Objective To investigate mRNA expression of matrix metalloproteinase (MMP-9) and tissue inhibitor of metalloproteinase (TIMP-1) in ectopic endometriosis tissue and uterine endometrium from women with and without endometriosis. Methods Thirty-eight women with endometriosis (Revised American Fertility Society classification, RAFSⅠ-Ⅳ) were selected as study group. Thirty-eight specimens of ovarian endometrioma(ovarian chocolate cysts, OCC), 16 red peritoneal endometriotic lesions(RPL), and 35 matched eutopic endometrium(Eu) were collected from them simultaneously at the time of surgery. Twenty specimens of endometrium from reproductive women undergoing laparoscopic surgery without endometriosis were obtained as control group. The mRNA expressions of MMP-9 and TIMP-1 were detected by reverse transcription polymerase chain reaction (RT-PCR). Results Expression of TIMP-1 mRNA was detected in all samples. The level from endometriosis patients and control group was similar(2.31?1.21, 2.40?0.89). However, ectopic endometrium expressed significantly fewer TIMP-1 mRNA(OCC 1.67?0.79, RPL 1.45?0.68)compared with eutopic endometrium from both endometriosis and endometriosis-free patients(P

Objective To investigate the influence of gonadotropin releasing hormone agonist (GnRH-a) on the expression mRNA of nerve growth factor (NGF) and its receptors (TrkA and P75NTR) in normal and eutopic endometrial stromal cells (ESC).Methods From January to April 2009,3 patients with endometriosis undergoing surgery in Peking Union Medical College Hospital were obtained eutopic endometrium as study group matched with eutopic endometrium from 3 parents with teratoma as control group.ESC were incubated with different concentration of GnRH-a (0,5 × 10-11,5 × 10-10,5 × 10-9,5 ×10-8,5 × 10-7 g/ml).The expression of mRNA of NGF,TrkA and P75NTR were measured by real-time-PCR.Results At concentration of 0 g/ml,the levels of NGF,TrkA and P75NTR mRNA in ESC were 6.32,8.55,8.08 in study group,which were significantly higher than 0.94,0.67,1.08 in control group (P ＜0.05).Treated by the following concentration of GnRH-a (5 × 10-11,5 × 10-10,5 × 10-9,5 × 10-8,5 ×10-7 g/ml),the median expression of NGF,TrkA and P75NTR mRNA was 1.00,0.96,1.05; 1.09,0.82,1.27 ; 1.04,0.52,0.81 ; 1.00,0.55,0.64; 0.78,0.49,1.02 in study group.Compared with the expressions of those untreated by GnRH-a in study group, they showed significantly lower trends (P ＜0.05).In control group,the median expression of NGF,TrkA and P75NTR mRNA was 0.98,0.37,0.92; 0.70,0.45,1.15; 1.55,0.80,1.35; 1.09,0.41,1.35; 0.90,0.82,1.18.Compared with the expressions of those untreated by GnRH-a in control group,there were no statistically differences ( P ＞0.05).And treated by the same concentration of GnRH-a,the expressions of NGF,TrkA and P75NTR mRNA did not show statistically difference between the two groups ( P ＞ 0.05 ).Conclusion The expression of NGF.TrkA and P75NTR mRNA were suppressed by GnRH-a.

Objective To study the relativity analysis of abnormal cervical pathology results in cytology and histology.Methods With retrospective analysis of 31,634 cases of fluid-based thin-layer method(ThinPrep Cytology Test,TCT)of PUMC Hospital from January,2001 to March,2003,which reported in the Bethesda System,we checked the abnormal results and advised different diagnose biopsy of vaginoscopy and/or conization,and got the relativity description of abnormal results in TCT and CINⅢ/CIS results validated by vaginoscopy,match analysis of the CINⅡ～Ⅲ and CINⅢ/CIS results validated by vaginoscopy and conization labeled by the age group,and relativity analysis of abnormal results in TCT and CINⅢ/CIS results validated by vaginoscopy.Results Among 31,634 cases of TCT test,948 cases had confirmed biopsy results validated by vaginoscopy,of which 70 cases were of CINⅡ～Ⅲ,56 cases were of CINⅢ/CIS.The risk ratio(RR)of different abnormal TCT results in predicting CINⅢ/CIS results validated by vaginoscopy is:ASCUS group,14.7(95% confidence interval 8.0～27.0,P=0.00);CINⅠ group,13.9(6.3～30.9,P=0.00);CINⅡ group,44.2(15.5～126.5,P=0.00);CINⅢ group,272.2(161.6～458.6,P=0.00);Cancer group,unmeasured.As noted,there is no significant difference between the RR of ASCUS group and CINⅠ group(P=0.951)in predicting CINⅢ/CIS results.Conclusions Vaginoscopy examination and biopsy could verify histology abnormity of CINⅡ～Ⅲ及CINⅢ/CIS from abnormal results of TCT,and has a good accordance along with biopsy results of conization.There are significantly greater risk of being CINⅢ/CIS validated by vaginoscopy in the abnormal TCT patients,among which ASCUS group and CINⅠ group have the coequal risk.

Objective To investigate the ultrastructural features and it's significance of the skip area with giant cell arteritis(GCA).Methods 20 GCA patients and 7 non-GCA patients underwent temporal artery biopsies. The sections were stained with HE and methylene blue(MB) for light microscopy(LM), doubly stained with uranyl acetate and lead curate for electron microscopy (EM). 20 GCA patients were divided into skip area GCA group(14 cases) and active inflammatory cell infiltration GCA group(6 cases) according to the definition of skip area or skip lesion. The ultrastructural changes of each group were observed by EM and assessed by using 4 grades from 0 to 3 scores.Results The scores of ultrastructural changes were as follows: the skip area GCA group, 0 in 1 patient, 2 to 6 in 9 patients, and 8 to 9 in 4 patients; the active inflammatory cell infiltration GCA group, 7 to 15 in 6 patients; the non-GCA group, 0 to 1 in 6 patients, and 5 in 1 patient. The scores of the three groups were tested by H check, the difference was evidently significant( P0.05) in comparison with active inflammatory cell infiltration GCA group.Conclusions At electron microscopic level, the skip area of temporal artery biopsy with GCA showed obvious pathological changes, especially in the intima of artery. The results suggest that the investigation of ultrastructure features of the skip areas of temporal artery with GCA may be benefit for the diagnosis and treatment of this disease.

Objective To investigate the effect of IGF-I on the apoptosis and the expression of survivin through the signaling pathway of PI-3K/Akt in colon cancer cell line SW480.Methods When colon cancer cell line SW480 was culfured,Western blot was used to detect the expression of survivin protein in SW480 cells after they were stimulated by different concentrations of IGF-I for different lengths of time.The phosphorylation of Akt in SW480 cells was determined by Western blot after SW480 cells were stimulated by 100 ng/mL IGF-I with in 2 h.Before and after the specific inhibitor LY294002 was treated in SW480 cells to block the pathway of PI-3K/Akt,the phosphorylation level of Akt protein was detected by western blot,survivin protein by western blot and cell immunofluorescence and the cell apoptosis rates of different treated-groups were measured by flow cytometry.Results IGF-I up-regulated the expression of survivin in a dose-dependent and time-dependent manner in colon cancer line SW480(when treated with IGF-I for 12h,the expression of Survivin reached the peak and when treated with 100ng/ml IGF-I,the Survivin reached the highest expression level);IGF-I actived the signaling pathway of PI-3K/Akt of SW480 cells quickly(the expression of p-Akt proteins in SW480 reached the maximum level when cultured with IGF-I for 15 and 30min,but after that they quickly decreased);IGF-I induced survivin expression through the PI-3K/Akt in colon cancer line SW480;IGF-I could inhibited the apoptosis of SW480 cells through the PI-3K/Akt[use of flow cytometry for detection in the blank,stimulation and block groups showed the SW480 cell apoptosis rate was(5.18?0.415)%,(0.85?0.052)%,(3.15?0.411)% respectirely,with significant differences between the groups(P

Objective To investigate clinicopathological characteristics of recurrent endometriosis and outcomes of secondary surgery.Methods From Jan.2003 to Dec.2008,69 cases with recurrent endometriosis operated by the same senior gynecologist in Peking Union Medical College Hospital were studied retrospectively in order to summarize clinicopathological characteristics and clinical outcomes.In prior surgery,both ovaries were involved in 29 cases (42％,29/69),and unilateral ovarian endometriomas were found in 40 cases ( 58％,40/69),including 19 cases (48％,19/40) with left lesions and 21 cases (52％,21/40) with right lesions.After first surgery,57 cases presented recurrent pelvic cystic masses and 12 cases presented moderate to severe pain without pelvic mass.Results The median recurrence interval was 38 ( 1 - 144) months.Among 57 cases with recurrent pelvic masses,bilateral ovarian endometiomas recurred in 24 cases at median recurrence interval of 31 months.Unilateral ovarian endometrioma recurred in 33 cases at recurrence interval of 39 months.There was no significant different recurrence period between blilateral and unilateral recurrent ovarian mass ( P =0.452).The recurrent rate of left and right side ovarian lesion was 77％ (37/48) and 68％ (34/50 cases),respectively,which did not reach statistical difference (P=0.396).Among 12 recurrent cases with pure pelvic pain,10 cases were founded combined with adenomyosis ( AM),of which 4 cases had deep infiltrated endometriosis (DIE).Compared with the 40 cases of simple ovarian endometriomas,29 cases complicated by DIE and (or) AM had longer operation time (75.1 min vs.49.9 min,P=0.017) and more blood loss (114.9 ml vs.38.4 ml,P＜0.05).In those 69 recurrent endometriosis patients,the median period of following-up was 32 months (3 months to 8 years).Six cases showed recurrent disease again at median recurrence interval of 3 years ( 6 months 6 years).Thirty-eight cases had expecting childbearing,however,only 4 women underwent childbirth.Conclusions The rate of clinical diagnosis of recurrent endometriosis is quite high.Pain is mostly associated with AM.The major difficulty and challenge of secondary surgery was ovarian endometrioma combined with DIE or AM.Prognosis of recurrent endometriosis is not optimistic after secondary surgery.

ObjectivesTo compare operative characteristics, postoperative residue, recurrence, and pregnancy outcome between laparoscopic myomectomy (LM) and transabdominal myomectomy (TAM),and investigate the favourable surgical approach in women with uterine myomas. MethodsFrom Jan 2008 to Dec 2008, 313 women undergoing LM and 148 women undergoing TAM were studied retrospectively in Peking Union Medical College Hospital. The patients' general information, including the largest diameter,mean numbers and weights of excised myomas, peri-operative characteristics (operating time, blood loss,and hemoglobin decrease), and residue, recurrence of myoma, and pregnancy outcome were compared and analyzed. Results The largest diameter, mean numbers and mean weight of myomas removed were larger in TAM group [( 7.6 ± 3.0) cm, (5.6 ± 5.5 ), ( 308 ± 364) g, respectively]than those in LM group [(6.8±2.0) cm, (2.4 ±2.1), (140 ± 109) g, respectively; P＜0.01]. While the extension of operating time [(89±32) versus (74 ±35) min], increased blood loss [(239 ±251 ) versus ( 149 ±252) ml]and hemoglobin decrease [(22 ± 14) versus ( 15 ± 12) g/L], and longer hospital stay [(6. 4 ± 1. 6)versus (4. 4 ± 1.3) d]were observed in TAM group when compared with those in LM group ( P ＜0. 01 ).However, the residue rate of LM and TAM was 2. 6％ versus 1.4％ respectively ( P = 0. 5130 ) ; the recurrence rate of LM and TAM was 11.1％ versus 12. 3％ (P ＞ 0. 05 ) ; the pregnancy rate of LM and TAM was 49. 2％ versus 9/13 separately, the difference was not statistically significant ( P = 0. 2330 ). The number of myomas removed was the significant risk factors associated with recurrence ( OR = 2. 805, 95％CI: 1. 192 -6. 601, P = 0. 0180). No uterine rapture occurred during pregnancy. ConclusionsBoth LM and TAM are effective surgical approaches for the patients with leiomyoma who desire to pregnancy, or to retain the integrity of their uteruses. Most of uterine myoma could be treated through laparoscopy. The residue rate of LM is higher than that of TAM. However, the short term recurrence rates of LM and TAM are similar. Multiple myomas is the risk factor associated with recurrence after myomectomy. The pregnancy rates are comparable between LM and TAM groups.

The training of teaching ability is an important context of master course.Pathology Department of Xiang Ya School of Medicine take experimental teaching practice as the important way to improve their pathological experimental teaching skill.In this paper we introduced our experience.

Objective To investigate the relationship between the distribution of nerve fibers in multiple endometriosis lesions and pelvic pain.MethodsFrom Sept.2007 to Sept.2008, 120 endometriosis patients treated in Peking Union Hospital were enrolled in this study, which including 19 cases with stage Ⅰ , 29 cases with stage Ⅱ , 44 cases with stage Ⅲ and 28 cases with stage Ⅳ.The pain symptom was evaluated by visual analogue scales(VAS) score and nerve fibers in multiple endometriosis lesions were detected by immunohistochemical staining.Results The number of nerve fibers in multiple endometriosis lesions were (29.74 ± 17.33)/mm~2 in uterosacral ligament, (24.53 ± 13.34)/mm~2 in vaginal septum, (17.09 ± 10.09)/mm~2 in uterus rectum crux, (6.77 ± 4.21)/mm~2 in peritoneal endometriosis lesions, (0.07 ± 0.25)/mm~2 in endometriosis ovarian cyst wall.The number of nerve fibers in uterosacral ligament was mostly correlated with the degree of pain (r = 0.56).The nerve fibers of uterus rectum crux and vaginalseptum were correlated with defecation pain (r = 0.58 and 0.41) and dyspareunia (r = 0.82 and 0.67),which were significantly higher than those in endometriosis leision in peritoneum and ovary.There was no significant different number of nerve fibers among different stage disease (P > 0.05).Conclusion There was significantly different distribution of nerve fibers in multiple endometriosis lesions, which was correlated with dysmenorrhea, anus pain, dyspareunia and chronic pelvic pain, not with clinical staging.

Objective To evaluate short-term clinical effects of modified total pelvic floor reconstruction surgery in treatment of severe pelvic organ prolapse.Methods Thirty-nine cases with severe pelvic organ prolapse including vault prolapse diagnosed by pelvic organ prolapse quantification (POP-Q) system received modified total pelvic floor reconstruction surgery.Clinical parameters associated peri-operative period and 12 months after surgery and complications were analyzed Results Median operation time was 70 minutes (30-240 minutes),median blood loss was 100 ml (10-200 ml).Seventy-seven percent (30/39) patients were able to micturate spontaneously in the next morning after surgery with postvoid residual volume less than 100 ml (0-650 ml).No severe intra-operative complications were recorded and the rate of postoperative morbidity was 20% (8/39 ).Median post-operative hospital stay was 4 days (1-11 days).The patients were followed up at median 24 months(13-29 months).According to POP-Q system evaluation,the successful rate of operation reached 100% .Two cases (5%,2/39) were recorded as symptomatic recurrence which manifested as posterior wall prolapse within 24 months after operation.During follow-up,8% (3/39) patients were found to have erosion within 7 months after surgery,and urgent urinary incontinence was observed in 5% (2/39) cases,while constipation occurred in 8% (3/39) cases.The most remarkable complication was dyspareunia (36%,5/14); while 50% (7/14) experienced better sexual life after surgery.Conclusions Modified total pelvic reconstruction is a safe,efficient and micro-invasive surgery in treatment of severe pelvic organ prolapse.However,its influence on post-operative sexual life should be concerned.