Objective To investigate the change of adiponectin level with menopause status in women aged 40 to 65, and its relationship with androgen. Methods A cross-sectional study included woman (aged from 40 to 65) who were in hospital for routine check-up at the Sun Yat-sen Memorial Hospital from August to October in 2013. All subjects underwent laboratory examinations of adiponectin, sex hormone binding globulin (SHBG), dehydroepiandrosterone-sulfate (DHEA-S), total testosterone (TT), collected anthropometric measurements and then calculated free androgen index (FAI) and body mass index (BMI). According to their menstrual status, the subjects were divided into 4 groups: premenopausal group with 119 subjects, perimenopausal group with 60 subjects, early postmenopausal group with 62 subjects, late postmenopausal group with 64 subjects. Results (1) Adiponectin levels declined to its lowest level in menopausal transition and gradually becoming higher after menopause, which showed a U-shaped trajectory. When compared adiponectin levels in late postmenopausal group [(13 ± 5) mg/L] with those in perimenopausal [(8 ± 6) mg/L] or early postmenopausal group [(9 ± 6) mg/L], it all showed significantly difference (P<0.05). (2) Both the adiponectin levels were negatively correlated with waistline in the 4 groups (premenopausal group, r=-0.276;perimenopausal group, r=-0.334;early postmenopausal group, r=-0.211;late postmenopausal group, r=-0.218; all P<0.05). Levels of adiponectin were positively correlated with SHBG (r=0.536, P<0.05) and negatively with FAI (r=-0.363, P<0.05) in menopausal transition, while in late postmenopausal group, negatively correlated with level of DHEA-S (r=-0.450, P<0.05). When adjusted for age, BMI and waistline, the above correlations still exist. Conclusions Adiponectin levels declined to its lowest level in menopausal transition and gradually becoming higher after menopause, which showed a U-shaped trajectory during the sequential menopause status transition in middle aged women. Low level of adiponectin in menopausal transition is closely associated with the relative excess androgen occurred during this stage.

Objective To investigate the feasibility,safety and curative effect of combined laparoscopic and thoracoscopic esophagectomy for esophageal carcinoma and gastro-esophageal anastomosis in right thoracic cavity.Methods We retrospectively evaluated 357patients with esophageal carcinoma who received minimally invasive esophagectomy(MIE) in our center between October 2011 and March 2014.Of those 357 patients,219 underwent MIILE and 138 underwent MIME.The clinicopathologic factors,operational factors,postoperative complications and postoperative recurrence were compared.Results The 2 groups were similar in terms of age,sex,American Society of Anesthesiologists grade,tumor location,preoperative staging.The MILLE approach was associated with no significant decrease in surgical blood loss.Duration of operation,chest tube duration,hospitalization expenses and postoperative stay relative to the MIME approach(P ＞ 0.05).There was no significant difference between the 2 groups in postoperative complications(P ＞0.05).The MIILE approach was associated with significantly fewer anastomotic fistula,RLN injury,anastomotic stensis than the MIME approach(P ＜0.05).Conclusion Our MIILEtechnique can be safely and effectively performed for intrathoracic anastomosis during esophageal surgeries with favorable early outcomes.

Objective To investigate the effect of the artificial cycle on the prognosis after transcervical resection of adhesion (TCRA) and its mechanism .Methods 80 patients with intrauterine adhesion were randomly divided into the observation group and the control group .The observation group were performed TRCA and postoperative artificial cycle for successive 3 months :oral es-tradiol valerate(9 mg once daily) for 21 d ,adding oral medroxyprofgesterone acetate(10 mg once dialy) on 15 d ,then the medication discontinuation for 7 d ,which was taken as 1 cycle;the control group received only TCRA .The re-examination was performed after 3 months .The levels of follicle stimulating hormone(FSH) ,luteinizing hormone(LH) ,estradiol(E2 ) ,prolactin(PRL) ,progesterone (P) and testosterone(T) were examined by ELISA after TCRA three months .The expression of MMP-9 and TGF-β1 in adhesive endometrium were detected by real-time PCR and Western blot .Results Compared with the control group ,the artificial cycle thera-py combined with the operation could significantly increase the effective rate of TCRA for treating mild and moderate intrauterine adhesion(P<0 .05);the seum levels of FSH ,LH ,E2 ,PRL ,P and T had no statistical differences between the observation group and the control group(P>0 .05);the artificial cycle significantly improved the adhesive degree of intrauterine adhesion ,increased the MMP-9 expression and decreased the TGF-β1 expression .Conclusion Artificial cycle could improve the degree of uterine cavity ad-hesion after TCRA ,which the mechanism might be related to the increase of MMP-9 expression and decrease of TGF-β1 expres-sion .

Objective To investigate the clinical efficacy of autologous dendritic cells and cytokine-induced killer cells (DC/CIK) combined with transcatheter arterial chemoembolization (TACE) in the treatment of moderate and advanced hepatocellular carcinoma (HCC). Methods Sixty patients with moderste and advanced HCC were randomly divided into two groups: the experimental group (n = 32), in which the treatment of DC/CIK combined with TACE was used, and the control group (n=28), in which TACE treatment was used only. The parameters of tumor size , serum alpha-fetoprotein , survival rate , the median survival time and quality of life , were detected in patients of the two groups before and after corresponding therapy . Results ( 1 ) After receiving corresponding treatments, the efficient rates of DC/CIK combined with TACE and TACE only were 87.50% and 64.29%, respectively, with significant difference;(2) The level of serum AFP decreased in the two groups after corresponding treatment, with no significant difference; (3) The 6-month survival rate was 96.88%and 92.85%, and the 1-year survival rate was 84.38%and 64.29%, the 2-year survival rate was 65.63%and 42.86%in the experimental group and in the control group, respectively. And the median survival time was 21 months and 17 months in the experimental group and the control group, respectively, with no significant difference; (4) The quality of life was improved significantly in the DC/CIK combined with TACE group after treatment. Conclusions Administration of DC and CIK combined with TACE can prolong the survival time, increase the survival rate and especially improve the life quality of HCC patients. It is a promising approach for the treatment of patients with moderate and advanced HCC.

Objective:To investigate the feasibility, safety, and short-term effect of minimally invasive McKeown esophagecto-my. Methods: We conducted a retrospective evaluation of 88 patients with esophageal carcinoma who received minimally invasive esophagectomy in our center from October 2013 to April 2014. Among the 88 patients, 46 patients underwent total endoscopy McKe-own esophagectomy (TEME) and 42 patients underwent thoracoscope combined with laparotomy Mckeown esophagectomy (TLME). The clinicopathologic factors, operational factors, and postoperative complications of the two approaches were compared. Results:The two groups were similar in terms of age, sex, American Society of Anesthesiologists grade, tumor location, preoperative staging, and co-morbidity. The TEME approach was associated with a significant decrease in abdominal blood loss and postoperative pain relative to the TEME approach (P<0.05). No significant differences were found between the two groups in terms of histologic type, postoperation TNM staging, abdominal operation time, intensive care unit stay, chest tube duration, postoperative stay, the number of total lymph nodes dissected or the stations of the total lymph nodes dissected, and lymph metastasis rate (P>0.05). The total morbidity and total re-spiratory complications in the TEME group were lower than those in the TLME group (P<0.05). Incidences of pneumonia, arrhythmia, wound infection of minor complications, and pneumonia of major complications were relatively low in the TEME approach. Conclu-sion:Our TEME technique can be safely and effectively performed for cervical anastomosis during esophageal surgeries to achieve fa-vorable early outcomes.

Objective To investigate the value of contrast-enhanced ultrasound (CEUS) in percutaneous nephrostomy for the treatment of complex renal calculi without hydronephrosis.Methods 22 patients with complex renal calculi underwent puncture and catheterization under the conventional ultrasound guidance,and then were injected with ultrasound contrast agent (SonoVue) through the needles and tubes to confirm appropriate puncture and catheterization.The display rates of puncture needle,renal pelvis,calyces,drainage tube body and distal end under CEUS were observed,and the results were compared with those of routine ultrasonography.The dosage of contrast agent,success rate and complications were also recorded.Results The display rates of puncture needle,renal pelvis,calyces,drainage tube body and distal end under routine ultrasonography were 63.64％,36.36％,63.64％,18.18％,as compared with CEUS the display rates were 100％,100％,100％,81.18％.The differences were statistically significant between CEUS and routine ultrasonography (P ＜ 0.05).Conclusions CEUS guided percutaneous catheterization makes up for the inadequacy of conventional ultrasound in patients of complex renal calculi without hydronephrosis,and it can be worthy for clinical application.

ObjectiveTo investigate the relationship between testosterone level and related index and metabolic syndrome(MS) of women in perimenopause or postmenopause period.MethodsFrom May 2009 to August 2010,911 women aged 40 - 65 years underwent physical examination in the Memorial Hospital,Sun Yat-sen University were enrolled in this study,which were divided into 175 women with early perimenopause period in group A,112 women late perimenopause period in group B,161 women with early postmenopause period in group C,132 women with moderate postmenopause period in group D,88 women with late postmenopause period in group E,243 women with regular menstruation as control group (group F).MS was defined according to the International Diabetes Federation (IDF) criteria.The relationship of free testosterone level and MS of women in different stage of menopause was analyzed.Results (1) Compared with 1.13 nmol/L in group F,median testosterone level of 1.03 nmol/L in group A,0.91 nmol/L in group B,0.91 nmol/L in group C,0.87 nmol/L in group D,0.83 nmol/L in group E decreased significantly at early peri-menopause period(P ＜0.01 ).Median free androgen index(FAI) was 1.33 in group A,1.56 in group B,1.69 in group F.When compared median FAI in group A with those in group F or B,it all showed significantly difference ( P ＜ 0.01 ) ; Testosterone ( T)/estradiol ( E2 ) were 0.042 in group C,0.040 in group D,0.042 in group E,0.010 in group A.When compared T/E2 in group C with group F,D and E,it all reached statistical difference (P ＜ 0.01 ).(2)There were negative correlation among waist circumference (WC,r =- 0.287 ),fasting blood glucose ( FBG,r =- 0.281 ),triglyceride ( TG,r =-0.224) and sex hormone-binding globulin (SHBG) and positive correlation with high density lipoprotein cholesterone (HDL-C,r =0.314).The logistic regression analysis for MS showed that the MS was associated with SHBG significantly ( OR =0.993,95％ CI:0.986 - 0.999,P =0.035 ).( 3 ) When cut-off value of SHBG was defined at 56.14 nmol/L,SHBG was used to predict MS with sensitivity of 63.13％ and specificity of 69.45％.Conclusions Serum testosterone was associated with MS in women at perimenopausal and postmenopausal period,so window period of preventing MS was set at perimenopausal period.A serum testosterone level was elevated from premenopause to postmenopause period.Because there was an association between SHBG and MS,SHBG was a selectable parameter to predict MS.

Recently,the main treatment for esophageal cancer remains curative resection combined with adjuvant chemoradiotherapy.With the application of minimally invasive esophagectomy (MIE) in the surgical treatment in recent years,patients with esophageal cancer who received MIE are proved to have less postoperative complications,better quality of life,and better surgical effect.However,different operation methods of MIE have different advantages and disadvantages,that makes the clinical promotion of MIE need further clinical experience,surgical techniques and procedures.The long-term effect of MIE remains to be further verification.

OBJECTIVETo investigate the changes in local endometrial contents of estrogen receptors (ER) and progesterone receptors (PR) after insertion of levonorgestrel-releasing intrauterine system (LNG-IUS) and evaluate the efficacy of LNG-IUS in treating endometrial hyperplasia.

METHODSThe endometrial histological changes were observed in 25 anovulatory women with dysfunctional uterine bleeding after insertion of LNG-IUS, and the contents of ERs and PRs in the endometrium were measured by immunohistochemistry.

RESULTSThe endometrial proliferation activity was obviously inhibited 6 months after LNG-IUS insertion with decreased endometrial glands, glandular dysplasia and decidualization of interstitial cells. The positive cell rate for ERs and PRs in the glandular epithelial and interstitial cells were significantly reduced after LNG-IUS insertion.

CONCLUSIONSLNG-IUS can reduce ER and PR expressions in the endometrium and inhibit endometrial proliferation, and therefore can be effective in treating simple and complex endometrial hyperplasia.

Adult ; Endometrial Hyperplasia ; metabolism ; pathology ; Endometrium ; pathology ; Female ; Gene Expression Regulation ; drug effects ; Humans ; Intrauterine Devices, Medicated ; Levonorgestrel ; administration & dosage ; pharmacology ; Middle Aged ; Receptors, Estrogen ; metabolism ; Receptors, Progesterone ; metabolism

Objective:To investigate the role of pleiotrophin (PTN) gene in carcino genesis using cDNA microarray and in situ hybridization. Methods:The expression of PTN gene in 5 cases of glioma, 10 laryngeal squamous cell carcinoma, 6 cases of hepatocarcinoma, and normal controls were detected by BioDoor 4096 type cDNA microarray and in situ hybridization. Results: The expression of PTN gene in carcinoma samples were significantly higher than in normal controls by cDNA microarray, the results was the same as by in situ hybridization. Conclusion: cDNA microarray is an effective technique in analysis of functional study of associated genes in carcinoma. High expression of PTN gene might be correlated with mechanism of multiple carcinoma. [