Background: The impact of para-aortic lymphadenectomy (PALD) on prognosis and quality of life (QoL) for IB2-IIA2 cervical cancer patients remain controversial. And whether intraoperative frozen pathology exam on common iliac lymph nodes could help predict para-aortic lymph node (PALN) metastasis was unanswered with high-level evidence. Methods A multi-center, randomized controlled study is intended to investigate the effect of PALD on the prognosis and QoL in cervical cancer patients and to assess the value of intraoperative frozen pathological evaluation of common iliac nodes metastasis for the prediction of PALN metastasis. After choosing whether to receive intraoperative frozen pathological examination of bilateral common iliac lymph nodes, eligible patients will be randomly assigned (1:1) to receive PALD or not. The primary end point is 2-year progression-free survival (PFS). The secondary end points include 5-year PFS, 2-year overall survival (OS), 5-year OS, adverse events (AEs) caused by PALD, AEs caused by radiotherapy and QoL. A total of 728 patients will be enrolled from 8 hospitals in China within 3-year period and followed up for 5 years.

Background::The potential impact of β cell function and insulin sensitivity on adverse pregnancy outcomes in women with gestational diabetes mellitus (GDM) remains uncertain. We aimed to investigate the association between β cell dysfunction, insulin resistance, and the composite adverse pregnancy outcomes.Methods::This observational study included 482 women diagnosed with GDM during pregnancy. Quantitative metrics on β cell function and insulin sensitivity during pregnancy were calculated using traditional equations. The association of β cell dysfunction and insulin resistance with the risk of the composite adverse pregnancy outcomes was investigated using multivariable-adjusted logistic regression models.Results::Multivariable-adjusted odds ratios (ORs) of adverse pregnancy outcomes across quartiles of homeostatic model assessment for insulin resistance (HOMA-IR) were 1.00, 0.95, 1.34, and 2.25, respectively ( P for trend = 0.011). When HOMA-IR was considered as a continuous variable, the multivariable-adjusted OR of adverse pregnancy outcomes was 1.34 (95% confidence interval 1.16-1.56) for each 1-unit increase in HOMA-IR. Multivariable-adjusted ORs of adverse pregnancy outcomes across quartiles of homeostatic model assessment for β cell function (HOMA-β) were 1.00, 0.51, 0.60, and 0.53, respectively ( P for trend = 0.068). When HOMA-β was considered as a continuous variable, the multivariable-adjusted OR of adverse pregnancy outcomes was 0.57 (95% CI 0.24-0.90) for each 1-unit increase in HOMA-β. However, other quantitative metrics were not associated with the composite adverse pregnancy outcomes. Conclusions::We demonstrated a significant association of β cell function and insulin sensitivity with the risk of adverse pregnancy outcomes. We have provided additional evidence on the early identification of adverse pregnancy outcomes besides the glycemic values.

Background: In China, secondary cytoreductive surgery (SCR) has been widely used in ovarian cancer (OC) over the past two decades. Although Gynecologic Oncology Group-0213 trial did not show its overall survival benefit in first relapsed patients, the questions on patient selection and effect of subsequent targeting therapy are still open. The preliminary data from our pre-SOC1 phase II study showed that selected patients with second relapse who never received SCR at recurrence may still benefit from surgery. Moreover, poly(ADP-ribose) polymerase inhibitors (PARPi) maintenance now has been a standard care for platinum sensitive relapsed OC. To our knowledge, no published or ongoing trial is trying to answer the question if patient can benefit from a potentially complete resection combined with PARPi maintenance in OC patients with secondary recurrence. Methods SOC-3 is a multi-center, open, randomized, controlled, phase II trial of SCR followed by chemotherapy and niraparib maintenance vs chemotherapy and niraparib maintenance in patients with platinum-sensitive second relapsed OC who never received SCR at recurrence. To guarantee surgical quality, if the sites had no experience of participating in any OC-related surgical trials, the number of recurrent lesions evaluated by central-reviewed positron emission tomography–computed tomography image shouldn't be more than 3. Eligible patients are randomly assigned in a 1:1 ratio to receive either SCR followed by 6 cyclesof platinum-based chemotherapy and niraparib maintenance or 6 cycles of platinum-based chemotherapy and niraparib maintenance alone. Patients who undergo at least 4 cycles of chemotherapy and must be, in the opinion of the investigator, without disease progression, will be assigned niraparib maintenance. Major inclusion criteria are secondary relapsed OC with a platinum-free interval of no less than 6 months and a possibly complete resection. Major exclusion criteria are borderline tumors and non-epithelial ovarian malignancies, received debulking surgery at recurrence and impossible to complete resection. The sample size is 96 patients. Primary endpoint is 12-month non-progression rate.

Objective To investigate the expressions of growth factor receptor binding protein 7 (GRB7) and human epidermal growth factor receptor 2 (HER2) in endometrial carcinoma and their clinical significances. Methods Immunohistochemistry was used to detect the expressions of GRB7 and HER2 in 52 endometrial carcinoma tissues, 38 endometrial atypical hyperplasia tissues and 30 normal endometrial tissues collected from patients in the Sixth People's Hospital of Shanghai Jiao Tong University from May 2015 to September 2017. The relationship between the expressions of GRB7 and HER2 and clinicopathological features of endometrial carcinoma patients was analyzed. Results The positive expression rates of GRB7 in endometrial carcinoma, endometrial atypical hyperplasia and normal endometrial tissues were 71.2％ (37/52), 39.5％(15/38), and 13.3％(2/30), respectively, and the difference was statistically significant (χ2=35.14, P<0.05). The positive expression rates of HER2 in endometrial carcinoma, endometrial atypical hyperplasia and normal endometrial tissues were 67.3％ (35/52), 34.2％ (13/38), and 10.0％ (3/30), respectively, and the difference was statistically significant (χ2= 29.360, P< 0.05). The positive expression rates of GRB7 in endometrial carcinoma patients with different clinical stages, histological grades and pathological types were statistically significant (all P<0.05). The positive expression rates of HER2 in endometrial carcinoma patients with different clinical stages, histological grades, lymph nodes metastasis and myometrial invasion were statistically significant (all P< 0.05). The expression of GRB7 in endometrial carcinoma was positively correlated with the expression of HER2 (r=0.375, P<0.05). Conclusion The high expressions of GRB7 and HER2 in endometrial carcinoma are closely related to the malignant degree of endometrial carcinoma.

In women with preeclampsia (PE), endothelial cell (EC) dysfunction can lead to altered secretion of paracrine factors that induce peripheral vasoconstriction and proteinuria. This study examined the hypothesis that PE sera may directly or indirectly, through human umbilical vein ECs (HUVECs), stimulate phospholipase C-gamma1-1,4,5-trisphosphate (PLC-gamma1-IP3) signaling, thereby increasing protein kinase C-alpha (PKC-alpha) activity, collagen I expression and intracellular Ca2+ concentrations ([Ca2+]i) in human umbilical artery smooth muscle cells (HUASMCs). HUASMCs and HUVECs were cocultured with normal or PE sera before PLC-gamma1 silencing. Increased PLC-gamma1 and IP3 receptor (IP3R) phosphorylation was observed in cocultured HUASMCs stimulated with PE sera (P<0.05). In addition, PE serum significantly increased HUASMC viability and reduced their apoptosis (P<0.05); these effects were abrogated with PLC-gamma1 silencing. Compared with normal sera, PE sera increased [Ca2+]i in cocultured HUASMCs (P<0.05), which was inhibited by PLC-gamma1 and IP3R silencing. Finally, PE sera-induced PKC-alpha activity and collagen I expression was inhibited by PLC-gamma1 small interfering RNA (siRNA) (P<0.05). These results suggest that vasoactive substances in the PE serum may induce deposition in the extracellular matrix through the activation of PLC-gamma1, which may in turn result in thickening and hardening of the placental vascular wall, placental blood supply shortage, fetal hypoxia-ischemia and intrauterine growth retardation or intrauterine fetal death. PE sera increased [Ca2+]i and induced PKC-alpha activation and collagen I expression in cocultured HUASMCs via the PLC-gamma1 pathway.
Adult ; Apoptosis ; Calcium/*metabolism ; Cell Line ; Cell Survival ; Cells, Cultured ; Coculture Techniques ; Collagen Type I/analysis/*metabolism ; Female ; Human Umbilical Vein Endothelial Cells ; Humans ; Muscle, Smooth, Vascular/*cytology/metabolism ; Phospholipase C gamma/genetics/*metabolism ; Pre-Eclampsia/*blood/*metabolism/pathology ; Pregnancy ; Protein Kinase C-alpha/metabolism ; RNA Interference ; *Signal Transduction ; Young Adult

Objective To study the value of hCG ratio of blood in peritoneal cavity versus venous blood (RPhCG/VhcG) in diagnosis of early ectopic pregnancy (EP).Methods From Mar.2009 to Oct.2012,268 cases with EP (EP group) and 53 women with intrauterine pregnancy with haemoperitoneum (hIUP) (hIUP group) from International Peace Maternity and Child Health Hospital of Shanghai Jiaotong University School of Medicine,Shanghai 6th People Hospital and Shanghai Jiangwan Hospital were enrolled in this prospective study.The HCG of all subjective were measured in blood in peritonea cavity and venous blood,then calculate the ratio of RPhCG/VhCG.Scatter point analysis and ROC were used to differentiate EP,determine threshold of hlUP and evaluate the sensitivity,specificity and accuracy in diagnosis EP preoperatively.Results The mean RPhCG/VhCG; of EP group was 4.35,which was significantly higher than 0.81 in hIUP group (P ＜ 0.01).Scatter point analysis showed that the threshold value of RPhCG/VhCG between ectopic pregnancy and hIUP was 1.0.The overall sensitivity of RPhCG/VhcG in the diagnosis of EP was 98％,the specificity was 100％,the positive predictive value was 100％ and the negtive predictive value was 93％.Conclusion RPhCG/VhCG ＞ 1.0 could be used to diagnose and differentiate EP from hIUP accurately.

Objective To investigate the effects of preeclampsia serum on activity and invasive ability of cultured cytotrophoblasts of first trimester of pregnancy. Methods Cytotrophoblasts of normal 6 to 8-week pregnancy were cultured by tissue explants adherent method,and were incubated with serum of women with normal pregnancy(normal group)and preeclampsia(preeclampsia group),respectively for 24 h.The activity of cytotrophoblasts was examined by CCK-8,invasive ability was determined by Transwell invasion assay,and expression of MMP-2,MMP-9 and PAI-1 mRNA was detected by reverse transcription-polymerase chain reaction(RT-PCR). Results The activity and invasive ability of cytotrophoblasts in preeclampsia group were lower than those in normal group(P<0.05,P<0.01).Compared with normal group,the expression of MMP-2 and MMP-9 mRNA of cytotrophoblasts was significantly lower(P<0.01),and the expression of PAI-1 mRNA was significantly higher(P<0.01).In both groups,the expression of MMP-2 mRNA was negatively related to that of PAI-1 mRNA(r=-0.985,P<0.01;r=-0.933,P<0.05),while there was no correlationship between the expression of MMP-9 mRNA and that of PAI-1 mRNA. Conclusion The preeclampsia serum may affect the invasive ability of cytotrophoblasts by regulating the expression of MMP-2,MMP-9 and PAI-1.

Objective To evaluate the impact of bilateral ovariectomy in post-menopausal women by comparison of climacteric symptoms before and after operation. Methods Post-menopausal women who received hysterectomy with concurrent bilateral ovariectomy on benign uterine indications were recruited.Climacteric symptoms before and after operation were accessed by a questionaire including modified Kupperman Index.Comparison was made after grouping the patients into early menopause group,whose menopausal period was no more than 5 years,and late menopause group,whose menopausal period was more than 5 years. Results Among a total of 95 individuals,8 had normal,46 had mild,34 had moderatc,and the other 7 had severe Kupperman Index scores before operation,while 5 had normal,28 had mild,48 had moderate,and the other 14 had severe Kupperman Index scores after operation,with more moderate and severe climacteric symptoms after operation than before operation(P<0.05).Women of early menopause group had higher total Kupperman Index scores and symptom scores of sweating,insomnia,depression,fatigue and headache than those of late menopause group before operation(P<0.05).Women of early menopause group had significantly higher Kupperman Index scores after operation than before operation(23.93±7.53 vs 17.63±8.07,P<0.05).However,there was no significant difference in total Kupperman Index scores in women of late menopause group before and after operation. Conclusion Bilateral ovariectomy may affect the climacteric symptoms in post-menopausal women,especially in early menopausal period.

Objective To identify the morphological characteristics of pelvic diaphragm hiatus in pregnant women with stress urinary incontinence ( SUI) by transperineal three-dimensional (3-D) ultrasound.Methods From Oct.2008 to Mar.2009,145 pregnant women (third trimester group) at 37-41 weeks of gestation underwent transperineal 3-D ultrasound investigation at Department of Obstetrics and Gynecology,the Sixth People's Hospital,Shanghai Jiaotong University,including 38 pregnant women with stress urinary incontinence (SUI) and the other 107 non SUI pregnant women.In the mean time,50 normal nulliparous healthy women were chosen as control group.The morphological characteristics of pelvic diaphragm hiatus,the diameter of pelvic diaphragm hiatus,pubovisceral muscle thickness and genitohiatal and levator ani angle were measured at rest,on maximum Valsalva and maximum pelvic floor contraction by 3-D ultrasound,respectively.Results Loosen connective tissue and pubococcygeus avulsion were observed in some pregnant women at third trimester.The area of pelvic diaphragm hiatus were (15.2 ±1.9),(16.4 ± 2.0) and (13.6±1.9) cm2,pubovisceral muscle thickness were (0.72 ±0.11),(0.68 ±0.14) and(0.77 ±0.11) cm,levator ani angle were (60 ±8) °,(57±10) ° and (64 ± 14)° at rest,on maximum Valsalva and maximum pelvic floor contraction respectively.These parameters were significantly increased than those in control group[(11.2 ±2.6),(14.5 ±4.5) and (9.2 ±2.6) cm2; (0.66 ±0.10),(0.67 ± 0.14) and (0.71 ±0.14) cm; (50 ±4) °,(51 ±5) ° and (46 ±5)°]at three maneuvers,respectively ( P <0.05).And those parameters of the anteroposterior hiatal diameter,lateral hiatal diameter,perimeter of pelvic diaphragm hiatus and area of pelvic diaphragm hiatus in SUI pregnant women were increased than those in non SUI pregnant women at three maneuvers,respectively (P < 0.05 ).Pubovisceral muscle thickness in SUI pregnant women was significantly lower than that in non SUI pregnant women at maximum pelvic floor contraction (P < 0.05 ),but there were not significant difference between SUI and non SUI pregnant women at rest and on maximum Valsalva in pubovisceral muscle thickness and genitohiatal and levator ani angle (P >0.05).Conclusions Pelvic floor anatomic remodeling is identified in late pregnant women.When compared with non pregnant women,the loosen pelvic floor connective tissue and the bigger diameters of pelvic diaphragm are observed in late pregnant women.It is observed that the increased diameters of pelvic diaphragm and decreased thickness of pubovisceral muscle in later pregnant SUI women than those in non SUI pregnant women.