Effect of non-mechanical bowel preparation on postoperative gastrointestinal recovery following surgery on malignant gynecological tumors: A randomized controlled trial.

OBJECTIVE: To investigate the efficacy and safety of non-mechanical bowel preparation (non-MBP) in patients undergoing surgery for malignant gynecological tumors. METHODS: Patients undergoing surgery for a gynecological malignancy (n = 105) were randomized to receive mechanical bowel preparation (MBP) or non-MBP. Parameters indicating postoperative gastrointestinal function recovery were the primary outcomes. The secondary outcomes included the number of postoperative complaints, the plasma levels of D-lactate and diamine oxidase (DAO), ease of visualization of the surgical field, involuntary defecation during surgery, operation time, wound healing, surgical site infection, length of hospital stay, and tolerance to MBP. RESULTS: The participants in the non-MBP group exhibited shorter time intervals until the first postoperative bowel movement (27.87 vs. 29.48 h), first passage of flatus (50.96 vs. 55.08 h), and first passage of stool (75.94 vs. 98.50 h) compared with the MBP group, while they also exhibited fewer postoperative gastrointestinal symptoms, including nausea (18.9% vs. 38.5%), vomiting (26.4% vs. 51.9%), abdominal pain (34.0% vs. 78.9%), and bloating (3.8% vs.26.9%). The plasma D-lactate and DAO levels were significantly increased following bowel preparation compared with the baseline levels in the MBP group (2.93 vs. 5.68 nmol/mL and 20.46 vs. 54.49 ng/mL, respectively), but no such differences were observed in the non-MBP group. Compared with the MBP group, surgical field visualization was superior (92.45% vs. 78.85%), and the operation time was shorter (173.58 vs. 203.88 min) in the non-MBP group. The patients undergoing MBP complained of bloating (182.35%), an unpleasant taste (78.43%), sleep disturbance (70.59%), nausea (68.63%), abdominal pain (64.71%), vomiting (45.10%), polydipsia (33.33%), dizziness (25.49%), and headache (7.84%). CONCLUSIONS: The use of non-MBP in patients undergoing surgery for gynecological malignancies is more conducive to the postoperative recovery of gastrointestinal function.

Inhibition of invasion and metastasis in choriocarcinoma by migration and invasion inhibitory protein.

INTRODUCTION: Choriocarcinoma is a highly invasive gynaecologic malignancy. Molecular mechanism of metastasis in choriocarcinoma is poorly understood. Migration and invasion inhibitory protein (MIIP) regulates cell migration and invasion. Therefore, we aimed to elucidate the function of MIIP in choriocarcinoma. METHODS: Choriocarcinoma cell lines, JAR and JEG-3, were transfected with lentivirus carrying the MIIP-interfering RNA (to downregulate MIIP expression) or left untransfected (negative control). Cell migration and invasion were studied using transwell migration assays and scratch assays. In vivo tumour burden was studied using tumour xenograft models in specific-pathogen-free nude mice and live imaging. We elucidated possible molecular signalling pathways using western blotting. RESULTS: In transwell migration and scratch assays MIIP-downregulated JAR and JEG-3 cells migrated and invaded faster compared to their respective negative control cells. Migration and invasion by the MIIP-upregulated SWAN cells was slower than that by negative control SWAN cells. Live imaging revealed that bioluminescence values were higher in MIIP-downregulated tumours than in the negative control tumours. Mice with MIIP-downregulated tumours had higher serum human chorionic gonadotropin (HCG) levels than those with negative control tumours. The MIIP expression was negatively correlated with that of histone deacetylase (HDAC6) and positively correlated with that of acetylated α-tubulin. DISCUSSION: Thus, MIIP-by inhibiting cellular motility in choriocarcinoma-acts as a tumour suppressor gene. This highlights a potential therapeutic target for refractory choriocarcinoma. Additionally, HDAC6 and acetylated α-tubulin may be involved in the regulatory effects of MIIP on the biobehaviour of choriocarcinoma cells.

Safety and feasibility of oral carbohydrate consumption before cesarean delivery on patients with gestational diabetes mellitus: A parallel, randomized controlled trial.

AIM: To investigate the safety and feasibility of taking low-concentration carbohydrate solution at 2 h before induction of anesthesia for gestational diabetes mellitus (GDM) patients. METHODS: GDM patients undergoing cesarean section were randomly assigned to experimental group (n = 43) and control group (n = 42). Two hours before induction of anesthesia, participants in experimental group orally received 300 mL low-concentration carbohydrate solution, while those in control group received equivalent warm water. Blood glucose and serum insulin were measured at 2 h before induction of anesthesia, right before induction of anesthesia, and the morning of postoperative day 1. Neonatal blood glucose level was monitored at birth. Maternal gastrointestinal function and well-being were assessed perioperatively. RESULTS: The levels of blood glucose and serum insulin right before induction of anesthesia in the experimental group were significantly higher than those in the control group. There were four cases with hypoglycemia in the experimental group and 19 cases in the control group right before induction of anesthesia (9.3% vs 45.2%, p < 0.001). The incidence of neonatal hypoglycemia was 2.3% in the experimental group and 7.1% in the control group with no significance. Hunger score of the participants between the two groups right before induction of anesthesia was significantly different. No aspiration, nausea, and vomiting occurred in both groups before, during, and after surgery. No significant difference was found in the time to the first flatus and abdominal distension between the two groups. CONCLUSION: Taking low-concentration carbohydrate solution is safe and feasible for patients with GDM undergoing elective cesarean section.

Perioperative nursing care of a patient with urogenital sinus malformation who underwent vaginal calculus removal and correction: a case report.

Cases of urogenital sinus malformation with a huge calculus are complex and rare. Improper nursing care of these cases can lead to a series of problems. We report here a 23-year-old married woman who was admitted to hospital because of primary amenorrhea and failed sexual intercourse for 5 years. Through combined diagnosis and treatment of radiology, ultrasound, urology, gynecology, and other disciplines, the patient was diagnosed with urogenital sinus malformation, a vaginal calculus, and primary amenorrhea. After full preparation, the patient underwent an operation for extraction of the vaginal calculus, urethroplasty, vaginoplasty, and hysteroscopy. The calculus of the patient was removed and the vagina was returned to its normal anatomy. Patients with urogenital sinus malformation and a huge calculus have complex care requirements and experience a particular state of vulnerability during the diagnostic phase. By establishing good communication with patients and providing proper perioperative nursing, physiological and psychological rehabilitation of these patients can be achieved.

Whole-exome sequencing reveals genetic variants in ERC1 and KCNG4 associated with complete hydatidiform mole in Chinese Han women.

Complete hydatidiform mole (CHM) is a rare pregnancy-related disease with invasive potential. The genetics underlying the sporadic form of CHM have not been addressed previously, but maternal genetic variants may be involved in biparental CHM. We performed whole-exome sequencing of 51 patients with CHM and 47 healthy women to identify genetic variants associated with CHM. In addition, candidate variants were analyzed using single base extension and Matrix Assisted Laser Desorption/Ionization-Time of Flight Mass Spectrometry in 199 CHM patients and 400 healthy controls. We validated candidate variants using Sanger sequencing in 250 cases and 652 controls, including 205 new controls. Two single nucleotide polymorphisms, c.G48C(p.Q16H) inERC1 and c.G1114A(p.G372S) in KCNG4, were associated with an increased risk of CHM (p<0.05). These variants may contribute to the pathogenesis of CHM and could be used to screen pregnant women for this genetic abnormality.

Gum chewing combined with oral intake of a semi-liquid diet in the postoperative care of patients after gynaecologic laparoscopic surgery.

AIM AND OBJECTIVES: To evaluate the effects of gum chewing combined with a semi-liquid diet on patients after gynaecologic laparoscopic surgery. BACKGROUND: Previous studies suggested that chewing gum before traditional postoperative care promotes the postoperative recovery of bowel motility and function after open and laparoscopic surgery. However, gum chewing combined with a semi-liquid diet has not been reported in postoperative care of patients following gynaecologic laparoscopic surgery. DESIGN: A prospective randomised study. METHODS: Total 234 patients were randomly assigned after elective gynaecologic laparoscopic surgery to a gum chewing and semi-liquid diet group, a semi-liquid only diet group or a liquid diet group. The gum chewing and semi-liquid diet group chewed sugar-free gum with an oral intake of a semi-liquid diet six hours postoperatively. The semi-liquid only diet and liquid diet groups received a semi-liquid diet or a liquid diet, respectively. The time to first bowel sounds, time to first regular postoperative bowel sounds, time to first passage of flatus, time to first defecation, serum gastrin and incidences of hunger, nausea, vomiting and abdominal distension were recorded. Hunger and gastrointestinal sensations were assessed using a four-point scale. Serum gastrin was assayed pre- and postoperatively using a gastrin radioimmunoassay kit. RESULTS: The gum chewing and semi-liquid diet group had first bowel sounds, first regular bowel sounds, first passage of flatus and first defecation earlier than the semi-liquid only and liquid groups. Increased serum gastrin was observed in the gum chewing and semi-liquid diet group. Incidences of nausea, vomiting and abdominal distention were not significantly different between these groups. CONCLUSION: Chewing gum combined with an oral intake of a semi-liquid diet is safe and accelerates the postoperative recovery of bowel function. It might be recommended as a better postoperative care regimen for patients after gynaecologic laparoscopic surgery. RELEVANCE TO CLINICAL PRACTICE: This study developed a new postoperative diet regimen to improve the postoperative care of patients undergoing laparoscopic gynecologic surgery.

Residual disease and risk factors in patients with high-grade cervical intraepithelial neoplasia and positive margins after initial conization.

BACKGROUND: The purpose of this study was to determine the clinicopathologic predictors of residual disease in patients with high-grade cervical intraepithelial neoplasia (CIN) and margin involvement after initial conization. METHODS: Data from 145 patients who underwent subsequent surgery for high-grade CIN with positive margins were retrospectively analyzed. RESULTS: After subsequent surgery, residual disease was diagnosed in 47 (34.2%) patients, of whom five had invasive cervical carcinoma, 31 had CIN 3, nine had CIN 2, and two had CIN 1. Multivariate analysis revealed that only age ≥35 years (P=0.033), major abnormal cytology (P=0.002), and pre-cone high-risk human papillomavirus load ≥300 relative light units (P=0.011) were significant factors associated with residual disease. CONCLUSION: Age ≥35 years, major abnormal cytology, and pre-cone high-risk human papillomavirus load ≥300 relative light units were the only significant factors predicting post-cone residual disease. Appropriate application of these predictive factors may avoid delayed treatment and overtreatment.

Women's knowledge of human papillomavirus (HPV) and their attitudes toward HPV vaccine: preparing for HPV vaccination in China.

To explore women's knowledge of human papillomavirus (HPV) and attitudes toward the HPV vaccine in Zhejiang, China, women attending the checkup clinics were invited to participate. A questionnaire-guided interview was conducted with a representative sample of 1490 women, and 1432 effective questionnaires were obtained. The authors found 39.1% of women in urban areas and 27.1 % in rural areas had heard of HPV, whereas 23.7% and 15.1%, respectively, had heard of the HPV vaccine. The mean score of HPV knowledge was 3.75 in urban areas and 3.18 in rural areas, with a significant difference (P = .016). Of the sample who had heard of the HPV vaccine, the supportive mean score was 2.59 and 2.11, with a significant difference (P = .003). Women with more HPV knowledge were more likely to support the HPV vaccination (r = 0.50 and r = 0.61). The authors conclude that inadequate knowledge and misconceptions about HPV are common. Attitudes toward HPV vaccine are unsatisfactory. Education campaigns targeting different populations are needed prior to the introduction of an HPV vaccine.

[Value of serum CA(125) detection for predicting recurrence and prognosis in ovarian epithelial cancer].

OBJECTIVE: To analyze the association of serum CA(125) level at the different phases with recurrence and survival, for providing simple and efficient methods about predicting recurrence and prognosis in epithelial ovarian cancer. METHODS: The clinical-pathological data from 151 patients were collected, who were histologically confirmed as primary ovarian cancer between Jan 2002 and Dec 2005. All the patients were followed up. The relationship between serum CA(125) level at different phases and clinical-pathological data were analyzed, including prognostic associated factors, 2-year or 5-year recurrent rate, 5-year survival rate, progression-free survival times, and overall survival times. RESULTS: Serum CA(125) level at pre-surgery and the end of 3-course chemotherapy were associated with most of the clinical-pathological parameters, included stage, pathological grade, amount of ascites, residual tumor size, type of recurrence, 2-year and 5-year recurrent rate, and 5-year survival rate (all P < 0.05). Progression-free survival and overall survival times were shorter in the patients with higher CA(125) level at pre-surgery or abnormal CA(125) level at the end of 3-course chemotherapy (P < 0.01). There was no relationship between the ratio of CA(125) level at pre- and post-surgery and recurrence or prognosis (all P > 0.05). CONCLUSION: Serum CA(125) level at pre-surgery and the end of 3-course chemotherapy can be used for predicting the recurrence and prognosis of epithelial ovarian cancer.

Early oral intake after intra-abdominal gynecological oncology surgery.

To explore and evaluate the safety and efficacy of early oral intake following major abdominal gynecological oncology surgery. During an 11-month period, 60 gynecological oncology patients undergoing major intra-abdominal surgery were enrolled in a randomized controlled clinical trial of semiliquid diet (experimental group) compared with clear feeds (control group) 6 hours after operation. Patients were evaluated for nausea, vomiting, bowel sound, passage of flatus, body weight difference before and after operation, urine acetone, fasting blood sugar, and prealbumin level, and need for nasogastric tube decompression. There were significantly higher incidences of nausea, shorter time of regular diet resumption, and higher level of prealbumin on postoperative day 7 in patients from the experimental group than those from the control group (P < .05). No significant differences were found in vomiting, the time to development of bowel sound and passage of flatus, body weight difference before and after operation, urine acetone and fasting blood sugar on postoperative day 1, and prealbumin level on postoperative day 2 between the 2 groups. Early oral intake with semiliquid diet 6 hours after major intra-abdominal gynecological oncology surgery is safe and well tolerated.

[Single methotrexate chemotherapy for low-risk gestational trophoblastic tumor].

OBJECTIVE: To investigate the efficacy and toxicity of methotrexate (MTX) give intravenously in the primary treatment of gestational trophoblastic tumor (GTT). METHODS: A total of 37 patients with low-risk GTT was primarily treated by single MTX in Women's Hospital, School of Medicine, Zhejiang University. Data on the patients' age, clinical stage, WHO classification criteria, antecedent pregnancy, presenting level of human chorionic gonadotropin, courses of chemotherapy required to achieve complete remission, and toxicity related to chemotherapy treatments were collected. RESULTS: Thirty-seven patients with low-risk GTT totally received 137 cycles of MTX between Oct. 1999 and Sep. 2002, 34 patients (91.9%) achieved complete remission. Twenty-nine patients received multiple courses of MTX, complete remission was induced in 26 patients (89.7%). The complete response rates of I stage and III stage were 100.0% and 70.0% (P = 0.03) respectively in patients who were received multiple courses of MTX. However, eight patients received single course of chemotherapy, 7 patients achieved complete remission, and 1 achieved complete remission after another additional course of MTX was conducted. Grade III side effects (WHO criteria) only appeared in 7 courses (5.1%) during MTX treatment. Follow-up data showed that only one patient with single course of chemotherapy relapsed after 6 months. CONCLUSION: Single MTX chemotherapy may be effective and well tolerated for low-risk GTT.