Comprehensive genomic variation profiling of cervical intraepithelial neoplasia and cervical cancer identifies potential targets for cervical cancer early warning.

BACKGROUND: To better understand the pathogenesis of cervical cancer (CC), we systematically analysed the genomic variation and human papillomavirus (HPV) integration profiles of cervical intraepithelial neoplasia (CIN) and CC. METHODS: We performed whole-genome sequencing or whole-exome sequencing of 102 tumour-normal pairs and human papillomavirus probe capture sequencing of 45 CCs, 44 CIN samples and 25 normal cervical samples, and constructed strict integrated workflow of genomic analysis. RESULTS: Mutational analysis identified eight significantly mutated genes in CC including four genes (FAT1, MLL3, MLL2 and FADD), which have not previously been reported in CC. Targetable alterations were identified in 55.9% of patients. In addition, HPV integration breakpoints occurred in 97.8% of the CC samples, 70.5% of the CIN samples and 42.8% of the normal cervical samples with HPV infection. Integrations of high-risk HPV strains in CCs, including HPV16, 18, 33 and 58, also occurred in the CIN samples. Moreover, gene mutations were detected in 52% of the CIN specimens, and 54.8% of these mutations occurred in genes that also mutated in CCs. CONCLUSION: Our results lay the foundation for a deep understanding of the molecular mechanisms and finding new diagnostic and therapeutic targets of CC.

Laparoscopic sacral hysteropexy versus laparoscopic sacrocolpopexy with hysterectomy for pelvic organ prolapse.

INTRODUCTION AND HYPOTHESIS: Treating pelvic organ prolapse (POP) with uterine conservation and sacral hysteropexy has uncertain subjective and objective outcomes. We sought to compare laparoscopic sacral hysteropexy with laparoscopic sacrocolpopexy/total laparoscopic hysterectomy (TLH with LSC). METHODS: Clinical data of 34 patients who underwent TLH with LSC and 65 patients who underwent laparoscopic sacral hysteropexy performed by the same group of surgeons between January 2008 and December 2013 were reviewed retrospectively. The primary outcome was subjective satisfaction rate based upon validated questionnaire (Patient Global Impression of Change [PGI-C]). Secondary outcomes were: anatomical cure, impact on quality of life based upon validated questionnaires (pelvic floor distress inventory-short form 20 [PFDI-20], Pelvic Floor Impact Questionnaire 7 [PFIQ-7], and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12 [PISQ-12]), surgical complications, and cost. RESULTS: After a mean follow-up of 33 months, the subjective satisfaction rate was significantly higher in the TLH with LSC cohort (92.3% vs 100%; p < 0.001). The POP-Q scores in both groups were significantly improved postoperatively. However, the anatomical cure in the two groups (72.3% vs 88.2%; p = 0.07) did not differ significantly The postoperative PFIQ-7 and PFDI-20 scores were significantly better in the TLH with LSC cohort than in the laparoscopic sacral hysteropexy cohort (p = 0.043 and p = 0.035 respectively). CONCLUSIONS: Relative to laparoscopic sacral hysteropexy, the TLH with LSC approach provides similar anatomical results, excellent patient satisfaction, and improved quality of life scores.

Laparoscopy versus laparotomy for the management of early stage cervical cancer.

BACKGROUND: The possible advantages of laparoscopic radical hysterectomy (LRH) versus open radical hysterectomy (RH) have not been well reviewed systematically. The aim of this study was to systematically review the comparative effectiveness between LRH and RH in the treatment of cervical cancer based on the evaluation of the Perioperative outcomes, oncological clearance, complications and long-term outcomes. METHODS: The systematic review was conducted by searching PubMed, MEDLINE, EMBASE, the Cochrane Library and BIOSIS databases. All original studies that compared LRH with RH were included for critical appraisal. Data were pooled and analyzed. RESULTS: A total of twelve original studies that compared LRH (n = 754) with RH (n = 785) in patients with cervical cancer fulfilled quality criteria were selected for review and meta-analysis. LRH compared with RH was associated with a significant reduction of intraoperative blood loss (weighted mean difference = -268.4 mL (95 % CI -361.6, -175.1; p < 0.01), a reduced risk of postoperative complications (OR = 0.46; 95 % CI 0.34-0.63) and shorter hospital stay (weighted mean difference = -3.22 days; 95 % CI-4.21, -2.23 days; p < 0.01). These benefits were at the cost of longer operative time (weighted mean difference = 26.9 min (95 % CI 8.08-45.82). The rate of intraoperative complications was similar in the two groups. Lymph nodes yield and positive resection margins were similar between the two groups. There were no significant differences in 5-year overall survival (HR 0.91, 95 % CI 0.48-1.71; p = 0.76) and 5-year disease-free survival (hazard ratio [HR] 0.97, 95 % CI 0.56-1.68; p = 0.91). CONCLUSIONS: LRH shows better short term outcomes compared with RH in patients with cervical cancer. The oncologic outcome and 5-year survival were similar between the two groups.

Comparison of polypropylene mesh and porcine-derived, cross-linked urinary bladder matrix materials implanted in the rabbit vagina and abdomen.

INTRODUCTION AND HYPOTHESES: Our aim was to compare histological and biomechanical effects of polypropylene (PP) mesh and porcine-derived, cross-linked urinary bladder matrix (cUBM) graft materials using a rabbit vaginal and abdominal model. METHODS: Forty rabbits were implanted with PP mesh (n = 20) or cUBM (n = 20) in the vagina and abdomen. Two grafts (PP or cUBM) of the same type were placed into each site, so each rabbit had four grafts. Grafts were harvested 12 weeks later and processed for histologic analysis and biomechanical testing. RESULTS: There were high rates of two types of grafts missing in the vagina. Vaginal PP was associated with erosion reaction (67%), whereas abdominal PP and cUBM showed no sign of erosion. All patches adhered to rectus abdominis or vaginal mucosa and shrank to varying degrees, especially for PP grafts. Compared with vaginal PP, vaginal cUBM induced milder chronic inflammation response, had lower scores (P = 0.000) for inflammation response, and showed higher scores for neovascularization (P = 0.000) and fibroblastic proliferation (P = 0.002). In the abdomen, both histopathological parameters were insignificantly different (P > 0.05) between cUBM and PP. The mechanical properties of UBM did not deteriorate following implantation, whereas the ultimate tensile strength and elastic modulus of vaginal PP increased. PP had higher scores for tensile and break strength than did cUBM (P < 0.05). CONCLUSIONS: The cUBM has good biocompatibility, high ability to integrate with the vagina, and maintains mechanical properties in vivo. It may be a promising material for pelvic floor reconstruction.

Prospective randomized comparison of laparoscopic peritoneal vaginoplasty with laparoscopic sigmoid vaginoplasty for treating congenital vaginal agenesis.

INTRODUCTION AND HYPOTHESIS: The aim of this study was to compare the effectiveness and long-term anatomic and functional results of laparoscopic peritoneal vaginoplasty and laparoscopic sigmoid vaginoplasty. METHODS: From January 2002 to December 2010, 40 patients with congenital vaginal agenesis were prospectively randomized to undergo either laparoscopic peritoneal vaginoplasty (26 cases) or laparoscopic sigmoid vaginoplasty (14 cases) in 2:1 ratio. Pre- and postoperative examination findings, Female Sexual Function Index (FSFI) questionnaire responses, and sexual satisfaction rates are reported. RESULTS: All surgical procedures were performed successfully, with no intraoperative complications. The laparoscopic peritoneal vaginoplasty group had significantly less blood loss and a surgery shorter on average than the laparoscopic sigmoid colovaginoplasty group. Postoperative course was uneventful for all patients in both groups, though postoperative retention time and hospital stay were less for peritoneal vaginoplasty patients than for sigmoid vaginoplasty patients. Mean neovaginal length, excessive mucous production, sexual life initiation time, and sexual satisfaction rate were similar between groups. Patient complaints of abdominal discomfort, unusual odor from vaginal secretions, and vaginal contraction during intercourse were higher in the sigmoid colovaginoplasty group (p < 0.005 vs. peritoneal vaginoplasty). Postoperative FSFI scores did not differ significantly between groups. CONCLUSIONS: Relative to laparoscopic sigmoid colovaginoplasty, laparoscopic peritoneal vaginoplasty provides good anatomic and functional results and excellent patient satisfaction.

High levels of circulating CD34+/VEGFR3+ lymphatic/vascular endothelial progenitor cells is correlated with lymph node metastasis in patients with epithelial ovarian cancer.

AIM: Lymph node metastasis is one of the predictive factors associated with poor prognosis of epithelial ovarian cancer. To clarify the role of CD34 and vascular endothelial growth factor receptor-3-positive (CD34+/VEGFR3+) lymphatic/vascular endothelial progenitor cells (LVEPC) in patients with lymph node metastasis and epithelial ovarian cancer progression, the levels of circulating CD34+/VEGFR3+ LVEPC in epithelial ovarian cancer patients were detected. We also tested the plasma protein levels of VEGF and stromal cell-derived factor to find out their possible relationships with lymph node metastasis in our epithelial ovarian cancer cohort. MATERIAL AND METHODS: Peripheral blood samples were collected from 54 patients diagnosed as epithelial ovarian cancer, and 31 normal samples as control. The circulating levels of LVEPC were carried out by flow cytometry, and blood protein levels of biomarkers were measured by enzyme-linked immunosorbent assay (ELISA). RESULTS: The level of circulating LVEPC was significantly higher in patients with ovarian cancer compared with that of healthy controls. There was also a statistically significant correlation between LVEPC levels and surgical staging of epithelial ovarian cancer (P < 0.01). CONCLUSION: The circulating levels of bone marrow-derived LVEPC are significantly increased in epithelial ovarian cancer patients and these levels correlate with lymph node metastasis too.

Laparoscopic nerve-sparing radical parametrectomy for occult early-stage invasive cervical cancer after simple hysterectomy.

OBJECTIVE: To investigate the feasibility and surgical outcomes of laparoscopic nerve-sparing radical parametrectomy (LNSRP) and lymphadenectomy for treatment of occult early-stage invasive cervical cancer after simple hysterectomy. METHODS: From 2006 to 2010, 28 patients who were discovered to have occult early-stage invasive cervical cancer after a simple hysterectomy underwent LNSRP, upper vaginal resection, and pelvic lymphadenectomy. A retrospective analysis of these cases was performed. RESULTS: All patients underwent successful LNSRP. There was no conversion to laparotomy. The mean ± SD operation time was 173.30 ± 56.20 minutes. The mean ± SD estimated blood loss was 230.00 ± 109.55 mL. Two intraoperative complications were recorded. The median number of extracted pelvic and para-aortic lymph nodes was 23 (range, 12-36) and 7 (range, 3-15), respectively. The mean ± SD time before Foley catheter removal was 5.6 ± 2.74 days (range, 3-14 days ), and bladder voiding function recovery to grade 0 to grade 1 was observed in 26 patients (92.9%). Of the 28 patients, 3 patients received further adjuvant therapy. The median follow-up period was 38 (range, 4-62) months for all patients. No recurrence case was found in this series. CONCLUSION: Laparoscopic nerve-sparing radical parametrectomy is a therapeutic option for occult early-stage invasive cervical cancer discovered after hysterectomy. Nerve-sparing radical surgery in indicated patients may lead to optimal preservation of bladder function.

Laparoscopic nerve-sparing radical vaginectomy in patients with vaginal carcinoma: surgical technique and operative outcomes.

STUDY OBJECTIVES: To describe our technique for laparoscopic nerve-sparing radical vaginectomy and to assess the feasibility and safety of the procedure via operative outcomes. DESIGN: Retrospective study (Canadian Task Force classification II-2). SETTING: Major university teaching hospital in Chongqing, China. PATIENTS: Twelve consecutive patients with early stage vaginal carcinoma. INTERVENTIONS: Laparoscopic radical parametrectomy/vaginectomy with pelvic/paraaortic lymphadenectomy. MEASUREMENTS AND MAIN RESULTS: Nerve-sparing radical vaginectomy was completed laparoscopically without conversion to laparotomy in 12 patients with early stage vaginal cancer. Mean (SD) operative time was 158.5 (36.7) minutes, and estimated blood loss was 135.2 (62.8) mL. No intraoperative complications occurred, and no patients required blood transfusion. The number of pelvic nodes obtained was 21.2 (9.8), and of para-aortic nodes was 13. All nodes were negative for malignancy. Histologic analysis confirmed the absence of any residual cancer tissue in the margins of the parametrial tissue and vagina. The median (range) time before Foley catheter removal was 9.76 (3-14) days, and bladder void function recovery to grade 0-I was observed in 11 patients (91.7%). Neither long-term bladder voiding dysfunction nor any other long-term complications were reported. The median duration of follow-up was 28 months. One patient with stage II vaginal cancer received pelvic regional radiation therapy; the other patients did not require adjuvant therapy after the operation. All patients were included in the follow-up protocol, and there was no recurrence of disease in any patients. CONCLUSIONS: Laparoscopic radical parametrectomy/vaginectomy with pelvic/para-aortic lymphadenectomy is a therapeutic option for early stage vaginal carcinoma. Nerve-sparing radical surgery in indicated patients may lead to optimal preservation of bladder function. The technique described in this preliminary study seems to be safe and feasible, and was relatively easy to perform in our study population.

A New Process of Preparing Rice Straw-Reinforced LLDPE Composite.

To reduce the pollution resulting from discarding waste plastic film and burning straw, a new method of preparing straw-reinforced LLDPE composites was developed to utilize these wastes. The straws were first laid parallel on an LLDPE film and then rolled up. The rolls containing long straws were laid into a mat and then hot-pressed into a long straw composite board (the mass of straw accounted for 60%). Slope-cutting the straw, grinding the straw, and twisting the roll were designed to improve the physical and mechanical properties of long straw composites. Among them, slope-cutting the straw combined with twisting the roll provided the best properties. Compared to the extruded straw particle composite, the composite prepared with the new method improved the tensile strength, bending strength, impact strength, and water resistance by 358%, 151%, 416%, and 81%, respectively. Slope-cutting exposed more inner surface at the end of the straw. Scanning electron microscope observations showed that the straw inner surface was more tightly bonded with the LLDPE matrix than the outer surface. Meanwhile, the integrity of the straw was retained as much as possible, and thus greatly improved the performance of the resulting composites. Dynamic mechanical analysis, differential scanning calorimetry, and thermogravimetric analysis show that the viscous deformation of the composites prepared by the new method was reduced and the rigidity was increased, and the combination of straw and LLDPE forms a dense composite material with good interfacial bonding. It greatly slowed down the degree of its pyrolysis.

Laparoscopic sacrospinous ligament fixation for uterovaginal prolapse: experience with 93 cases.

INTRODUCTION AND HYPOTHESIS: the aim of this study was to investigate the technique, efficacy, and safety of laparoscopic sacrospinous ligament fixation (LSSLF) for patients with uterovaginal prolapse. METHODS: from May 2004 to December 2006, 93 patients underwent LSSLF at Southwest Hospital, Chongqing, China. All patients had either grade 3 or 4 uterovaginal prolapse. The surgical results and complications were evaluated. RESULTS: all patients had their surgery completed by LSSLF. The average time for LSSLF was 65 min. The average blood loss was 105 ml. Bladder was injured in four cases (4.3%). The mean follow-up was 18 onths. Of the 93 patients, 87 (93.5%) had been cured of their vault or uterovaginal prolapse. Minor postoperative complications were observed. CONCLUSIONS: LSSLF can be successfully completed in patients with uterovaginal prolapse. It is a safe and effective treatment method for patients with uterovaginal prolapse. A long-term follow-up is necessary to detect therapeutic effect and late complication.

Evaluation of the biocompatibility and mechanical properties of xenogeneic (porcine) extracellular matrix (ECM) scaffold for pelvic reconstruction.

INTRODUCTION AND HYPOTHESIS: Xenogeneic (porcine) extracellular matrix (ECM) scaffolds have been suggested as ideal biomaterials for regeneration medicine; however, ECM prepared from different tissue sources has shown distinctive biological properties. Therefore, a comprehensive understanding of biological characteristics of different tissue-derived ECM is essential in the design of scaffolds for pelvic reconstruction. METHODS: We compared the biological properties of ECM derived from different tissue sources of Bama miniature pigs as a pelvic biological patch in terms of histological structure, water absorption ability, biodegradation ability, mechanical properties, antimicrobial activity, and biocompatibility in vitro. RESULTS: Different ECM scaffolds have distinct structural differences, and all have good biocompatibility, and UBM exhibited better water uptake ability (above 500%), anti-biodegradation ability, mechanical properties, antimicrobial activity, and stem cell attachment properties than other tissue-derived ECM. CONCLUSIONS: Porcine UBM might serve as an ideal pelvic biological patch.

Endoscopic inguinal lymphadenectomy with a novel abdominal approach to vulvar cancer: description of technique and surgical outcome.

STUDY OBJECTIVE: To evaluate the feasibility and surgical outcome of a novel technique of endoscopic inguinal lymphadenectomy to treat vulvar cancer. DESIGN: Retrospective analysis performed by a single center over 2 years (Canadian Task Force classification II-2). SETTING: Major university teaching hospital. PATIENTS: The medical records for 17 consecutive patients who underwent endoscopic inguinal lymphadenectomy because of invasive vulvar cancer were retrospectively reviewed. INTERVENTION: Endoscopic inguinal lymphadenectomy was performed using a novel abdominal approach. MEASUREMENTS AND MAIN RESULTS: All patients underwent abdominal endoscopic inguinal lymphadenectomy without intraoperative complications. Median (range) operative time for the endoscopic procedure was 94 minutes, with estimated blood loss of approximately 137 mL (80-170 mL). A mean (range) of 16 (11-23) nodes were retrieved. In an additional 5 patients, pelvic node dissection was performed, with retrieval of 6 (3-11) nodes. Of the 17 patients, 2 demonstrated vulvar wound necrosis, and 1 exhibited lymphorrhea through the drain orifice. No other inguinal wound-related complications were observed. Mean postoperative hospital stay was 11 (8-19) days. All patients were followed up for more than 13 months, with no recurrence of cancer. CONCLUSIONS: Endoscopic inguinal lymph node dissection using this novel abdominal approach in patients with vulvar cancer is a safe and feasible technique that may diminish the wound-related complications associated with the standard open approach.

A 14-year multi-institutional collaborative study of Chinese pelvic floor surgical procedures related to pelvic organ prolapse.

BACKGROUND: It has been a global trend that increasing complications related to pelvic floor surgeries have been reported over time. The current study aimed to outline the development of Chinese pelvic floor surgeries related to pelvic organ prolapse (POP) over the past 14 years and investigate the potential influence of enhanced monitoring conducted by the Chinese Association of Urogynecology since 2011. METHODS: A total of 44,594 women with POP who underwent pelvic floor surgeries between October 1, 2004 and September 30, 2018 were included from 22 tertiary academic medical centers. The data were reported voluntarily and obtained from a database. We compared the proportion of each procedure in the 7 years before and 7 years after September 30, 2011. The data were analyzed by performing Z test (one-sided). RESULTS: The number of different procedures during October 1, 2011-September 30, 2018 was more than twice that during October 1, 2004-September 30, 2011. Regarding pelvic floor surgeries related to POP, the rate of synthetic mesh procedures increased from 38.1% (5298/13,906) during October 1, 2004-September 30, 2011 to 46.0% (14,107/30,688) during October 1, 2011-September 30, 2018, whereas the rate of non-mesh procedures decreased from 61.9% (8608/13,906) to 54.0% (16,581/30,688) (Z = 15.53, P < 0.001). Regarding synthetic mesh surgeries related to POP, the rates of transvaginal placement of surgical mesh (TVM) procedures decreased from 94.1% (4983/5298) to 82.2% (11,603/14,107) (Z = 20.79, P < 0.001), but the rate of laparoscopic sacrocolpopexy (LSC) procedures increased from 5.9% (315/5298) to 17.8% (2504/14,107). CONCLUSIONS: The rate of synthetic mesh procedures increased while that of non-mesh procedures decreased significantly. The rate of TVM procedures decreased while the rate of LSC procedures increased significantly. TRIAL REGISTRATION NUMBER: NCT03620565, https://register.clinicaltrials.gov.

Laparoscopic nerve-sparing radical hysterectomy with fascia space dissection technique for cervical cancer: description of technique and outcomes.

OBJECTIVES: The objectives of this study were to describe our laparoscopic nerve-sparing radical hysterectomy (LNSRH) technique and to assess the feasibility and safety of the procedure, as well as its impact on voiding function. We introduce a fascia space dissection technique in order to preserve the pelvic splanchnic nerve, the hypogastric nerve and the bladder branch of the inferior hypogastric plexus under magnification (×10.5) during laparoscopic radical hysterectomy (LRH) with pelvic lymphadenectomy. METHODS: From October 2006 to November 2009, 163 consecutive patients with cervical cancer underwent laparoscopic radical hysterectomy (LRH) and pelvic lymphadenectomy, with 82 women undergoing LNSRH with fascia space dissection technique (LNSRH group) and 81 undergoing LRH (LRH group). Data from 163 patients were prospectively collected and compared. Post-operative assessment of bladder function included the following: the time to recover the ability to void spontaneously and to achieve a post-void residual urine (PVR) volume of less than 50 ml, with urination function graded. RESULTS: The laparoscopic nerve-sparing radical hysterectomy procedure was completed successfully and was conducted safely in all of the patients. There were no conversions to open surgery in the two groups. The median operative duration in the LNSRH and the LRH groups were 163.52±34.47 min and 132.13±31.42 min, respectively. Blood loss was 142.12±62.38 ml and 187.69±68.63 ml, respectively. The time taken to obtain a post-void residual urine volume of less than 50 ml after removal of the urethral catheter was 7.42±2.35 d (5-18 d) in LNSRH group and was 16.75±7.73 d (5-35 d) in LRH group (P<0.05). The bladder void function recovery to Grades 0-I was 76 (92.7%) for the LNSRH group and 59 (72.8%) for the LRH group. A mean follow-up of 22.3 (5-42) months was adhered to, and no patient had a recurrence or metastasis. CONCLUSIONS: The technique described in this preliminary study appears to be safe, feasible, and easy in our population, with satisfactory recovery of voiding function.

Performance of Straw/Linear Low Density Polyethylene Composite Prepared with Film-Roll Hot Pressing.

Thermoplastic composites are usually prepared with the extrusion method, and straw reinforcement material must be processed to fiber or powder. In this study, film-roll hot pressing was developed to reinforce linear low density polyethylene (LLDPE) with long continuous straw stems. The long straw stems were wrapped with LLDPE film and then hot pressed and cooled to prepare straw/LLDPE composite. Extruded straw fiber/LLDPE composite was prepared as a control. The mechanical properties of these LLDPE-based composites were evaluated. The hot pressed straw/LLDPE composite provided higher tensile strength, tensile modulus, flexural strength, flexural modulus, and impact strength than the traditional extruded straw/LLDPE composite, by 335%, 107%, 68%, 57%, and 181%, respectively, reaching 35.1 MPa, 2.65 GPa, 3.8 MPa, 2.15 GPa, and 25.1 KJ/m2. The density of the hot pressed straw/LLDPE composite (0.83 g/cm3) was lower than that of the extruded straw/LLDPE composite (1.31 g/cm3), and the former had a higher ratio of strength-to-weight. Scanning electron microscopy indicated that the orientation of the straws in the composite was better with the new method. Differential scanning calorimetry tests revealed that in hot pressed straw/LLDPE composite, straw fibers have a greater resistance to the melting of LLDPE than extruded composite. Rotary rheometer tests showed that the storage modulus of the hot pressed straw/LLDPE was less affected by frequency than that of the extruded composite, and the better elastic characteristics were pronounced at 150 °C. The hot pressed straw/LLDPE composite absorbed more water than the extruded composite and showed a potential ability to regulate the surrounding relative humidity. Our results showed that straw from renewable sources can be used to produce composites with good performance.

[Laparoscopic anatomical nerve sparing radical hysterectomy for cervical cancer: a clinical analysis of 37 cases].

OBJECTIVE: To investigate feasibility of laparoscopic anatomical nerve sparing radical hysterectomy (LANSRH) used for locally advanced cervical cancer treatment and evaluate early recovery of bladder function postoperatively. METHODS: From October 2006 to September 2007, 37 cervical cancer patients with stage Ib1 to II a underwent LANSRH (LANSRH group) with pelvic lymphadenectomy matched 25 patients with cervical cancer treated by general laparoscopic radical hysterectomy (LRH, LRH group) with pelvic lymphadenectomy. The data of operating time, blood loss, numbers of lymph node, the length of resected vaginal and paracervix tissue were collected and compared. In the mean time, postoperative recovery of bladder function was evaluated. RESULTS: The laparoscopic anatomic nerve-sparing procedure was performed successfully and safely among all patients. (1) There was no remarkable difference in the following clinical parameters between LANSRH and LRH group: median operating time [(175 +/- 41) min vs. (178 +/- 30) min, P = 0.72], blood loss [(233 +/- 104) ml vs. (218 +/- 77) ml, P = 0.06], numbers of lymph nodes (13 +/- 4 vs. 15 +/- 6, P = 0.16), resected length of paracervix tissue [(3.6 +/- 0.5) cm vs. (3.7 +/- 0.6) cm, P = 0.43], resected length of vaginal tissue [(3.5 +/- 1.0)cm vs. (3.5 +/- 0.8) cm, P = 0.80]. (2) The mean time of the Foley catheter removed was (10.6 +/- 2.7) days (7 - 17 days) in LANSRH group and (17.2 +/- 4.2) days (9 - 25 days) in LRH group (P = 0.02). After Foley catheter removed, 95% (35/37) presented bladder fulfilling sense, 86% (32/37) presented automatic micturition and urination emptying in LANSRH group. However, In LRH group, 88% (22/25) presented bladder fulfilling sense, 76% (19/25) presented automatic micturition and urination emptying. The bladder void function recovery were 68% (25/37) in class 0 and 3% (1/37) in class II in LANSRH group, when compared with 40% (10/25) in class 0 and 12% (3/25) in class II in LRH group, it reached statistical difference (P < 0.05). In the mean time, there was no significant difference in Class I bladder void function recovery, which were 24% (9/37) and 48% (12/25). (3) No surgery complications and blood transfusion were observed in LANSRH and LRH group. Postoperative pathology suggested that no tumor cell invasion occurred in paracervix tissue and lymph nodes. During the range of 11 to 19 months follow-up, all patients were alive without tumor recurrence and metastasis. CONCLUSION: LANSRH is safe and feasible surgical management for cervical cancer at early stage and would improve the recovery of bladder voiding function postoperatively by sparing anatomical nerve.

Evaluation of the bioactivity about anti-sca-1/basic fibroblast growth factor-urinary bladder matrix scaffold for pelvic reconstruction.

Introduction and hypothesis: Pelvic support structure injury is the major cause of pelvic organ prolapse. At present, polypropylene-based filler material has been suggested as a common method to treat pelvic organ prolapse. However, it cannot functionally rehabilitate the pelvic support structure. In addition to its poor long-term efficiency, the urinary bladder matrix was the most suitable biological scaffold material for pelvic floor repair. Here, we hypothesize that anti-sca-1 monoclonal antibody and basic fibroblast growth factor were cross-linked to urinary bladder matrix to construct a two-factor bioscaffold for pelvic reconstruction. METHODS: Through a bispecific cross-linking reagent, sulfosuccinimidyl 4-[N-maleimidomethyl] cyclohexane-1-carboxylate (sulfo-smcc) immobilized anti-sca-1 and basic fibroblast growth factor to urinary bladder matrix. Then scanning electron microscope and plate reader were used to detect whether the anti-sca-1/basic fibroblast growth factor-urinary bladder matrix scaffold was built successfully. After that, the capacity of enriching sca-1 positive cells was measured both in vitro and in vivo. In addition, we evaluated the differentiation capacity and biocompatibility of the scaffold. Finally, western blotting was used to detect the level of fibulin-5 protein. RESULTS: The scanning electron microscope and plate reader revealed that the double-factor biological scaffold was built successfully. The scaffold could significantly enrich a large number of sca-1 positive cells both in vitro and in vivo, and obviously accelerate cells and differentiate functional tissue with good biocompatibility. Moreover, the western blotting showed that the scaffold could improve the expression of fibulin-5 protein. CONCLUSION: The anti-sca-1/basic fibroblast growth factor-urinary bladder matrix scaffold revealed good biological properties and might serve as an ideal scaffold for pelvic reconstruction.

A systematic review and meta-analysis of conventional laparoscopic sacrocolpopexy versus robot-assisted laparoscopic sacrocolpopexy.

BACKGROUND: Robot-assisted laparoscopic sacrocolpopexy (RALSC) has spread rapidly without the availability of comprehensive and systematically recorded outcome data. OBJECTIVE: To systematically review and compare the outcomes of laparoscopic sacrocolpopexy (LSC) and RALSC. SEARCH STRATEGY: PubMed and Scopus were searched for reports published from 2000 to 2014, using the search terms "robotic sacrocolpopexy," "laparoscopic sacrocolpopexy," and "sacral colpopexy." SELECTION CRITERIA: Studies were included if they directly compared the outcomes of RALSC and LSC, the sample size in each group was more than 15, the follow-up duration was longer than 3 months, and the report was in English. DATA COLLECTION AND ANALYSIS: The studies' characteristics, quality, and outcomes were recorded. Random-/fixed-effects models were used to combine data. MAIN RESULTS: Data on 264 RALSC and 267 LSC procedures were collected from seven studies. The mean operative time was longer in the RALSC group (245.9 minutes vs 205.9 minutes; P<0.001). The estimated blood loss in the two groups was similar (114.4 mL vs 160.1 mL; P=0.36). The differences in incidence of intraoperative/postoperative complications were also similar (P=0.85 vs P=0.92). The costs of RALSC were significantly higher than were those of LSC series in each of three studies (P<0.01 for all). CONCLUSIONS: The clinical outcomes of prolapse surgery are similar with RALSC and LSC, but RALSC is less efficient in terms of cost and time.

Androgen/androgen receptor axis maintains and promotes cancer cell stemness through direct activation of Nanog transcription in hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) is one of the most common and malignant cancers. The HCC incidence gets a strong sexual dimorphism as men are the major sufferers in this disaster. Although several studies have uncovered the presentative correlation between the axis of androgen/androgen receptor (AR) and HCC incidence, the mechanism is still largely unknown. Cancer stem cells (CSCs) are a small subgroup of cancer cells contributing to multiple tumors malignant behaviors, which play an important role in oncogenesis of various cancers including HCC. However, whether androgen/AR axis involves in regulation of HCC cells stemness remains unclear. Our previous study had identified that the pluripotency factor Nanog is not only a stemness biomarker, but also a potent regulator of CSCs in HCC. In this study, we revealed androgen/AR axis can promote HCC cells stemness by transcriptional activation of Nanog expression through directly binding to its promoter. In HCC tissues, we found that AR expression was abnormal high and got correlation with Nanog. Then, by labeling cellular endogenous Nanog with green fluorescent protein (GFP) through CRISPR/Cas9 system, it verified the co-localization of AR and Nanog in HCC cells. With in vitro experiments, we demonstrated the axis can promote HCC cells stemness, which effect is in a Nanog-dependent manner and through activating its transcription. And the xenografted tumor experiments confirmed the axis effect on tumorigenesis facilitation in vivo. Above all, we revealed a new sight of androgen/AR axis roles in HCC and provided a potential way for suppressing the axis in HCC therapy.

Efficacy and safety of solifenacin succinate tablets versus solifenacin succinate tablets with local estrogen for the treatment of overactive bladder in postmenopausal women--a multicenter, randomized, open-label, controlled comparison study.

OBJECTIVE: The aim of the study was to compare the effectiveness and safety of solifenacin succinate tablets alone or combined with local estrogen for overactive bladder treatment in postmenopausal women. METHODS: This multicenter, randomized, open, parallel-controlled clinical trial enrolled 104 women between January 2012 and August 2013. Participants meeting the inclusion criteria were randomized 1:1 to 12 weeks of treatment with group A (solifenacin 5 mg qd + promestriene vaginal capsules intravaginally) or group B (solifenacin 5 mg qd). Before and after 12 weeks of treatment, symptoms (urinary urgency, frequency, and urge incontinence) were analyzed. Our primary outcome was the change from baseline to the end of treatment in the mean number of voids in 24 hours. Quality of life (QoL) was assessed using International Prostate Symptom Score and Overactive Bladder Symptom Score questionnaires and safety according to the incidence of adverse events. The t test or the Mann-Whitney U test was used to compare continuous variables, and the χ(2) test or Fisher's exact test was used to compare categorical variables. RESULTS: The median decreases in the mean number of voids in 24 hours in groups A and B were 5.2. and 4.3, respectively, which were not significantly different. The median decreases in urgency episodes in groups A and B were 2.0 and 2.5, respectively. In addition, the QoL scores significantly changed in both groups (both P < 0.05). The most common adverse event was dry mouth (19.2% in both groups). CONCLUSIONS: Solifenacin with or without local estrogen was effective and safe for overactive bladder treatment in postmenopausal women. The addition of local estrogen improved subjective feelings and QoL.