Effects of Different Doses of Clopidogrel plus Early Rehabilitation Therapy on Motor Function and Inflammatory Factors in Patients with Ischemic Stroke.

This prospective randomized controlled study was intended to assess the effects of different doses of clopidogrel plus early rehabilitation therapy on motor function and inflammatory factors in patients with ischemic stroke. Between August 2018 and October 2020, 90 cases of ischemic stroke treated in the Second People's Hospital of Yibin were randomized at a ratio of 1 : 1 to receive either oral 50 mg/d clopidogrel plus early rehabilitation therapy (low-dose group) or oral 75 mg/d clopidogrel plus early rehabilitation therapy (high-dose group), with 45 cases in each group. The outcome measures including the Barthel Index (BI), National Institutes of Health Stroke Scale (NIHSS), Fugl-Meyer simplified scale, hypersensitive C-reactive protein (hs-CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and occurrence of adverse events were collected. After treatment, the high-dose group had higher BI results than the low-dose group. All eligible patients showed significantly declined NIHSS scores, and the high-dose group had markedly lower results (P < 0.05). After treatment, the Fugl-Meyer scores of both upper and lower extremities of the high-dose group were significantly higher than those in the low-dose group. The high-dose group achieved a greater decrease in inflammatory factor levels after treatment versus the low-dose group. The two groups showed a similar incidence of adverse events. High-dose clopidogrel plus early rehabilitation outperforms the low-dose treatment for patients with ischemic stroke by effectively mitigating the inflammatory response in the body, promoting the restoration of neurological function, improving the level of motor function, and enhancing the patient's quality of life, with manageable safety.

Visualization of implanted mesh in the pelvic reconstructive surgery using an X-ray-detectable thread.

PURPOSE: Visualization of the implanted mesh after a pelvic floor repair surgery is important for evaluating mesh-related complications. We made an X-ray-detectable mesh and studied the histocompatibility and toxicity of it. METHODS: A thin barium sulfate thread was weaved on a traditional polypropylene mesh to make it X-ray detectable. The cytotoxicity of the mesh was tested by the MTT assay on L929 cell line. The histocompatibility and toxicity of mesh were evaluated in rabbits. Meshes were first implanted intraperitoneally. On postoperative day 7, bloods were tested to estimate the acute toxicity of meshes. After 6 months, rabbits were sacrificed and local inflammatory reaction and tissue regeneration at implantation sites were estimated by the HE stain and Masson stain. In addition, CT scans were performed after surgeries to display the location and shape of implanted meshes. RESULTS: Compared to the polypropylene mesh group, no significant difference was observed in the X-ray-detectable mesh group on both in vitro cytotoxicity and in vivo acute and chronic toxicity. The amounts of extra cellular matrix between two groups did not differ. Through CT scan and 3D remodeling, the barium sulfate thread clearly revealed the position and shape of the X-ray-detectable mesh, whereas the traditional mesh was invisible under CT scan. CONCLUSION: Adding a thin barium sulfate thread on the polypropylene mesh does not change its histocompatibility or toxicity in rabbit model. The barium sulfate thread can effectively show the location and shape of implanted mesh under CT scan.

Do Pelvic Organ Prolapse Quantification Examination Ba and D Guide the Selection of Operation for Severe Pelvic Organ Prolapse?

Purpose: To determine whether the preoperative Ba and D point could help to guide the choice of surgical procedure for POP. Materials and Methods: This prospective cohort study included 250 subjects with anterior/apical defect from January 2012 to June 2015. All subjects underwent a complete preoperative evaluation and completed 12 months of follow-up. Based on the connection of preoperative Ba and D point of Pelvic Organ Prolapse Quantification (POP-Q), patients were assigned two groups: 137 patients who underwent anterior vaginal repair with mesh (AVM) and 113 patients who underwent AVM combined with sacrospinous ligament fixation (SSLF). The primary outcomes were anatomical cure and recurrence rate of both procedures. Secondary outcomes were prolapse symptom, quality of life and sexual function based upon validated questionnaires. The complications were also recorded in both groups. Results: Both groups were homogeneous preoperatively. The anatomical success rates for the anterior, apical and posterior vaginal compartments were 99.2%, 97.0% and 97.7% in the AVM group, respectively. For patients who underwent AVM-SSLF, the anatomical success rates for the anterior, apical and posterior compartments were 96.1%, 98.1% and 98.1%, respectively. The recurrence for both techniques was low. Both procedures presented a significant improvement with regard to postoperative quality of life (QOL), prolapse symptoms, and sexual function after 1-year follow-up. Conclusion: The preoperative Ba and D point correlated with surgical choice for the treatment of anterior/apical prolapse, which further decided the surgical outcomes for prolapse support.

Laparoscopic inguinal ligament suspension combined with hysterectomy for the treatment of uterovaginal prolapse.

AIM: To demonstrate the efficacy and safety of a modified technique of laparoscopic inguinal ligament suspension (LILS) with hysterectomy for the treatment of uterovaginal prolapse. METHODS: A total of 57 patients were treated by LILS combined with hysterectomy between Jan 2014 and Feb 2016. The perioperative parameters, such as operative time, estimated blood loss, length of stay and intra- and postoperative complications were recorded. The Pelvic Organ Prolapse questionnaire classification was applied to evaluate the Pelvic Organ Prolapse stage, and Patient Global Impression of Improvement scale was used to determine the patients' satisfaction. Pelvic Floor Distress Inventory-20 and Pelvic Floor Impact Questionnaire were used to evaluate the functional improvement. All data were collected preoperatively and then at 12 months postoperatively. RESULTS: The mean surgical time was 130.4 (82-190) min, the average blood loss was 50.4 (10-300) mL and the mean hospitalization was 5.3 (4-8) days. The rates of intra- and postoperative complications were low. After a minimal of 12 months follow-up, the anatomical success rate was 85.5%, and the subjective satisfaction rate was 92.7%. The functional measures also presented a significant improvement with no recurrence of prolapse. CONCLUSION: LILS combined with hysterectomy was a safe and effective technique and might be considered as an alternative treatment for patients with uterovaginal prolapse.

Effect of pelvic floor dysfunction on sexual function and quality of life in Chinese women of different ages: An observational study.

AIM: The aim of the present study was to investigate the effect of female pelvic floor dysfunction on sexual function and quality of life among different age groups. METHODS: An observational study was carried out on 648 patients with pelvic organ prolapse (POP) or/and stress urinary incontinence. We assessed female sexual function and quality of life through the Prolapse/Urinary Incontinence Sexual Questionnaire Short Form and Incontinence Quality of Life Scale before surgeries, respectively. Patients were assigned into different age groups. RESULTS: The mean age of all patients was 62.04 ± 9.39 years. A total of 436 patients had POP, 120 patients had stress urinary incontinence and the remaining patients had both. Although sexual frequency decreased with increasing age, 517 patients still remained sexually active. A total of 10.83% of the patients aged ≥70 years were still sexually active, and 8.51% of them had sex less than one time per month. The Prolapse/Urinary Incontinence Sexual Questionnaire Short Form score and sexual frequency decreased with increasing age. However, the Incontinence Quality of Life Scale score increased with increasing age. Patients with only POP and aged ≥70 years showed a higher Incontinence Quality of Life Scale score (P < 0.001). CONCLUSIONS: The present study showed that POP and stress urinary incontinence are common among older Chinese women, and re associated with decreased sexual satisfaction and quality of life in China. It suggests that the existing sexual requirement of these patients should also be reconsidered before surgical assessment. Doctors should take sexual satisfaction into consideration when choosing a personalized type of surgery to improve the patients' quality of life physiologically and psychologically. Geriatr Gerontol Int 2019; 19: 299-304.

Laparoscopic inguinal ligament suspension: a novel procedure to repair uterine prolapse.

INTRODUCTION AND HYPOTHESIS: Traditionally, surgical treatment for uterine prolapse has included hysterectomy. However, more patients now prefer a uterine-preserving operation because of concerns about fertility or sexual dysfunction. In this video, we describe a novel approach to correcting uterine prolapse in an attempt to demonstrate an alternative option for patients. METHODS: A 42-year-old woman with symptomatic stage I-IV uterine prolapse (POP-Q: Aa +2, Ba +2, C + 3, gh 6.5, pb 3, TVL 8.5, Ap 0, Bp 0, D 0) underwent inguinal ligament suspension. The principle steps and techniques to complete the operation are outlined in the video. RESULTS: Prolapse repair was successfully completed without any intraoperative complications. The uterus was restored to its anatomic position. During the 12-month follow-up, neither recurrence nor postoperative complications, such as mesh exposure, de novo incontinence or bowel obstruction, etc., occurred. CONCLUSIONS: Laparoscopic inguinal ligament suspension is a safe and feasible alternative for correcting the uterine prolapse. This surgery could be an attractive choice for patients who prefer a uterine-sparing surgery.

Laparoscopic inguinal ligament suspension with uterine preservation for pelvic organ prolapse: A retrospective cohort study.

OBJECTIVE: To introduce an alternative surgical technique of laparoscopic inguinal ligament suspension (LILS) with uterine preservation and evaluate its efficacy and safety for patients with severe pelvic organ prolapse (POP). METHODS: Between June 2014 and December 2015, 35 patients with symptomatic stage III or IV were treated by LILS with uterine preservation. The perioperative parameters including surgical time, blood loss, hospital stay and complications were recorded. The anatomical cure rate was evaluated according to the Pelvic Organ Prolapse Questionnaire (POP-Q) assessment. The anatomical points were analyzed by dynamic Magnetic Resonance Imaging (MRI). Validated questionnaire of the Pelvic Floor Distress Inventory (PFDI-20), the Pelvic Floor Impact Questionnaire (PFIQ-7) and the Pelvic organ prolapse urinary Incontinence Sexual Questionnaire (PISQ-12) were recorded to evaluate the symptom severity, quality of life and sexual activity. RESULTS: The mean surgical time was 163.8 ±â€¯42.3 min (range: 120-280 min), the mean estimated blood loss was 48.6 ±â€¯60.5 ml (range: 10-200 ml), and the mean hospital stay was 5 days (range: 3-7 days). No intra-operative complications were encountered. The anatomical success rate at postoperative 6-month and 12-month was 97.1% and 94.3%, respectively. The postoperative anatomical points on straining showed a significant improvement on dynamic MRI as compared to baselines. The symptom severity, quality of life and sexual activity also presented significant improvement both 6-month and 12-month after surgery. After a minimal 12 months follow-up, no postoperative complications occurred and the recurrence prolapse were low. CONCLUSION: LILS with uterine preservation is a feasible, effective and safe surgical alternative in the treatment of POP for patients who desire to reserve uterus. Longer follow-up data from larger studies are required to confirm the benefits of LILS with uterine preservation as a minimally invasive surgical approach.

Laparoscopic inguinal ligament suspension versus laparoscopic sacrocolpopexy in the treatment of pelvic organ prolapse: study protocol for a randomized controlled trial.

BACKGROUND: Pelvic organ prolapse (POP) is a common health problem. The lifetime risk of undergoing surgery for prolapse is 11%. POP significantly affects the effects on quality of life and activities of daily living. Laparoscopic sacrocolpopexy (LSC) has been viewed as the gold standard treatment for women with POP who desire reconstructive surgery. However, LSC is associated with technical difficulties, resulting in a long learning curve and operative time. Recently, our team introduced a new laparoscopic technique of inguinal ligament suspension (LILS) and had confirmed its safety and efficacy in treating vaginal vault prolapse. As a new surgical technique for POP, a prospective randomized controlled trial comparing the LILS with the standard technique of LSC is necessary. Therefore, we will conduct a trial. METHODS: The trial is a randomized controlled trial. It compares LILS with LSC in women with stage 2 or higher uterine prolapse. The primary outcomes of this study are perioperative parameters, including surgical time, blood loss, intraoperative complications, and hospital stay as well as surgical anatomical results using the pelvic organ prolapse questionnaire (POP-Q) classification at 6 weeks, 6 months, 12 months, and annually till 5 years after surgery. Secondary outcomes are subjective improvement in urogenital symptoms and quality of life, postoperative complications, postoperative recovery, sexual functioning, and cost-effectiveness at each follow-up point. Validated questionnaires will be used and the data will be analyzed according to the intention-to-treat principle. Based on an objective success rate of 90%, a noninferiority margin of 15%, and a dropout of 20%, 107 patients are needed in each arm to prove the hypothesis with a 95% confidence interval. DISCUSSION: The trial is a randomized controlled, multicenter, noninferiority trial that will provide evidence whether the efficacy and safety of LILS is noninferior to LSC in women with symptomatic stage 2 or higher uterine prolapse. TRIAL REGISTRATION: China Trial Register (CTR): ChiCTR-INR-15007408 . Registered on 9 November 2015.

Impact of transvaginal modified sacrospinous ligament fixation with mesh for the treatment of pelvic organ prolapse-before and after studies.

BACKGROUND: Pelvic organ prolapse (POP) is a common disease in women. The aim of this research was to evaluate the safety, efficacy and complication of transvaginal modified sacrospinous ligament fixation with mesh using for the treatment of vaginal vault prolapse. MATERIALS AND METHODS: This was a prospective study including information from 60 symptomatic women with anterior-apical pelvic floor prolapse. The patients underwent transvaginal modified sacrospinous ligament fixation combined with anterior vaginal wall mesh between May 2014 and Sep 2015. The perioperative data including clinical characteristic, operation time, blood loss, and surgical complications were collected at 1 year and 2 years. During a 2-year follow-up, the primary outcome evaluation included Pelvic organ prolapse Quantification system (POP-Q), Incontinence Quality of Life scale (I-QoL), the Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) and the Pelvic Floor Distress Inventory, short form 20 (PFDI-20). RESULTS: The mean follow-up time was 2 years (range 24-37 months). The patients' mean age was 66.75 ±â€¯6.44. Of 60 patients who were enrolled in this research, 26 patients had severe stress urinary incontinence (SUI). The mean operation time was 99.14 ±â€¯19.60 min and the mean estimated blood loss was 73.83 ±â€¯41.05 ml. The rate of anatomical success was 98.3% and one patient had a recurrence. The POP-Q point measurements were evaluated preoperatively and postoperatively (P < 0.001). Moreover, the quality of life and sexual activity were all improved postoperatively via I-QoL, PISQ-12 and PFDI-20 scores (P < 0.001). There was no injury to the rectum, bladder, major pelvic vessels and pudendal nerves. However, 18 patients had postoperative complications. CONCLUSIONS: This study showed that transvaginal modified sacrospinous ligament fixation with mesh might be performed easily and might be a safe surgery for elderly patients whose requirements for sexual life were relatively low. Further researches were required to investigate its long-term efficacy.

A new laparoscopic technique of inguinal ligament suspension for vaginal vault prolapse.

INTRODUCTION: The aim of the study was to evaluate the efficacy and safety of laparoscopic inguinal ligament suspension (LILS) as a new surgical technique for the treatment of vaginal vault prolapse. METHODS: From Feb 2014 to Mar 2016, 21 symptomatic women with grades III-IV vaginal vault prolapse were enrolled. All patients underwent LILS procedure in which a bifurcated mesh was used to suspend the vaginal vault to inguinal ligament. The perioperative parameters including surgical time, blood loss, and hospitalization time were recorded. At a minimal 12-month follow-up, the primary outcome measures, such as the anatomical cure rate and patients' satisfaction were respectively evaluated according to Pelvic organ prolapse questionnaire (POP-Q) and Patient Global Impression of Improvement (PGI-I) scale. The secondary outcomes including the impact on symptom severity, quality of life and sexual activity were also recorded. RESULTS: The mean surgical time was 130.71 ± 16.07 min, the mean estimated blood loss was 53.57 ± 48.43 ml, and the mean hospital stay was 6 days (range: 5-8 days). After a minimal 12-month follow-up (range: 12-36 months), the rate of anatomical success and the subjective satisfaction were 100% and 90.5%. The symptom severity, quality of life and sexual activity also presented significant improvement. In addition, no serious peri- and postoperative complications occurred. CONCLUSIONS: LILS was a potential method for the treatment of vaginal vault prolapse. The technique could be performed easily and might be an alternative to other POP surgeries. However, further studies were required to focus on its long-term efficacy.

Aberrant expression of E-cadherin and integrin ß-1 in trophoblasts is associated with malignant gestational trophoblastic diseases.

OBJECTIVE: To investigate the association between malignant gestational trophoblastic diseases and aberrant local expression of E-cadherin and integrin ß-1 in the context of identifying a method to predict and diagnose malignant gestational trophoblastic diseases at an early stage. METHODS: We used immunohistochemistry to assess E-cadherin and integrin ß-1 expression profiles in normal chorionic villus, hydatidiform mole, and invasive mole. RESULTS: E-cadherin expression gradually decreased from normal tissue to malignant tissue. Staining for E-cadherin was positive in 90% of normal trophoblastic villus in early pregnancy, 80% in benign hydatidiform mole, and 50% in invasive mole. Notably, invasive mole had significantly lower E-cadherin expression than benign mole (P < 0.05). However, there was no significant difference in staining between benign and malignant moles (15% vs 10%, P > 0.05). Integrin ß-1 expression was identical in benign hydatidiform mole and malignant mole (90% and 90%), but this value was significantly higher than that in normal trophoblastic villus (40%, both P < 0.05). Moreover, malignant mole staining was significantly higher than in the benign mole (30% vs 15%, P < 0.05). CONCLUSIONS: Aberrant expression of E-cadherin and integrin ß-1 is closely related to malignant transformation and hydatidiform mole development. Changes in the expression of E-cadherin and integrin ß-1 are informative and may improve the early diagnosis of malignant/invasive moles.

Efficacy of Pap test in combination with ThinPrep cytological test in screening for cervical cancer.

BACKGROUND: Our aim was to investigate the efficacy of the Pap test in combination with the ThinPrep cytological test (TCT) in screening for cervical cancer in China. DESIGN: From March 2006 to October 2008, 988 women with the mean age 46.4 ± 10.5 years (range, 23-80 years) were recruited to receive cervical cancer screening. Pap test results ≥ grade III and TCT findings ≥ ASCUS/AGUS were considered abnormal. Subjects with a Pap test result ≥ grade IIb received TCT. Colposcopy and biopsies were performed in all participants, and final diagnosis was based on pathological findings. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and Youden index for predicting CIN I or above were determined. RESULTS: The sensitivity, specificity, PPV, NPV and Youden index of the Pap test were 43.1%, 97.2%, 70.0%, 91.9%, and 40.3%, respectively. The same values for TCT in predicting CIN were 80.0%, 63.2%, 16.0%, 97.3%, and 43.2%, respectively. The two tests in combination gave values for predicting CIN of 64.8%, 87.6%, 43.6%, 94.4%, and 53.5%, respectively. Combined testing exhibited the highest Youden index (53.4%). CONCLUSION: The Pap test with a reduced threshold in combination with the TCT has high sensitivity and high specificity in screening for cervical cancer.

[Survey on menopausal age and menstruation span in women in Pudong district of Shanghai].

OBJECTIVE: To investigate natural spontaneous menopausal age, menstruation span and their relationship with menarche age and parity in Pudong district of Shanghai. METHODS: From Jan 2007 to Jul 2008, 15 083 spontaneous menopause women undergoing cervical cancer screening were enrolled in this study. The questionnaire included menarche age, parity, spontaneous menopausal age and menstruation span. Those women were divided into four groups based on age, which were group of 56 - 60, 61 - 65, 66 - 70 and more than 70.Analysis of variance (ANOVA) was used for comparing difference between menopausal age and menstruation span. Multiple factor regressions was used to analyze the relationship between menarche age, parity and menopausal age and menstruation span. RESULTS: (1) Spontaneous menopausal age: the minimum was 29 years old, the maximum was 61 years old, and the mean age was (50.6 ± 3.7) years old. The mean spontaneous menopause age were (50.9 ± 3.4), (50.7 ± 3.7), (50.0 ± 4.1), (49.6 ± 4.0) years in groups of 56 - 60, 61 - 65, 66 - 70 and more than 70 years. With the increasing age range in four groups, the increasing trends of menopausal age were observed, which the difference of 1.36 year was shown between groups of 56 - 60 and more than 70 years. (2) Menstruation span: the mean of menstruation span was (34.3 ± 4.1) years, which the minimal age of 12 years and maximal age of 48 years were recorded. (34.6 ± 3.8), (34.3 ± 4.1), (33.9 ± 4.6), (33.2 ± 4.5) were observed in groups of 56 - 60, 61 - 65, 66 - 70 and more than 70 years. With the increasing age range in four groups, the increasing trends of menstruation span were observed, which the difference of 1.41 year was shown between groups of 56 - 60 and more than 70 years. (3) The impact of menarche age on menopausal age and menstruation span: there was no correlation between menarche age and menopausal age (r = 0.02); however, menstruation span was found to be negatively correlated with the menarche age (r = -0.43). (4) The impact of parity on menopausal age and menstruation span: the mean menopausal age of women who had 1 - 2 deliveries was significantly higher than those had no delivery or more than 3 deliveries (P < 0.05). However, there was no difference in menopausal age between women with 1 and 2 deliveries or between women without delivery and more than 3 deliveries (P > 0.05). Menstruation span of women with 1 delivery was significantly longer that those with more than 1 delivery (P < 0.05), similarly, women with 2 deliveries had longer menstruation span than women without delivery or more than 3 deliveries (P < 0.05). There were no difference in menstruation span between women with more than 3 deliveries and without delivery (P > 0.05). (5) Multifactor regression analysis for menstruation span: menarche age was correlated with menstruation span negatively (r = -0.97, P < 0.001). There was significantly different menstruation span between group of 61 - 65, 66 - 70 or more than 70 years and group of 56 - 60 (r = -0.18, P = 0.020; r = -0.78, P < 0.001 and r = -1.23, P < 0.001). Menstruation span in women with 1 - 2 deliveries was significantly longer than that of women without delivery or more than 3 deliveries. (6) Multifactor logistic analysis of menopausal age: there was no association between menarche age and menopausal age, however, significant differences were found in mean menopausal age between different groups, which show that menopausal age of group 56 - 60 years was significant higher than the other groups, including age-group 61 - 65 years, 66 - 70 years and over 70 years (r = -0.18, P = 0.020; r = -0.78, P < 0.001; r = -1.23, P < 0.001). Menopausal age in women with 1 - 2 deliveries was significantly higher than those of women without delivery or with more than 3 deliveries, however, no difference between women with 1 and 2 deliveries or between women without deliveries and more than 3 deliveries was observed. CONCLUSION: (1) Menopausal age and menstruation span exhibited increasing trends in Pudong district of Shanghai. (2) Menarche age and parity were the important factors influencing menopausal age and menstruation span. (3) With younger age of menarche, the menstruation span become longer.(4) Deliveries of 1 - 2 times can significantly delay the menopause and prolong menstruation span, however, the multiple deliveries (≥ 3 times) had no significant impact on menopausal age and menstruation span.

[Survey on age of menarche in 56,924 women recruited from Pudong district of Shanghai].

OBJECTIVE: To survey age of menarche in Pudong district in Shanghai. METHODS: Data in this study were derived from 56,924 women at age of 20-81 years in screening for cervical cancer between January 2007 and July 2008 in Pudong district. The age of menarche were recorded in a questionnaire. To investigate the trends in age at menarche in different socioeconomic status, the subjects were divided into 12 groups in 5-year birth cohorts. The mean menarche age in each group was analyzed by analysis of variance (ANOVA). The percentage of menarche age at 10-12 years and more than 18 years was analyzed by chi2 method. RESULTS: (1) The minimum age of menarche recorded is 10 years old, and the maximum is 28 years old, with average age of menarche at 15.7 years. In all groups, the smallest average age of menarche is 14. 6 years in 26-30 years old age group, while the biggest average age of menarche age is 16.5 years in >75 years old group; The difference showed statistical significance (P < 0.01). (2) The percentages for participants with early menarche age (10-12 years old) or late menarche age (>18-year-old menarche) were 1.82% (1034/56,924) and 5.20% (2959/56,924) respectively. However, the maximum percentage for early menarche was recorded in 31-35 years old group (4.45%, 197/4431), only 0.84% (10/1191) of participants in >75 years old group was classified as early menarche. Meanwhile, the lowest percentage for late menarche was 0.38% (17/4431) in 31-35 years old group, and the highest percentage was 14.70% (91/619) in >75 years old group. The changes in the percentages for early menarche or late menarche are significantly associated with age differences (P < 0.01). CONCLUSION: The study suggested that the average of onset age of menarche in Pudong district has declined over the past decades in an age-based way, accompanied with the increase of the percentage for early menarche and the decrease of percentage for late menarche.

[Involvement of matrix metalloproteinase-2, -9, and tissue inhibitors of metalloproteinase-1, 2 in occurrence of the accrete placenta].

OBJECTIVE: To investigate the roles of matrix metalloproteinase-9, -2 (MMP-9, 2), and tissue inhibitors of metalloproteinase-1, 2 (TIMP-1, 2) in pathogenesis of the accretio placenta. METHODS: The women with the placenta accrete were recruited and the placenta (23) and deciduas tissues (9) after labor were obtained, and the placenta (28) and deciduas (11) from women without the placenta accreta were obtained as control to get, too. The expressions of MMP-9, -2, TIMP-1, 2 in the placental and decidual tissues were analyzed by real-time PCR. RESULTS: mRNA expression of MMP-9 in the placenta accreta was (3.21 +/- 0.76) copies/microg total RNA, significantly higher (P < 0.05) than that of normal placenta [(3.84 +/- 0.24) copies/microg total RNA)]. MMP-9 transcription in the decidua accreta was (2.50 +/- 0.49) copies/microg total RNA, significantly higher (P < 0.05) than that of normal decidua [(3.81 +/- 0.66) copies/microg total RNA]. mRNA expression of TIMP-1 in normal placenta and placenta accreta was (5.91 +/- 0.56) and (5.92 +/- 0.46) copies/microg total RNA, respectively, with no significant difference between the two groups. mRNA expression of TIMP-1 in the accrete deciduas was (6.63 +/- 0.51) copies/microg total RNA, significantly lower (P < 0.05) than that of normal decidua (7.09 +/- 0.55) copies/microg. mRNA expression of MMP-2 in the accrete placenta was (4.55 +/- 1.13) copies/microg total RNA, significantly higher (P < 0.05) than that of normal placenta (5.53 +/- 0.59) copies/microg. mRNA expression of MMP-2 in the accrete decidua and normal decidua was (6.07 +/- 0.83) and (5.97 +/- 0.76) copies/microg total RNA, respectively, with no significant difference between the two groups. mRNA expression of TIMP-2 in the accrete placenta was (4.69 +/- 0.60) copies/microg total RNA, significantly higher (P < 0.05) than that of normal placenta (3.79 +/- 1.06) copies/microg. mRNA expression of TIMP-2 in the accrete decidua was (5.06 +/- 0.33) copies/microg total RNA, higher significantly (P < 0.05) than that of normal decidua (3.98 +/- 0.60) copies/microg. CONCLUSIONS: The upregulation of MMP-9, MMP-2 in placenta and downregulation of TIMP-1 in decidua were involved in occurrence of the placental accreta, and the roles of TIMP-2 in occurrence of the placental accreta need to elucidated.