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Objective To evaluate the efficacy,bleeding profile and safety of low-dose levonorgestrel-releasing intrauterine system (LNG-IUS 8) in Chinese healthy women of childbearing age.Methods A multi-center,open-label,single-arm clinical trial conducted at 16 centres in China enrolled 773 healthy women of childbearing age (mean age 31.6 years old,range 18 to 40 years old),who demanded contraception,from April 2006 to June 2013.All women placed LNG-IUS 8 for 3 years and then been followed up at 3,6,9,12,18,24,30,36 months.The efficacy variables including pregnancy rate and expulsion rate were analyzed using life table,while observing adverse events (AE) to evaluate the safety.The bleeding profile happened during the study was assessed using 90-day reference intervals (World Health Organization criteria).Results Eight pregnancies occurred among 773 women,resulting in a overall Pearl index of 0.42 per 100 women years.The 3-year cumulative pregnancy rate was 0.37 per 100 women years and the 3-year cumulative expulsion rate was 1.99 per 100 women years.The number of women with bleeding/spotting reduced and the bleeding/spotting days declined over time.Totally 219 AE were reported related to LNG-IUS 8 placements.The most common AE were vaginal bleeding (8.2％,63/773)and the ovarian cyst (6.2％,52/773).LNG-IUS 8 had an improving effect on dysmenorrhea that the percentage of women with dysmenorrhea as well as the days of dysmenorrhea decreased over time.The percentage of women satisfied or very satisfied with LNG-IUS 8 was 87.2％ (622/713).Conclusion LNG-IUS 8 is highly effective and safe for Chinese healthy women of childbearing age.
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To investigate the relationship between serum retinol-binding protein 4(RBP4) and gestational diabetes mellitus (GDM) in Chinese Han pregnant women.195 (23-42 years) pregnant women were recruited (July 2005 to December 2007) from the Department of Gynecology and Obstetric in Ruijin Hospital during their visiting for routine prenatal examination.99 subjects belonged to GDM group,and 96 belonged to the group with normal glucose tolerance (NGT).65 non-pregnant healthy women served as control.Serum RBP4 was measured using sandwich enzyme linked immunosorbent assay (ELISA).Pregnant women had higher level of serum RBP4 than that of non-pregnant control.The concentration of serum RBP4 was significantly increased in GDM group as compared with NGT group[(43.04±1.85 vs 33.84±2.17) rag/L,P<0.01].Multiple stepwise regression analysis showed that triglycerides and homeostasis assessment for insulin resistance (HOMA-IR) were independent variables of RBP4 (r2 =0.165) in pregnant women.The results suggest that serum RBP4 level is significantly increased in pregnant women.Women with GDM had even higher RBP4 level than that of normal pregnant women,and RBP4 levele was positively correlated with triglycerides and HOMA-IR.
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Objective To investigate the expression of tumor necrosis factor-alpha (TFN-α) in human villus and deciduas from different abortion. Methods From May 2008 to May 2009, 45 women with early pregnancy( <49days)were divided into three groups, medical abortion completed group ( n = 15),medical abortion uncompleted group( n = 15 )and control group( n = 15, patients with dilatation and curettage ). The villus and deciduas were collected at the third day of medical abortion or at the day of curettage.Immunohistochemical technique was carried out to examine the distribution of TNF-α in villus and deciduas of the three groups. Results The age, gestational age, diameter of gestional sac and levels of serum E2, P and B-HCG before abortion were similar in all three groups. The expression of TNF-o in villus and deciduas of the control group was lowest among three groups[(4. 75 ± 10. 22)% vs (2. 66 ±2. 57)%]. The expression of TNF-α in villus and deciduas of medical abortion completed group was highest among three groups [(26. 67 ± 7.46) % vs ( 18. 44 ± 11. 14) %, P < 0. 05]. Conclusion Appropriate amount of TNF-α exists in the normal pregnancy, mifepristone can increase the expression of TNF-α in human villus and deciduas. and disturb reproductive immunity and effect matenal-fetal interface to induce abortion.
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Objective To investigate the value of laparoscopic operations for the diagnosis and treatment of acute or chronic pelvic inflammatory diseases (PID). Methods A series of 83 patients with PID diagnosed and treated by laparoscopic technique from January 1999 to December 2003 were retrospectively analyzed. Results Conversions to open surgery were required in 2 patients because of serious pelvic adhesions. No complications were observed. The diagnostic accordance rate before and after the surgery was 63.9% (53/83): 74.3% (26/35) in patients with acute PID and 56.2% (27/48) in patients with chronic PID. Among 35 patients with acute PID, the duration of operation was 20~75 min (mean, 44.7 min) and the postoperative hospital stay was 3~12 d (mean, 6.2 d). Postoperative pyrexia occurred in 28 patients, whose temperatures returned to normal within 5 days. The blood routine examination results were restored to normal levels in 26 patients at 2 days after operation. Out of 48 patients with chronic PID, the length of operation was 20~130 min (mean, 75 min) and the postoperative hospital stay, 2~8 d (mean, 5.5 d). Postoperative pyrexia occurred in 5 patients and a complete recovery of temperature was observed within 3 days. The blood routine examinations revealed normal findings in 42 patients at 2 days after operation. Follow-up checkups for 3 months in all the patients found no relapse. Conclusions Prompt application of laparoscopic operations is of importance in increasing diagnostic accuracy, improving curative efficacy, and preventing possible complications.
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Objective To discuss the clinical value of laparoscopic myomectomy.Methods We compared clinical data of laparoscopic myomectomy(Laparoscopic Group,n=185) with open myomectomy(Open Group,n=69),from December 2002 to February 2005,in respect of operative time,hemorrhage volume,time to normal temperature,recovery time of bowel movement,and duration of hospital stay.Results Conversions to open surgery were required in 2 cases in the Laparoscopic Group because of difficulties of hemostasis.There was no significant difference in the operative time(t=1.849,P=0.066) between the Laparoscopic Group(81.3?14.7 min) and the Open Group(77.2?18.1 min).The intraoperative hemorrhage volume was significantly less in the Laparoscopic Group(101.5?36.7 ml) than in the Open Group(154.5?61.1 ml)(t=-8.397,P=0.000).Shorter time to normal temperature,recovery time of bowel movement,and hospital stay were achieved in the Laparoscopic Group(2.7?0.8 d;13.8?5.4 d;6.0?1.5 d) than in the Open Group(3.8?1.0 d;23.3?6.0 d;8.0?2.0 d),with significant difference(t=-9.064,P=0.000;t=-12.074,P=0.000;t=-8.575,P=0.000).Follow-ups were conducted in 152 cases in the Laparoscopic Group for 13.2?8.7 months,which revealed 17 cases of recurrence(11.2%) and 17 cases of pregnancy within 1 year out of 57 cases of infertility(29.8%).As compared with the Laparoscopic Group,followups were conducted in 48 cases in the Open Group for(12.5?)7.9 months(t=0.511,P=0.610),which revealed 8 cases of recurrence(16.7%;?~2=1.003,P=0.317) and 4 cases of pregnancy within 1 year out of 16 cases of infertility(25.0%;?~2=0.004,P=0.949).Conclusions Laparoscopic myomectomy has advantages of micro-invasion,little blood loss,rapid postoperative recovery,and short hospitalization.However,it cannot entirely supersede the open myomectomy.
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Objective To investigate effects of laparoscopy in the early diagnosis of atypical tubal pregnancy.Methods We retrospectively studied clinical records of 36 cases of "probable tubal pregnancy" from January 2003 to May 2005 in this hospital.All the patients were given transvaginal ultrasonography and serum ?-human chorionic gonadotropin examinations.Then laparoscopy was performed to clarify the diagnosis.The accordance rate before and after the laparoscopy was evaluated. Results After laparoscopy,26 patients were confirmed as having ectopic pregnancy(oviduct,25 patients;ovary,1 patient) and 3 patients were excluded for having ectopic pregnancy,the confirmative diagnosis rate being 80.5%(29/36).The diagnosis could not be identified with certainty in 7 patients,2 of whom were cured with radix trichosanthis and 5 of whom were afterwards clinically diagnosed as having tubal pregnancy(1 patient) or intrauterine early pregnancy(4 patients).Conclusions Laparoscopic management at proper time is the best choice in the diagnosis of ectopic pregnancy,especially in early-stage or atypical cases.
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Objective To evaluate the clinical value of laparoscopic procedure for benign ovarian diease. Methods 1387 cases of benign ovarian diease diagnosed from Jannary,1995 to February,2001 according to patient's age,history,ultrasound exam and tumor markers and laparoscopy were retrospectively analyzed in this study. Results 531 cases postoperatively diagnosed as endometriotic cyst,254 cases teratoma,139 inflammatory masses,121 serous cystademona,67 cases mucinous cystadenoma,128 parovarian,140 simple ovarian cyst,3 cases brenner tumor,1 case borderline mucinous cystadenoma,1 case mucinous cystadenocarcinoma,1 case endometrioid carcinoma and 1 case malignant brenner tumor.99.7% of preoperative diagnosis of benign ovarian diease was consistant with that done postoperatively laparoscopy were performed in All of the patients except for two cases of ovarian carcinoma,who were given laparohysterectomy. Conclusions Laparoscopic management for benign ovarian diease has much the same effect that laparotomy does.It should be encouraged to be clinically applied for it's quicker recovery,shorter hospitalization duration,less morbidity,and so on.