Levonorgestrel-releasing intrauterine system-based therapies for early-stage endometrial cancer: a systematic review and meta-analysis.

OBJECTIVE: To conduct a systematic review and meta-analysis of studies evaluating the oncological and fertility outcomes of early-stage endometrial cancer (EC) treated with the levonorgestrel-releasing intrauterine system (LIUS)-based regimens. METHODS: The Meta-analyses Of Observational Studies in Epidemiology statement for meta-analyses was followed. Searches were conducted on MEDLINE, Embase, PubMed, Preprints, and the Cochrane Central Register of Controlled Trials from January 1990 to August 4, 2022. The Joanna Briggs Institute Critical Appraisal Checklist was used for quality assessment. The primary endpoint was the complete response (CR) rate and the secondary endpoints were relapse, pregnancy, and live birth rate. RESULTS: A total of 25 studies (821 women) were included. The CR rate of LIUS-based regimens was 63.4% (95% confidence interval [CI]=52.3%-73.2%), with 29.6% (95% CI=23.3%-36.8%) of cases experiencing recurrence during follow-up. In sensitivity analyses, patients younger than 45 years of age with a body mass index <30 kg/m² who were treated with LIUS-based regimens achieved a high CR rate of 84.6% (95% CI=80.3%-88.1%) over a median follow-up of more than 24 months. Overall pregnancy and live birth rates were 37.9% (95% CI=24.1%-53.9%) and 39.3% (95% CI=24.0%-57.0%), respectively. No statistical differences were apparent in CR or relapse rates among the LIUS+GnRH agonist, LIUS+oral progesterone, or hysteroscopic resection followed by LIUS subgroups. CONCLUSION: LIUS-based therapies are viable for the conservative management of early-stage endometrioid EC on CR and fertility outcome. TRIAL REGISTRATION: PROSPERO Identifier: CRD42022352890.

The relationship between pelvic floor functions and vaginal microbiota in 6-8 weeks postpartum women.

The impairment of pelvic floor muscle functions and Lactobacillus-deficient vaginal microbiota is common in postpartum women. However, few studies have explored the correlation between pelvic floor muscle functions and vaginal microbiota. Given this research gap, our study aims to investigate any potential association between these two conditions of postpartum women (6-8 weeks after childbirth). A total of 230 women who required postpartum pelvic floor function examination at Peking University International Hospital from December 2021 to April 2022 were enrolled in this study. The collected questionnaire information included progestational weight, body mass index (BMI), weight gain during pregnancy, neonatal weight, delivery type, multiparity, postpartum time, and urinary incontinence (UI). A total of 187 samples of vaginal secretions were collected, and the vaginal microbiota was detected by 16S rRNA sequence analysis. Finally, 183 samples were analyzed in the trial. All individuals were divided into two groups according to the results of pelvic floor muscle assessment to explore the difference between the incidence of postpartum urinary incontinence and vaginal microbiota. We found that the prevalence of UI was higher in the group with weakened pelvic floor muscles. Vaginal delivery, overweight, age, neonatal weight, and weight gain during pregnancy were all risk factors for postpartum urinary incontinence. The vaginal microbiome was no longer Lactobacillus dominant of most postpartum women (91.8%), while the diversity of microbiota increased. The Lactobacillus-deficient community, commonly labeled as community state type (CST) IV, was sub-divided into four communities. The abundance of vaginal Lactobacillus decreased in the group with compromised pelvic muscle functions, while the species richness and diversity increased significantly. In conclusion, the decreased pelvic floor muscle functions of postpartum women 6-8 weeks after delivery may disrupt the balance of vaginal microbiota, and the restoration of pelvic floor functions may contribute to a healthy and balanced vaginal microbiota.

The impact of pelvic floor electrical stimulation on vaginal microbiota and immunity.

Pelvic floor electrical stimulation (ES) is an effective treatment for pelvic floor dysfunction. However, the impact of ES on vaginal microbiota and local inflammatory response is yet poorly understood. Therefore, we designed a longitudinal study to investigate the impact of ES on vaginal microbiota and cytokines. A total of 170 participants were recruited into the study at Peking University International Hospital, Beijing, China, from December 2021 to April 2022. They were divided into two groups concerning the follow-up: long-term cohort (n = 147) following up to seven treatment sessions and short-term cohort (n = 23) following up to 7 h after a 30-min treatment. Paired vaginal discharge samples were collected from 134 individuals. Vaginal microbiota was characterized by 16S rRNA sequencing, and local cytokines concentrations were detected by the cytometric bead array method. A significant increase in the relative abundance of Lactobacillus spp. was observed after ES treatment (P < 0.001). In addition, L. crispatus (P = 0.012) and L. gasseri (P = 0.011) also increased significantly. Reduced microbial diversity was observed in the vaginal microbiota after the treatment. In the long-term cohort, a significant downregulation of IFN-γ, IL-2, IL-4, IL-10, IL-17A, and TNF-α was compared with baseline. However, the short-term cohort presented with an elevated IL-6 level at 7 h after the treatment. In conclusion, this study suggested that transvaginal electrical stimulation might help to restore and maintain a healthy vaginal microbiota dominated by Lactobacillus, reducing the risk of vaginal inflammation.

A Robust Gene Expression Prognostic Signature for Overall Survival in High-Grade Serous Ovarian Cancer.

The objective of this research was to develop a robust gene expression-based prognostic signature and scoring system for predicting overall survival (OS) of patients with high-grade serous ovarian cancer (HGSOC). Transcriptomic data of HGSOC patients were obtained from six independent studies in the NCBI GEO database. Genes significantly deregulated and associated with OS in HGSOCs were selected using GEO2R and Kaplan-Meier analysis with log-rank testing, respectively. Enrichment analysis for biological processes and pathways was performed using Gene Ontology analysis. A resampling/cross-validation method with Cox regression analysis was used to identify a novel gene expression-based signature associated with OS, and a prognostic scoring system was developed and further validated in nine independent HGSOC datasets. We first identified 488 significantly deregulated genes in HGSOC patients, of which 232 were found to be significantly associated with their OS. These genes were significantly enriched for cell cycle division, epithelial cell differentiation, p53 signaling pathway, vasculature development, and other processes. A novel 11-gene prognostic signature was identified and a prognostic scoring system was developed, which robustly predicted OS in HGSOC patients in 100 sampling test sets. The scoring system was further validated successfully in nine additional HGSOC public datasets. In conclusion, our integrative bioinformatics study combining transcriptomic and clinical data established an 11-gene prognostic signature for robust and reproducible prediction of OS in HGSOC patients. This signature could be of clinical value for guiding therapeutic selection and individualized treatment.

A Posterior Approach to Laparoscopic Sacrospinous Ligament Suspension.

BACKGROUND AND OBJECTIVES: Laparoscopic sacrospinous ligament suspension, as commonly performed, is associated with extensive stripping, high risk of intraoperative bleeding, and prolonged operative time. We explore the safety and feasibility of posterior laparoscopic approach sacrospinous ligament suspension (LPASLS) in the treatment of pelvic organ prolapse (POP). METHODS: We retrospectively analyzed the clinical data of 9 patients with symptomatic POP treated intraoperatively with LPASLS at the Women's and Children's Health Centre, The Third Affiliated Hospital of Chongqing Medical University, between November 2016 and July 2017. Regular follow-up was performed at 1, 3, and 6 months after the operation. Subjective cure was considered as the absence of any postoperative subjective symptoms, and objective cure was considered as a postoperative POP-Q grade of 0. RESULTS: All operations were completed successfully. The operative time ranged from 90 to 140 (mean, 117.78 ± 20.01) minutes, and the mean suspension time was about 30 minutes. The intraoperative estimated blood loss ranged from 30 to 100 (range, 54.9 ± 24.2) mL, and pelvic vascular injury occurred in 1 patient. Postoperative sacrococcygeal pain occurred in 5 patients, and Visual Analog Scale scores ranged from 3 to 4 (mean, 3.4 ± 0.5). The symptom disappeared without any treatment after 3-4 d. Patients were followed up for 3-10 (mean, 6.3 ± 2.1) months, and the subjective and objective cure rates were both 100%. CONCLUSION: LPASLS is safe and feasible and may be considered as an alternative approach to traditional laparoscopic sacrospinous ligament suspension.

Is Ki-67 of Diagnostic Value in Distinguishing Between Partial and Complete Hydatidiform Moles? A Systematic Review and Meta-analysis.

BACKGROUND/AIM: To demonstrate the value of Ki-67 in distinguishing between partial and complete hydatidiform moles. MATERIALS AND METHODS: We searched electronic databases included Medline, WOK, Cochrane Library and CNKI, through January 24, 2015. Experts were consulted, and references from related articles were examined. The meta-analysis was conducted with RevMan5.3, according to the PRISMA guidelines. Mantel-Haenszel estimates were calculated and pooled under a random effect model, with data expressed as odds ratio (OR) and 95% confidence interval (CI). RESULTS: We analyzed eight trials with a total of 337 participants who underwent uterine curettage and met the inclusion criteria. A significantly higher expression of Ki-67 was observed in complete than in partial hydatidiform moles (OR=3.28; 95%CI=1.80-5.96; p<0.0001). CONCLUSION: The Ki-67 expression was higher in complete than in partial hydatidiform moles. Therefore, Ki-67 may be of diagnostic value in distinguishing between partial and complete hydatidiform moles. However, the present study had only a limited number of samples, so investigation of a greater number of cases is needed to confirm this conclusion.

Laparoscopic Radical Hysterectomy in Early Stage Cervical Cancer: A Systematic Review and Meta-Analysis.

PURPOSE: To investigate the value of laparoscopic radical hysterectomy (LRH) in the treatment of early stage cervical cancer by comparing intraoperative and postoperative outcomes with abdominal radical hysterectomy (ARH). MATERIALS AND METHODS: We searched the Medline, Web of Knowledge, Cochrane Library, and Chinese National Knowledge Infrastructure, through February 2, 2016 with keywords of "laparoscopic OR laparoscopy" AND "radical hysterectomy OR early cervical cancer OR stage IB, stage IB1, stage IB2, stage IIA, stage IIA1, stage IIA2, stage IIA cervical cancer" to identify all relevant studies that compared LRH with ARH in treating early cervical cancer. Two reviewers evaluated the quality of literature independently. Standardized tables were used to extract data (study or participant details and results) from the texts, tables, figures, or any other attachments of eligible publications. Weighted mean differences (MDs) and odds ratios (ORs) were pooled with the random effects model. Then we conducted meta-analysis using the RevMan5.3 software. RESULTS: A total of 615 studies were initially identified. After screening, 23 studies, including 4205 patients were recruited. LRH was associated with lower estimated blood loss (mL) (MD = -178.41, 95% confidence interval [CI] = -214.89 to -141.94, P < .00001), longer operation time (minutes) (MD = 43.68, 95% CI = 29.42-57.95, P < .00001), fewer retrieved lymph nodes (MD = -3.44, 95% CI = -5.96 to -0.92, P = .007), shorter hospital stay (day) (MD = -3.17, 95% CI = -4.06 to -2.29, P < .00001), quicker return to normal bowel activity (day) (MD = -0.7, 95% CI = -0.96 to -0.45, P < .00001), and shorter duration of bladder catheterization (day) (MD = -1.69, 95% CI = -2.83 to -0.55, P < .004) than ARH. LRH also demonstrated lower odds of transfusion (OR = 0.47, 95% CI = 0.30-0.73, P = .0007), and ileus (OR = 0.34, 95% CI = 0.12-0.91, P = .03) than ARH. CONCLUSION: LRH outweighs ARH in treating early stage cervical cancer in most essential aspects, which should arouse sufficient attention.

Nanomechanical clues from morphologically normal cervical squamous cells could improve cervical cancer screening.

Applying an atomic force microscope, we performed a nanomechanical analysis of morphologically normal cervical squamous cells (MNSCs) which are commonly used in cervical screening. Results showed that nanomechanical parameters of MNSCs correlate well with cervical malignancy, and may have potential in cancer screening to provide early diagnosis.

[Relationship between endometriosis stage, characteristics of enodmetriotic lesions and severity of dysmenorrhoea].

OBJECTIVE: To explore the association between endometriosis stage, characteristics of endometriotic lesions and severity of dysmenorrhoea. METHODS: The clinical data were collected from 140 patients with laparoscopically diagnosed endometriosis between May 2013 and December 2013. They were scored by visual analogue scale (VAS) according to their preoperative dysmenorrhoea. Endometriotic lesions were recorded by their anatomical distributions. And endometriosis was staged and scored according to the score of Revised American Fertility Society (r-AFS). The relationship between dysmenorrhoea and endometriosis stage as well as endometriotic foci was analyzed. Chi-square test and Logistic regression were used for statistical analyses. RESULTS: Among them, there were 95 (67.86%) patients with dysmenorrhoea and 45(32.14%) without dysmenorrhoea. No significant inter-group difference existed in age (P > 0.05). The interval from menarche to the onset of dysmenorrhoea was (8 ± 9) years and duration of dysmenorrhoea (2.3 ± 1.5) days each month. A correlation existed between endometriosis stage and severity of dysmenorrhoea (χ² = 20.677, P < 0.05). A strong association was found between posterior cul-de-sac obliteration and severity of dysmenorrhoea (χ² = 8.471, P < 0.05). No significant difference was found for ovarian endometriomas, ovarian adhesion, superficial peritoneal lesions and deep infiltrating endometriosis in non- and minimal dysmenorrhoea groups with moderate and severe dysmenorrhoea (P > 0.05). Posterior cul-de-sac obliteration was an independent influencing factor for dysmenorrhoea. The odds ratio (OR) was 3.291 and 95% confidence interval (CI) 1.453-7.454. However, no relevance existed between ovarian endometriomas and dysmenorrhoea by Logistic analysis. CONCLUSION: The severity of dysmenorrhoea has close correlation with posterior cul-de-sac obliteration. However, there is a weak relevance with ovarian endometreaiomas.

[Clinical effect of fetoscopic laser occlusion of chorioangiopagous vessels for twin-twin transfusion syndrome: experience of an center from China].

OBJECTIVE: To study the clinical effect of fetoscopic laser occlusion of chorioangiopagous vessels (FLOC) in treating twin to twin transfusion syndrome. METHODS: The clinical data of 44 consecutive cases of twin to twin transfusion syndrome (TTTS)who had FLOC in the Department of Obstetrics and Gynaecology of Peking University Third Hospital were reviewed and analyzed for perioperative complications, perinatal outcomes and fetal survival rate. RESULTS: (1) PATIENT CHARACTERISTICS: the mean maternal age was (29±4) years, the median gestational age at TTTS being primarily diagnosed was 20.4 weeks, the median gestational age at FLOC was 21.2 weeks. According to the Quintero staging system, there were 9 cases had stages progressed before the operation. (2) FLOC parameter and intraoperative complications: 44 cases all could tolerate the operation; there was 1 case of placenta vascular rupture in the operation, no fetal body injury by laser or placental abruption. 3 cases underwent cervical cerclage following FLOC. The average operation time of 41 cases alone with FLOC was (60.1±15.1) minutes. (3) Postoperative complications: the rate of intrauterine fetal death was 15% (13/88), the rate of intrauterine growth restriction after FLOC was 5% (4/88), the rate of membranes rupture less than 28 weeks was 16% (7/44), the rate of TAPS after FLOC was 5% (2/44), the rate of membrane sepration after FLOC was 5% (2/44). (4) Perinatal outcome and survival rate: there were 25 patients after FLOC had delivered in the perinatal period. The average gestational age of delivery was (33.5±2.7) weeks. The donor fetuses survival rate was 88% (22/25), the recipient fetuses survival rate was 100% (25/25). The birth weight of donor fetuses was significantly less than that of recipient fetuses (1 631g vs 2 071 g, P = 0.016). From Quintero staging I to IV, the rate that 44 cases of TTTS had entered the perinatal period was 4/7, 11/14, 7/19, 3/4; both twins survival rates were 4/7, 10/14, 5/19, 3/4; all the fetal survival rate was 8/14, 75% (21/28), 32% (12/38), 6/8, respectively. (5) Compared the early stage (I+II) with the advanced stage (III+IV), the rates that 44 cases of TTTS had entered the perinatal period (71% vs 44%) and that both twins survived (67% vs 35%) had no statistically significance. The rate that all the fetus survived in the early stage was significantly (69% vs 39%) more than that in the advanced stage. (6) All the cases of neoborn were followed up till 1 month postpartum, the donor fetuses and the recipient fetuses had 12 and 5 cases of cardiac abnormalities respectively, each had 1 case of neonatal death and 2 cases of neonatal white matter damage. CONCLUSIONS: FLOC for TTTS is associated with a better survival rate. Quintero staging probably does not effectively predict the fetal diagnosis of TTTS after FLOC. When TTTS diagnosed, the sooner FLOC given, the better fetal prognosis had.

[Clinical value of MRI in cesarean scar pregnancy].

OBJECTIVE: To explore the clinical value of MRI in diagnosing and treating cesarean scar pregnancy (CSP). METHODS: A retrospective analysis was conducted on the clinical manifestations of 54 patients diagnosed with CSP between January 2009 to January 2013 in Peking University Third Hospital. Based on the patients' MRI image and other clinical datas, we did transvaginal operation on patients with CSP1, and transvaginal combined with abdominal operations on patients with CSP2. The intraoperative blood loss, operation time, postoperative hospital stay, and the length of time required for of serum hCG dropping to normal of the patients were analyzed. RESULTS: The average age of the 54 patients was (34±5) years and the average duration of gestation was (56±16) days, all patients' vital sign were stable, the hCG level was 23-142 962 U/L before treatment. Twelve patients were diagnosed with CSP1 by MRI, and 5 of them had focus of 1-2 cm in diameter, the 5 patients' serum hCG level was 436-1 159 U/L and 23-32 days after drug administration, their hCG level returned to normal; the other 7 patients had focus of 2.0-4.4 cm in diameter, and their hCG level was 2 218-63 446 U/L, lesion resection was done on the 7 patients by hysteroscope or under B-ultrasound monitor. Forty-two patients were diagnosed with CSP2, and their focus were 1.0-7.1 cm in diameter, and serum hCG level were 23-142 962 U/L. We did bilateral uterine artery occlusion by laparoscope or laparotomy during operation for 22 patients or bilateral uterine artery embolization (UAE) before operation for 20 patients, then we did lesion resections. The blood loss during operation of CSP1 or CSP 2 was 50.1, 267.2 ml; operation time was 30, 128 minutes; postoperative hospital stay was 4.6, 6.7 days; their serum hCG returned to normal 13-30 days after the surgery. All the 54 patients' uterus were and the patients undergoing operations were all cured without the second operation. CONCLUSION: MRI is an effective method to conduct clinical treatment in CSP.

[Umbilical cord ligation in the fetocide of complicated monochorionic multiple gestations].

OBJECTIVE: To evaluate the clinical effect and safety of umbilical cord ligation in the fetocide of complicated monochorionic multiple gestations. METHODS: From January 2009 to December 2012, clinical data of 18 women with complicated monochorionic multiple gestations who experienced intrauterine percutaneous umbilical cord ligation in Peking University Third Hospital were collected. Among the patients, 6 were selective intrauterine growth restriction (1 with type I, 4 with type II, 1 with type III); 4 were acrania or hydropic twins; 4 were acardiac twins, 2 were complicated triplet gestation; 1 was twin-twin transfusion syndrome with right ventricular dysplasia and 1 was monochorionic diamniotic (MCDA) with caesarean section history. The procedure was performed under both endoscopic and sonographic guidance. The gestational age at the time of the procedure were 17-27(+6) weeks. The procedure and perinatal outcome were analyzed. RESULTS: (1) The procedure was performed successfully in all the 18 cases. The average duration of the procedure was 63 min (24-156 min). The blood loss was 7.6 ml (5-20 ml). The mean gestational age at the time of the procedure was 20 weeks (17-27(+) weeks). The average birth weight of the neonates was 2441 g (1000-3400 g) .(2) There were 206 fetuses survived. Two fetuses had cardiac anomalies and were terminated in the following 2-3 weeks.Intrauterus fetal demise occured in 3 twin reverse arterial perfusion syndrome (TRAP) cases 3-14 weeks after the procedure.1 case delivered as early preterm birth at 28 weeks and the neonate died of respiratory distress syndrome (RDS) and hypoxie-ischemicen-cephalopathy (HIE) .Fourteen neonates were in healthy and normal development by 3-51 months' follow-up.(3) Fourteen cases delivered at more than 28 weeks (28-38 weeks, averagely 33(+1) weeks). The gestational weeks were prolonged by 5-21 weeks (averagely 13(+4) weeks). Among them, 3 case were early preterm birth (28-33 weeks) and 3 were late preterm birth (34-36 weeks). CONCLUSION: Percutaneous umbilical cord ligation is a reliable technique for the fetocide of complicated monochrionic mutilple gestations, especially for monochronic monoamniotic pregnancies.

Endoscopic treatment of ectopic pregnancy in a cesarean scar.

STUDY OBJECTIVE: To describe our experience with endoscopic removal of cesarean scar pregnancy. DESIGN: Retrospective study (Canadian Task Force classification II-3). SETTING: Tertiary-care university hospital. PATIENTS: Twenty-one patients with cesarean scar pregnancy. INTERVENTIONS: All the patients underwent removal of pregnancy mass at hysteroscopy or combined with laparoscopy. Nine patients received a methotrexate injection before the operation, and 13 underwent uterine artery embolization before surgery. MEASUREMENTS AND MAIN RESULTS: Clinical data, serum ß-human chorionic gonadotropin concentration, findings of ultrasound or magnetic resonance imaging examinations, therapeutic options, operative time, operative blood loss, and duration of hospitalization time were recorded. The mean serum ß-human chorionic gonadotropin concentration at diagnosis was 53,350.4 IU/ L. Seventeen patients underwent hysteroscopy, which failed in 2, and the other 4 patients underwent hysteroscopy combined with laparoscopy. Mean operative time was 51.4 minutes, and mean blood loss was estimated at 48.1 mL. A gestational mass can be removed at hysteroscopy, with rapid recovery and a high success rate. If a cesarean scar pregnancy mass grows toward the bladder and abdominal cavity, hysteroscopy combined with laparoscopy is more appropriate. Preoperative uterine artery embolization can decrease blood loss substantially during the operation. No patients underwent hysterectomy. CONCLUSIONS: Endoscopy seems to be the optimal surgical management in patients with a cesarean scar pregnancy and who desire to preserve the uterus and fertility. However, further study is warranted.

[Human papillomavirus type 16 variant analysis of upstream regulatory region and E6, E7 oncogene from cervical cancer patients in Beijing].

To investigate distributional characteristics of mutations of HPV16 upstream regulatory region (URR) and E6 and E7 oncogene in the patients with cervical cancer in Beijing and to explore the potential association between oncogenesis of cervical cancer and HPV variants in this region, cervical cancer tissue from 31 cases with positive HPV16 were subjected to regular DNA extraction procedure. The corresponding primers were then designed to amplify the target sequence of URR, E6 and E7. The PCR products were sequenced and blast analysis against GenBank was carried out to evaluate the gene mutation and identify the phylogenetic branches. Among all the cases studied, URR was found to be the most frequent mutation fragments, followed by E7, and E6 was the most conservative sequence. A total of 8 hot mutation spot was identi-fied, which were URR G7521A (100%), C7435G (96.77%), C24T (45.16%), A7729C (45.16%), G7839A (45.16%), E6 T178G (41.94%), E7 A647G (45.16%), and T846C (45.16%). The most frequent HPV 16 branch was type As (54.84%), followed by type E (45.16%). Our results suggested that the mutations of G7521A, A7729C, G7839A, T178G, T350G, A647G, and G658A were likely to be associated with the enhanced oncogenic potential of HPV16 and oncogenesis of cer-vical cancer. In Beijing area, two major branches of HPV16 were type As and E. This finding provides valuable information for HPV vaccine development and infection treatment. Type As and E variants had different distributions among various ages and clinic stage groups. It might lead to a new explanation for the getting younger trend of cervical cancer.

Proteomic studies of early-stage and advanced ovarian cancer patients.

OBJECTIVES: The objectives of this study were to evaluate the diagnostic value for ovarian cancer using proteomic pattern established by surface-enhanced laser desorption/ionization (SELDI-TOF-MS) profiling of plasma proteins coupled with support vector machine (SVM) data analysis, and to investigate whether the proteomic pattern established by advanced ovarian cancer could be used for diagnosis of early-stage ovarian cancer patients. METHODS: The study included 44 ovarian cancer patients (11 early-stage and 33 advanced ovarian cancer patients) and 31 age-matched non-cancer controls. SELDI-TOF-MS coupled with SVM analysis was performed to establish a proteomic pattern to discriminate 33 advanced ovarian cancer patients from 31 non-cancer controls. A blind test, including 11 early-stage ovarian cancer cases, was performed to investigate whether proteomic pattern established by advanced ovarian cancer could be used for diagnosis of early-stage ovarian cancer patients. RESULTS: A seven-peak proteomic pattern was established which discriminated 33 advanced ovarian cancer patients from 31 non-cancer controls effectively. A sensitivity of 93.94% (31/33) and a specificity of 93.55% (29/31) were yielded from the proteomic pattern. Among the 7 protein peaks, 5 with mass charge ratio (m/z) 4099 Da, 5488 Da, 4144 Da, 4479 Da and 3940 Da were up-regulated, while 2 peaks, with m/z 13 783 Da and 8588 Da were down-regulated in the advanced ovarian cancer group compared with non-cancer control group. After blind test, 9 of 11 early-stage ovarian cancer patients were successfully diagnosed with the accuracy of 81.82% (9/11). CONCLUSIONS: This study demonstrated that SELDI-TOF-MS coupled with SVM is effective in distinguishing protein expression between ovarian cancer and non-cancer plasma and it may be feasible to diagnose early-stage ovarian cancer using proteomic pattern established by advanced ovarian cancer. The gained and lost protein peaks in plasma may exist in both early-stage and advanced ovarian cancer plasma. Further studies should be performed using larger sample numbers.

Expression of the human fast-twitch skeletal muscle troponin I cDNA in a human ovarian carcinoma suppresses tumor growth.

To explore the efficiency and mechanism of ovarian carcinoma gene therapy with the human fast-twitch skeletal muscle troponin I gene (Tnl-fast), Tnl-fast cDNA was transferred into human ovarian adenocarcinoma cell-line SK-OV-3. In vitro, the cell growth and cell cycle of Tnl-fast-, vector-, and mock-transfected cells were determined by MTT and flow cytometry assay, respectively. The conditioned media of Tnl-fast-, vector-, and mock-transfected SK-OV-3 cells were collected, and the cell proliferation inhibiting rates of human umbilical cord venous endothelial cells (HUVECs) by the three conditioned media were assayed. All the three cell lines were implanted into nude mice, and the tumor growth, cell apoptosis, angiogenesis, and expression of Tnl-fast were observed or analyzed, respectively. In vitro, expression of Tnl-fast protein had no inhibiting effect on the growth of the dominant and stable transfectant cells, but endothelium, when compared with vector-transfected cells and nontransfected parental SK-OV-3 cells. Implantation of stable clone expressing Tnl-fast in the female BALB/c nude mice inhibits primary tumor growth by an average of 73%. The nude mice grafts expressing Tnl-fast exhibit a significant decrease of microvascular density, a higher rate of tumor cells apoptosis and a comparable proliferation rate as control. Our study, to our knowledge, shows the slowed down growth of the primary ovarian carcinoma, suggested that grafts were self-inhibitory by halting angiogenesis. Our data might also provide a novel useful strategy for cancer therapy by antiangiogenic gene therapy with a specific angiogenesis inhibitor Tnl-fast.

[Complication of laparoscopic radical hysterectomy and lymphadenectomy: an analysis of 23 cases].

OBJECTIVE: To explore complications of laparoscopic radical hysterectomy and lymphadenectomy in patients with cervical and endometrial carcinoma, and its prevention. METHODS: From July 2000 to December 2004 at our institution, a total of 278 laparoscopic radical hysterectomy and lymphadenectomy procedures were performed in 242 patients with cervical carcinoma and 36 patients with endometrial carcinoma. We reviewed the clinical data of patients who underwent laparoscopic radical hysterectomy and lymphadenectomy to check their complications and other factors related to this open surgical procedure. RESULTS: All but 4 surgical procedures were completed laparoscopically. Paraaortic lymphadenectomy was performed in 108 patients and pelvic lymphadenectomy was performed in all of 278 patients. Major and minor intraoperative complications occurred in 4.7% (13/278) of patients. The overall conversion rate was 1.4% (4/278), consisting of 3 emergency and 1 elective conversions. Vascular injuries occurred in 7 patients, five of them were repaired or treated laparoscopically and one left external iliac vein injury required laparotomy, another patient underwent laparotomy to control bleeding. Operative cystotomies occurred in 4 patients and all were repaired laparoscopically. One patient underwent laparotomy because of hypercapnia. Another patient underwent laparotomy because of ascending colon injury. Postoperative surgery complications occurred in 3.6% (10/278) of patients. Three patients had a ureterovaginal fistula and three patients had a vesicovaginal fistula after the operation that required reoperation. There was one patient with ureterostenosis while three patients with urinary retention. CONCLUSIONS: Laparoscopic radical hysterectomy in combination with lymphadenectomy is becoming a routine procedure in the armamentarium of many gynecologists. Complications that are unique to laparoscopy exist but they decrease with more practice and experience.

[Role of radical vaginal trachelectomy and laparoscopic pelvic lymphadenectomy in treating early cervical carcinoma].

OBJECTIVE: To investigate the possibility and effect of radical vaginal trachelectomy and laparoscopic pelvic lymphadenectomy in treating women with early cervical cancers who desired to maintain fertility. METHODS: From August 2001 through May 2003, we performed vaginal radical trachelectomy with laparoscopic lymphadenectomy on 12 patients with biopsy-proven early stage cervical carcinomas. Subjects were selected for this treatment on the basis of favorable cervical tumors and a desire to maintain fertility. Pelvic lymphadenectomies were performed in all patients. Vaginal radical trachelectomy was performed immediately if lymph nodes were negative. RESULTS: Twelve women underwent this procedure. The median age was 27.6 years (range 24 - 31 years); 10 were nulligravid and 2 were multipara. Mean operative time was 142 min (115 - 178 min), with a mean blood loss of 180 ml (120 - 230 ml), and an average hospital stay of 6.7 days. There was no intra- or post-operative complication. With an average follow-up of 21.5 months, there have been no recurrences. One woman has become pregnant. CONCLUSIONS: Radical vaginal trachelectomy with laparoscopic pelvic lymphadenectomy permits preservation of fertility in selected patients. It is mini-invasive, and needs shorter recovery time.

[Laparoscopic suture uterosacral ligament hysteropexy for uterine prolapse].

OBJECTIVE: To investigate possibility and effect of laparoscopic suture uterosacral ligament hysteropexy or colpopexy for women with uterine prolapse. METHODS: Thirty-two women with symptomatic uterine prolapse underwent laparoscopic suture uterosacral ligament hysteropexy. At the laparoscopic suture hysteropexy or colpopexy, the pouch of Douglas was closed and the uterosacral ligaments were plicated and reattached to the cervix. All patients were multipara and menopausal with prolapse of anterior wall of vagina. Additionally, 4 patients were with prolapse of posterior wall of vagina, 15 with stress urinary incontinence, and 4 with myomas. RESULTS: All procedures were successfully completed laparoscopically. The mean operating time for the laparoscopic suture hysteropexy or colpopexy alone was (32 +/- 11) min (range 20 approximately 80 min), and the mean blood loss was less than 50 ml. After a mean follow-up of (12 +/- 6) months (range 4 approximately 28 months), 23 women had no symptoms of uterine prolapse and seven had no objective evidence of uterine prolapse. Two women presented recurrence of uterine prolapse 3 months after operation. CONCLUSIONS: The laparoscopy suture hysteropexy or colpopexy is effective and safe in the management of symptomatic uterine prolapse. It may be an appropriate procedure for women with uterine prolapse hoping for uterine preservation.