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 investigate the expression of transient receptor potential vanilloid subtype 1 (TRPV1) in uterosacral ligament and its correlation with pain in endometriosis.Methods Total of 54 patients undergoing endometriotic lesions excision in uteroscaral ligament by laparoscopy due to pelvic pain were enrolled in this study.According to visual analogue scale(VAS) scores,27 patients with VAS 5 - 10 were in group A and 27 patients with VAS 0 - 4 were in group B.In the mean time,20 patients with dysmenorrhea without endometriosis (VAS:0 -4 ) were matched as group C.Specimens (including the sacro-ligaments of 20 women without endometriosis) were immunostained with specific antibodies of TRPV1.Western blot and real time PCR were performed to detect TRPV1 expression in endometriosis lesions and control group.Results( 1 ) Immunohistochemnistry:the positive area of TRPV1 was found in endometriotic lesions in uterosacral ligament in group A,B and tissue of uterosacral ligament group C.The semi-qualitification of TRPV1 expression were 3 in group A, 1 in group B and 1 in group C by immunohistochemistry staining.There was significantly different expression between group B and group A ( P =0.005 ) or group C ( P =0.027 ).(2) mRNA expression:the expression of TRPV 1 was 1.84 in group A,0.80 in group B,0.24 in group C,respectively.With higher VAS scores,the expression of TRPV1 exhibited increasing trends.The expression of TRPV1 mRNA was higher in group A than thai in group B ( P =0.022).There was statistically different expression between group B and group C ( P =0.031 ).( 3 ) Western blot:the expression of TRPV1 protein was 0.63 in group A,0.19 in group B,0.02 in group C.There was significant differences between group A and group B ( P =0.022 ),and between group B and group C (P ＜ 0.01 ).Conclusion The expression of TRPV1 was correlated with the degree of pain in patient with endometriosis.

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.

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.

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 investigate the relationship between degree of endometrioma adhesions and clinical feature, surgical treatment and postoperative recurrence. Methods From Jan 2003 to Mar 2008, 662 patients with endometrioma undergoing laparoscopic ovarian endometrioma excision in Peking Union Medical College Hospital were studied retrospectively. All patients were classified into four groups according to the extent of adhesions: 31 cases in none adhesions group, 123 cases in mild adhesions group (filmy thickness, avascular, easily separated adhesions), 310 cases in moderate adhesions group (less than a half of ovary was adjacent to dense thickness adhesions which was difficult to separate, or above a half of ovary were adjacent to filmy thickness adhesions) and 198 cases in severe adhesions group (above a half of ovary was adjacent to dense thickness, well vascularized adhesions which was difficult to separate, and always involved the other pelvic organs, observed angiogenesis). The comparison of degree, characteristics, period of pain, lab test, surgical management and postoperative recurrence was performed among those above groups. In the mean time, risk factors and multinomial logistic regression were analyzed. Results (1)Clinical characteristics: The incidence of patients with dysmenorrhea, dyspareunia, straining feeling in anus, chronic pelvic pain and the level of CA125 (>35 kU/L) was remarkably higher in moderate-to-severe adhesion groups than in none-to-mild adhesions groups (P=0.000, 0.000, 0.001, 0.006 and 0.000, respectively). Infertility rate were significantly higher in severe adhesions group(15.7%,31/198) than none adhesions group(3.2%,1/31), mild adhesions group(11.4%,14/123) and moderate adhesions group(9.7%,30/310, OR=1.728, P<0.05).(2)Operating time and blood loss: Operating time of each groups was as followed: (37±15) min in none adhesions group, (42±19) min in mild adhesions group, (50±20) min in moderate adhesions group and (63±22) min in severe adhesion group. Blood loss was (23±12) ml in none adhesion group, (31±27) ml in mild adhesion group, (40±32) ml in moderate adhesion group and (70±67) ml in severe adhesions group. Thicker adhesions result in longer operation time and more blood loss. (3)Combined with other disease: The ratio of patients who combined with adenomyosis or deeply infiltrating endometriosis in moderate-to-severer adhesion groups was higher than patients in none-to-mild adhesions groups (OR=3.466, P=0.000). (4) Postoperative recurrence: It was categorized into recurrence of pain and cyst. Moderate-to-severe adhesions was related to higher recurrence rate of pain (OR=1.685,P=0.046), but was irrelevant to recurrence of cyst. Conclusion The more extent of endometrioma adhesions was related to severer pelvic pain symptoms, longer operating time and more blood loss. Postoperative pain recurrence rate was observed in moderate-to-severe adhesion group. Extent of adhesions was irrelevant to cyst recurrence.

Objective To investigate the expression of potassium channels and the influence of estrogen and progesterone on the cultured uterine smooth muscle cells (USMC) of adenomyosis in vitro.Methods There were 22 cases of adenomyosis hysterectomy in the adenomyosis group and 12 patients with cervical intraepithelial neoplasia Ⅲ removal of the uterus in the control group.USMC were separated and cultured in vitro, incubated with different concentrations of estrogen and progesterone.We used reverse transcription-PCR to dectect the expression of large-conductance calcium-and voltage-sensitive potassium channel α subunit (BKCa α) and voltage-gated potassium channel 4.3 (Kv4.3).Results The mRNA expression of BKCa α and Kv4.3 in the adenomyosis group (4.43 ±2.05 and 4.52± 1.97) were significantly higher than those in the control group (0.83±0.25 and 0.86±0.19, P＜0.05).In the control group, Kv4.3 mRNA decreased after treated with 0.1 nmol/L (0.17±0.10) and 1.0 nmol/L (0.13±0.08) estrogen than before (0.55±0.29, P＜0.05).In the adenomyosis group, BKCa α mRNA decreased significantly after treated with 10.0 nmol/L estrogen (0.56±0.27 versus 1.01±0.35, P＜0.05).0.1 μmol/L progesterone elevated both BKCa α mRNA (0.44±0.24 versus 0.16±0.09) and Kv4.3 mRNA (1.29±0.51 versus 0.55±0.29) in the control group (all P＜0.05);however, there were no significant difference in adenomyosis group of different concentration of progestrone (P＞0.05).Conelusuion There is an abnormal expression of potassium channels in the adenomyosis USMC, which is regulated by high concentration of estrogen and might be resistant to progesterone.

Objective To study the significance of pain symptoms and physical signs to diagnosis of deeply infiltrating endometriosis (DIE).Methods Totally 500 patients with laparoscopic diagnosis of endometriosis were studied retrospectively and divided into two groups depending on the existance of DIE.The pain symptoms and gynecological physical signs were recorded detail,and the correlation with diagnose of DIE were analyzed.Results (1) The significance of pain symptoms:the sensitivity,specificity,positive predictive value (PPV),negative predictive value (NPV) and OR,95％ CI of each pain symptom were:dysmenorrhae (90.5％,37.2％,59.6％,79.3％,5.66,3.46-9.28),chronic pelvic pain (35.2％,82.6％,67.4％,55.4％,2.58,1.70-3.91),dyspareunia (46.2％,80.6％,70.7％,59.6％,3.56,2.39-5.32),dyschezia (51.0％,73.7％,66.5％,59.5％,2.91,2.00-4.24),respectively.(2) Pelvic physical examination:the sensitivity,specificity,PPV and NPV of each physical sign were:fixed uterine:73.6％,71.2％,79.5％,64.0％; fixed ovarian cyst:94.1％,20.3％,63.3％,70.0％; uterosacral ligaments nodule:47.1％,97.5％,96.6％,54.9％; uterosacral ligaments nodule with tenderness:81.7％,75.0％,83.1％,73.2％; rectovaginal septum nodule:32.2％,100.0％,100.0％,49.4％; rectovaginal septum nodule with tenderness:32.2％,100.0％,100.0％,49.4％; blue nodule in posterior vaginal forni:14.9％,100.0％,100.0％,43.7％.Conclusions In the symptoms,the dysmenorrheal has the highest sensitivity and NPV for the diagnosis.And chronic pelvic pain has the highest specificity,and dysparaunia has the highest PPV for the diagnosis.In pelvic vaginal examination,fixed uterine,fixed ovarian cyst and the nodule on uretosarcal ligment and rectovaginal septum with tenderness,the blue lesion on posterior fornix have the strong significance for DIE.So record the symptom detail and careful digital vaginal examination,especially the vaginal-recto-abdominal examination could improve the diagnosis DIE obviously before procedure.

Objective To investigate the effect of comfort nursing on dysphoria patients in neurosurgical department.Methods Thirty-six patients with dysphoria in the neurosurgical department were treated with comfort nursing. The degree of dysphoria after implementation of comfort nursing and the incidence of nursing-related adverse events were investigated.Results The degree of dysphoria in the patients after implementation of comfort nursing was lower than that after the implementation(P<0.05).There were 3 cases(8.33%)of nasogastric tube slippage and skin injury,2 cases(5.56%)of urinary catheter slippage and no case of falling out of bed.Conclusions The implementation of comfort nursing can stabilize the mood of patients and comfort the patients. It is helpful for abating the degree of dysphoria of patients,reducing the adverse effects of nursing work and ultimately improving the quality of nursing.

OBJECTIVE: To observe the therapeutic effect of scalp acupuncture on cognitive dysfunction of traumatic brain injury. METHODS: Seventy patients with cognitive dysfunction of traumatic brain injury were randomly divided into an observation group and a control group, 35 cases in each group. After treatment, 5 cases dropped off in each group. The patients in the control group were treated with cognitive training; the patients in the observation group were treated with cognitive training and scalp acupuncture at Baihui (GV 20), Sishencong (EX-HN 1), Zhisanzhen and Niesanzhen, and the needles were retained for 6 h. The two groups were treated once a day, 6 times a week; one-month treatment was taken as one course, and 3 continuous courses were given. The scores of mini-mental state examination (MMSE), Montreal cognitive assessment (MoCA), activity of daily living (ADL) and functional independence measure (FIM) were compared between the two groups before and after treatment. RESULTS: Compared before treatment, the MMSE and MoCA scores in the observation group, and ADL and FIM scores in the two groups were significantly increased after treatment ( CONCLUSION Scalp acupuncture could improve cognitive function and self-care ability of daily life in patients with traumatic brain injury.
Acupuncture Points ; Acupuncture Therapy ; Brain Injuries, Traumatic/therapy* ; Cognition ; Humans ; Scalp ; Self Care