Curettage (D&C) or diagnostic hysteroscopy. The Cox proportional hazards regression model was employed to adjust for potential confounding factors. Results: 160 cases underwent D&C and 269 cases were diagnosed by diagnostic hysteroscopy. The 5-year DFS rate was 72.17% in the diagnostic hysteroscopy group and 76.16% in the D&C group, diagnostic hysteroscopy was not associated with deteriorated 5-year DFS rate (HR 1.25, 95% CI 0.84-1.86, P=0.281). The 5-year OS rate was 67.23% in the diagnostic hysteroscopy group and 70.71% in the D&C group, diagnostic hysteroscopy did not increase the risk of all-cause death (HR 1.11, 95% CI 0.78-1.57, P=0.573). Multivariable analysis showed that the method of endometrial sampling was not independently associated with DFS (aHR 1.38, 95% CI 0.92-2.07, P=0.122) and OS (aHR 1.23, 95% CI 0.85-1.77, P=0.272). Conclusion: For apparent early-stage type II endometrial cancer, endometrial sampling by diagnostic hysteroscopy was as safe as D&C.

Oncological Safety of Laparoscopic Surgery for Women with Apparent Early-stage Uterine Clear Cell Carcinoma: A Multicenter Retrospective Cohort Study.

STUDY OBJECTIVE: To study the effect of different surgical approaches (laparoscopy and laparotomy) on the oncological outcomes of patients with apparent early-stage uterine clear cell carcinoma (UCCC). DESIGN: Retrospective cohort study. SETTING: Four Chinese teaching hospitals. PATIENTS: A total of 273 women with apparent early-stage UCCC. INTERVENTIONS: All included patients were surgically staged by laparoscopy or laparotomy. MEASUREMENTS AND MAIN RESULTS: The eligible patients were divided into the laparotomy group and the laparoscopy group. Disease-free survival (DFS) and overall survival (OS) were evaluated by the Kaplan-Meier method and compared by the log-rank test. The Cox proportional hazards regression model was used to estimate the adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for the effect of surgical approach on DFS and OS. With a median follow-up of 31.0 months, the 3-year DFS rates were 68.82% and 64.27% in the laparotomy group and the laparoscopy group, respectively. The difference in DFS between the 2 groups was not statistically significant (HR, 1.06; 95% CI, 0.72-1.58; p = .758). In addition, the 3-year OS rate (72.76% vs 73.46%; HR, 1.06; 95% CI, 0.65-1.72; p = .823) was not different between the 2 groups. Furthermore, multivariable analysis showed that for patients with apparent early-stage UCCC, the approach of surgical staging was not an independent prognostic factor for OS (adjusted HR, 1.29; 95% CI, 0.78-2.12; p = .321) and DFS (adjusted HR, 1.11; 95% CI, 0.73-1.68; p = .621). CONCLUSION: For clinical early-stage clear cell carcinoma of the uterus, staging by laparoscopy is oncologically safe. This needs to be justified by further prospective studies.

Relationship Between Anti-Müllerian Hormone and In Vitro Fertilization-Embryo Transfer in Clinical Pregnancy.

Objectives: To retrospectively analyze the correlation between anti-Müllerian hormone (AMH) and the number of oocytes obtained by controlled ovarian hyperstimulation (COH) in women of different ages and explore the factors affecting in vitro fertilization and embryo transfer (IVF-ET) in clinical pregnancy of infertile women to provide evidence for infertile women to choose assisted reproduction strategies. Methods: Infertile women who received IVF-ET or intracytoplasmic sperm injection and embryo transfer (ICSI-ET) treatment in the reproductive center of XX hospital between October 2018 and September 2019 were included. Patient data on medical records, age, body mass index (BMI), years of infertility, basic follicle-stimulating hormone (FSH), basic luteinizing hormone (LH), basic estradiol (E2), anti-Müllerian hormone level (AMH), antral follicle count (AFC), gonadotropins (Gn) medication days, Gn dosage, endometrial thickness on transplantation day, the number of retrieved oocytes, the number of mature oocytes obtained, the number of embryos transferred, clinical pregnancy status, etc., were collected. Results: A total of 314 patients were enrolled in this study, with an average age of 31.0 ± 4.5 years. The infertility period ranged from 0-21 years. The AMH level showed a downward trend with increasing age. Overall, the AMH level of women of all ages was positively correlated with the number of retrieved oocytes (r = 0.335, p < 0.001). The AMH level of women between 22 and 28 years old was positively correlated with the number of retrieved oocytes (r = 0.164, p < 0.061) but it was not statistically significant. Similarly, the AMH level of women aged 29-35 and 36-43 was positively correlated with the number of retrieved oocytes (r = 0.356, p < 0.001; r = 0.461, p < 0.001). The average age of the pregnant group (30.6 ± 4.4 years) was lower than that of the non-pregnant group (32.2 ± 4.6 years) (p < 0.001). The number of oocytes obtained (9.8 ± 4.5) and the number of embryos transferred (1.9 ± 0.4) in the pregnant group was significantly higher than that in the non-pregnant group (9.2 ± 4.5; 1.7 ± 0.5); the difference was statistically significant. The multivariate logistic regression model showed that age (OR = 0.574 95% CI: 0.350-0.940), AMH (OR = 1.430 95% CI: 1.130-1.820) and the number of oocytes obtained (OR = 1.360 95% CI: 1.030-1.790) were factors affecting clinical pregnancy. Conclusion: We found that the level of AMH in infertile women decreased with age and the number of oocytes obtained in infertile women was positively correlated with AMH. Moreover, the number of oocytes and embryo transferred in the pregnant group was significantly higher than those in the non-pregnant group. Furthermore, age, AMH and the number of oocytes affected the clinical pregnancy.

The relationship between the hormone levels before transplantation and the outcomes of hormone replacement therapy frozen embryo transfer.

BACKGROUND: The aim of the present study was to analyze the relationship between the outcomes of hormone replacement therapy frozen embryo transfer (HRT-FET) and serum estradiol and progesterone levels on the day of endometrial transformation and before transplantation. METHODS: Clinical data of patients who underwent 426 cycles of HRT-FET were retrospectively analyzed and were divided into group according to estradiol and progesterone levels. Differences in embryo implantation rate and clinical pregnancy rate were compared, and relationship between estradiol levels and outcome of transplantation was analyzed. RESULTS: During the 426 cycles, clinical pregnancy rate was 49.77% and embryo implantation rate was 27.20%. Differences in estradiol and progesterone levels on the day of endometrial transformation and before transplantation between pregnant and non-pregnant groups were not statistically significant. Furthermore, embryo implantation rate and clinical pregnancy rate among different levels of estradiol patients was not statistical different. On the day before transplantation, serum estradiol level decreased in 98.36% of patients. Differences in implantation rate and clinical pregnancy rate among patients with different extents of decrease in estradiol and different progesterone levels the day before transplantation were statistically significant (P<0.05). CONCLUSIONS: The extent of decrease in serum estradiol and progesterone levels on the day before transplantation may be associated with outcome of HRT-FET.

[Changes of serum TOS and TAS levels and their association with apolipoprotein(a) in patients with polycystic ovary syndrome and infertility].

OBJECTIVE: To investigate changes of serum total oxidation status (TOS) and total antioxidant status (TAS) and their association with apolipoprotein (a) [Apo(a)] in patients with polycystic ovary syndrome (PCOS) combined with infertility. MWTHODS: Ninety patients with PCOS and infertility were selected as the study group, including 45 patients treated with antioxidants combined with Diane-35(group A) and 45 with Diane-35 therapy only (group B), with 45 healthy volunteers with normal menstruation and normal dual phase basic body temperatures as the control group. Serum TOS of the participants was determined by dual xylenol orange method, and serum TAS was determined with ABTS method; plasma Apo(a) level was determined by dual wavelength immune transmission turbidity method. RESULTS: Before treatment, serum TOS, OSI, and Apo(a) levels were significantly higher and TAS level was significantly lower in the study group than in the control group (P<0.05). Serum TOS, OSI, and Apo (a) were significantly lowered and TAS was significantly increased in group A after the therapy as compared with the levels before therapy and the levels in group B. The rate of natural recovery of menstruation was significantly higher and the incidence of cardiovascular disease was significantly lower in group A than in group B (P<0.05). Pearson correlation analysis showed that serum TOS and OSI were positively correlated with plasma Apo(a) (r=0.524 and 0.531, P<0.05), and serum TAS was negatively correlated with plasma Apo(a) (r=-0.519, P<0.05). CONCLUSION: Antioxidant therapy can lower TOS, OSI and Apo(a) levels and increase TAS level to lessen oxidative stress, improve the prognosis, and reduce the risks of cardiovascular disease in patients with PCOS and infertility.

Retinoic acid aliphatic amide inhibits the AMPK-HIF-1α pathway in human ovarian cancer.

Ovarian carcinoma the commonly observed gynecological cancers has a high mortality rate. In the present study effect of retinoic acid aliphatic amide (RACA) in ovarian cancer cells was investigated using proliferation, migration and invasion assays. Western blot was used to examine the Bcl-2, cleaved caspase 3, p-ERK, MMP-2, p-FAK, P-P38, p-AMPKα and HIF-1α protein expression. CoCl2 was used to induce HIF-1α expression in SKOV3ip. 1 and HEY-A8 cells. The results revealed that RACA treatment prompted cell proliferation, invasion and migration but inhibited apoptosis of SKOV3ip. 1 and HEY-A8 cells. RACA treatment also induced upregulation of Bcl-2 and MMP-2, activation of p-P38, p-ERK and p-FAK, inhibition of cleaved caspase 3. RACA treatment also caused upregulatation of HIF-1α in ovarian cells with the activation of p-AMPKα. Upregulation of HIF-1α expression in CoCl2-treated cancer cells resulted in decrease in SDHB. Thus RACA plays a key role in cell proliferation, invasion, migration and apoptosis of human ovarian carcinoma through AMPK-HIF-1α pathway.

Bartholin gland carcinoma: A case report.

Bartholin gland carcinomas (BGCs) are extremely rare tumors accounting for <1% of all female genital malignancies. The current study presents a 49-year-old female with an eight-year history of BGC. A mass was identified in the vulva and the patient underwent an excisional biopsy, which revealed a left Bartholin adenoid cystic carcinoma. The patient subsequently received surgery, chemotherapy and biological therapy, and has survived. Therefore, the present case indicates that surgery is important for the treatment of BGC, however; multimodal therapy may be a more effective treatment strategy.

Expression of integrin ß1 and its significance in squamous cell carcinoma of the cervix.

The aim of the present study was to examine the expression of integrin ß1 in squamous cell carcinoma (SCC) of the cervix and its association with the clinicopathological features of patients. The expression of integrin ß1 in 87 SCC cervical tissues and 32 normal cervical tissues was detected using an enzyme-linked immunosorbent assay, western blot analysis and the immunohistochemical streptavidin-peroxidase method. Integrin ß1 expression was greater in SCC cervical tissues compared with that in normal cervical tissues (P<0.05), and its mean expression level in the SCC cervical tissues was also markedly higher compared with that in the normal cervical tissues (P<0.05). In terms of the association between the expression of integrin ß1 with clinicopathological features, patients with stage IIA SCC had higher integrin ß1 positive rates compared with patients with stage I SCC (P<0.05). The integrin ß1 positive rates in SCC tissues with histological grade 3 were also significantly higher than that in the SCC tissues with histological grade 1 (P<0.05). Furthermore, patients with cervical SCC with lymph node metastasis showed increased integrin ß1 positive expression compared with those without lymph node metastasis (P<0.05). In conclusion, the expression of integrin ß1 protein in cervical SCC tissues was significantly higher than that in the normal cervical tissues, and it increased with the clinical stage and the degree of malignancy.