Objective To investigate the diagnostic value of hysteroscopy combined with B -ultrasonography for uterine incision diverticulum after secondary cesarean section . Methods From May 2012 to May 2013, hysteroscopy check was performed in 38 cases with a history of two times of caesarean sections . The hysteroscopic results and ultrasound images were analyzed retrospectively . Results Incision diverticulum was diagnosed in 34 cases by using diagnostic hysteroscopy combined with B-ultrasonography, with a diagnosis rate of 89.5%(34/38).There were 18 cases of mild diverticulum (47.4%), 16 cases of severe diverticulum (42.1%), and 4 cases of good healing (10.5%).Of the 16 cases of severe diverticulum , the distance from top to serosal surface was 1.6-6.0 mm, and the width was 3-17 mm.Preoperative transvaginal ultrasonography ( TVS) showed only 10 cases of uterine incision diverticulum in patients with severe diverticulum , providing a diagnosis rate of 26.3% (10/38).Compared TVS with hysteroscopy combined with B-ultrasonography , there was a significant difference (χ2 =31.091, P=0.000) in the diagnosis rate for uterine incision diverticulum . Conclusion Hysteroscopy combined with B-ultrasonography has a high diagnosis rate for the diagnosis of uterine incision diverticulum in patients with two times of cesarean sections , being worthy of clinical application as a minimally invasive examination method after cesarean sections .

Objective To analyze clinical characteristics and treatment experience for late complications after hysteroscopic transcervical resection of endometrium ( TCRE) . Methods Clinical data of 13 cases of late complications after hysteroscopic TCRE for dysfunctional uterine bleeding from January 2006 to June 2014 were retrospectively analyzed .A re-operation of hysteroscopic exploration and resection were required . Results The re-operation in the 13 patients found 6 cases of hematocele in uterine cavity (4 cases in the uterine horn, 2 cases in the uterine cavity) and 7 cases of focal or whole uterine endometrial hyperplasia (including 1 cases of PASS syndrome and 1 case of endometrial pathology of grade Ⅰatypical hyperplasia ) .Postoperative symptoms were relieved in 7 cases (53.8%).Laparoscopic total hysterectomy was performed in 3 cases of adenomyosis complicated with secondary progressive dysmenorrhea (23.1%), 2 cases of endometrial proliferation associated with a breast cancer history (15.4%), and 1 case of endometrial atypical hyperplasia grade Ⅰ (7.7%). Conclusion After hysteroscopic TCRE, residual functional endometrium or future regeneration of endometrium may lead to late complications , which need further clinical diagnosis and treatment .

Objective To explore the application of ultrasonography combined with hysteroscopy for the diagnosis of dated uterine false passage. Methods From May 2012 to May 2013, a total of 3437 cases were examined in the center by ultrasonic monitoring combined with hysteroscopic examinations.Dated uterine false passage was found in 4 cases.Under the guidance of ultrasonography, the hysteroscope was introduced into the uterine cavity.The ultrasonic probe was put at the site above the pubic symphysis for comprehensive examinations, with uterine distention fluid as reference. Results There were 2 cases of uterine anteversion and 2 cases of retroversion.There were 1 case of intracervical mouth stenosis, 1 case of intracervical mouth adhesion, and no intracervical mouth stricture or adhesion in 2 cases.The uterine false passage was located in the anterior wall in 2 cases and located in the back wall in 2 cases.The distance to serosal surface was about 3 mm at the thinnest place.The uterine false passage was 3-4 cm in depth. Conclusion Ultrasound monitoring combined with hysteroscopic examination can determine the part of the uterine endometrium line, improve the accuracy of diagnosis and treatment of intrauterine lesions.

Objective To explore the tubal patency after laparoscopic salpingotomy and embryo removal for tubal ectopic pregnancy. Methods A retrospective analysis was made on 28 patients receiving laparoscopic salpingotomy at other hospitals from September 2013 to September 2014.Within their 6 postoperative months, these patients were given hysterosalpingography in this gynecological minimally invasive center to evaluate the tubal patency. Results There were 6 cases of ipsilateral tubal patency (21.4%) and 22 cases of tubal obstruction or dropsy (78.6%), while 19 cases of contralateral tubal patency (67.9%) and 9 cases of tubal obstruction or dropsy (32.1%).Bilateral tubal embryo removal was carried out in 3 cases, with hysterosalpingography showing bilateral tubal obstruction in 2 cases and bilateral tubal dropsy in 1 case.One patient had ipsilateral tubal obstruction after tubal embryo patency and developed contralateral tubal patency after conservative treatment.Follow-up of the 28 cases for 6-15 months showed 4 cases of intrauterine pregnancy, 4 cases of examination of ovulation, 7 cases of preparation of assisted reproduction, 3 cases of laparoscopic salpingoplasty 1-2 months after hysterosalpingography, 1 case of endocrine regulation monitoring ovulation, 1 case of abnormal uterine bleeding 13 months later ( hysteroscopic examination showed endometritis and diagnostic curettage found proliferative phase endometrium that consistent with the menstrual cycle), and 8 cases without further treatment. Conclusion Laparoscopic salpingotomy for tubal ectopic pregnancy does not improve patient’ s tubal patency.

Objective To evaluate the clinical value of 18F-FDG PET/CT in preoperative assessment for endometrial cancer.Methods A retrospective study was performed in 51 patients (average age (59± 12) years) with confirmed or suspicious diagnosis of endometrial cancer from February 2013 to December 2015.Thirty-three patients underwent curettage surgery at least 1 week before PET/CT imaging.With SUVmax as the statistical variable,comparison was made between the pathologically confirmed benign and malignant groups,and in case of the latter,the extent of infiltration,histologic grade and subtype of primary tumor,lymph node and distant metastases were also analyzed.Two-sample t test was used to analyze the data,and diagnostic efficacy of PET/CT for metastasis was calculated.Results There were 43 patients with endometrial cancer and 8 patients with benign uterine tumor.SUVmax was found to significantly correlate with histopathology classification (benign:3.4 ± 1.2,malignant:12.8 ± 6.5) and depth of myometrial invasion (≥1/2:17.7±5.4,＜1/2:10.9±5.9;t=-8.7 and 3.2,both P＜0.05),but not with cervical stromal invasion,histologic grade or histologic subtype(t =1.8,-1.9,1.5,all P＞0.05).The sensitivity,specificity,accuracy,positive predictive value (PPV) and negative predictive value (NPV) of PET/CT for the detection of lymph node metastases on a lesion basis were 85.7％ (18/21),98.2％ (271/276),97.3％ (289/ 297),78.3％(18/23),98.9％ (271/274),respectively,and on a patient basis were 6/6,97.3％ (36/ 37),97.7％ (42/43),6/7,100％ (36/36),respectively.The sensitivity and PPV of PET/CT for the detection of other metastases on a lesion basis were both 11/12.Conclusion SUVmax could be a clinically valuable tool for preoperative evaluation of the presence of deep myometrial invasion,lymph node metastases and other metastases in patients with endometrial cancer,particularly in specificity and NPV.

Purpose To investigate the expression and significance of ArhGAP29 and E-cadherin in endometrial tissue of intrauterine adhesions (IUAs) and to explore their roles in the pathogenesis of IUAs.Methods The expression of ArhGAP29 and E-cadherin was detected by immunohistochemical PV 9000 two-step method.The correlation between ArhGAP29 and E-cadherin expression and clinical features was analyzed.Results (1) The immunoreactive score (IRS) of ArhGAP29 and E-cadherin in normal endometrial tissue were higher than those in IUAs endometrial tissue (P =0.017,P =0.004).(2) IRS of ArhGAP 29 and E-cadherin in moderate IUAs patients were higher than that in severe IUAs patients (P =0.020,P =0.026).In IUAs patients without amenorrhea,the IRS of ArhGAP29 and Ecadherin were higher (P =0.019,P =0.031) than that in IUAs patients with amenorrhea.(3) The decrease of ArhGAP29 expression had a significantly parallel relationship with the negative expression of E-cadherin (r =0.725,P ＜ 0.001).Conclusion The expression of ArhGAP29 and E-cadherin decreases in endometrial tissue of IUAs patients,which is related with degree of IUAs severity.ArhGAP29 and E-cadherin may participate in the IUAs formation.

Shenling Baizhusan is a traditional Chinese medicine compound prescription formulated on the basis of Si Junzitang （Ginseng Radix et Rhizoma， Atractylodis Macrocephalae Rhizoma， Poria， Glycyrrhizae Radix et Rhizoma）. It has excellent functions of replenishing Qi， invigorating spleen， draining dampness， and checking diarrhea， and is one of the classical prescriptions of ''reinforcing earth to generate metal''. This prescription is primarily used in clinical practice to treat malnutrition in children， chronic diarrhea， gastrointestinal dysfunction， and other disorders. In addition， it has a good effect on gastrointestinal adverse reactions associated with radiotherapy and chemotherapy. With the booming of molecular biology， researchers have revealed the role of Shenling Baizhusan in the treatment of diseases， especially the mechanism of regulating different signaling pathways. We retrieved 26 relevant papers （4 written in English and 22 in Chinese） published in recent 5 years from 6 databases including China National Knowledge Infrastructure （CNKI）， Wanfang Data， VIP， PubMed， Cochrance Library， and Excerpta Medica Database （Embase）. On the basis of these papers， we summarized the mechanisms of Shenling Baizhusan in disease treatment. In the animal model of inflammatory bowel disease， Shenling Baizhusan can protect gastrointestinal mucosa by regulating the activation of nuclear factor kappa-B （NF-κB）， mitogen-activated protein kinase （MAPK）， Janus kinase/signal transducer and activator of transcription （JAK/STAT）， and myosin light chain kinase-myosin light chain （MLCK-MLC） signaling pathways. In the animal model of non-alcoholic fatty liver disease， Shenling Baizhusan regulates the activation of phosphoinositide 3-kinase/protein kinase B/mammalian target of rapamycin （PI3K/Akt/mTOR） signaling pathway and Kelch-like ECH-associating protein 1/NF-E₂-related factor 2/advanced glycation end-products （KEAP1/NRF2/AREs） signaling pathway， thus alleviating the lipid metabolism disorder induced by high-fat diet and reducing liver lipid accumulation and inflammatory response. In the animal model of lung cancer with bone metastasis， Shenling Baizhusan regulates the activation of PI3K/Akt/mTOR signaling pathway， thus playing an analgesic role. By summarizing the mechanisms of Shenling Baizhusan in treatment of different disease models from signaling pathways， we aim to provide clues for the in-depth study of this prescription.