Metabolic syndrome( MS) is a group of clinical symptoms,which is based on the pathophysiol-ogy of insulin resistance that mainly includes obesity,hyperglycemia,hypertension,dyslipidemia,nonalcoholic fatty liver disease and other components.In recent years,many studies have suggested that the occurrence of colorectal cancer( CRC) is closely related with the MS components.This article reviews the research progress on the associa-tion between the major components of MS and the pathogenesis of CRC.

Objective To investigate the expression of Rap1 GTPase-activating protein 1 (Rap1GAP),matrix metalloproteinase 2 (MMP-2) and matrix metalloproteinase 9 (MMP-9),and their relation with clinical patterns in colorectal carcinoma.Methods Immunohistochemistry was used to detect the expression of Rap1GAP,MMP-2 and MMP-9 in colorectal carcinoma,villous adenoma,tubular adenoma and normal colorectal tissue,and their relationship with clinicopathological parameters was analyzed.Results The positive rate of Rap1GAP expression was 30.4 ％ (14/46),77.8 ％ (14/18),69.6 ％ (16/23) and 95.2 ％ (20/21) in colorectal carcinoma,villous adenoma,tubular adenoma,and normal colorectal tissue,respectively (x2 =30.659,P=0.000).The figures were 71.7 ％ (33/46),55.6 ％ (10/18),52.2 ％ (12/16) and 9.5 ％ (2/21) for the positive rate of MMP-2 expression (x2 =22.459,P =0.000),as well as for 76.1％ (35/46),61.1％ (11/18),56.5 ％ (13/23) and 14.3 ％ (3/21) for the positive rate of MMP-9 expression,respectively (x2 =22.643,P =0.000).In patients with colorectal carcinoma,the expression of Rap1GAP was correlated with tumor differentiation (x2 =5.275,P =0.022),but not sex,age,or lymphatic metastasis (all P ＞ 0.05).The expression of MMP-2 and MMP-9 were correlated with lymphatic metastasis (x2 =6.661,P =0.010;x2 =8.475,P =0.040),but not sex,age or tumor differentiation(all P ＞ 0.05).There was a negative correlation between expression of Rap1GAP and MMP-2,MMP-9 in colorectal carcinoma,respectively (r =-0.424,P =0.003;r =-0.294,P =0.048),but no correlation between the expression of MMP-2 and MMP-9 (r =0.101,P =0.505).Conclusions Rap1GAP,MMP-2 and MMP-9 play important roles in the malignant biological behavior of colorectal carcinoma,and the expression of Rap1GAP is negatively correlated with MMP-2 and MMP-9.The interactions among the three affect the occurrence and development of colorectal carcinoma.

Objective To explore the methylation status of Rap1 GTPase activating protein (Rap1GAP) promoter in colon cancer, and to provide the oretical basis and research direction for the early diagnosis, targeted therapy, anti-multidrug resistance of colon cancer and so on. Methods The paraffin embedded specimens of 33 patients with colonic adenocarcinoma diagnosed by pathology were analyzed from Department of Pathology of Xinzhou City People′s Hospital from January 2010 to September 2014, including 19 males and 14 females, and aged 41-72 years old. The paraffin embedded specimens of 16 patients with colonic adenoma were enrolled, including 9 males and 7 females, and aged 34-58 years old. 13 normal tissues from the tumor distal margin (from the tumor > 15 cm) were selected. Quantitative methylation specific PCR (q-MSP) was applied to detect methylation level of Rap1GAP gene promoter. The methylation level differences of Rap1GAP gene promoter region among 3 groups or between different clinicopathologic factor subgroups were compared. Results The methylation rates [median (interquartile range)] of Rap1GAP promoter were 65.43 % (50.35 %), 21.37 % (8.39 %) and 17.43 % (15.71 %) in colonic adenocarcinoma group, colonic adenoma group and adjacent normal tissue group, respectively. The methylation rate of colonic adenocarcinoma group was significantly higher than that of colon adenoma group or that of adjacent normal tissue group (P< 0.05). The methylation rates of Rap1GAP promoter in colonic adenocarcinoma were not correlation with age, sex, differentiation and the stage of TNM [ male vs. female: 42.74 % (70.44 %) vs. 21.98%(80.00%);≤60yearsoldvs.>60yearsold:36.26%(62.62%)and26.23%(76.42 %);well-differentiated vs. moderately/poorly-differentiated: 21.98 % (40.32 %) vs. 42.74 % (74.20 %); TNM Ⅰ-Ⅱ vsⅢ-Ⅳ: 25.31 % (48.27 %) vs. 36.26 % (75.55 %); all P> 0.05]. Conclusion The methylation status of RAP1GAP promoter maybe associate with genesis and development of colon cancer, which might be used as a target for early diagnose of colon cancer.

Objective To study the clinical outcomes of assistant treatment proposals for infertile women with polycystic ovary syndrome (PCOS). Methods PCOS patients were divided into four groups according to the assistant treatment proposals between Jan 2003 and Dec 2007 in Reproductive Medicine Center of the Provincial Hospital Affiliated to Shandong University. The four proposals were letrozole(LE) or clomiphene(CC) citrate ovulation induction group, in vitro fertilization and embryo transplantation group, ultrasound-guided immature follicle puncture group, and in vitro maturation and fertilization of oocytes from unstimulated cycles group. The treatment results were analyzed. Results (1) The ovulation rate was 66% (38/58) vs 47% (21/45). The mean endometrial thickness [ (0. 89±0. 13) vs (0. 78±0. 08) cm] and cervical mucus score (11.9±1.8 vs 9. 9±1.8 ) on the day of human chorionic gonadotropin ( hCG ) administration in LE group were both higher than that in CC group, while mature follicle ( 1.08±0. 28 vs 1.73±0. 59) and serum estradiol level [ (983±138) vs (1676±372) pmol/L] in LE group were lower than that in CC group(P <0. 05). (2) One southend five hundred and eighty-four patients accepted in vitro fertilization-embryo transplantation therapy because of PCOS (PCOS group) and 1615 patients because of tube factors (control group). The patients′ ages and infertility years were matched between the two groups. Total doses of Gn [ (980±1192) vs ( 1194±1389) IU] of PCOS group were lower than those of control group. The mean days of using gonadotropin [ (9.6±1.8) vs (9. 5±1. 8) d], serum estradiol (E2) levels on the hCG day [ ( 15 752±6206) vs (9675±4818) pmol/L], mean obtained oocytes (21±6 vs 9±3), mean fertilized oocytes ( 15±6 vs 7±3) and mean cleavaged oocytes ( 12. 9±5.7 vs 5.7±2. 8 ) of PCOS group were higher than those of the control group( P < 0. 05 ). Moderate and severe ovarian hyperstimulation syndrome (OHSS) rates (4. 86% vs 1.67% ) of PCOS group were higher than that of the control group. The pregnant rate (44. 7% vs 45.0% ) of PCOS group was similar to the control group ( P > 0. 05 ). (3) One hundred and nine PCOS patients were given ultrasound-guided immature follicle puncture therapy. After treatment, the testosterone level, luteinizing hormone (LH) level and LH/follicle stimulating hormone (FSH) ratio of the patients became normal. The basic follicle number decreased. (4) A total of 304 in vitro maturation cycles were performed. After embryo transfer, 76 pregnancies were reported. Conclusions There are many choices for the infertile patients with PCOS, such as LE or CC citrate ovulation induction, in vitro fertilization and embryo transplantation, ultrasound-guided immature follicle puncture, and in vitro maturation and fertilization of oocytes from unstimulated cycles. We can provide individualized treatment according to the medical treatment conditions, doctors′ professional capability and the patients′ situation.

Objective To study effect of drug treatment in polycystic ovary syndrome patients withhyperprolactinemia.Methods We retrospectively studied 63 women with polycystic ovary syndrome and hyperprolactinemia from the Reproductive Medicine Center,Provincial Hospital between January 2005 andMarch 2007.According to the beginning time of bromocriptine,all women were divided into two groups.Group Ⅰ was composed of 48 cases who received bromocriptine administration before induction of ovulation cycles,and the dose of bromocriptine was modulated depending on the level of serum prolactin.When serum prolactin was controlled at normal levels,we decreased the dosage of bromocriptine step by step(1.25 mgonce),and then continued the treatment at maintenance dosage for no less than 3 weeks.After a baselineultrasonographic examination on day 3,patients were treated with clomiphene citrate at a dosage of 100 mg (2 tablets/day)for 5 days of a normal cycle or progesterone-induced bleeding.On day 9,we monitored the growth conditions of follicles routinely with trans-vaginal uhrasound.If there was no dominant follicle,we added human menopausal hormone(hMG,75 U/d)to the protocol.Human chorionic gonadotropin(hCG,6000-10000 IU)was given intramuscularly when the mean diameter of a follicle reached at least 18 mm.At the same time we instructed the patients to have sexual intercourses or carried out artificial inseminationsbefore and after ovulation.Group Ⅱ were 15 cases in which induction of ovulations were commenced almostsimultaneously with beginning of bromocriptine.The same protocol was given to patients in group Ⅱ.The procedures of ovulation induction and the outcomes of treatment were analyzed and compared.Results Compared with groupⅡ.the days of using hMG in Group Ⅰ was shorter by instructing the time of sexualintercourse.The difference was significant(P=0.004).And there were similar results in the artificial insemination cycles(P=0.009).The rate of pregnancy in group Ⅰ(40%,19/48)was higher than that in groupⅡ(27%,4/15),but the difference was not obvious(P=0.525).Conclusion Bromocriptine administration before the stimulated ovulation therapy can decrease the total dosage and treatment course of ovulating drugs.Induction of ovulations simultaneously with start of bromocriptine therapy can shorten the treatment time of infertility.