Lymph node metastasis represents a common way of distant spread of gynecologic malignancies and an independent risk factor of poor prognosis of patients. The pelvic and paraaortic lymphadenectomy is a critical part of the surgical treatment of gynecologic cancer, which potentially improves the survival outcomes of patients through clarifying the node status to guide the subsequent management and/or removal of positive nodes to reduce the tumor burden. However, when we make a decision about lymphadenectomy, we should balance the related survival benefits and morbidities impacting the long-term quality of life. It is noteworthy that the principles of lymph node management are varied between different types and different stages of tumors characterized with different clinical features. Moreover, the sentinel lymph node biopsy, which has been emerging as a promising alternative to traditional systematic lymph node dissection, provides new options while bringing new issues. Here, based on the latest progress in relevant fields, we attempt to figure out the distinct features and unanswered questions in the management of lymph nodes of patients with cervical cancer, endometrial cancer, and ovarian cancer, which may trigger meaningful thoughts regarding related clinical decision.

Objective:To evaluate the feasibility and effectiveness of sentinel lymph node (SLN) detection in the ovarian neoplasms.Methods:A search of the literature describing ovarian SLN was performed using China National Knowledge Infrastructure (CNKI), WANFANG DATA, VIP, PubMed, Embase, web of science, Cochrane library from 2000.01.01 to 2020.07.29. The quality evaluation and data extraction of the included literature were conducted, and the development rate, sensitivity and negative predictive value of SLN were calculated.Results:Eight prospective single-arm studies were included, with heterogeneity I2=57.41%>50%, and the P<0.1. A total of 96 patients with ovarian cancer [Stage International Federation of Gynecology and Obstetrics (FIGO)Ⅰ-Ⅱ] were included, of whom 93 completed systematic pelvic and para-aortic lymphadenectomy after SLN detection. The most common tracers were technetium-99m radioactive colloid ( 99Tc m), blue dye or indocyanine green (ICG), and the most common injection sites were the infundibulopelvic ligaments and the proper ovarian ligaments. The SLN detection rate was 88.5%(85/96) and the average number was 2-3. SLN was found in the ipsilateral or contralateral regions of the tumor, 40.8%(31/76) was found only in the para-aortic, 14.5%(11/76) was found only in the pelvic, and 44.7%(34/76) was found only in the para-aortic and pelvic region. The sensitivity was 90.9%(10/11) and the negative predictive value was 98.8%(82/83) of lymph node metastasis. Conclusions:SLN detection for ovarian neoplasms is feasible, and whether it can effectively predict lymph node status of ovarian cancer still needs large sample, multi-center, prospective clinical studies to further verify.

Objective To assess roles of vascular endothelial growth factor(VEGF)and plateletderived growth factor(PDGF)in the mechanisms of lymphangiogenesis in epithelial ovarian carcinoma.Methods (1)Expression of Proxl,a newly described lymphatic endothelial cell nucleus marker,VEGF-A,VEGF-C,VEGF-D and PDGF-A,PDGF-B,PDGF-C,PDGF-D were detected bv RT-PCR in SKOV3 cell line and in 90 ovarian tissue samples,included 15 benigh tumors 10 borderline tumors, 45 malignant tumors and 20 normal ovarian samples.(2)Expression levels of Proxl,VEGF-A,-C,-D and PDGF-A,-B,-C,-D were detected in 90 ovarian tissue sample mentioned above by real-time quantitative PCR(RTQPCR).Resuls (1)Proxl was expressed in ovarian samples mentioned above,while not detected in SKOV3 cell. VEGF-A,-C,-D and PDGF-A,-B,-C,-D were found in SKOV3 cell and various ovarian tissues.(2)Expression levels of Proxl(2.2±1.3,P＜0.01),VEGF-A(3.5±1.5,P＜0.01),VEGF-C(19±14.P＜0.01),VEGF-D(3.0±1.8,P＜0.01)and PDGF-A(3.3±3.3,P＜0.05),PDGF-C(6.9±4.6,P＜0.01)in malignant group were found to be significantly higher than those in borderline group and benign group.(3)The expression levels of Proxl,VEGF-A and PDGF-A were significantly greater in samples from the patients with lymph node metastasis(Proxl:3.0±1.4,VEGF-A:4.1± 1.7,PDGF-A:4.9±4.1),peritoneum metastasis(Proxl:2.8±0.9,VEGF-A:4.0±1. 8,PDGF-A:4.5±4.0)and in stage Ⅲ-Ⅳ(Proxl:2.6±1.3,VEGF-A:4.0±1.4,PDGF-A:4.1±3.7)than those without lymph node metastasis,without peritoneum metastasis and in stage Ⅰ-Ⅱ.There was a significant increased in the degree of VEGF-C and VEGF-D expression in positive lymph node metastasis group(VEGF-C:24±13,VEGF-D:3.9±2.0)compared with negative group(P＜0.05).(4)There were significant positive correlations between the expression levels of Proxl and VEGF-D(r=0.62,P＜0.01),PDGF-C(r=0.91,P＜0.01)or PDGF-D(r=0.61.P＜0.01).Conclusions VEGF-A,VEGF-C and PDGF-A may promote lymphatic metastasis in epithelial ovarian carcinoma though else mechanisms other than lymphangiogenesis.VEGF-D may facilitate lymphangiogenesis and lymph node metastasis in epithelial ovarian cancer.There is no significant correlation between the expression of PDGF-B and lymphangiogenesis and lymph node metastasis.PCGF-C and PDGF-D may motivate lymphangiogenesis,but could not participate in lymph node metastasis in ovarian carcinoma.

The expression of N-myc down-regulated gene 1 (NDRG1) has previously been reported to be involved in the proliferation, differentiation, invasion and metastasis of cancer cells, but its role in cervical cancer is still unclear. This study aimed to investigate the expression of NDRG1gene in human cervical cancer and its effect on aggressive tumor behaviors. The NDRG1 expression in cervical tissues and cells was detected by RT-PCR. Specific expression plasmid pEGFP-N1-NDRG1-GFP was used to enhance the expression of NDRG1 in human cervical cancer cell lines. The mRNA and protein level of NDRG1 was assessed by RT-PCR and Western blotting, respectively. Its effects on cell proliferation, migration, invasion, cell cycle and apoptosis were detected by MTT, transwell migration assay and flow cytometry (FCM), respectively. The results showed that the expression of NDRG1 in cervical cancer tissues and cells was significantly lower than in normal cervical tissues (P<0.001). After transfection with pEGFP-N1-NDRG1-GFP, the mRNA and protein expression of NDRG1 was up-regulated in Siha cells, which suppressed cell proliferation (P<0.001), induced cell cycle arrest (P<0.05), reduced invasion and migration of Siha cells (P<0.05), but caused no cell apoptosis. Moreover, vascular endothelial growth factor (VEGF), a tumor-induced angiogenesis factor, was markedly reduced and E-cadherin, a cell adhesion molecule, was increased in the cells transfected with pEGFP-N1-NDRG1-GFP. It was concluded that up-regulated NDRG1 may play a role in the suppression of malignant cell growth, invasion and metastasis of human cervical cancer.

Objective To investigate the expression of microRNA 27a (miR-27a) and relationship with drug resistance in human ovarian cancer A2780/Taxol cells.Methods A stem-loop-mediated real-time PCR was used to detect miR-27a expression in A2780 and A2780/Taxol cells.The cells were transfected with the mimics or inhibitors of miR-27a or negative control RNA ( NC) by lipofectamine 2000.The expressions of MDR1 gene,P-glycoprotein (P-gp) and homeodomain-interacting protein kinase 2 (HIPK2) protein levels were measured by real-time PCR and western blot respectively.Methyl thiazolyl tetrazolium (MTT) assay was used to analyze drug sensitivity.Apoptosis analysis was measured by fluorescence activated cell sorter ( FACS).Results (1) miR-27a was an average of 2.2-fold higher expression level in A2780/Taxol cells than that in A2780 cells,with a significant difference between the two groups (P <0.05).(2) A2780/Taxol cells transfection with inhibitors of miR-27a showed that the levels of MDR1 mRNA was decreased by 39%,P-gp protein level[(26 ±5)%]decreased than that in the NC group[(43 ±7)%],HIPK2 protein level[(30 ±6)%]increased than that in the NC group[(19 ±4)%],the 50% inhibitionconcentration (0.5 (μmol/L) was less than that in the NC group (6.8 μmol/L),apoptosis rate[(32.5 ± 3.6) %]was higher than that in the NC group[(5.6 ±2.1) %],and there were significant differences between two groups (all P < 0.05 ).( 3 ) Transfection of A2780 cells with mimics of miR-27a led to increase MDR1 mRNA expression by 121% as compared with one transfection with NC (P<0.05).Conclusion The expression of miR-27a is upregulated in A2780/Taxol cells,which may regulate MDR1 and P-gp expression by targeting HIPK2.

Objective To explore the change of instant blood pressure after different rehabilitation exercises for stroke patients. Methods60 stroke patients were divided into Groups A, B and C. Group A raised both arms and ante flexed shoulders >70° in seat intermittently40～50 times in 3 minutes; Group B raised both arms and ante flexed shoulders >70° in seat continually for 3 minutes (isometric); Group Cwalked slowly more than 45 steps in 3 minutes. The brachial artery blood pressure and pulse of patients were monitored before and immediatelyafter training. Results The blood pressure of Group B raised significantly after training (P<0.05). Groups A and C did not raise significantlyafter training (P>0.05). The pulse of all the groups raised and there was no significant difference among them after training (P>0.05).Conclusion Continuous persistent isotonic contraction can cause elevation of blood pressure, which patients with hypertension should avoid.

Small cell carcinoma of cervix (SCCC) is a rare disease with highly aggressive behaviour and is pathologically hard to diagnose. In this study, the clinicopathological features, diagnosis, treatment and prognosis of the condition were examined. Clinical records and follow-up data of 7 cases of SCCC were retrospectively studied. Our results showed that five non-recurrent cases initially presented irregular vaginal bleeding or increased apocenosis of varying degrees. Pathological examination revealed that the stroma was diffusely infiltrated with small monomorphous cells ranging from round to oval shape. Three cases were immunohistochemically confirmed. One case was accompanied with squamous cell cancer. Of the 7 cases, one case was classified as stage I b1, two stage I b2, one stage IIa, one stage IIb, and one stage IIIb. On the basis of their stages of condition, one subject with stage III b underwent chemotherapy, and one with stage Ib2 received extensive hysterectomy plus pelvic lymphadenectomy, while the other 5 cases were treated by extensive hysterectomy and pelvic lymphadenectomy in combination with pre- and/or post-operative adjuvant chemotherapy and radiotherapy. Of the 7 patients, 4 had relapse-free survival of 14, 14, 16 and 28 months respectively. It is concluded that SCCC is an aggressive tumor with propensity for early pelvis lymph node metastases. Early-stage patients should be treated by extensive hysterectomy and pelvic lymphadenectomy in combination with pre- and/or post-operative adjuvant chemotherapy and radiotherapy.

This study investigated the effect of RhoC GTPase on the proliferation and metastasis of cervical cancer cells, SiHa cells, in vitro. RhoC siRNA was introduced into SiHa cells to silence the RhoC gene. The mRNA and protein expression of RhoC, before and after RhoC siRNA transfection,was examined by RT-PCR and Western blotting, respectively. The proliferation and apoptosis of SiHa cells were examined by MTT assay and flow cytometry (FACS), respectively. Adhesive rate was evaluated by Matrigel adhesive assay, and the invasive capability and migration capability were assessed by transwell invasive assay and migration assay, respectively. The results showed that after the RhoC siRNA transfection, the mRNA and protein expression of RhoC was down-regulated in SiHa cells. The down-regulation of RhoC GTPase did not affect the cell proliferation and apoptosis (P>0.05), but it did suppress SiHa cells' adhesion to matrigel (P<0.01), the invasive capability (P<0.01) and the migration capability (P<0.01). It was concluded that RhoC obviously promotes the adhesion, invasion and migration of SiHa cells in vitro, but not proliferation and apoptosis, suggesting that RhoC plays an important rote in the progression in cervical cancer.

In the past two decades,laparoscopic surgery has been increasingly used in the treatment of early-stage cervical cancer because of equal survival and faster recovery compared to abdominal surgery.Recently,a phase Ⅲ randomized controlled clinical trial revealed unexpected results that minimally invasive surgery was associated with significantly increased risks for tumor recurrence and death in patients with early-stage cervical cancer,causing a great debate worldwide.Herein,we highlighted the key points in the debate and tossed out several ideas on how to face and deal with the controversy.

The cancer burden caused by gynecological malignancies poses a serious threat to the health of women in China. Screening and early diagnosis are the key means to reduce the incidence rate and mortality of cancer. This article aims to briefly summarize the current status and challenges of screening and early diagnosis of three common female reproductive tract malignancies (cervical cancer, endometrial cancer, and ovarian cancer), in order to clarify the current stage and future direction of efforts.