Endometrial cancer is one of the common malignant tumors in female genital tract.The incidence of endometrial cancer is increasing,even the top one in the developed country and bigger cities in China.The screening of endometrial cancer should be performed in the high risk population.In the recent years,the popular screening methods for endometrial cancer include ultrasound,endometrial biopsy,and endometrial cytology (ECT),etc.This review introduces briefly above methods.

Objective:To study the mechanism on extracellular signal-regulate kinases ( ERK) signal transduction by calcium influx initiated by combination of estrogen with calcium channels or estrogen re-ceptor in endometrial cancer cell Ishikawa. Methods: Confocal test was used to determine the relative calcium mobilization by stimulation of estrodiol together with and without the inhibition of ICI182780 and nifedipine. Western-blotting was used to detect the protein expression of phosphorylated ERK1/2 (P-ERK1/2) in the same condition. Results:The transient calcium flux initiated by 17β-estrodiol (E2) and a membrane-impermeable conjugate of estrogen and bovine serum albumin ( E2-BSA ) , and the calcium mobilization could be inhibited by ICI182780 and nifedipine in 1 min. In Ishikawa cells, phosphorylation of ERK1/2 was stimulated by E2 , and the phosphorylation could not be inhibited by E2 after the combination with ICI182780 in 5 min and in 30 min. The phosphorylation also could not be in-hibited by E2-BSA after the combination with nifedipine in 5 min, but in 30 min the phosphorylation was decreased. The phosphorylation of ERK by E2-BSA was decreased by the combination with nifedipine in 30 min. Conclusion:The transient calcium flux initiated by estrogen has an effect on the activation of ERK signal pathway in endometrial carcinoma cells.

Objective To compare patients' quality of life followed by Prolift operation and the revised total pelvic floor reconstruction with Gynemesh.Methods Thirty one patients underwent total pelvic floor reconstruction surgery were divided into two groups,including 14 cases treated by Prolift surgery and 17 cases treated by the revised total pelvic floor construction with Gynemesh.The body weight index(BWI),menopausal age and gravidity history did not show significant difference between two groups(P ＞0.05).The patients' age with 63±9 in Prolift group was significantly lower than 69±5 in Gynemesh group (P ＜0.05).Questionnair score of quality of life were collected and evaluated pre-and post-operation.Result (1) Preoperative scores:there was no significantly different scores of the following index between two groups (P ＞0.05),which were 91±42 in pelvic floor impact query,100±59 in pelvic floor distress query and 77±26 in sexual life query in Prolift group,65±56 in pelvic floor impact query,89±73 in pelvic floor distress query and 75±18 in sexual life query in Gynemesh group.(2) Postoperative scores:similarly,there was also no significantly different scores in the following index between two groups (P ＞ 0.05),which were 7±15 in pelvic floor impact query,27±24 in pelvic floor distress query and 79±43 in sexual life query in Prolift group,13±24 in pelvic floor impact query,24±21 in pelvic floor distress query and 74±15 in sexual life query in Gynemesh group.Conclusions The patients' quality of life were improved after Prelift operation and the revised total pelvic floor construction with Gynemesh.However,about quality of sexual life,Prolift operation did much better than revised pelvic surgery with Gynemesh.

Objective To investigate clinical treatment and outcome of mesh-related pain after pelvic floor reconstruction. Methods Twelve patients were referred to Peking University People′s Hospital for post-operation pain related to polypropylene mesh or tape used in pelvic floor reconstruction and received reoperation from January 2007 to December 2014. The demographic characteristics, clinical manifestation, operation method and follow-up outcome were retrospectively analyzed, and current literature was also reviewed. Results (1)General information:the median age was 54 years old(range 43-74 years old). The median vaginal delivery times was 2 (range 1-5). Initial pelvic floor operation procedures included 4 cases vaginal mesh, 5 cases vaginal mesh plus tension-free vaginal tape (TVT), 1 case rectal surface mesh implantation, and 2 cases sacrocolpopexy. (2) Related complications:all 12 patients had pain-related post-operation symptoms including dyspareunia, perineal pain, urination and defecation difficulty. Seven patients also complicated with other symptoms including discharge and bleeding. Mean time from first operation to medical consultation was 30 months (range 1-72 months). (3) Reoperation results:all 12 patients received reoperation on mesh revision or tape, 10 cases of them reoperated by vaginal approach, while the other 2 cases by laparoscopy. The range of the mesh or tape depended on tender or firm tissue and scar by palpation. The visual analogue scale (VAS) was significantly improved, which was 7.1 ± 2.2 pre-operation, and 0.9 ± 1.9 post-operation (95%CI: 4.48-7.86, P<0.01). Conclusions Pain is one of the reason why patients was removal of the mesh or tape after pelvic floor reconstruction operation. The surgery procedure may be considered as partial or entire mesh or tape excision by vaginal or abdominal way. Mesh or tape removal surgery could relieve related pain and other complications, and the VAS score was significantly improved after surgical management.

0 05) The radiotherapy and chemotherapy ratio of them was significantly higher than the control ( P 0 05). Multivariate analysis showed that the prognosis were related to the stage and tumor cell differentiation affected the prognosis remarkable But the prognosis was independent of age and associated medical disorders Conclusions The endometrial carcinoma often associates with hypertension, diabetes mellitus, coronary heart disease, and so on The incidence rate of medical disorders increases with the aging of the patients The medical disorders might affect the therapy to a certain extent But they do not affect the prognosis remarkably

Objective To evaluate status of female pelvic floor function and sexual life after total hysterectomy.Methods From March 2001 to January 2004,92 patients with undergoing hysterectomy due to benign gynecological diseases were enrolled in this study.They were followed up at outpatient department,including pelvic examination,filling in female sexual quality questionnaire,pelvic floor distress inventory short form 20 ( PFDI-20 ),pelvic floor distress impact questionnaire short form 7 ( PFIQ-7 ) and quality of sexual life of chinese women questionnaire.Results At 6 years after total hysterectomy,it was observed that 7 cases (7/92,7.6％ ) were pelvic organ prolapse and 62 cases (62/92,67.4％ ) were urinary incontinence.A median score of PFDI-20 were 4.67.A median score of PFIQ-7 were 0.Symptoms of pelvic floor dysfunction concentrated in lower urinary tract ( 58 cases with cough leak,32 cases with spot urine leakage,31 cases with frequent micturition,24 cases with urgent urination)and bowel symptoms (26 cases with constipation,24 cases with defecation urgency,21 cases without fully drained stool).In the 68 patients filling in female sexual quality questionnaire,an average score were (127 ± 20) points.Female sexual quality questionnaire score,sexual satisfaction,sexual communication and adjustment,sexual response and sexual body image were positively correlated with the patients' income ( r = 0.432,P = 0.007 ; r = 0.356,P =0.028;r=0.475,P=0.003;r=0.421,P=0.009;r=0.324,P=0.047).Conclusions Hysterectomy may have long-term effect on female pelvic floor function and sexual life.Quality of sexual life in those patients was positively correlated with income.

Objective To make sure whether or not Bcrp1 is the marker of cervical cancer stem cells or not by studying the invasive ability and formation of tumors of Bcrp1 + phenotype HeLa cells.Methods The tumor cell migration and invasion assay were used by boyden chamber to identify the invasive ability of Bcrp1 + phenotype HeLa cells.The formation of tumors in vivo experiments were completed,in which the two groups of cells with different concentrations were inoculated in non obese diabetes-severe combined immunodeficiency disease ( NOD/SCID ) mice ( 1 × 104,1 × 105,1 × 106/ml ) and the differences of time,rate and volume in the formation of tumors between two groups were observed.Results ( 1 ) In the invasion assay,the amount of cells that invaded through the artificial basement membrane in Bcrp1 + group were 99 ± 14,which was significantly greater than those in Bcrp1- group ( 57 ± 13,P ＜ 0.05 ) ; the length of the Bcrp1 + group was ( 366 ± 52 ) μm,which was significantly greater than the Bcrp1 - group ( 301 ± 54) μm ( P ＜ 0.05 ).( 2 ) Following transplantation of 1 × 104 cells,only the Bcrp1 + cells formed tumors in NOD/SCID mice.When 1 × 105 or 1 × 106 cells were transplanted,the tumor incidence and the tumor mass were greater in the Bcrp1 + groups than those in the Bcrp1 - groups ( P ＜ 0.05 ).Conclusion Bcrp1 + HeLa cell have the greater capacity of invasive and the tumorigenicity,which may contain cancer stem cells.

Objective To study the effects of nifedipine and mibefradil on the cell proliferation,apoptosis,migration on the HEC-1 A in vitro and also study the mRNA and protein expression levels of the calcium channel alpha1 D( Cav1.3 ) and calcium channel alpha1G (Cav3.1 ) to discuss the effects of the calcium antagonists on the mechanisms of the endometrial carcinoma.Methods ( 1 ) Add 10 μmol/L nifedipine and mibefradil at 15 minutes before adding 10 μmol/L 17β-estradiol( 17β-E2 ) and 100 μmol/L b-estradiol-6-(O-carboxymethyl) oxime(E2-BSA) to the HEC-1A in different time including 0,5,15,30,60,120 minutes.Then the changes of mRNA and protein were detected by reverse transcripiton( RT)-PCR and western-blot.(2)Add 1.25,2.5,5,10,20,40,80,100 μmol/L nifedipine and mibefradil to the HEC-1 A at 24,48,96 hours to detect the cell proliferation by 3-( 4,5 )-dimethylthiahiazo (-z-y1)-3,5-diphenytetrazoliumromide (MTT) method.(3) Add 10 μmol/L nifedipine and mibefradil to the HEC-1A,then detect the apoptosis at 0 minute,30 minutes,1 hour,6 hours,24 hours and migration in vitro at 36 hours with transwell methods.Results ( 1 ) After the pretreated effect of the nifedipine before 17β-E2,the mRNA express of Cav1.3 genes was lowest at 15 minutes,and returned to the control level after 30 minutes.The protein level didn't change very much in 30 minutes,but rose after 60 minutes.The Cav3.1 genes mRNA express was lowest at 5 minutes,rose at 30 minutes and returned to the 0 minute level gradually.(2) After the pretreated effect of the nifedipine before E2-BSA,the Cav1.3 genes mRNA was lowest at 5 minutes and returned at 15 minutes.The protein level rose gradually in 15 minutes but reduced after 15 minutes.The Cav3.1 mRNA and protein level were reduced at every time point.(3) After the pretreated effect of the mibefradil before 17β-E2,there was no change of mRNA expression of Cav1.3 genes.The protein level rose at 15 and 60 minutes,there was no change in any other time.The Cav3.1 genes mRNA were gradually reduced and the protein level rose at 15 minutes,and there was no change in any other times.(4) After the pretreated effect of the mibefradil before E2-BSA,the mRNA and protein of Cav1.3 levels were reduced after 15 minutes.There was no mRNA expression of Cav3.1,while the protein level was lowest at 15 minutes.(5)Nifedipine and mibefradil affected HEC-1A proliferation depended on the different concentration and interval time points.There was significant difference than those in control group ( P ＜ 0.05 ).( 6 ) There were statistical differences in apoptosis rate after adding nifedipine ( P ＜ 0.05 ),while rose at mibefradil treated the same time ( 24 hours:8.41 ± 0.07,0 minute:3.74 ± 0.18 ; P ＜ 0.05 ).(7) The numbers of stained cells after both nifedipine and mibefradil treated reduced more than control group.Conclusions ( 1 ) Nifedipine and mibefradil could inhibit both the effect of the estrogen on the L-type and T-type calcium channel in short time,meanwhile the mibefradil effects last long time. (2) The inhibited effect of the mibefradil on the proliferation,apoptosis and migration of HEC-1A cells in vitro is more significant than that by nifedidipine.

Objective To investigate the etiology and clinical characteristics of pregnancy-emerged thrombocytopenia.Methods A retrospective analysis was conducted on clinical data of 159 pregnancies with thrombocytopenia,who were admitted to Peking University People's Hospital from January 2000 to January 2010.All the patients recruited in this study had no history of blood or immune system disease before pregnancy,and thrombocytopenia was the predominate clinical manifestation during pregnancy,with platelet counts less than 100 × 109/L at least twice during pregnancy.The thrombocytopenia should not be induced by drugs,viral infections,preeclampsia or hemolysis,elevated liver enzymes,and low platelets syndrome (HELLP).All cases were followed up.The general condition,the onset time of thrombocytopenia,platelet changes,accompany symptoms,maternal and perinatal outcomes as well as follow-up conditions were compared based on the etiology.Results ( 1 ) Etiology:among the 159 cases,101 (63.5％) were diagnosed gestational thrombocytopenia (GT) ;43 ( 27.0％ ) were idiopathic thrombocytopenic purpura(ITP) ;9 ( 5.7％ ) were blood system diseases,including 4 cases of megaloblastic anemia( MA ),2 cases of aplastic anaemia (AA),and 3 cases of myelodysplastic syndrome(MDS).Six cases (3.8％)were diagnosed immune system diseases,including 3 cases of systemic lupus erythematosus ( SLE),2 cases of antiphospholipid syndrome (APS),and 1 case of Evans syndrome.(2)Maternal and perinatal outcomes:pregnancy induced hypertension was diagnosed in 21 cases ( 13.2％ ),abnormal glucose metabolism in 13 cases ( 8.2％ ),anemia in 44 cases ( 27.7％ ) and preterm delivery in 18 cases ( 11.3％ ).Twenty-nine cases ( 18.2％ ) were treated with corticosteroids or gamma globulin during pregnancy.The average gestational week was 38 weeks.Fifty-five cases ( 34.6％ ) underwent vaginal delivery,104 cases ( 65.4％ ) received cesarean section.Postpartum hemorrhage was observed in 34 cases (21.4％),and puerperal infection happened in 2 eases ( 1.3％ ).No maternal death was found.In a total of 160 fetuses (including twins),there were 157 live births.Three cases of fetal death and 2 cases of early neonatal deaths were observed.Fetal growth restriction was observed in 4 cases,and neonatal thrombocytopenia was seen in 6 cases.No intracranial hemorrhage was detected.(3)The onset time of thrombocytopenia:among the 159 cases,29 cases ( 18.2％ ),67 cases (42.1％ ),63 cases (43.6％) of thrombocytopenia were detected in the first,second and third trimester,respectively.There was a significant difference of the onset time of thrombocytopenia between GT and ITP groups( P ＜ 0.05 ).Patients with GT tended to have a later onset of thrombocytopenia,which mainly happened in the second and third trimester,while patients with ITP tended to happen in the first and second trimester.(4)The degree of thrombocytopenia:the cases with the minimum platelets level of (51 - 100) × 109/L,(31 - 50) × 109/L,( 10 - 30) × 109/L,＜ 10 × 109/L during pregnancy were 75 (47.2％ ),39 (24.5％ ),31 ( 19.5％ ),14( 8.8％ ) respectively.There was a significant difference between GT and ITP groups in the lowest platelets level (P ＜ 0.01 ).(5)Thrombocytopenia accompany with anemia:among the 159 cases,there were 44 cases (27.7％ ) accompanied with anemia.The proportion was 9.9％ ( 10/101 ) in GT group,58.1％ (25/43) in ITP group,with significant difference(P ＜0.01 ).Anemia was also found in 5 cases in blood system disease group (5/9),and 1 case in immune system disease group (Evans syndrome,1/6).Pancytopenia was observed in 2 cases with ITP (4.7％,2/43 ) and 3 cases with blood system disease ( AA:1 cases,MA:2 cases,3/9).(6) The recovery of the platelets counts postpartum:the postpartum follow-up periods were 7 months to 10 years.Patients recovered within 1 week,6 weeks,6 months postpartum were 66 cases ( 41.5％ ),43 cases ( 27.0％ ),17 cases ( 10.7％ ) respectively.The platelets counts did not recover within 6 months postpartum in 33 cases(45.7％ ).Conclusions GT is the leading cause of pregnancy-emerged thrombocytopenia followed by ITP.There are significant differences between GT and ITP in the onset time of thrombocytopenia,the lowest platelets level,the proportion of anemia accompanied and the postpartum recovery.Other etiologies including immune and blood system diseases are rare.The relevant examinations should be taken for etiology and differential diagnosis.

Objective To investigate the perinatal outcomes of pregnancies complicated with varying degrees of thrombocytopenia.Methods Clinical data of 305 pregnant women with thrombocytopenia,who admitted to Peking University People's Hospital from January 1,2000 to January 31,2010 were retrospectively analyzed.The etiological diagnosis of them were gestational thrombocytopenia (GT),idiopathic thrombocytopenic purpura (ITP) or undetermined.The patients were divided into 4 groups according to the minimal level of platelets in pregnancy ( platelets count was lower than 100 ×109/L at least twice) : groupⅠ,(50-100) ×109/L (n=101) ; group Ⅱ,(30-50) × 109/L (n = 85); group Ⅲ,(10-30) × 109/L (n = 87); group Ⅳ,< 10 × 109/L (n = 32).Demographic data such as pregnancy complications,treatment,neonates and follow-up results of the patients in each group were compared with ANOVA,Spearman rank correlation analysis,Chirsquare test and Chi-square trend test in SPSS 17.0.Results Medical complications in pregnancy of these patients included hypertensive disorder complicating (n = 35,11.48%) and abnormal glucose metabolism (n=23,7.54%),no difference was found in the incidence of these diseases among the four groups.There were 68 patients complicated with anemia (22.30%),40 preterm delivery (13.11%),60 postpartum hemorrhage (19.67%); there were significant differences in the incidence among the four groups (P＜0.05),the incidence increased with the aggravation of thrombocytopenia (P＜0.05).There were 2 cases of puerperal infection (0.66%),no maternal deaths.Fifty-one patients (16.72%) accepted treatment of corticosteroids or Gamma globulin during pregnancy.There were 116 cases (38.03%) of vaginal delivery and 189 cases (61.97%) of cesarean section.The postpartum bleeding amount within 24 hours increased with the aggravation of thrombocytopenia.Two hundred and eleven (69.18%) patients were followed up and platelet count regained normal,among which 152 cases recovered within six months after delivery.The recovery rates were 90.59% (77/85),82.36% (42/51),46.16% (24/52) and 39.13% (9/23) from group Ⅰ to group Ⅳ,as declined with the aggravation of thrombocytopenia in pregnancy ( x2trend = 42.616,Ptrend =0.000).Among the 306 perinatal fetuses,neonatal outcomes included 301 live births,5 fetal deaths,4 early neonatal deaths,4 low birth-weight infants after term birth,1 intracranial hemorrhage and 18 (5.98%) neonatal thrombocytopenia cases.Incidence of neonatal thrombocytopenia increased with the aggravation of maternal thrombocytopenia.Sixteen cases of neonatal thrombocytopenia recovered at 3-8 weeks after birth,but two cases did not recover within three years during followed up.Conclusions The perinatal outcomes are different in pregnancies complicated with varying degrees of thrombocytopenia.As thrombocytopenia in pregnancy become worse,the risk of anemia,premature delivery,postpartum hemorrhage and neonatal thrombocytopenia increases.While,perinatal outcomes may be better under close perinatal care.