Changed epidemiology of anthrax and molecular characteristics of Bacillus anthracis in Inner Mongolia Autonomous Region, China.

Anthrax is a natural foci disease in Inner Mongolia, which poses a severe threat to public health. In this study, the incidence number, rate and constituent ratio were used to describe the epidemiological characteristics of anthrax in the region from 1956-2018. The molecular correlation and genetic characteristics of the strains were investigated using canonical single nucleotide polymorphisms (CanSNP), multiple-locus variable-number tandem repeat analysis (MLVA-15) and whole genome sequencing (WGS). The epidemiological characteristics of anthrax in Inner Mongolia have altered significantly. The incidence of anthrax has decreased annually without vaccination, and the regional distribution of anthrax gradually transferred from central and western regions to the eastern. Moreover, the occupation distribution evolved from multiple early occupations to predominated by farmers and herdsmen. This change is closely related to policy factors and to changes in the means of production and the living habits of the local population. This indicates that reformulating the control and prevention strategies is essential. Both A. Br. Ames and A. Br. 001/002 subgroups were the predominant CanSNP genotypes of Bacillus anthracis in Inner Mongolia. A total of 36 strains constituted six shared MLVA-15 genotypes, suggesting an epidemiological link between the strains of each shared genotype. The six shared genotypes ([GT1, 9, 11 and 15] and [GT8 and 12]) consisting of 2-7 strains confirmed the occurrence of multiple point outbreaks and cross-regional transmission caused by multiple common sources of infection. Phylogenetic analysis based on the WGS core genome showed that strains from this study formed an independent clade (C.V.), and they were positioned close to each other, suggesting a common origin. Further comparison analysis should be performed to ascertain the geographic origin of these strains.

Monoclonal antibody against l-lectin module of SraP blocks adhesion and protects mice against Staphylococcus aureus challenge.

BACKGROUND/PURPOSE: SraP is a serine-rich repeat protein (SRRP) from Staphylococcus aureus that binds to sialylated receptors to promote bacterial adhesion to and invasion into host epithelial cells, mediated by the l-lectin module of its ligand-binding region. METHODS: The sequence encoding the L-lectin module of SraP was inserted into pET28a plasmid, and the recombinant protein was purified by His label affinity chromatography. A monoclonal antibody (mAb) against the l-lectin module was obtained and confirmed by enzyme-linked immunosorbent assay and western blotting. The effect of the mAb on S. aureus adhesion and invasion was assessed in A549 cells and mice subjected to S. aureus challenge. RESULTS: We successfully obtained a mAb against the l-lectin module of SraP. Pre-incubation with the mAb dramatically inhibited the bacteria's ability to adhere to and invade A549 cells. Moreover, mice administered mAb through tail vein injection had significantly fewer bacteria in the blood. CONCLUSION: The anti-SraPL-Lectin mAb significantly reduced the adherence and invasion of S. aureus to host cells. This study lays the foundation for the future development of the l-lectin module of SraP as a target for the prevention and treatment of S. aureus infection. Our findings suggest that specific subdomains of SRRPs may represent potential antibacterial drug targets for intervention.

Microscale endometrial sampling biopsy in detecting endometrial cancer and atypical hyperplasia in a population of 1551 women: a comparative study with hysteroscopic endometrial biopsy.

BACKGROUND: Endometrial cancer is one of the most common malignancies of the reproductive system. Effective and cost-effective screening method for populations at high risk is not available. This study aimed to investigate specimen adequacy and the influencing factors in microscale endometrial sampling biopsy and to evaluate the diagnostic accuracy and medical cost of biopsy in endometrial cancer and atypical hyperplasia screenings in comparison with hysteroscopic endometrial biopsy. METHODS: A total of 1551 patients at high risk for endometrial lesions who required hysteroscopic endometrial biopsy from November 2017 to August 2018 were included. Microscale endometrial sampling biopsy was performed, followed by hysteroscopic endometrial biopsy. We evaluated the specimen adequacy and influencing factors of microscale endometrial sampling. Diagnostic consistency between microscale endometrial sampling biopsy and hysteroscopic endometrial biopsy was evaluated. The sensitivity, specificity, positive predictive value, and negative predictive value of microscale endometrial sampling biopsy in screening for endometrial cancer and atypical hyperplasia were analyzed, and the medical costs of the two procedures were compared. RESULTS: The specimen adequacy was 81.2%. Patient age, menopausal status, endometrial thickness, and endometrial lesion type were correlated with specimen adequacy. There was good consistency in distinguishing benign and malignant endometrial diseases between microscale endometrial sampling biopsy and hysteroscopic biopsy (kappa 0.950, 95% CI 0.925-0.975). The sensitivity, specificity, positive predictive value, and negative predictive value of microscale endometrial sampling biopsy were 91.7%, 100.0%, 100.0%, and 99.3% for endometrial cancer screening, respectively, and 82.0%, 100.0%, 100.0%, and 99.4% for atypical hyperplasia screening. The medical cost of endometrial sampling biopsy was only 22.1% of the cost of hysteroscopic biopsy. CONCLUSIONS: Microscale endometrial sampling biopsy is a minimally invasive alternative technique for obtaining adequate endometrial specimens for histopathological examination. It has the potential to be used in detecting endometrial cancer and atypical hyperplasia with high efficiency and low cost.

Emergency Response for a Laboratory Biosafety Incident.

On December 14, 2017, a faculty member of a university in Hunan Province reported that an anthrax vaccine strain might have recovered virulence during an undergraduate experiment and potential exposure could not be ruled out for the students involved. Upon receiving the case report, the CDC, health bureaus, and local governments at the county, prefectural, and provincial levels promptly organized experts in different fields (including epidemiologists, biosafety experts, and laboratory testing experts) for case investigation, evaluation, and response. As the investigation results showed, no virulence recovery was identified in the involved anthrax vaccine strain; and no contamination of Bacillus anthracis was detected at the involved areas. Thus, the university returned to normal functioning.

Genetic source tracking of an anthrax outbreak in Shaanxi province, China.

BACKGROUND: Anthrax is an acute zoonotic infectious disease caused by the bacterium known as Bacillus anthracis. From 26 July to 8 August 2015, an outbreak with 20 suspected cutaneous anthrax cases was reported in Ganquan County, Shaanxi province in China. The genetic source tracking analysis of the anthrax outbreak was performed by molecular epidemiological methods in this study. METHODS: Three molecular typing methods, namely canonical single nucleotide polymorphisms (canSNP), multiple-locus variable-number tandem repeat analysis (MLVA), and single nucleotide repeat (SNR) analysis, were used to investigate the possible source of transmission and identify the genetic relationship among the strains isolated from human cases and diseased animals during the outbreak. RESULTS: Five strains isolated from diseased mules were clustered together with patients' isolates using canSNP typing and MLVA. The causative B. anthracis lineages in this outbreak belonged to the A.Br.001/002 canSNP subgroup and the MLVA15-31 genotype (the 31 genotype in MLVA15 scheme). Because nine isolates from another four provinces in China were clustered together with outbreak-related strains by the canSNP (A.Br.001/002 subgroup) and MLVA15 method (MLVA15-31 genotype), still another SNR analysis (CL10, CL12, CL33, and CL35) was used to source track the outbreak, and the results suggesting that these patients in the anthrax outbreak were probably infected by the same pathogen clone. CONCLUSIONS: It was deduced that the anthrax outbreak occurred in Shaanxi province, China in 2015 was a local occurrence.

Optimization of Pulsed-field Gel Electrophoresis Procedure for Bacillus cereus.

In order to develop a rapid and reliable method for B. cereus genotyping, factors influencing PFGE results, including preparation of bacterial cells embedded in agarose, lysis of embedded cells, enzymatic digestion of intact genomic DNA, and electrophoresis parameters allowing for reproducible and meaningful DNA fragment separation, were controlled. Optimal cellular growth (Luria-Bertani agar plates for 12-18 h) and lysis conditions (4 h incubation with 500 µg/mL lysozyme) produced sharp bands on the gel. Restriction enzyme NotI was chosen as the most suitable. Twenty-two isolates were analyzed by NotI digestion, using three electrophoretic parameters (EPs). The EP-a was optimal for distinguishing between isolates. The optimized protocol could be completed within 40 h which is a significant improvement over the previous methods.

[Clinical features and drug resistance characteristics of ovarian clear cell adenocarcinoma and analysis of its prognostic factors].

OBJECTIVE: To investigate the clinical features and factors involved in the drug resistance and prognosis of ovarian clear cell adenocarcinoma (OCCA). METHODS: Forty-seven OCCA patients and 53 ovarian serous cyst adenocarcinoma (OSCA) patients were included in this study. Their clinical characteristics, drug resistance, and prognostic factors were analyzed. RESULTS: The onset age of OCCA was (49.09 + 11.80) years old, and that of OSCA was (55.51 + 1.38) year old. There were 53.3% (24/45) of OCCA and 98.0% (50/51) of OSCA patients who had elevated CA125 levels. There were 46.8% (22/47) of OCCA patients and 7.5% (4/53) of OSCA patients who suffered from endometriosis (EMS). The percentage of early stage (stage I and stage II) OCCA was 80.9% (38/47), and that of OSCA was 11.3% (6/53). A statistically significant difference was observed on all these aspects (P < 0.05). The percentage of drug resistant OCCA was 26.1% (12/46), and that of OSCA was 24.0% (12/50), with a non-significant difference (P = 0.814).Among the patients with advanced stage disease, the percentage of drug resistance was 87.5% (7/8) for OCCA, while that of OSCA was 25.0% (11/44), showing a statistically significant difference (P = 0.003). Multiple logistic regression analysis revealed that OCCA (OR = 21.774, 95%CI: 2.438 to 194.431) and advanced stage (OR = 58.329, 95%CI: 5.750 to 591.703) were independent risk factors of drug resistance in ovarian epithelial cancers. For the advanced stage patients, the median overall survival time of OCCA and OSCA were 11 and 29 months, respectively, with a statistically significant difference (P = 0.000). Cox survival analysis showed that OCCA, advanced stage, suboptimal surgery, fewer than 6 cycles of chemotherapy and drug resistance were all risk factors of OS in ovarian cancer patients (P < 0.05). CONCLUSIONS: The age of onset in OCCA patients is younger than that of OSCA patients. The proportion of combination with endometriosis (EMS) is higher, and more early stage disease is observed in OCCA patients. The percentage of drug resistant in OCCA is higher, especially in advanced stage patients. The prognosis of advanced stage OCCA patients is poorer than that of OSCA patients in advanced stage.

[Re-evaluation of interval debulking surgery in advanced epithelial ovarian cancer].

OBJECTIVE: Previous study showed that interval debulking surgery (IDS) may improve the survival of patients with advanced epithelial ovarian cancer (EOC). The precise significance of IDS needs to be evaluated. METHODS: Totally 136 consecutive patients with stage IIIc or IV EOC (including primary peritoneal carcinoma and primary fallopian tube carcinoma) who completed primary debulking surgery (PDS) and platinum-based chemotherapy were enrolled from January 2000 to December 2009 in a retrospective cohort study. The study group was divided into three groups: 65 cases underwent optimal PDS (Group A), 41 cases received chemotherapy alone after suboptimal PDS (Group B), and 30 patients underwent IDS after suboptimal PDS (Group C). All patients received six to eight courses of platinum-based combination chemotherapy (paclitaxel plus carboplatin/cisplatin, cyclophosphamide plus epirubicin and cisplatin). Patients' clinical characteristics, perioperative situation and prognosis were compared. RESULTS: Sixty-five cases (47.8%, 65/136) from 136 patients achieved optimal PDS. For Group C, 77% (23/30) patients obtained optimal debulking surgery after IDS. Intraoperative injury rates were similar between Group B and Group C (P > 0.05). Mild perioperative complications rate was also similar (P > 0.05). Median progression-free survival (PFS) of Group A was 26 months. Median overall survival (OS) of Group B and Group C were 31 months and 40 months, respectively (P = 0.254). Median PFS of Group B and Group C were 13 months and 24 months, respectively (P = 0.289). Although when it came to 20 months after PDS, patients who underwent IDS had a significantly lower progressive disease (PD) rate (Group B 33% versus Group C 61%, P = 0.046), it still showed that there was no significant difference in either OS or PFS of these two groups. Those patients in Group C who obtained no visible residual got similar PFS (27 months) comparing to Group A (26 months, P = 0.730), but OS was still shorter (P = 0.010). CONCLUSIONS: For advanced EOC patients, IDS has little effect on improving survival. While it is safe and acceptable, also may prolong PFS in those patients who got no visible residual after IDS. The results suggest that IDS might be used as an alternative treatment for advanced EOC patients who cannot obtain optimal PDS in certain local hospitals.

[Expression and promotor methylation of p73 gene in ovarian epithelial tumors].

OBJECTIVE: To investigate the expression and promoter methylation status of p73 gene in ovarian epithelial tumors and their clinicopathological correlations. METHODS: Tissue microarrays (TMA) consisting of 68 ovarian cancers, 37 ovarian borderline tumors and 21 ovarian benign tumors were constructed. p73 expression was detected by immunohistochemistry (EnVision method). Fresh-frozen tissue samples from 13 cases of ovarian carcinomas and 5 cases of borderline tumors were evaluated for the presence of p73 promoter methylation using bisulfite sequencing. RESULTS: Overall, 92.6% (63/68) ovarian carcinomas expressed p73, with a mean value of 32% (percentage of p73 positive cells in the tumor). The mean value of p73 expression rate (40%) in serous carcinoma (26/26) was higher than those of other cancer types (P = 0.006). The mean value of p73 expression rate (40%) in type II ovarian carcinoma was significantly higher than that in type I ovarian carcinoma (24%, P = 0.010). The expression of p73 was not associated with FIGO stage and histological grade (both P > 0.05). The mean values of p73 expression in ovarian borderline tumor (30/37) and benign tumor (12/21) were 16% and 15%, respectively. Of the two groups, the mean value of p73 expression rate in serous type was higher than that in mucous type (P = 0.003, P = 0.026). Ovarian carcinomas had a higher level of p73 expression than borderline tumors and benign tumors (both P < 0.05), while that between ovarian borderline tumors and benign tumors had no statistical difference (P > 0.05). Among serous tumors (49/53), the mean value of p73 expression in the carcinoma group (26/26) was significantly higher than those in the borderline tumor group (12/14) and benign tumor group (11/13; P = 0.024 and P = 0.002, respectively), while that between borderline tumor group and benign tumor group had no statistical difference (P = 0.428). Among mucous tumors (15/27), the mean value of p73 expression in carcinoma group (6/7) was higher than that in benign tumor group (1/8; P = 0.032). No statistical difference of p73 expression was seen between the carcinoma group and ovarian borderline tumor group (8/12) and between the borderline tumor group and benign tumor group (P = 0.234, P = 0.201, respectively). p73 promotor methylation was found in 8 of 13 cases of carcinomas but at different methylation levels with a mean value of 8.0%. Two of 5 ovarian borderline tumors showed detectable p73 promotor methylation with a mean value of 9.0%. Compared with the borderline tumors, ovarian carcinomas showed a similar p73 methylation level (P > 0.05). The p73 methylation level in ovarian carcinomas was not associated with histological type, pathogenetic type, histological grade and FIGO stage (all P > 0.05). CONCLUSIONS: Most of ovarian epithelial tumors express p73 protein with mean values higher in ovarian carcinomas than those in the borderline and benign tumors. Ovarian serous carcinomas have the highest expression level of p73. A simple linear correlation does not exist between the promoter methylation and protein expression of p73.

[Prediction of chemoresistance in epithelial ovarian cancer by clinical factors].

OBJECTIVE: To compare the clinical features and prognosis among patients with different chemosensitivity and determine the specific clinical influencing factors of chemotherapeutic resistance. METHODS: In references to the 2010 NCCN clinical practice guidelines on ovarian cancer and in accordance with the length of disease-free interval, 244 patients were divided into 3 groups: platinum-resistant, partially sensitive and platinum-sensitive. The differences of clinical features, treatment and prognosis were compared among these 3 groups. RESULTS: The resistant, partially sensitive, sensitive rates to platinum-based chemotherapy were 23.4%, 13.5% and 63.1% respectively. Such factors as age, pathological type, primary tumor size. intraperitoneal chemotherapy and venous chemotherapy regimen had no effect on the responses to the combination platinum-based chemotherapy. The platinum-resistant percentage of advanced stage patients without optimal cytoreductive surgery was higher (P < 0.01). The poorly differentiated rate of partially sensitive patients was higher than that of platinum-sensitive ones (P < 0.05). The CA125 level and lymph node metastasis rate of platinum-resistant patients were higher than those of platinum-sensitive patients (P < 0.05, P < 0.01). The 5-year survival rates of resistant, partially sensitive and sensitive patients were 9.5%, 38.4% and 81.9% respectively. There were statistics differences in overall survival and progression-free survival among the 3 groups (P < 0.01). CONCLUSION: Advanced ovarian cancer, poor differentiation, lymph node-positivity, CA125 rising above 1000 × 10(3) U/L and suboptimal cytoreductive surgery would lead to the occurrences of resistance or partially sensitivity. Clinical factors have some reference values for the prediction of resistance. But it is impossible to accurately determine chemoresistance.

Hysteroscopy and directed biopsy in the diagnosis of endometrial carcinoma.

BACKGROUND: Diagnostic hysteroscopy and directed biopsy has been widely used to evaluate abnormal uterine bleeding. We aimed to explore the value of hysteroscopy and directed biopsy in the diagnosis of endometrial carcinoma. METHODS: Two hundred and eighty-seven patients with endometrial carcinoma who were treated in Beijing University People's Hospital, Beijing, China were distributed into 2 groups: Group A (90 patients) was examined using hysteroscopy and directed biopsy, and Group B (197 patients) was examined using fractional dilatation and curettage (D&C). The diagnostic veracity of the two methods, the rate of positive peritoneal cytology and the prognosis of the 2 groups were compared. RESULTS: In Group A, 97.8% (88/90) of patients were diagnosed pathologically before surgery; the rate was 88.8% (175/197) for Group B. The difference between the 2 groups was statistically significant (P < 0.05). The sensitivity, specificity, positive predictive value and negative predictive value for the two methods for detecting cervical involvement were 77.8%, 100%, 100% and 97.6% for Group A and 65.3%, 92.6%, 74.4% and 90.0% for Group B, respectively. The positive peritoneal cytology rate was 5.6% (5/90) in Group A and 6.09% (12/197) in Group B. The difference was not statistically significant (P > 0.05). The 3-year and 5-year overall survival rates were 91.4% (33/36) and 82.4% (14/17) for Group A and 95.6% (87/91) and 86.7% (39/45) for Group B. There were no statistically significant differences between the two groups' survival rates (P > 0.05). CONCLUSION: Compared with fractional D&C, hysteroscopy and directed biopsy offered improved pathological diagnostic accuracy before surgery and discovered cervical involvement more precisely in endometrial carcinoma patients, but it did not increase the positive peritoneal cytology rate or affect the prognosis of these patients.

[Profiling of serum tumor markers in patients with epithelial ovarian carcinoma].

OBJECTIVE: To investigate whether the change of serum tumor markers profile after chemotherapy in epithelial ovarian carcinoma and evaluate the clinical significance. METHODS: The levels of CA(125), CA(19-9) and CP2 before and after initial surgery, during primary chemotherapy and follow-up were serially measured and analyzed retrospectively in 28 cases of recurrent epithelial ovarian carcinoma patients and 20 cases of primary chemo-resistant ovarian carcinoma patients from Jan 1999 to July 2007. According to whether the change of serum tumor markers profile, all the patients were divided into two groups: marker changed-group and marker un-changed group. The average follow up period was 25 months. RESULTS: (1) The changes of tumor marker profile were included the number and(or) types of markers, which included 13 cases (46%, 13/28) of the recurred cases and 9 cases (45%, 9/20) of the primary chemo-resistant cases. (2) For recurrent ovarian carcinoma changed tumor marker profile, the highest pathology type was serous histological type (77%, 10/13), while was mucinous histological type (4/9) for primary chemo-resistant patients. (3) For recurred patients, the median progression-free survival (PFS) and median overall survival (OS) in marker changed-group (22.2 and 60.0 months) were significantly longer than that in marker un-changed group (17.4, 46.0 months; P < 0.05). For primary chemo-resistant ovarian carcinoma patients, median OS in marker changed-group (15.9 months) was significantly shorter than that in marker un-changed group (25.0 months; P < 0.05). CONCLUSION: The profile of serum tumor makers in epithelial ovarian carcinoma may be changed after chemotherapy, which should be concomitantly determinate different serum tumor markers for monitoring the response to chemotherapy and follow-up of patients.

[Effect of reduced expression of Her2 by RNA interference on the biological characters of ovarian carcinoma cells].

OBJECTIVE: To observe the effects of short hairpin RNA (shRNA) targeting Her2 on its gene expression when the shRNA was stably transfected into human ovarian cell lines, SKOV3 and SKOV3.ip1, which have different extent of malignancy and investigate the changes of the biological characters of the two cell lines after the stable transfection. METHODS: The plasmids expressing shRNA targeting Her2 gene were transfected into SKOV3 and SKOV3.ip1 cells. The stably transfected cells were gained by antibiotic screening. The expression of Her2 before and after the transfection was detected by RT-PCR and western blot. The transwell experiment was used to observe the invasion ability of the cancer cells before and after the transfection, and the parent and the transfected cells were injected into nude mice to observe the tumor growth. RESULTS: After the stable transfection with Her2 shRNA, mRNA and protein levels of Her2 gene in SKOV3 and SKOV3.ip1 cells were remarkably reduced. The expression of mRNA were (68.0 +/- 3.1)%, (40.8 +/- 2.0)%, (99.9 +/- 1.3)%, (42.4 +/- 2.5)%. The expression of protein were (72.1 +/- 3.4)%, (36.4 +/- 1.5)%, (98.2 +/- 1.7)%, (40.7 +/- 2.1)%. The invasion ability into basilar membrane of the transfected cells was greatly reduced compared with the parent cells. The invasion cell numbers were 7.6 +/- 1.1, 1.8 +/- 0.8, 36.2 +/- 9.7, 15.7 +/- 7.2. The growth rate of the planted tumors was lower in transfected groups than that of the parent groups. CONCLUSIONS: (1) The expression of Her2 gene in SKOV3 and SKOV3.ip1 cells was remarkably reduced by RNA interference targeting Her2. (2) The biological characters of SKOV3 and SKOV3.ip1 cells are changed when the expression of Her2 gene is reduced by RNA interference.

[Clinical value of serum CA19-9, CA125 and CP2 in mucinous ovarian tumor: a retrospective study of 273 patients].

OBJECTIVE: To evaluate the diagnostic and prognostic value of serum CA19-9, CA125 and CP2 in mucinous ovarian tumors. METHODS: In this retrospective study, the serum CA19-9, CA125 and CP2 levels of 273 hospitalized patients with ovarian tumors of either mucinous or non-mucinous type were analyzed. RESULTS: (1) CA19-9 had the biggest area under curve (AUC) in mucinous tumors followed with CA125 while CA125 and CP2 had bigger AUC in non-mucinous tumor. (2) For the diagnosis of mucinous tumors, CA19-9 and CA125 combination showed a greatly increased sensitivity compared with CA19-9 or CA125 alone (93.8% versus 75.0% and 66.7%, P<0.05) with no significant improvement of the specificity (P>0.05). For the diagnosis of non-mucinous tumors, CA125 and CP2 combination showed an increased sensitivity compared with CA125 or CP2 alone (85.0% versus 80.7%, P>0.05, 85.0% versus 70.6%, P<0.05) with no significant improvement of the specificity (P>0.05). (3) Seventy percent of tumor marker-positive patients could undergo cytoreductive surgery. Compared with those who could not undergo cytoreductive surgery, they were more likely to have normal tumor marker two months after surgery (P<0.05) and longer interval to re-elevation of tumor markers (P>0.05), with lower recurrence and death rate (P<0.05). All of the 20 tumor marker-negative patients could have cytoreductive surgery with only 10% recurrence. (4) CA19-9 increased mainly in recurrent mucinous tumor, while CA125 increased dominantly in recurrent non-mucinous tumor. (5) The survival rate of CA125 and CP2 positive patients was much lower than CA125 and CP2 negative patients (P<0.05), while the survival rate was similar between CA19-9 positive and CA19-9 negative patients. CONCLUSIONS: CA19-9 is a sensitive index for diagnosis of mucinous ovarian tumors. Combination of CA19-9 with CA125 can improve the sensitivity of diagnosis and postoperative monitoring of mucinous ovarian tumors. Combination of CA125 with CP2 is more valuable in the diagnosis of non-mucinous ovarian tumors.

[Relationship between ureaplasma urealyticum infection and ectopic pregnancy].

OBJECTIVES: To explore the relationship between different subtypes of Ureaplasma Urealyticum infection and ectopic pregnancy. METHODS: Ectopic pregnancy group included 33 patients and another 40 patients undergoing salpingo-ovariectomy with ovarian cyst or uterine myoma were investigated as control group. Polymerase chain reaction technique was used to detect Uu DNA in the two groups samples from endosalpinx and secretion of cervix. At the same time, these samples were set to electron microscope for examination. RESULTS: (1) Uu was detected in 27 fallopian tubal epithelium tissues among 33 ectopic pregnancy samples (81.8%), in which biovar1 was positive in 17 samples (52%, 17/33), biovar 2 was positive in 15 (46%, 15/33) and both biovar 1 and 2 positive was 5 (15.2%). While in the control group, Uu was detected in 24 fallopian tubal epithelium tissues among 40 samples (60%), in which biovar1 was positive in 21 samples (52%, 21/40), biovar 2 was positive in 5 (12%, 5/40) and both biovar 1 and 2 positive was 2 (5%). There was no significant difference between the two groups in Uu of biovar 1 (P > 0.05). The positive rate of Uu in biovar 2 show a significant difference (P < 0.05). (2) Co-expression samples in both fallopian tubal epithelium and cervical mucus samples from ectopic pregnancy patients in biovar1 was 13 (72.2%), and in biovar 2 was 11 (71.4%). While in control group, co-expression samples in both fallopian tubal epithelium and cervical mucus samples in biovar 1 was 18 (81.8%), and in biovar 2 was 5 (71.4%). There was no significant difference between the two groups in co-expression in both fallopian tubal epithelium and cervical mucus samples (P > 0.05). (2) The fallopian tubes infected by biovar 2 have a high rate (90%) of ciliary adhesion and exuviation. While there is a low rate (10%) for biovar1 with ciliary adhesion and exuviation. There was significant difference between the two groups of Uu (P < 0.05). CONCLUSION: The infection of ureaplasma urealyticum may increase the occurrence of fallopian pregnancy. The infection of ureaplasma urealyticum may be concerned with the morphological changes and functional damage of uterine fallopian epithelium.

[Outcome analysis of stage III - IV endometriosis after conservative surgery].

OBJECTIVE: To analyze the recurrence and fertility outcome of stage III - IV endometriosis after conservative surgery. METHODS: A retrospective study was performed on 90 women with stage III - IV endometriosis who had been diagnosed by pathology after conservative surgery. They were divided into three groups: 16 without endocrine therapy (Group A), 52 treated with gestrinone (Group B), 22 treated with gonadotropin releasing hormone agonist (GnRHa) (Group C). The number of infertile patients in the three groups was 10, 15 and 10, respectively. The recurrent and pregnant outcomes were compared after a median follow-up of 48.5 months (2 - 7 years). RESULTS: The recurrent rate of groups A, B, and C was 18.8% (3/16), 30.8% (16/52) and 13.6% (3/22), respectively (P = 0.247); the recurrent time in the three groups were Group A: 63.8 months, Group B: 63.3 months, and Group C: 47.6 months (P = 0.376). There were no significant differences in pregnant outcome among the three groups. The cumulative pregnant rates were 70.0% (7/10), 66.7% (10/15) and 60.0% (6/10), respectively (P = 0.890). There was also no difference in the first pregnant interval after surgery (P = 0.092) and 65.2% of the patients acquired pregnancy spontaneously in the first year after surgery. CONCLUSIONS: Neither gestrinone nor GnRHa can prolong the recurrent time or reduce the recurrent rate after conservative surgery. Surgery can improve the fertility ability of stage III and IV endometriosis patients; however, the pregnant rate cannot be improved with endocrine therapy after conservative surgery.

[Evaluation of transposed ovarian function in young women with cervical cancer].

OBJECTIVE: To evaluate the function of transposed ovary and its affecting factors in young women with cervical cancer. METHODS: The patients of cervical cancer who were admitted into Peking University People's Hospital during September 1999 to January 2004 and underwent ovarian transposition in peritoneal cavity, were followed regularly and analyzed retrospectively. The questionnaire of climacteric symptoms and sexual activity were designed and delivered to all patients. Serum levels of estradiol and follicle-stimulating hormone (FSH) were measured and transposed ovaries were observed with B ultrasound post operation. RESULTS: The climacteric symptoms of patients who received transposed ovary unilaterally or bilaterally were not difference significantly at the mean follow-up times of 14.2 and 17.4 months, respectively (P > 0.05). However, of the patients who underwent adjuvant radiotherapy and/or chemotherapy post-surgery, climacteric symptoms were significantly more common (85%) than without adjuvant therapy (13%) (P < 0.05). Serum estradiol, and FSH levels and climacteric symptoms of the patients, who received adjuvant radiotherapy, had no significant difference between the ovaries transposed 2 cm above and 2 cm below anterosuperior horizontal iliac spine. CONCLUSIONS: Transposed ovary to peritoneal cavity could preserve the function of ovary. Once the patients undergo adjuvant radiotherapy, the function of transposed ovary will be affected wherever the transposed ovary locates 2 cm above or below anterosuperior horizontal iliac spine.

[Clinical management and prognostic analysis of primary peritoneal neoplasms].

OBJECTIVE: To investigate the clinical management strategies and prognostic factors of primary peritoneal neoplasms. METHODS: We retrospectively reviewed the clinical and pathological records of 24 cases with primary peritoneal neoplasms treated in the People's Hospital, Peking University during May 1995 and April 2004. RESULTS: Among 24 cases, 15 patients were diagnosed as serous papillary adenocarcinoma (9 highly and intermediately differentiated, and 6 lowly differentiated), 6 as mixed epithelial carcinoma and 3 as mixed malignant Mullerian tumor (MMMT). All patients underwent cytoreductive surgery, 21 cases having, suboptimal debulking one. Then they received a platinum-based chemotherapy. Thirteen cases received paclitaxel + cisplatin (TP) and 9 received cisplatin + doxorubicin + cyclophosphamide (PAC) combination chemotherapy. The primary response reached 80% (complete response 55% and partial response 25%). The median survival of all patients was 42 months (95% CI = 22-62 months). Survival for patients with primary peritoneal serous papillary carcinoma (PPSPC), mixed epithelial carcinoma and MMMT was 44, 19 and 13 months respectively, with a significant difference between PPSPC and MMMT (P < 0.05). Patients receiving TP combination also exhibited longer survival than those receiving PAC regimen (mean survival 75 vs 28 months, P < 0.05). CONCLUSIONS: Patients with primary peritoneal neoplasms should be treated with appropriate cytoreductive surgery. A primary surgical protocol is bilateral salpingo-oophorectomy and omentectomy. Overestimating an optimal debulking surgery may have no benefit on the survival. TP combination therapy may bring longer survival than PAC regimen. Histopathologic types and chemotherapy regimens are the essential factors of the prognosis.