Clinical efficacy analysis of different therapeutic methods in patients with cesarean scar pregnancy.

OBJECTIVE: The purpose of this study was to analyze the clinical efficacy of five therapeutic strategies in patients with CSP. MATERIALS AND METHODS: A total of 135 CSP patients were included and divided into five groups based on the treatment they received, including transvaginal resection (Group A), laparoscopic resection (Group B), uterine arterial embolization (UAE) combined with hysteroscopic curettage (Group C), UAE combined with uterine curettage (Group D), and hysteroscopic curettage (Group E). To investigate the clinical efficacy of these strategies, intraoperative bleeding, serum ß-hCG levels and recovery time, menstruation recovery time, hormone levels at 1 month after treatment. RESULTS: Patients in group A had the lowest postoperative serum ß-hCG levels, and the shortest recovery times of both serum ß-hCG and menstruation, followed by patients in group B. Group C and D had small amount of blood loss. The hospital stays and costs were low in group E. In addition, the sex hormone levels showed no significant difference among the five groups. CONCLUSION: Our results indicated that resection surgery and UAE have good curative effects, but high hospital costs in CSP treatment. The selection of an optimal treatment regimen for CSP should be carried out based on specific conditions of the patients.

[Correlation of retinol binding protein 4 expression in maternal serum and subcutaneous adipose tissue with insulin resistance in gestational diabetes mellitus.].

OBJECTIVE: To investigate the expression of retinol binding protein 4 (RBP-4) in maternal serum and subcutaneous adipose tissue and its relationship with insulin resistance (IR) in gestational diabetes mellitus (GDM). METHODS: From May 2008 to April 2009, 62 pregnant women who underwent elective cesarean section in the Department of Obstetrics, Affiliated Hospital of Qingdao University Medical College, were recruited, including 32 with GDM (GDM group) and 30 with normal glucose tolerance test (control group). Enzyme-linked immunosorbent assay (ELISA) was used to determine the serum concentrations of RBP-4 and radio immunoassay to measure the serum levels of fasting insulin (FINS). Fasting plasma glucose (FPG) was tested by glucose oxidase, and the Home model insulin resistance index (HOMA-IR) was calculated. Reverse transcription PCR (RT-PCR) and Western blot were applied to investigate the expression of RBP-4 mRNA and protein in subcutaneous adipose tissue. The correlations between the expression of RBP-4 mRNA and protein in subcutaneous adipose tissue and the serum RBP-4 concentrations and HOMA-IR were analyzed. RESULTS: (1) The serum concentrations of RBP-4, FINS, FPG, HOMA-IR in GDM group were significantly higher compared with the control group [(27.0 +/- 1.2) mg/L vs. (19.4 +/- 1.8) mg/L, (12.1 +/- 1.4) mU/L vs. (8.3 +/- 0.8) mU/L, (5.3 +/- 0.9) mmol/L vs. (4.1 +/- 0.6) mmol/L, 2.5 +/- 0.2 vs. 1.5 +/- 0.1, P < 0.05, respectively]. (2) The expression of RBP-4 mRNA and protein in subcutaneous adipose tissue in the GDM group were significantly higher than that of the control group (0.76 +/- 0.12 vs. 0.53 +/- 0.06, 0.74 +/- 0.09 vs 0.54 +/- 0.06, P < 0.05). (3) In the GDM group, the expression of both RBP-4 mRNA and protein in the subcutaneous adipose tissue were positively correlated with HOMA-IR (r = 0.575 and 0.851, P < 0.05). The serum concentration of RBP-4 were also positively correlated with HOMA-I (r = 0.635, P < 0.05). No correlations was found between the expressions of RBP-4 mRNA and protein in subcutaneous adipose tissue with the serume RBP-4 concentrations. CONCLUSION: High expression of RBP-4 mRNA in subcutaneous adipose tissue and the elevation of serum RBP-4 levels in GDM women may contribute to IR.