Effect of coexisting adenomyosis on tumour characteristics and prognosis of endometrial cancer: A systematic review and meta-analysis.

To compare clinicopathological features and survival outcomes in patients with endometrial cancer, with and without associated adenomyosis. PubMed, Embase and Scopus databases were systematically searched for relevant observational studies. The pooled effect sizes were reported as either hazards ratio (HR) for survival-related outcomes or as odds ratio (OR) for other categorical outcomes. Weighted mean difference (WMD) was reported for continuous outcomes. All the analyses used the random effects model. A total of 21 studies (N = 46,420) were included. Compared to endometrial cancer patients without adenomyosis, patients with associated adenomyosis had improved overall 5-year survival (OS) (HR 0.62, 95% CI: 0.50, 0.79) and disease-free survival (DFS) (HR 0.60, 95% CI: 0.44, 0.82). Disease-specific survival was statistically similar in patients with and without adenomyosis (HR 0.60, 95% CI: 0.35, 1.05). Among patients with adenomyosis, the risk of having an advanced tumour grade (Grade 2 or 3) was lower (OR 0.51, 95% CI: 0.42, 0.62) and a risk of having International Federation of Gynaecology and Obstetrics (FIGO) stage I or II was higher (OR 2.23, 95% CI: 1.65, 3.01). Patients with adenomyosis had lower risk of tumour invasion of adnexa, cervical stromal invasion, deep myometrial involvement (DMI), lympho-vascular space invasion (LVSI) and peritoneal invasion. Presence of adenomyosis in patients with endometrial cancer is associated with favourable tumour characteristics and may improve the survival.

Levonorgestrel-releasing intrauterine system effects on metabolic variables in PCOS.

BACKGROUND: We aimed to determine and compare the reproductive hormone level and metabolic of patients with polycystic ovary syndrome (PCOS) when treated with a levonorgestrel-releasing intrauterine system (LNG-IUS). OBJECTIVES: Sixty-four women with PCOS (Group A) and sixty-six healthy women inserted with a LNG-IUS for conception (Group B) were recruited from the Department of Obstetrics and Gynecology in Jinhua Hospital Zhejiang University School of Medicine. METHOD: We compared the general characteristics of the cases between the two groups, including age, body mass index (BMI), systolic arterial pressure (SAP), diastolic arterial pressure (DAP), abdominal circumference (AC) and waist circumference (WC). Each patient was evaluated by transvaginal ultrasonography (TVS) to determine the number of oocytes and ovarian volume, and the intima-media thickness (IMT) of the common carotid artery was measured on an ECG image from the left common carotid artery before and six months, 12 months and 24 months after patients were inserted with the LNG-IUS. Hormone levels (follicle stimulating hormone, luteinizing hormone, serum estradiol and total testosterone), serum insulin, sex hormone binding globulin (SHBG), total cholesterol (TC), high density lipoprotein (HDL), and triglyceride (TG), were evaluated before and six months, 12 months and 24 months after patients were inserted with an LNG-IUS. The levels of testosterone (T) in the non-HA (hyperandrogenemia) group and HA group in PCOS group were compared with the baseline. We also compared cases without insulin resistance in the PCOS group with their baseline. RESULTS: Prior to LNG-IUS insertion, the PCOS group had significantly higher total testosterone levels (p < 0.05), lower HDL levels (p < 0.05), and a greater ovarian volume (p < 0.05) than the control group. Compared to baseline values, there was a significant increase in fasting glycemia at six months after LNG-IUS insertion (p < 0.05). Mean ovarian volume was significantly smaller than the volume prior to LNG-IUS insertion (p < 0.05); LDL and TC were significantly reduced when compared to baseline evaluation in the PCOS group. The remaining variables did not differ significantly during the 24 months follow-up period. The control group did not show any significant changes when compared to the period before LNG-IUS insertion. When the groups were compared after the 24-month follow-up, WC, AC, FSH, LH, T, SHBG, HDL, FINs, FAI and ovarian volume were significantly different when compared between the two groups (p < 0.05) . CONCLUSION: The LNG-IUS is an effective and safe non-surgical device and the use of this system for 24 months did not result in significant changes in the clinical and metabolic variables in women with PCOS and healthy control females.

A modified technique to perform para-aortic lymphadenectomy up to the renal vein.

OBJECTIVE: To investigate the safety and feasibility of our modified technique to perform lymph node excision up to the renal vein in cases of gynecological cancer. MATERIALS AND METHODS: 87 patients with endometrial or ovarian neoplasms underwent laparoscopic para-aortic lymphadenectomy (LPAL) up to the left renal vein were enrolled prospectively. During surgery, the surgeon was positioned to the right side of the patient and an additional trocar was introduced into the upper right abdomen. The laparoscopic video screen was placed to the side of the patient's head. Three-fan retractor forceps were used to hold up the duodenum and small bowel. The rest of the procedure was the same as conventional LPAL. RESULTS: The median operating time for LPAL was 72 min (range: 40-115 min) and the median estimated blood loss was 45 ml (range: 15-1000 mL). There were two cases of intra-operative vascular injury. The median number of retrieved para-aortic lymph nodes (PALNs) was 18 (range: 10-37). Of the 87 patients, 11 patients had positive PALNs. None of the cases required laparotomy. CONCLUSION: Our findings demonstrate that our modified LPAL technique is feasible, reproducible, can achieve good exposure and reduces surgical difficulty.

Changes in the Level of Immunoglobulins and CD4/CD8 Ratio in Young and Aged Mice with Estradiol Deficiency.

Studies demonstrated that deficiency in 17ß-estradiol (E2) in postmenopausal women influences their immune system. However, few studies have reported alterations in immunologic presentation during nonnatural menopause in young females. Here we compared the differences in immune response between young C57BL/6N mice with surgical or medical variectomy and aged C57BL/6N mice with the common feature of E2 deficiency following Con A stimulation. We observed inverted CD4/CD8 ratios in the aged group and apparent reduced production of serum immunoglobin (Ig)G, IgA, and IgM in the surgical group, whereas changes in immune parameters in the medical group were moderate. These data suggested that the immunological response to Con A stimulus differed among the three groups and that E2 deficiency was only partially responsible for the development of immune deficiency in aged mice.

AMH trend after laparoscopic cystectomy and ovarian suturing in patients with endometriomas.

PURPOSE: To evaluate the ovarian reserve after laparoscopic cystectomy with suturing in patients with endometriomas. METHODS: A total of 80 women with unilateral or bilateral endometriomas underwent laparoscopic cystectomy using sutures for hemostasis after the excision of ovarian cysts. Serum levels of antimullerian hormone (AMH) and FSH were measured at the day 3 of menstrual cycles preoperatively, 6 and 12 months postoperatively. RESULTS: In the bilateral endometrioma group, serum AMH level decreased significantly from the baseline (4.68 ± 2.87 ng/ml) to 6 months (3.05 ± 1.99 ng/ml) and 12 months (2.26 ± 1.88 ng/ml) postoperatively, whereas the FSH level increased significantly from baseline to 12 months postoperatively (P < 0.05). Those patients with unilateral endometriomas also had lower levels of AMH in 6 and 12 months after operation. When compared between unilateral and bilateral endometrioma group, the rate of AMH decline 6 and 12 months and the rate of FSH increase 12 months postoperatively reached statistical significance (P < 0.05). CONCLUSIONS: The changes of the AMH and FSH values suggest that the ovarian reserve is obviously reduced in spite of suturing technology used as a method of hemostasis after stripping ovarian endometriomas, especially in those with bilateral cysts. The protective effect of the ovarian suturing for ovarian reserve may be marginal.

Prevalence and Treatment of Children's Asthma in Rural Areas Compared with Urban Areas in Beijing.

BACKGROUND: The prevalence of childhood asthma has been increasing in China. This study aimed to compare the prevalence, diagnosis, and treatment of asthmatic children from urban and rural areas in Beijing, China. METHODS: Schools, communities, and kindergartens were randomly selected by cluster random sampling from urban and rural areas in Beijing. Parents were surveyed by the same screening questionnaires. On-the-spot inquiries, physical examinations, medical records, and previous test results were used to diagnose asthmatic children. Information on previous diagnoses, treatments, and control of symptoms was obtained. RESULTS: From 7209 children in rural areas and 13,513 children in urban areas who completed screening questionnaires, 587 children were diagnosed as asthma. The prevalence of asthma in rural areas was lower than in urban areas (1.25% vs. 3.68%, χ2 = 100.80, P < 0.001). The diagnosis of asthma in rural areas was lower than in urban areas (48.9% vs. 73.9%, χ2 = 34.6, P < 0.001). Compared with urban asthmatic children (56.5%), only 35.6% of rural asthmatic children received inhaled corticosteroids (P < 0.05). The use of bronchodilators was also lower in rural areas than in urban areas (56.5% vs. 66.4%, χ2 = 14.2, P < 0.01). CONCLUSION: The prevalence of asthma in children was lower in rural areas compared with children in the urban area of Beijing. A considerable number of children were not diagnosed and inadequately treated in rural areas.

Management of caesarean scar pregnancies using an intrauterine or abdominal approach based on the myometrial thickness between the gestational mass and the bladder wall.

AIM: To describe our experience with various interventions for caesarean scar pregnancies (CSPs) based on the myometrial thickness between the gestational mass and the bladder. METHODS: All patients were initially administered methotrexate. Then, the appropriate therapies hysteroscopy alone or combined with uterine artery embolization (group A) and direct laparoscopy alone or combined with laparoscopic uterine artery occlusion (group B) was selected based on the myometrial thickness between the gestational mass and the bladder. RESULTS: The uteri of all 53 patients with CSPs were conserved; no conversion to laparotomy or blood transfusion was required. Uterine rupture occurred in one case during surgery in group A. The operative time in group B was longer than group A (42 ± 18 vs. 80 ± 33 min; p = 0.022). The two groups were also similar with respect to other characteristics (p > 0.05). CONCLUSION: Myometrial thickness should be considered during the management of CSPs. Surgical approaches in the treatment of CSPs using 2-mm boundaries may yield an optimal clinical outcome.

[Epidemiological survey of children asthma prevalence in Beijing urban area].

OBJECTIVE: To explore the prevalence, diagnosis and management of childhood asthma in Beijing urban area. METHODS: Multi-stage, stratified and random cluster sampling was used to recruit children born during November 1, 1995 to October 31, 2010 from Beijing or other provinces but residing in Beijing for over half a year. The same screening questionnaires for the third national epidemiological survey of children's asthma were distributed to parents of children at schools, kindergartens and communities during October 2010 to March 2011. Asthmatic children were picked among the screening-positive children based on on-the-spot inquiries, physical examinations, medical records and supporting test results. Further survey of asthmatics was carried out to investigate the diagnosis and treatment status of childhood asthma and other associated allergic diseases. All data required double entry by Epi-Info 3.5.3 software and were processed by SPSS 19.0. RESULTS: Among a total of 14 085 questionnaires, 13 513 were completed with a response rate of 95.94%. And 497 (3.68%) children were diagnosed with typical (n = 451, 3.34%) and cough variant (n = 46, 0.34%) asthma. Among them, 40.64% (202/497) were newly diagnosed and 59.36% (295/497) had been previously diagnosed with asthma. The prevalence of asthma was higher in boys than in girls (4.80% (345/1790) vs 2.40% (152/6323), χ(2) = 54.446, P < 0.01). The asthma prevalence of preschoolers (3 - < 7 years old) was the highest (5.05% (180/3563)). In the past two years, the symptoms of 69.42% (345/497) children persisted and the current two-year prevalence of asthma was 2.55% (345/13513). Among the 295 children with previous asthma, only 46.44% (137/295) received inhaled corticosteroids according to the Global Initiative for Asthma (GINA) and 82.37% (243/295) of them used antibiotics. CONCLUSIONS: The prevalence of asthma is 3.68% in children under 14 years old in Beijing urban area and it varies in children with different genders and ages. A considerable number of children are not diagnosed or treated properly. And the management of asthma requires further improvement.

Temporary bilateral uterine artery occlusion combined with vasopressin in control of hemorrhage during laparoscopic management of cesarean scar pregnancies.

STUDY OBJECTIVE: To describe temporary bilateral uterine artery occlusion with titanium clips in combination with vasopressin as an effective surgical intervention to control hemorrhage during laparoscopic management of cesarean scar pregnancies (CSPs). DESIGN: Retrospective study (Canadian Task Force classification III). SETTING: University hospital in an obstetrics and gynecology department. INTERVENTIONS: Five patients with CSPs underwent removal of gestational ectopic masses via laparoscopy. At the beginning of the procedure, all 5 women had temporary bilateral uterine artery occlusion with titanium clips, and vasopressin 6 U was injected into the myometrium. MEASUREMENTS AND MAIN RESULTS: Clinical data, serum ß-human chorionic gonadotropin levels, operative times, and operative blood loss levels were recorded. The mean gestational age at the time of CSP diagnosis was 9.2 ± 1.9 weeks. The mean serum ß-hCG level on the day of surgery was 14262 ± 12870 IU/L. The mean operative time was 86 ± 21.6 minutes, the mean uterine artery occlusion time was 58 ± 13.8 minutes, and the mean blood loss was 144 ± 79.6 mL. No cases were converted to laparotomy, no blood transfusions were required, and there were no complications. CONCLUSIONS: Laparoscopy combined with titanium clip occlusion of the uterine arteries bilaterally with vasopressin injection is an effective, minimally invasive procedure to preserve the uterus in patients with a CSP.