Focused Ultrasound Ablation Surgery combined with ultrasound-guided suction curettage in the treatment and management of Cesarean Scar Pregnancy.

OBJECTIVE: To evaluate the feasibility, safety, and effectiveness of Focused Ultrasound Ablation Surgery (FUAS) combined with ultrasound-guided suction curettage in the management of Cesarean Scar Pregnancy (CSP). STUDY DESIGN: We retrospectively analyzed 52 patients with CSP from April, 2017, to December, 2019. All the patients received one session of FUAS, and suction curettage under ultrasound guidance was performed 1-3 days after FUAS. The intraoperative blood loss in suction curettage, duration of vaginal bleeding after curettage, reproductive outcomes, and adverse effects were recorded and analyzed. RESULTS: All the 52 patients completed one session of FUAS combined with suction curettage without serious adverse effects. The mean intraoperative blood loss was 32.81 ± 53.83 mL. 47 (90.38 %) patients had a successful suction curettage with a blood loss of less than 80 mL. 5 (9.62 %) patients had an active bleeding of ≥80 mL; however, the bleeding was stopped effectively by Foley's urinary catheter and no evident bleeding presented when the catheter was removed 24 h later. The mean duration of vaginal bleeding was 7.88 ± 4.24 days. 48 (92.30 %) patients recovered with little vaginal bleeding after curettage. 4 (7.69 %) type III CSP patients experienced late-onset severe bleeding and required UAE or surgery. During 6-36 months of the follow-up period, 12 patients expressed reproductive plan, in which 4 patients delivered by cesarean section, 3 patients had an ongoing pregnancy and 1 patient had an abortion in the early pregnancy. CONCLUSIONS: FUAS combined with ultrasound-guided suction curettage is a safe and effective treatment strategy in the management of CSP type I and CSP type II and is particularly advantageous for CSP patients with reproductive requirements. However, further studies are warranted to determine the meticulous inclusion criteria for patients with type III CSP.

Diagnosis and treatment of uterine sarcoma: A multicenter, real-world study in western China.

ABSTRACT: A detailed understanding of the diagnosis and treatment of uterine sarcoma in the real world is required due to its low incidence, high malignancy, lack of specific symptoms, and lack of high-level evidence supporting its clinical diagnosis and treatment. This study aimed to provide a basis for the standardized diagnosis and treatment of uterine sarcoma. It retrospectively analyzed the real-world data on the diagnosis, treatment, and prognosis of uterine sarcoma in western China.The clinical and pathological data of patients with uterine sarcoma diagnosed and treated between January 2009 and January 2019 in 13 medical centers from 4 western provinces of China, Sichuan, Guangxi, Shaanxi, and Xinjiang, were collected and further examined by univariate and multivariate analyses to find possible risk factors affecting the prognosis of uterine sarcoma.A total of 299 patients with various pathological types of uterine sarcoma were included, with an average age of 47.7 ±â€Š11.1 years. The univariate and multivariate analyses showed that age (P = .0081), family history (P = .0358), and chemotherapy regimen (P = .0005) significantly correlated with progression-free survival; while age (P = .0393) and International Federation of Gynecology and Obstetrics staging (P = .0141) significantly correlated with overall survival.As age increased, the risk of death in patients with uterine sarcoma increased; The disease tended to progress faster in lower-age patients. A family history of tumors had an impact on disease progression; however, the way in which it affected needs further exploration. Different chemotherapy regimens affected the patient's disease progression. This study suggested that the anthracycline chemotherapy regimen was slightly better.

[Proliferation and apoptosis effect of rosiglitazone on human ovarian cancer cell line SKOV3].

OBJECTIVE: To study the effect of PPARgamma, activated by Rosiglitazone (RSG), on the regulation of cell cycle and apoptosis in human ovarian cancer cell line SKOV3. METHODS: SKOV3 was treated with various levels of RSG (0.1, 1.0, 10 and 100 micromol/L), its proliferation was evaluated by MTT assay, apoptosis was determined by Hoechst33258 fluorescence and PI staining flow cytometry, and cell cycle analyzed by flow cytometry, respectively. The expression of PPARgamma, c-myc mRNA and protein were investigated by means of RT-PCR and immunocytochemistry respectively. RESULTS: MTT assay indicated that RSG could inhibit the proliferation of SKOV3 in a concentration-dependent and time-dependent pattern. PI staining flow cytometry data demonstrated that the apoptosis of SKOV3 and cell cycle was arrested at G1 stage induced by RSG in a concentration-dependent manner, after 24h inducing with RSG at the concentration of 10, 100 micromol/L, the apoptosis rates were 45.75% and 51.97% respectively, which were significantly higher than that of control group. Hoechst33258 fluorescence staining demonstrated that the apoptosis bodies were found in the SKOV3 treated with RSG. RT-PCR and immunocytochemistry indicated human ovarian cancer SKOV3 cells expressed PPARgamma. PPARgamma mRNA and protein expression increased, while c-myc mRNA and protein expression decreased in SKOV3 cells treated with RSG after 24 h. (P < 0.05). CONCLUSIONS: RSG significantly inhibits SKOV3 survival and induces its apoptosis by stoppage in G1 phase. The effect of growth inhibition is associated with downregulating expression of c-myc mRNA and protein via activation of PPARgamma.

Upregulation of the BDNF/TrKB pathway promotes epithelial-mesenchymal transition, as well as the migration and invasion of cervical cancer.

Brain-derived neurotrophic factor (BDNF) has previously been demonstrated to be associated with several types of cancer. In addition, its receptor, tropomyosin related kinase B (TrkB) is involved in tumor invasion and metastasis. Epithelial-mesenchymal transition (EMT) is associated with metastasis in cancers. Thus, The aim of the present study was to examine whether BDNF/TrKB expression is linked to a poor survival and the acquisition of the EMT phenotype in cervical cancer. We found that a high positive expression of BDNF/TrKB was associated with poor survival in cervical cancer. Our results revealed that high expression levels of BDNF/TrKB were observed in cervical cancer compared to normal cells. Importantly, we demonstrated that the silencing of TrKB suppressed the activation of EMT via the downregulation of N-cadherin, vimentin, matrix metalloproteinase (MMP)2 and MMP9, and the upregulation of E-cadherin and tissue inhibitor of metalloproteinases (TIMP)2, which resulted in suppressed cell proliferation, migration and invasion. Furthermore, high phosphorylation levels of ERK and Akt were observed in the cervical cancer cells, while these levels were decreased in the cells in which TrKB was knocked down. On the whole, these findings suggest that the BDNF/TrKB pathway is a promising target for the prevention of tumor proliferation, invasion, metastasis and EMT in cervical cancer cells.

Proliferative role of BDNF/TrkB signaling is associated with anoikis resistance in cervical cancer.

Brain­derived neurotrophic factor (BDNF) is known as one of the members of the neurotropin family. BDNF­induced activation of its receptor tyrosine kinase B (TrkB) is associated with anoikis tolerance, tumor progression and poor prognosis in many types of malignancy. However, to the best of our knowledge, there are no reports describing the contribution of the BDNF/TrkB axis to cervical cancer. BDNF and TrKB expression in cervical cancer (CC) tissues and adjacent normal tissues from 87 patients were analyzed by immunohistochemistry, western blot analysis and quantitative PCR assays and the results showed that they were significantly higher in cancer tissues than that in normal adjacent tissues, respectively. Higher expression rates of BDNF and TrKB were observed in stage IIB or higher and BDNF expression was positively associated with lymph node metastasis. Notably, a high expression of TrKB may be contributed to poor survival time, which confirmed by Kaplan­Meier analysis. Compared to the corresponding CC cell lines, HeLa, SiHa, CASKI, C4­1 and C­33a, BDNF and TrKB expression was enhanced in anoikis­like apoptotic tolerance (AAT), a cell model established from cervical cancer cell lines. AAT cells showed a higher proliferation activity compared with CC cell lines, which was confirmed by a shorter G0/G1 phase, elevated cyclin A, cyclin D1 and c­myc, decreased caspase­3 and Bax, and increased Bcl­2. By contrast, the knockdown of TrKB expression reversed these changes in AAT cells, induced G0/G1 arrest and suppressed proliferation activity. The results of the present study show that PI3K/Akt signaling is involved in the BDNF/TrKB­induced proliferation of AAT cells in cervical cancer. These findings indicate that BDNF/TrKB pathway is a potential target for the treatment of cervical cancer.