Objective To explore the efficacy and safety of biological mesh during female anterior pelvic organ reconstruction.Methods The 68 consecutive women with symptomatic anterior vaginal wall prolapse in Beijing hospital from January 2010 to June 2013 were divided into two groups:6 cases underwent anterior vaginal wall repair with biological mesh,and 32 cases underwent vaginal approach to paravaginal repair.Preoperative and postoperative pelvic evaluations were performed with the POP-Q system.Patients were followed up at 1,3,6,12,24 months after operation.Objective cure was defined if the lateral sulci of the anterior vaginal walls were at grade 0 and firmly apposed to the lateral pelvic sidewalls.Results Among 68 patients,38 had grade Ⅲ and 30 had grade Ⅳ anterior vaginal wall prolapse.In all patients the anterior vaginal repair was performed successfully.The indexes of operation time,amount of bleeding,the postoperative retention time of catheter and hospital stay had no difference between biological mesh and vaginal approach groups [(88.1±18.3)min vs.(88.0±17.4)min,(140.3±77.6) ml vs.(141.3±64.9) ml,(5.30±1.79) d vs.(4.90±2.34) d,(5.53±2.00)d vs.(5.50±2.08)d,t=0.01,0.05,0.64,0.06,respectively,all P＞0.05].No complication happened during and after operation.No one relapsed in biological mesh group and 4 cases relapsed in paravaginal repair group.The relapse rate between two groups is statistically different(x2 =4.79,P＜0.05).Conclusions The anterior vaginal repair with biological mesh is effective during female anterior pelvic organ reconstruction,but the long-term outcome of biological mesh in pelvic floor construction needs further study.

Forty two resident general practitioners (GPs) attending obstetrics and gynecology course in Beijing Hospital were divided into trial group and control group with 21 in each group. The 2-hour study content uterine fibroids was taught by the same teacher. For control group the traditional classroom teaching mode was used, while for the trial group the WeChat-based flipped classroom model was used. The teaching effectiveness was evaluated by means of paper examination, critical examination and questionnaire survey. The average scores and the clinical reasoning scores of trial were significantly higher than those of control group [(90.5±3.4) vs. (82.5±4.2) points and (94.5±1.5) vs. (84.5±2.0) points; t=4.28, P<0.05 and t=5.01, P<0.05, respectively]. Compared with the control group, the trial group presented more learning interest, higher learning efficiency and self-learning ability; and also the ability of expression and communication was improved, the ability of teamwork and the ability of analyzing and solving problems was enhanced more markedly in trial group (all P<0.05). The result indicates that WeChat-based flipped classroom teaching model can improve the learning efficiency in general practice residency training.

Objective To investigate the prevalence of nutritional risk and malnutrition,and the application of nutrition support in hospitalized patients with surgically treated gynecologic malignant tumors.Methods 237 hospitalized patients with malignant tumors receiving surgery in Department of Gynecology of Beijing Hospital from January 1 to December 31,2013 were continuously sampled.Nutritional Risk Screening 2002 (NRS 2002) was performed in the morning the day after admission.NRS 2002 score ≥ 3 was considered indicating nutritional risk.Malnutrition was judged in accordance with NRS 2002.The application of postoperative nutrition support was recorded.Results The nutritional risk screening was applicable in all the patients (100％).The prevalence of malnutrition was 5.1％ (12/237) in the whole study population,9.2％ in the elderly (≥65 years),significantly higher than that in the patients ＜ 65 years (2.7％) (P =0.034).The nutritional risk rate was 21.1％ (50/237),which was 29.9％ in the patients ≥ 65 years and significantly lower in the patients ＜ 65 years (16.0％) (P =0.014).The nutritional risk rate in the patients with ovarian and endometrial cancers was higher the rate in those patients with vaginal and vulvar cancer was lower.47 patients (19.8％)received postoperative nutrition support,all being parenteral nutrition,including total parenteral nutrition in 13 patients (5.5％) and single transfusion (providing two or more than two amongs glucose,fat emulsion,andi amino acids) in 34 (14.3％).Tube feeding was not applied in all the patients.33 cases (66％) in the 50 patients with nutritional risk were supported by parenteral nutrition,while 14 cases (7.5％) in the 187 patients without nutritional risk were supported by parenteral nutrition.Conclusions There is nutritional risk in the patients with gynecology malignant tumors,the rate of which is higher in elderly patents (≥ 65 years) than in the patients of other age groups.Therefore,attention must be paid to ensure adequate postoperative nutrition support in the elderly patients.

To assess the effect of cystocele (anterior pelvic organ prolapse,AOP)or stress urinary incontinence (SUI) on sex life quality in postmenopausal women under 65 years and observe the change of sex life quality after individualized surgical repair and tension-free vaginal tape-obturator (TVT-O).The postmenopausal patients aged 48 to 65 years at Beijing Hospital were observed from June 2008 to December 2010.They were divided into 3 groups of AOP (n =52),SUI (n =30) and control without gynecological and urinary system diseases on routine examinations (n =25).Their sexual life qualities were evaluated by pelvic organ prolapse/urinary incontinence sexual questionnaire (PISQ-31)with 31 items before treatment and at 3,6 months after surgical treatment in AOP and SUI groups.The sexual life quality scores were significantly lower in SUI group than those in control and AOP groups(P ＜ 0.01).It significantly increased after TVT-O treatment(P ＜0.01).There was no significant difference after treatment when compared with that before treatment in POP group.

Objective To investigate the expression of different inflammatory variables,such as procalcitonin(PCT),C-reactive protein (CRP),D-dimer (DD),fibrinogen (FIB),white blood cell (WBC),neutrophils and platelet(PLT)in septic elderly female patients with bacterial bloodstream infection,in order to assess the early diagnostic value of these variables.Methods A total of 308 elderly female patients with systemic inflammatory response syndrome(SIRS)were enrolled for this prospective study in Beijing Hospital between January 2014 and December 2015.Patients were divided into the sepsis group(n=210)and non-sepsis group(n=98)based on the diagnostic criteria of sepsis.The early inflammatory variables in blood,including PCT,CRP,DD,FIB,WBC,neutrophils and PLT,were detected within 6 hours of bloodstream infection,and their correlations were analyzed.The receiver operating characteristic(ROC)curve of inflammatory variables for the diagnosis of bloodstream infection was plotted,and the area under ROC curve (AUC)was calculated and used to evaluate diagnostic value for bloodstream infection.The best diagnostic cut-off points were identified based on the best(largest)AUC and the best sensitivity and specificity of inflammatory variables for bloodstream infection.Results The levels of all the inflammatory variables were significantly higher in the sepsis group than in non-sepsis group(all P＜0.05).Additionally,PCT and CRP were independent factors for diagnosis of blood stream infection.AUC of the combination of two biomarkers of PCT and CRP was 0.694 for diagnosis of sepsis,which was higher than the either biomarkers alone with AUC of 0.628 for PCT and 0.627 for CRP.The combination group of PCT and CRP showed better values of sensitivity,specificity,positive predictive,and negative predictive (86.2 ％,59.1％,65.1 ％,81.3 ％),as compared with those used individually(63.4％,58.2％,60.3％,61.4％ for PCT;and 62.4％,58.2％,59.9％,60.7％ for CRP,respectively).Conclusions The combination assay of PCT and CRP enhances the diagnostic ability for bacterial bloodstream infection.

Objective To evaluate the value of hysteroscopy in elder women with abnormal uterine bleeding (AUB) and asymptomatic postmenopausal women with a thickened endometrium.Methods Fifty-three cases in the AUB group and seventy-eight cases in the endometrial hyperplasia group underwent hysteroscopy examination and hysteroscopy-guided biopsy,then the hysteroscopic and histopathological results were compared between the two groups.Results Of the 131 cases,the normal endometrium accounted for 29.8％ (n=39),endometrial polyp for 49.6％ (n=65),submucous myomas for 4.6％ (n=6),hyperplasia endometrii for 6.1％(n=8) and endometrial carcinoma for 9.9％ (n=13).Both the AUB group and theendometrial hyperplasia group had 8 cases of endometrial carcinoma (15.1％,6.4％,respectively).For the diagnosis of normal endometrium with hysteroscopy,the sensitivity,specificity,positive predictive value (PPV) and negative predictive value (NPV) were 88％,97％,94％ and 95％,respectively,in the AUB group,versus 82％,95％,86％ and 93％,respectively,in the endometrial hyperplasia group.For the endometrial polyps,hysteroscopy showed a sensitivity,specificity,PPV and NPV of 100％,79％,74％,100％,respectively,in the AUB group and 98％,88％,92％,97％,respectively,in the endometrial hyperplasia group.For the endometrial cancer,hysteroscopy had a sensitivity,specificity,PPV and NPV of 75％,100％,100％ and 96％,respectively,in the AUB group;while in the endometrial hyperplasia group,the sensitivity was 80％,the specificity and PPV were 100％,and the NPV was 99％.Conclusions In elder females,hysteroscopy allows for an accurate diagnosis in endometrial disease,and hysteroscopically directed sampling is mandatory,even if the uterine cavity appears normal at hysteroscopy,to rule out endometrial neoplasms.

Objective:To investigate the ultrasonographic and clinical features of postmenopausal ovarian endometriosis(OEM).Methods:Clinical, transvaginal sonography(TVS)and pathological data of 26 postmenopausal OEM patients confirmed by surgery and histology in our hospital from June 2014 to June 2019 were included in this retrospective analysis.The ages of patients ranged from 47 to 65 years(median age: 57 years old), and the age at natural menopause was(48.8±3.3)years.The duration after menopause was 1-25 years(median duration: 8 years). Transvaginal sonography(TVS)results were compared with pathological data.Results:A total of 36 adnexal lesions were found by TVS.Postoperative pathological examination confirmed 39 lesions, of which 76.9%(30 cases)were OEM lesions and 23.1%(9 cases)were non-OEM lesions in the ovary.92.3% of the adnexal lesions(36 cases)were effectively screened by TVS, and 3 lesions less than 1 cm were missed in the ovary.Among 26 subjects, unilateral OEM lesions accounted for 84.6%(22 cases). Simple cysts were the most common concurrent condition(6 cases), followed by uterine leiomyoma(4 cases), ovarian cancer(2 cases)and serous cystadenoma(1 case). The sizes of 30 postmenopausal OEM lesions ranged from 0.8 cm to 6.6 cm, and 53.3%(16 cases)were anechoic, typical of OEM on TVS.TVS found that 40.0%(12 cases)showed no specific sonographic features, 16.7%(5 cases)showed a heterogeneous echo pattern, 13.3%(4 cases)showed a homogeneous hypoecho pattern, and 10.0%(3 cases)showed a hypoechoic mass with strong internal echo, following a shadow behind it.The rate of missed diagnoses of 30 postmenopausal OEM lesions by TVS was 30.0%(9 cases), of which 23.3%(7 cases)were misdiagnosed as solid masses in the adnexal area on TVS, and 6.7%(2 cases)were missed on TVS(OEM lesions less than 1.0 cm).Conclusions:Ultrasonographic heterogeneity exists in postmenopausal OEM patients.Unilateral and anechoic ultrasound is the most common type of ultrasound imaging.It is of great significance to pay attention to TVS examination and corresponding ultrasound imaging analysis in postmenopausal women for the early diagnosis of postmenopausal OEM.

Objective To investigate the relationship of serum and carcinoma levels of plasminogen activator inhibitor-1 (PAI-1)with clinical characteristics in patients with endometrial carcinoma.Methods Serum level of PAI-1 was determined by using enzyme-linked immunosorbent assay(ELISA) in patients with endometrial carcinoma (n =40),uterine prolapsed with normal endometrial tissues(n=40).The protein expression of PAI-1 in endometrial tissue was detected by using immunohistochemistry in patients with endometrial carcinoma and uterine prolapse patients.Results Serum level of PAI-1 was higher in patients with endometrial carcinoma than in uterine prolapse patients with normal endometrial tissues(19.43±7.12 μg/L vs.6.58±2.33 μg/L,P＜0.05).The rate of positive expression of PAI-1 was higher in endometrial carcinoma tissue than in uterine prolapse tissue[62.5 ％ (25/40) vs.7.5 ％ (3/40),P ＜ 0.01].Compared with early-stage endometrial carcinoma,advanced endometrial carcinoma had an increased rate of positive expression of PAI-1 (P ＜0.01).Compared with endometrioid adenocarcinoma,other pathological types of endometrial carcinoma had an increased rate of positive expression of PAI-1 (P ＜ 0.05).Poorly differentiated endometrial carcinoma versus highly differentiated endometrial carcinoma had an increased positive rate of PAI-1 (P ＜0.05).The rate of positive expression of PAI-1 was higher in endometrial carcinoma with myometrial invasion than without myometrial invasion(25/31 vs.0/9,P＜0.01).Conclusions The expression level of PAI-1 may be related to the invasion and metastasis of endometrial carcinoma.

Objective To investigate the efficacy and safety of modified anterior vaginal wall repair in the treatment of anterior vaginal prolapse and cystocele in elderly women.Methods We retrospectively analyzed the clinical value of modified anterior vaginal wall repair in 58 elderly women with stage Ⅱ-Ⅳ anterior vaginal prolapse and cystocele,which were evaluated by pelvic organ prolapse quantitation (POP-Q) system.The modified anterior vaginal wall repair was based on the paravaginal repair as an add-on to a reverse bridge repair and cross stitching of bilateral sutures stemmed from vaginal repair.According to the condition of each patient,other pelvic floor repair,perineal laceration repair,and paraurethral fascia reinforcement might be performed at the same time.The curative effectiveness was subjectively and objectively evaluated in the postoperative follow-up.Results A total of 58 operations were successfully finished.The follow-up time was 6-24 months with an average of (14±8) months.The subjective cure rate was 100％ and the rate of objective cure defined as the top of the vagina above the level of ischial spine was 100％ at 3 months follow-up (n=58).The subjective and objective cure rate was 100％ and 96.6％ (56/58) at 6 months follow-up (n=58),100％ and 94.1％ (32/34) at 12 months follow-up (n=34),91.7％ (11/12) and 91.7％ (11/12) at 24 months follow-up (n=12),respectively.Conclusions The modified anterior vaginal wall repair is safe and effective for anterior vaginal prolapse and cystocele in elderly women.

Objective:To investigate risk factors for severe hematological toxicity of adjuvant chemotherapy and prognostic factors in elderly patients with ovarian cancer.Methods:We retrospectively analyzed 117 ovarian cancer patients aged 60 years and older who underwent surgery followed by adjuvant chemotherapy between January 2006 to December 2016 at Beijing Hospital.Risk factors for grade Ⅲ-Ⅳ hematological toxicity were assessed by using multivariate logistic regression analysis.Prognostic factors influencing progression-free survival(PFS)were evaluated by univariate and multivariate Cox regression analysis.Results:The mean age of patients was(69.3±7.9)years.After surgery, 67.3% patients(70/104)had a satisfactory tumor reduction, and 83.5%(86/103)received a standard treatment.Multivariable logistic regression analysis showed that risk factors for severe hematological toxicity included albumin level<40 g/L( OR=3.434, 95% CI: 1.074~10.968)and age>75( OR=3.676, 95% CI: 1.032~13.093). Progression-free survival for patients was 20.4 months(95% CI: 19.4~26.0). Univariate Cox regression analysis showed that FIGO(the International Federation of Gynecology and Obstetrics)staging, pelvic lymphadenectomy, tumor burden, transfusion therapy and residual tumor size were risk factors influencing 3-year PFS.Multivariate Cox regression analysis showed that low tumor burden was the only independent risk factor for 3-year PFS( HR=2.067, 95% CI: 1.174~4.424, P=0.023). Conclusions:Age ≥75 and albumin levels have effects on the incidences of complications during adjuvant chemotherapy, which in turn affect whether patients can complete standard adjuvant therapy and the clinical outcome of patients with ovarian cancer after surgery.To maximize the efficacy of treatment and reduce the side effects of adjuvant therapy, individualized treatment plans should be formulated for elderly patients with poor prognostic factors.