Objective To elaborate the risk factors for leiomyoma residue and relapse after different approaches of myomectomy.Methods From Jan.2005 to Dec.2010 and Jan.2011 to Jan.2013,769 patients underwent myomectomy were recruited in Beijing Obstetrics and Gynecology Hospital.The patients demographic,leiomyoma characteristics,preoperative gonadotropin-releasing hormone agonist (GnRH-a) therapy,surgical approach,pathological type,follow-up information were collected.Results Leiomyoma number was the risk factor of postoperative residue and relapse,with the leiomyoma number increased one,the risk of residue and relapse increase 1.085 times (OR=1.085,95％CI:1.019-1.154,P=-0.010),1.043 times (RR=1.043,95％CI:1.014-1.073,P=0.003) respectively.Leiomyoma type (intramural leiomyoma) was the risk factor of relapse (RR=1.665,95％CI:1.029-2.693,P=0.038).Age was not the risk factor for postoperative residue rate (P=0.828) and relapse rate (P=0.193).GnRH-a didn't increase the postoperative residue and relapse rate (P=0.542,0.133).The postoperative residue rate (P=0.764),relapse rate (P=0.279) between transabdominal and laparoscopic myomectomy groups had no significant difference.Bizarre leiomyoma (RR=5.678,95％CI:1.373-23.490,P=0.017) and celluar leiomyoma (RR=2.201,95％CI:1.466-3.303,P＜0.01) were the risk factors for postoperative relapse rate.Conclusions Leiomyoma number,leiomyoma type (intramural leiomyoma) are the main risk factors for postoperative relapse.Pretreatment of GnRH-a and laparoscopic approach wouldn't increase the rate of residue and relapse.Bizarre leiomyoma and cellular leiomyoma have a higher relapse rate than common leiomyoma.

Objective To explore the feasibility of Lugol's iodine staining in association with P53 oncoprotein test to detect early esophageal cancer and precancerous lesions through endoscopy. Methods Lugol's iodine was sprayed on esophageal mucosa under endoscopy in 78 patients with suspected early malignancy. Severe dysplasia which taken from unstained position by iodine were prepared immunohistochemically for P53 oncoprotein study. Then endoscopic mucosal resection (EMR) was performed to these severe dysplasia with P53 oncoprotein－ positive mucosa. Results There were 31 unstained areas (25 patients) including squamous cell carcinomas (n=3) and severe dysplasias (n=16). Expression of P53 was found in 7 severe dysplasia (43.8％ ),and 1 carcinoma in situ was found by EMR. Conclusion This modified method seemed feasible not only to detect early esophageal cancer,but also to resect severe dysplasia mucosa selectively by EMR.

Objective To analyze the live birth situation after intrauterine adhesions separation opera-tion in the patients with different types of intrauterine adhesions(IUA)and its influencing factors.Methods The medical records data in 188 patients with hysteroscopic electrotomy separation for IUA and pregnancy within postoperative two years in the Affiliated Beijing Obstetrics and Gynecology Hospital of Cap-ital Medical University from January 2010 to January 2022 were analyzed retrospectively.The basic data and pregnancy outcomes of the patients were collected.The main influencing factors of postoperative live birth were analyzed by univariate analysis and multivariate logistics regression.Results Among 188 cases of IUA,there were 163 cases of live births with a live birth rate of 86.7％.There was no statistical difference in the composition situation of conception methods and delivery methods among the patients with different degrees of IUA(P＞0.05),and there was statistical difference in postpartum bleeding volume(P＜0.05).There were significant differences in the composition of placenta implantation,conducting clamp and uterine clearance a-mong the patients with different degrees of IUA(P＜0.05).The univariate analysis results showed that arti-ficial abortion,early pregnant curettage(P=0.008)and labor induction in second trimester(P＜0.001)were the influencing factors of postoperative live birth;the multivariate analysis results showed that induction of la-bor in the second trimester(95％CI:0.02-0.35,P=0.001)was the influencing factor of postoperative live birth.Conclusion Placenta-related diseases and postpartum hemorrhage are prone to occur after IUA opera-tion,and the uterine operation during delivery is increased.The patients with history of previous multiple in-duced abortions and mid-term induced labor should be vigilant against the occurrence of adverse pregnancy outcomes.

Objective To investigate the effect of long non-coding RNA(lncRNA)lung cancer-related transcript 1(LUCAT1)on the pathogenesis of intrauterine adhesion by regulating the expression of amphiregulin(AREG),to provide a new molecular target for the prevention and treatment of intrauterine adhesions.Methods Real-time quantitative polymerase chain reaction(RTqPCR)was used to determine the mRNA expression levels of lncRNA LUCAT1,fibrotic markers of α-smooth muscle actin(α-SMA)and collagen type Ⅰ alpha 1 chain protein(COL1A1)in samples of intrauterine adhesion tissue and endometrial stromal cell treated with transforming growth factor-β1.Western blot was used to determine the protein expression levels of AREG,α-SMA,COL1A1.Then,si-LUCAT1,pcDNA LUCAT1,si-AREG were transfected into ESC and RT-qPCR was used to detect the mRNA expression levels of lncRNA LUC-AT1 and AREG.Next,si-LUCAT1 and pcDNA LUCAT1 were transfected into ESC and treated these cells with TGF-β1 for 48h,re-spectively.Western blot was used to further detect the protein expression levels of AREG,α-SMA and COL1A1,and cell proliferation and apoptosis were detected by cell proliferation assay and cell apoptosis assay.Results The expression levels of lncRNA LUC AT1,AR-EG and fibrosis markers α-SMA and COL1A1 were upregulated in endometrial tissues from patients with intrauterine adhesion and in ESC that had been treated with TGF-β1.AREG changed with the change of lncRNA LUCAT1,and the expression of lncRNA LUC-AT1did not change significantly after downregulation of AREG,and AREG was positively regulated by lncRNA LUCAT1.During the process of the transformation of ESC into fibroblasts,si-LUCAT1 significantly inhibited the protein expression levels of AREG,α-SMA and COL1A1(P＜0.01),significantly reduced cell proliferation and significantly induced cell apoptosis,the difference was statistically significant(P＜0.001).pcDNA LUCAT1 significantly induced the protein expression levels of AREG,α-SMA and COL1A1,and the difference was statistically significant(P＜0.01).Conclusion LncRNA LUCAT1 promotes the pathogenesis of intrauterine adhesion by up-regulating the expression of AREG.LncRNA LUCAT1/AREG axis may provide novel molecular target for the prevention and treat-ment of intrauterine adhesion.

Objective:To estimate the safety of myomectomy in twin pregnant women with intramural myomas during cesarean section.Methods:The clinical data of 145 cases of twin pregnancies with intramural myomas who were delivered by cesarean section in Beijing Obstetrics and Gynecology Hospital, Capital Medical University from June 2013 to December 2021 were collected. Maternal demographics, fibroids′ characteristics, maternal and fetal outcomes were compared between groups of cesarean section with myomectomy (myomectomy group, 49 cases) and cesarean section only (non-myomectomy group, 96 cases).Results:Compared with non-myomectomy group, myomectomy group had significantly prolonged operative time [50.0 minutes (37.5-57.5 minutes) vs 40.0 minutes (35.0-50.0 minutes), respectively; P=0.007] and significantly longer postoperative hospital stay [4.0 days (3.0-4.0 days) vs 3.0 days (3.0-4.0 days), respectively; P=0.047). Other maternal and fetal outcomes such as estimated blood loss, hemoglobin difference, postpartum hemorrhage, blood transfusion, B-Lynch structure, uterine artery ligation, postoperative fever and neonatal Apgar score showed no significant differences (all P>0.05). For intramural myomas <5 cm, there were no significant differences in maternal and fetal outcomes between myomectomy group and non-myomectomy group (all P>0.05). For intramural myomas ≥5 cm, operative time [55.0 minutes (40.0-60.0 minutes) vs 42.5 minutes (40.0-50.0 minutes), respectively; P=0.019] was significantly prolonged, postoperative hospital stay [4.0 days (4.0-5.0 days) vs 4.0 days (3.0-4.0 days), respectively; P=0.048] was significantly longer in myomectomy group than non-myomectomy group, but there were no significant differences in other maternal and fetal outcomes (all P>0.05). Conclusion:For twin pregnancies with intramural myomas, it is safe and feasible to remove intramural myomas during cesarean section by experienced obstetricians.