[Summary] From February 2008 to June 2008, two cases of old ectopic pregnancy were misdiagnosed: Case 1 was misdiagnosed as gestational trophoblastic disease (GTD), and Case 2 was misdiagnosed as cornual pregnancy.In order to further confirm the diagnosis, two cases were all given laparoscopic exploration.Surgery confirmed interstitial chronic ectopic pregnancy, leading to a resection of the fallopian tubes and mass lesions.Embryo tissue was pathologically confirmed postoperatively.The diagnosis of old ectopic pregnancy is difficult.Serum hCG determination is often found no positive, and ultrasound examination has no specificity.The clinical images are varied.Detailed medical history inquiry and attention to differential diagnosis are key for the diagnosis of old ectopic pregnancy.

Objective To investigate the expression of RhoA and Rho kinase in junctional zone (JZ) of adenomyosis and normal myometrium and explore its relationship with severity of dysmenorrheal.Methods From Mar.to Dec.2012,32 cases with adenomyosis undergoing hysterectomy were enrolled as adenomyosis group including 18 cases with proliferative endometrium and 14 cases with secretory endometrium matched with 29 cases with hysterectomy due to cervical disease and ovarian tumor as control group including 12 cases with proliferative endometrium and 17 cases with secretory endometrium in Beijing Obstetrics and Gynecology Hospital Affiliated to Capital Medical University.JZ smooth muscle cells were isolated and cultured immediately after the operation.The expression of mRNA and protein of RhoA and ROCK Ⅰ in JZ in two groups were measured by real-time fluorescence quantitative RT-PCR and western blot.Results (1) The mRNA expression of RhoA and ROCK Ⅰ in JZ of adenomyosis group did not show cyclic change.In proliferative phase,the expression of RhoA and ROCK Ⅰ (1.41 ±0.16,1.05 ±0.15) was not significantly higher than that in secretory phase (1.17 ± 0.25,0.98 ± 0.10) (P ＞ 0.05).While JZ in control group,it showed obviously cyclic change.The expression level of them in proliferative phase(0.93 ±0.10,1.00 ± 0.18) was significantly higher than that in secretory phase (0.48 ± 0.03,0.55 ± 0.05) (P ＜0.05) ; It also showed that expressions of RhoA and ROCK Ⅰ in adenomysis group were significant higher than those in the control (P ＜ 0.05).(2) The mRNA and protein expression of RhoA and ROCK Ⅰ was positively correlated in each of two groups (r =0.48,P ＜ 0.01 ; r =0.67,P ＜ 0.01).(3) The expression of RhoA and ROCK Ⅰ were 1.66 ±0.19,1.32 ±0.11 in severe dysmenorrheal,1.28 ±0.12,1.09 ±0.08 in moderate dysmenorrheal and 0.93 ± 0.09,0.81 ± 0.06 in mild dysmenorrheal,it all reached statistical difference when compared the other group.(All P ＜ 0.05).Conclusions The expressions of RhoA and ROCK Ⅰ in JZ in adenomyosis group were higher than those in control group,and positively correlated with the severity of dysmenorrheal in adenomysis group,but it does not change with the menstrual cycle.High expression of RhoA and ROCK Ⅰ might be involved in abnormal contraction of uterine myometrium and correlated with the dysmenorrheal in adenomysis.

Objective To investigate the effect and mechanism of the formation of intrauterine adhesion (IUA) at different dose of estrogen. Methods Thirty-three New Zealand female rabbits were randomly divided into low estrogen group, normal physiological estrogen group, moderate estrogen group and high estrogen group. Animals of the low, moderate and high groups were ovariectomized (OVX) while normal group underwent sham operation. The moderate and high group animals received 0. 5 mg or 1.0 mg estradiol benzoate after OVX twice a week respectively. Two weeks later, all animals received curettage under direct vision. Serum was collected regularly to determine levels of estradiol (E2), transforming growth factor β1 (TGF-β1) and basic fibroblast growth factor (bFGF). Two weeks after curettage, we cut open cavity to collected endometrium for HE and Masson staining to score extent of endometrial fibrosis and IUA.Results The score of extent of endometrial fibrosis in high group (6. 1 ± 1.5) was higher than those in low estrogen group, normal estrogen group, moderate estrogen group (2. 7 ± 2. 1, 1.2 ± 1.8, 2. 7 ± 2. 0; all P <0. 05). The score of extent of IUA in high group (4. 0 ±2. 5) was higher than that in any other groups (0. 3 ± 0. 8, 1.0 ± 1.6, 1.7 ± 1.9; all P < 0. 05). The levels of TGF-β1 and bFGF was correlated with the level of E2 positively (P < 0. 01) and they had positive relationship with extent of endometrial fibrosis and IUA (P <0. 05). Conclusion High estrogen could accelerate endometrial fibrosis and IUA by promoting expression of TGF-β1, bFGF.

Objective To investigate the clinical characteristics of pre-malignant and malignant polyps in postmenopausal patients and to evaluate the diagnositic value of hysteroscopy in this disease. Methods From June 2005 to October 2014, 403 postmenopausal patients with polyps were treated in the Gynecologic Minimally Invasive Center, Beijing Obstetrics and Gynecology Hospital. There were 27 patients including 22 patients with pre-malignant and 5 patients with malignant polyps. All malignant lesions were endometrioid adenocarcinoma. The clinical data were retrospectively analyzed. Based on pathology, the diagnostic value of hysteroscopy was evaluated. Results (1) Clinical characteristics: there were 27 cases with pre-malignant and malignant polyps (group 1) and 376 cases with benign polyps (group 2). Compared the two groups, the average age was (60 ± 8) vs (58 ± 6) years old, the period of menopause was (9.8 ± 8.1) vs (8.3 ± 6.9) years. Thirteen cases (48.1%, 13/27) in group 1 and 159 cases (42.3%, 159/376) in group 2 had clinical symptoms including postmenopausal bleeding and vaginal discharge. Twelve cases (44.4%, 12/27) in group 1 and 140 cases (37.2%, 140/376) in group 2 were with hypertension. Five cases (18.5%, 5/27) in group 1 and 43 cases (11.4%, 43/376) in group 2 were with diabetes. The measures above were no significant differences(P>0.05)(2) Ultrasound features:the average thick of endometrium in group 1 and group 2 were respectively (1.3±0.7) and (0.8±0.4) cm, which had statistical significance (t=4.98, P=0.001). (3) Hysteroscopic diagnosis:the average diameters of polyp in group 1 and group 2 were respectively (2.4 ± 1.0) and (1.6 ± 1.0) cm, which had statistical significance (t=2.93, P=0.004). Six cases in group 1 were diagnosed by hysteroscopy including 4 cases of malignant polyp and 2 cases of pre-malignant polyp. The sensitivity, specificity, positive predictive value, negative predictive value and the accuracy were 22.2%(6/27), 100.0%(376/376), 100.0%(6/6), 94.7%(376/397) and 94.8%(382/403), respectively. Conclusions Pre-malignant and malignant endometrial polyps are more common in the subjects with the larger diameters and the thicker endometrium. All polyps should be under complete resection by hysteroscopy and through pathology examination.

ObjectiveTo observe the effect of ultrashort waves combined with medication on children with cerebral dysfunction syndrome (CDS) accompanied with pneumonia.Methods76 children with CDS accompanied with pneumonia were randomly divided into treatment group (n=38, treated with anti-inflammatory and ultrashort waves one time per day for ten days) and control group (n=38, treated only with anti-inflammatory). The effective rate and the days of rales vanished of children in two groups after treatment were compared.ResultsIn the treatment group, 14 cases cured, 20 cases got significant result, 4 cases were effective, total effective rate was 100%; in the control group, 10 cases cured, 14 cases got significant result, 9 cases were effective, 5 cases were invalid, total effective rate was 86.8%. There was a significant difference between therapeutic effects of two groups ( P<0.05).ConclusionThe ultrashort waves therapy is an effective method for the children with CDS accompanied with pneumonia.

Objective To evaluate effect of clinical study combined with short-term intensive simulation on training of hysteroscopy technology. Methods Trainees receiving training of hystero-scopy technology from the January to December 2012 in Gynecology Minimally Invasive Center, Bei-jing Gynecology and Obstetrics Hospital Affiliated to Capital Medical University were enrolled and di-vided into two groups depending on the different training modes. Twenty-four trainees in group1 par-tic-ipated in three-month hysteroscopic clinical study program. Twenty-two trainees in group2 partici-pated in three-month clinical study program including one-week short term intensive simulation. After the training, the effect was evaluated by the rating scale and the Rank sum test was used for statisti-cal analysis. P<0.05 signifies statistically significant difference. Results The operation time(P=0.03), forward planning (P=0.02), instrument handing (P=0.00) and knowledge of specific procedure (P=0.04) were improved significantly in group 2 compared with those in group 1. Conclusions The training mode of clinical study combined with the short-term intensive simulation can improve hys-teroscopy technology effectively and should be widely applied.

Objective To investigate the effect and mechanism of estrodial (E2) on intracellular free calcium in the endometrial-myometrial interface (EMI) smooth muscle cells from uteri with adenomyosis.MethodsFrom March 2011 to October 2011,16 uterus specimens were collected from patients with adenomyosis undergoing hysterectomy in Beijing Obstetrics and Gynecology Hospital,which included 9 proliferative endometrium and 7 secretory endometrium.EMI smooth muscle cells from the uterus were cultured and loaded with calcium ion ( Ca2 + ) fluorescent probe fluo-4/AM.The labeled cells were stimulated with the various concentration of E2 ( 1 × 102,1 × 103,1 × 104,1 × 105 pmol/L,respectively),then the changes of intracellular Ca2+ fluorescence intensity were measured by laser scanning microscopy.The most suitable concentration of E2 was selected,and the reaction difference between the EMI smooth muscle cells of two menstrual phases were also investigated; The changes of intracellular Ca2 + fluorescence intensity were detected proliferative and secretory smooth muscle cells in E2 conjugated to bovine serum albumin (17β-E2-BSA) group,cycloheximide (CHX) group,fulvestrant (ICI182780) group and pertussis toxin (PTX) group.Results ( 1 ) The cell viability of primary cultured EMI smooth muscle cells was well at 24 hours culture.(2) 1 × 102 - 1 × 105 pmol/L E2 can rapidly increase the intracellular Ca2+ fluorescence intensity within 1 min ( P ＜ 0.01 ) ;The increased amplitudes caused by 1 × 104 pmol/L and 1 × 105 pmoL/L E2 were the most significant,but there was no significant difference between them (P ＞0.05).1 × 104 pmol/L was the most suitable concentration.( 3 ) With the 1 × 104 pmol/L E2,the Ca2+ fluorescence intensity changes showed no significant difference between the EMI smooth muscle cells from the proliferative phase and secretory phase uterus (P ＞ 0.05 ).The Ca2+ fluorescence intensity changes were 646 ± 32 in 17β-E2-BSA group and 602 ±31 in CHX group,when compared with 513 ±26 and 617 ±35 in respective control group,no significant difference was observed (P ＞ 0.05 ).The increased amplitude of 188 ± 20 in the PTX group and 302 ± 11 in ICI182780 group exhibited significant difference with 632 ± 33 and 635 ± 24 in respective control group ( P ＜ 0.01 ).Conclusion E2 could increase the intracellular Ca2 + of EMI through a membrane receptor dependent and nongenomic mechanism of action.

Objective To evaluate the correlation between imaging features of spiral computed tomography(SCT) and pathology, MVD, and the expression of VEGF in renal cell carcinoma(RCC). Methods Thirty patients with RCC diagnosed by pathology underwent SCT examinations.MVD and the expression of VEGF were examined immunohistochemically using SABC techniques. Results The detection and characterization rate as well as accuracy of staging before operation about 30 RCC of multiphasic SCT scans were 100 %, 100 % and 83.3 %, respectively. In 30 cases of RCC, the mean MVD was 36±12.4. The positive expression rate of VEGF were 73.33 %. There were no correlation between the MVD and the expression of VEGF in RCC (r =0.057, P >0.05). The features of SCT: on multiphasic SCT scans, the pathological nuclear grade, the MVD and positive expression of VEGF in groups of RCC with diameter larger than 3.0 cm, central necrosis, pseudocapsule and intravenous tumor emboli were obviously higher than those of the contrast group (P <0.05, P <0.05, P <0.05, respectively). The pathological nuclear grade and MVD in groups of RCC with lymph node metastasis were higher than the contrast group (P <0.05, P <0.05, respectively). There were the positive correlation between the enhanced Hounsfield' s units in the CMP and the MVD in 30 cases of RCC(r =0.784, P <0.05). The degree of enhancement correlated well positively with the MVD in 30cases of RCC (P < 0.05). Conclusion Multiphasic enhanced SCT scan is a reliable technique in the detection, pathologic characterization of RCC. Some SCT features are closely correlated with MVD and expressions of VEGF in RCC, which could be a noninvasive method in predicting aggressiveness and metastasis.

Objective To study the ultrastructural features of myocytes in uterine junctional zone (JZ).Methods From August 2010 to August 2013,there were 16 pre-menopause patients who suffered from cervical neoplasm to be performed hysterectomy.Samples of JZ and outer myometrium (OM) of hysterectomy specimens were collected.There were 8 specimens from the proliferative-phase and 8 specimens from the secretory-phase of endometrium.Ultrastructural features of JZ and OM were examined by using transmission electron microscopy and the related indices of myocytes were compared by using Student's t test.Results At JZ,there were more cytoplasmic process in the myocytes.The myocytes of JZ exhibited significant difference compared with those of OM.Firstly,the contractile structural components,such as the dense patches,dense bodies and the myofilaments were less abundant.In contrast,the perinuclear cell organelles were more distinct.The mitochondria,endoplasmic reticulum and Golgi apparatus were more prominent,denoting active protein synthesis.Secondly,the mean diameter of cell and nuclei demonstrated cyclic change.In proliferative phase of endometrium,the cell diameters of JZ and OM were (4.70_±0.52) and (4.69± 1.20) μm,respectively,which there were no significant difference(P=0.987).While in secretory phase,the cell diameters of JZ and OM were (3.75±0.36) and (4.92±0.51) μm,which there were significant difference (P=0.006).In proliferative phase,the nuclei diameters of JZ and OM were (3.24±0.41) and (2.90±0.62) μm,and in secretory phase,the nuclei diameters of JZ and OM were (2.44±0.27) and (2.92±0.44) μm.There were no significantly different in both phases (P=0.374,P=0.097).The diameters of cell and nuclei had cyclical changes (P ＜ 0.05).However,the cyclical changes were absent in OM (P＞ 0.05).Thirdly,the myofilaments/cytoplasm ratio of JZ in proliferative and secretory phases were 0.27±0.04 and 0.34±0.03,which were significantly less than those of OM in respective phases (0.49±0.03and 0.54±0.03;P=0.000,P=0.000).The myofilaments/cytoplasm ratio exhibited cyclical changes in JZ (P=0.029),but in OM,the cyclical changes were absent (P=0.083).Conclusions Compared with OM,ultrastructures associated with synthetic organelles are prominent,whereas the contractile organelles are reduced.And there are the cyclical changes in ultrastructural characteristics.The ultrastructural features of JZ are the basis of its physiology.

Objective To study the mechanisms of extrarenal arterial blood supply of renal malignancy for its interventional therapy.Methods Routine abdominal aortography and selective questionable feeding arteriography were performed in 141 patients with renal malignancy.The characteristics and formation mechanisms of extrarenal arterial blood supply for renal malignancy were analyzed.Results Of the 141 patients,extrarenal arterial blood supply of renal malignancy were found in 51 patients and there were 87 branchs.The breakthrough of renal capsule with malignancy were found in those 51 patients.No extrarena]arterial blood supply of renal malignancy was found in 90 patients,including 50 patients with and 40 patients without the renal capsule breakthrough with malignancy.The emerge of extrarenal arterial blood supply of renal malignancy were significantly different(x~2 = 31.64,P