A novel 3D printed type II silk fibroin/polycaprolactone mesh for the treatment of pelvic organ prolapse.

Pelvic organ prolapse (POP) is one of the common diseases in middle-aged and elderly women, caused by weakened pelvic floor muscle ligament tissue support. Pelvic floor reconstruction with mesh implantation has been proven to be an effective treatment for POP. However, traditional non-degradable and inflexible pelvic floor implantation meshes have been associated with pain, vaginal infections, and the need for additional surgeries. In this study, novel meshes with pre-designed structures were fabricated with solution-based electrohydrodynamic printing (EHDP) technology, using a series of polycaprolactone/silk fibroin composites as bioinks. The PCL/SF mesh mechanical performances were particularly enhanced with the addition of silk II, leading it to obtain higher adaptability with soft tissue repair. The mesh containing SF showed more robust degradation performance in the in vitro degradation assay. Furthermore, biocompatibility tests conducted on mouse embryonic fibroblasts (NIH/3T3) revealed enhanced cell affinity. Finally, the biocompatibility and tissue repair properties of PCL/SF mesh were verified through the implantation of meshes in the muscle defect site of mice. The results demonstrated that the 3D printed PCL/SF mesh prepared by EHDP exhibits superior mechanical properties, biocompatibility, biodegradability, as well as ligament and muscle fiber repair ability. The novel implantable meshes are promising for curing POP.

STAT3 inhibitor BBI608 reduces patient-specific primary cell viability of cervical and endometrial cancer at a clinical-relevant concentration

Aberrant activation of STAT3 signal pathway promotes tumor progression in many solid tumor types, including cervical cancer and endometrial cancer. BBI608, the STAT3 inhibitor had been reported in previous studies for restraining cancer stem cells. However, whether BBI608 is available for inhibiting the proliferation of cervical cancer or endometrial cancer remains poorly understood. This study investigated the anti-tumor effect and molecular mechanism of BBI608 on the patient-specific primary cells (PSPC) generated from cervical and endometrial cancer in vitro. Methods PSPCs were obtained from four patients via biopsy. The cell viability was analyzed by the CCK8 assay. The PSPCs were treated with various concentrations of BBI608 or/and paclitaxel; and then, western blot was applied to investigate the expression of phosphorylated STAT3 (pSTAT3). Results The PSPCs cell viability was reduced after treated with BBI608 at a lower concentration. Western blot results showed a reduction trend of pSTAT3 after PSPCs treated with BBI608. Our results demonstrated that BBI608 at the certain concentrations worked well in reducing the cell viability of PSPC from the patients who suffered from cervical cancer and endometrial cancer. Conclusions In this study, the patient-specific primary cell (PSPC) was used as the pre-clinical model for investigating the efficiency of BBI608 in reducing cancer cells viability. BBI608, at a clinical-relevant concentration, had valid efficiency in PSPCs from the patients. The dose of drugs treatment and the measured results were more valuable for further guiding clinical trials (AU)

STAT3 inhibitor BBI608 reduces patient-specific primary cell viability of cervical and endometrial cancer at a clinical-relevant concentration.

PURPOSE: Aberrant activation of STAT3 signal pathway promotes tumor progression in many solid tumor types, including cervical cancer and endometrial cancer. BBI608, the STAT3 inhibitor had been reported in previous studies for restraining cancer stem cells. However, whether BBI608 is available for inhibiting the proliferation of cervical cancer or endometrial cancer remains poorly understood. This study investigated the anti-tumor effect and molecular mechanism of BBI608 on the patient-specific primary cells (PSPC) generated from cervical and endometrial cancer in vitro. METHODS: PSPCs were obtained from four patients via biopsy. The cell viability was analyzed by the CCK8 assay. The PSPCs were treated with various concentrations of BBI608 or/and paclitaxel; and then, western blot was applied to investigate the expression of phosphorylated STAT3 (pSTAT3). RESULTS: The PSPCs cell viability was reduced after treated with BBI608 at a lower concentration. Western blot results showed a reduction trend of pSTAT3 after PSPCs treated with BBI608. Our results demonstrated that BBI608 at the certain concentrations worked well in reducing the cell viability of PSPC from the patients who suffered from cervical cancer and endometrial cancer. CONCLUSIONS: In this study, the patient-specific primary cell (PSPC) was used as the pre-clinical model for investigating the efficiency of BBI608 in reducing cancer cells viability. BBI608, at a clinical-relevant concentration, had valid efficiency in PSPCs from the patients. The dose of drugs treatment and the measured results were more valuable for further guiding clinical trials.

In silico characterization of IncX3 plasmids carrying bla OXA-181 in Enterobacterales.

Carbapenem-resistant Enterobacterales poses a global urgent antibiotic resistance threat because of its ability to transfer carbapenemase genes to other bacteria via horizontal gene transfer mediated by mobile genetic elements such as plasmids. Oxacillinase-181 (OXA-181) is one of the most common OXA-48-like carbapenemases, and OXA-181-producing Enterobacterales has been reported in many countries worldwide. However, systematic research concerning the overall picture of plasmids harboring bla OXA-181 in Enterobacterales is currently scarce. In this study, we aimed to determine the phylogeny and evolution of bla OXA-181-positive (gene encoding OXA-181) plasmids. To characterize the plasmids harboring bla OXA-181 in Enterobacterales, we identified 81 bla OXA-181-positive plasmids from 35,150 bacterial plasmids downloaded from the NCBI RefSeq database. Our results indicated that diverse plasmid types harbored bla OXA-181 but was predominantly carried by IncX3-type plasmids. We systematically compared the host strains, plasmid types, conjugative transfer regions, and genetic contexts of bla OXA-181 among the 66 bla OXA-181-positive IncX3 plasmids. We found that IncX3 plasmids harboring bla OXA-181 were mostly ColKP3-IncX3 hybrid plasmids with a length of 51 kb each and were mainly distributed in Escherichia coli and Klebsiella pneumoniae. Most of the IncX3 plasmids harboring bla OXA-181 were human origin. Almost all the bla OXA-181-positive IncX3 plasmids were found to carry genes coding for relaxases of the MOBP family and VirB-like type IV secretion system (T4SS) gene clusters, and all the 66 IncX3 plasmids were found to carry the genes encoding type IV coupling proteins (T4CPs) of the VirD4/TraG subfamily. Most IncX3 plasmids harbored both bla OXA-181 and qnrS1 in their genomes, and the two antibiotic resistance genes were found to a composite transposon bracketed by two copies of insertion sequence IS26 in the same orientation. Our findings provide important insights into the phylogeny and evolution of bla OXA-181-positive IncX3 plasmids and further address their role in acquiring and spreading bla OXA-181 genes in Enterobacterales.

GALNT14 regulates ferroptosis and apoptosis of ovarian cancer through the EGFR/mTOR pathway.

Background: Chemoresistance usually occurs in ovarian cancer. We aimed to explore the mechanisms of chemoresistance. Methods: Western blotting assay was used to detect the expression of GALNT14. Further cell function experiments were performed to investigate the effect of GALNT14 in ovarian cancer. Results: GALNT14 is significantly upregulated in ovarian cancer. Downregulation of GALNT14 significantly inhibits both apoptosis and ferroptosis of ovarian cancer cells. A further mechanism assay illustrated that downregulation of GALNT14 suppresses the activity of the mTOR pathway through modifying O-glycosylation of EGFR. Finally, an additive effect promoting cell death occurs with a combination of an mTOR inhibitor and cisplatin. Conclusion: Our study might provide a promising method to overcome cisplatin resistance for patients with ovarian cancer.

Comparison between laparoscopic and abdominal radical hysterectomy for low-risk cervical cancer: a multicentre retrospective study.

PURPOSE: To compare oncological outcomes of laparoscopic radical hysterectomy (LRH) and abdominal radical hysterectomy (ARH) for low-risk cervical cancer. METHOD: We retrospectively compared the 3-year overall survival (OS) and 3-year disease-free survival (DFS) of 1269 low-risk cervical cancer patients with FIGO 2009 stage IA2, IB1 and IIA1 with a tumour size < 2 cm, no lymphovascular space invasion (LVSI), superficial stromal invasion and no lymph node involvement on imaging, and who received LRH (n = 672) and ARH (n = 597) between 2009 and 2018 at 47 hospitals. RESULTS: In the total study population, LRH and ARH showed similar 3-year OS (98.6% vs. 98.9%, P = 0.850) and DFS rates (95.7% vs. 96.4%, P = 0.285). LRH was not associated with worse 3-year OS (HR 0.897, 95% CI 0.287-2.808, P = 0.852) or DFS (HR 0.692, 95% CI 0.379-1.263, P = 0.230) as determined by multivariable analysis. After propensity score matching in 1269 patients, LRH (n = 551) and ARH (n = 551) still showed similar 3-year OS (98.4% vs. 98.8%, P = 0.704) and DFS rates (95.5% vs. 96.3%, P = 0.249). LRH was still not associated with worse 3-year OS (HR 0.816, 95% CI 0.262-2.541, P = 0.725) or DFS (HR 0.694, 95% CI 0.371-1.296, P = 0.251). CONCLUSION: Among patients with low-risk cervical cancers < 2 cm, no LVSI, superficial stromal invasion, and no lymph node involvement on imaging, no significant differences were observed in 3-year OS or DFS rates between LRH and ARH.

Comparison of survival outcomes of abdominal radical hysterectomy and radiochemotherapy IIA2 (FIGO2018) cervical cancer: a retrospective study from a large database of 63,926 cases of cervical cancer in China.

AIM: This study aimed to compare the 5-year overall survival (OS) and 5-year DFS disease-free survival (DFS) of abdominal radical hysterectomy (ARH) and radiochemotherapy (R-CT) for stage IIA2 (FIGO 2018) cervical cancer patients. METHODS: Based on this multicenter, retrospective cohort study based on data from the clinical diagnosis and treatment of cervical cancer in China (Four C) database, 609 cases with 2018 FIGO stage IIA2 cervical cancer from 2004 to 2018 were reviewed. The 5-year OS and 5-year DFS of patients with either of the two treatment methods were compared by means of a multivariate Cox regression model and the log-rank method in the total study population and after propensity score matching (PSM). RESULTS: We selected 609 of 63,926 patients and found that R-CT was associated with a significantly worse 5-year OS (71.8% vs. 95.3%, P < 0.001; hazard ratio (HR) = 6.596, 95% CI 3.524-12.346) and 5-year DFS (69.4% vs. 91.4%, P < 0.001; HR = 4.132, 95% CI 2.570-6.642, P < 0.001) than ARH in the total study population. After matching (n = 230/230), among FIGO 2018 IIA2 patients, the 5-year OS and DFS were lower in the R-CT group than in the ARH group (OS: 73.9% vs. 94.7%, P < 0.001; HR = 5.633, 95% CI 2.826-11.231, P < 0.001; DFS: 69.2% vs. 91.1%, P < 0.001; HR = 3.978, 95% CI 2.336-6.773, P < 0.001, respectively). CONCLUSIONS: In patients with stage FIGO 2018 IIA2 cervical cancer, ARH offers better 5-year OS and DFS outcomes than R-CT; however, due to the inherent biases of retrospective studies, this needs to be confirmed by randomized trials.

Comparison of oncological outcomes and major complications between laparoscopic radical hysterectomy and abdominal radical hysterectomy for stage IB1 cervical cancer with a tumour size less than 2 cm.

OBJECTIVE: To compare the oncological outcomes and major complications of laparoscopic radical hysterectomy (LRH) and abdominal radical hysterectomy (ARH) for stage IB1 cervical cancer (FIGO 2009) with a tumour size less than 2 cm. METHODS: We retrospectively compared the oncological outcomes and major complications of 1207 stage IB1 cervical cancer patients with a tumour size less than 2 cm who received LRH (n = 546) or ARH (n = 661) in 37 hospitals. RESULTS: (1) There was no significant difference in 3-year overall survival (OS; 97.3% vs. 98.5%, P = 0.288) or 3-year disease-free survival (DFS; 95.1% vs. 95.4%, P = 0.792) between LRH (n = 546) and ARH (n = 661).(2) The rate of any 1 complication refers to the incidence of one or more complications in a patient, which was higher with LRH than ARH (OR = 4.047, 95% CI = 2.035-8.048, P < 0.001). Additionally, intraoperative complications occurred with LRH (OR = 12.313, 95% confidence intervals [CI] = 1.571-96.493, P = 0.017), and postoperative complications (OR = 3.652, 95% CI = 1.763-7.562, P < 0.001) were higher with LRH than ARH. The ureteral injury rate was higher with LRH than with ARH (1.50% vs. 0.20%, OR = 9.814, 95% CI = 1.224-78.712, P = 0.032). The ureterovaginal fistula rate was higher with LRH than ARH. The rates of obturator nerve injury, bladder injury, vesicovaginal fistula, rectovaginal fistula, venous thromboembolism, bowel obstruction, chylous leakage, pelvic haematoma, and haemorrhage were similar between the groups. CONCLUSIONS: The oncological outcomes of LRH and ARH for stage IB1 cervical cancer patients with a tumour size less than 2 cm do not differ significantly. However, incidences of any 1 complication, intraoperative complications, and postoperative complications were higher with LRH than ARH, with complications manifesting mainly as ureteral injury and uterovaginal fistula.

Analysis of endometrial microbiota in intrauterine adhesion by high-throughput sequencing.

BACKGROUND: Intrauterine adhesions (IUA) arise from scar tissue formation between the endometrial surfaces in response to mechanical or infectious injuries. However, the potential role of endometrial microbiota in IUA remains unclear. We aimed to explore the composition of endometrial microbiota and its potential role in IUA. METHODS: We retrospectively enrolled 46 patients diagnosed with IUA and 21 infertility patients without intrauterine lesions, as control subjects. All cases were diagnosed with hysteroscopy and endometrial tissues were taken from the intrauterine cavity using a hysteroscopic cutting ring without electricity study. After endometrial samples were collected, DNA was extracted and amplified for barcoded Illumina high-throughput next-generation sequencing targeted to the 16S rRNA V4 region for microbiota. Microbiota data were compared between two groups using α-diversity, ß-diversity and Nonmetric Multidimensional Scaling based on Weighted Unifrac distance. RESULTS: At the phyla level, the dominant bacteria included Proteobacteria, Firmicutes, Bacteroidetes and Actinobacteria. Proteobacteria accounted for more than 64.48%. At the genus level, the proportions of Klebsiella, Shewanella, and Lactobacillus were higher in patients with IUA than in non- IUA participants (20.67% and 8.77%, P=0.006, 13.37% and 4.53%, P=0.175, 12.74% and 6.95%, P=0.882; respectively). The proportion of Acinetobacter was significantly lower in patients with IUA than in non- IUA participants (P=0.005). CONCLUSIONS: Endometrial microbiota differ between patients with IUA and infertility patients without intrauterine lesions, and the potential variation of endometrial microbiota might cause IUA.

CD34 and Bcl-2 as predictors for the efficacy of neoadjuvant chemotherapy in cervical cancer.

BACKGROUND: Successful neoadjuvant chemotherapy (NACT) could improve the surgical resection rate and radical curability of patients with cervical cancer, but only a subset of patients benefits. Therefore, identifying predictive biomarkers are urgently needed. The aim of this study was to evaluate the predictive value of CD34 and Bcl-2 in the NACT effectiveness of cervical cancer. METHODS: Sixty-seven patients with locally advanced cervical cancer (FIGO stages IB3, IIA2 or IIB) were classified into two groups based on effective (n = 48) and ineffective (n = 19) response to NACT. Immunohistochemistry was employed to identify CD34 and Bcl-2 expression before and after NACT. We analyzed the associations between the pre-NACT expression of these two biomarkers and the response of NACT. The expression of these two biomarkers before and after NACT was also assessed and compared. RESULTS: More patients were CD34 positive expression before NACT in effective group compared to ineffective group (p = 0.005). However, no statistically significant difference in Bcl-2 expression before NACT were found between two groups (p = 0.084). In NACT effective group, the expression of both CD34 and Bcl-2 after NACT are down-regulated (p < 0.001 and p < 0.001, respectively), while there are no statistical differences between the pre- and post-NACT expression of CD34 and Bcl-2 in NACT ineffective group (p = 0.453 and p = 0.317, respectively). CONCLUSION: The positive CD34 expression before NACT may serve as a predictive biomarker for NACT of cervical cancer, but the pre-NACT expression of Bcl-2 is not an independent predictor. The down-regulated expression of these two indicators after NACT may indicate effective NACT.

Total laparoscopic sigmoid vaginoplasty: a novel therapeutic approach.

BACKGROUND: This study aimed to evaluate the technical feasibility and outcomes of total laparoscopic sigmoid vaginoplasty (TLSV) in women with congenital absence of the vagina. METHODS: We investigated 10 women with congenital absence of the vagina, who underwent TLSV at Guangdong Provincial People's Hospital between April 2013 and July 2016. RESULTS: All 10 women were unmarried, the mean age was 22.8 (range 17-33) years, mean estimated blood loss was 149.2 ± 54.8 (60-170) mL, mean operative time was 108.4 ± 52.6 (130-210) min, mean post-operative hospital stay was 8.0 ± 2.8 (6-12) days and the mean neovaginal length was 13.4 ± 3.0 (12-16) cm. Eight of the 10 women were heterosexually active. Trocar port site infection and neovaginal stenosis occurred 3 months after TLSV in one patient; a vaginal mould was used to relieve the stenosis. CONCLUSION: TLSV is an optimal minimally invasive procedure to treat women with congenital absence of the vagina and is associated with rapid recovery and acceptable cosmetic effects.

Intratumoral levels and prognostic significance of Fusobacterium nucleatum in cervical carcinoma.

Growing evidence suggests that microbes can influence the onset of cancer and its consequent development. By researching samples from patients afflicted by cervical cancer, we aimed to explore the associated dynamics and prognostic value of intratumoral levels of F. nucleatum. We used qPCR to analyze tumor tissues obtained from 112 cervical cancer patients in order to characterize the levels and influences of intratumoral levels of the F. nucleatum. Especially for recurrent tissues, there was a distinct observation of higher levels of F. nucleatum in cervical cancer. Patients with high burdens of F. nucleatum intratumoral infiltration exhibited correspondingly poor rates of both overall survival and progression-free survival. Measures of the levels of F. nucleatum were found to have been reliable independent prognostic factors that could predict rates of PFS for afflicted patients (HR = 4.8, 95%CI = 1.2-18.6, P = 0.024). Notably, the levels ofF. nucleatum were positively correlated with tumor differentiation. Cancer cells from patients with relatively high levels of F. nucleatum were observed to possess the characteristics of cancer stem cells (CSCs). We propose that F. nucleatum might be one potential cervical cancer diagnostic and prognostic biomarker, and these findings will help to provide a sound rationale and merit for further study of this bacterium.

Predict Ki-67 Positive Cells in H&E-Stained Images Using Deep Learning Independently From IHC-Stained Images.

OBJECTIVE: To obtain molecular information in slides directly from H&E staining slides, which apparently display morphological information, to show that some differences in molecular level have already encoded in morphology. METHODS: In this paper, we selected Ki-67-expression as the representative of molecular information. We proposed a method that can predict Ki-67 positive cells directly from H&E stained slides by a deep convolutional network model. To train this model, we constructed a dataset containing Ki-67 negative or positive cell images and background images. These images were all extracted from H&E stained WSIs and the Ki-67 expression was acquired from the corresponding IHC stained WSIs. The trained model was evaluated both on classification performance and the ability to quantify Ki-67 expression in H&E stained images. RESULTS: The model achieved an average accuracy of 0.9371 in discrimination of Ki-67 negative cell images, positive cell images and background images. As for evaluation of quantification performance, the correlation coefficient between the quantification results of H&E stained images predicted by our model and that of IHC stained images obtained by color channel filtering is 0.80. CONCLUSION AND SIGNIFICANCE: Our study indicates that the deep learning model has a good performance both on prediction of Ki-67 positive cells and quantification of Ki-67 expression in cancer samples stained by H&E. More generally, this study shows that deep learning is a powerful tool in exploring the relationship between morphological information and molecular information. AVAILABILITY AND IMPLEMENTATION: The main program is available at https://github.com/liuyiqing2018/predict_Ki-67_from_HE.

Long non-coding RNA in cervical cancer: From biology to therapeutic opportunity.

Genome regions that do not for code for proteins are generally transcribed into long non-coding RNAs. Growing evidence reveals that lncRNAs, defined as transcripts longer than 200 nucleotides, are commonly deregulated in cervical malignancies. New sequencing technologies have revealed a complete picture of the composition of the human transcriptome. LncRNAs perform diverse functions at transcriptional, translation, and post-translational levels through interactions with proteins, RNA and DNA. In the past decade, studies have shown that lncRNAs participate in the pathogenesis of many diseases, including cervical cancer. Hence, illuminating the roles of lncRNA will improve our understanding of cervical cancer. In this work, we summarize the current knowledge on lncRNAs in cervical cancer. We describe the emerging roles of lncRNAs in cervical cancer, particularly in cancer progression, metastasis, treatment resistance, HPV regulation, and metabolic reprogramming. The great promises of lncRNAs as potential biomarkers for cervical cancer diagnosis and prognosis are also discussed. We discuss current technologies used to target lncRNAs and thus control cancers, such as antisense oligonucleotides, CRISPR-Cas9, and exosomes. Overall, we show that lncRNAs hold great potentials as therapeutic agents and innovative biomarkers. Finally, further clinical research is necessary to advance our understanding of the therapeutic value of lncRNAs in cervical cancer.

Chinese expert consensus on the prevention of abdominal pelvic adhesions after gynecological tumor surgeries.

Adhesion is a postoperative complication that has plagued gynecologists for many years, as 60-90% of gynecological patients develop adhesions after abdominopelvic surgeries. Abdominopelvic adhesions could lead to chronic pelvic pain, infertility, intestinal obstruction, and complicated reoperations. Adhesions might also increase the risk of postoperative chemoradiotherapy failure and endanger patients' lives, especially after surgeries for gynecological malignant tumors. The aim of this consensus was to review the pathogenesis and clinical consequences of adhesions and to summarize various surgical procedures and preventive measures that can reduce the occurrence of adhesions after gynecological tumor surgeries based on a discussion among well-known domestic gynecology specialists.

Laparoendoscopic single-site surgery compared with conventional laparoscopic surgery for benign ovarian masses: a systematic review and meta-analysis.

OBJECTIVE: We aimed to evaluate the safety, efficiency and preferred indication for laparoendoscopic single-site surgery (LESS) compared with conventional laparoscopic (CL) surgery for benign ovarian masses. DESIGN: A systemic review and cumulative meta-analysis were performed in line with the criteria of Grading of Recommendations Assessment, Development and Evaluation: levels of evidence and grades of recommendation. DATA SOURCES: We comprehensively searched the electronic databases including PubMed, Medline, Embase and the Cochrane Library in November 2018. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: We included all randomised controlled trials (RCTs) and retrospective studies published in recent 10 years, which investigated the performance of LESS versus CL in patients at all ages with benign ovarian masses. RESULTS: Four RCTs and nine retrospective studies published in recent decade including 1542 cases (744 cases for LESS and 798 cases for CL) were identified. Perioperative complication was consisted of intraoperative and postoperative complications, including ileus, wound infection or dehiscence and incisional hernia. Although LESS has less postoperative analgesic consumption (46.78% and 79.25%; OR: 0.49; 95% CI: 0.33 to 0.74, p<0.001) and shorter hospital stay (weighted mean difference (WMD): -0.24 days; 95% CI: -0.35 to -0.14; p<0.001), CL has less perioperative complications (6.59% and 2.85%; OR: 2.08; 95% CI: 1.05 to 4.11, p=0.04) and shorter operative time (WMD: 3.43 min; 95% CI: -0.03 to 6.88; p=0.05). Body mass index, history of previous abdominal surgery, size of adnexal mass, estimated blood loss and postoperative pain scores did not differ significantly between two techniques. CONCLUSIONS: The indications of LESS for benign ovarian masses are similar to CL and it has better postoperative recovery. However, with less perioperative complications, CL surgery is safer than LESS.

Intravenous leiomyomatosis with different surgical approaches: Three case reports.

BACKGROUND: Intravenous leiomyomatosis (IVL) is a rare and complicated disease, which requires surgery by a multidisciplinary team. However, the optimal surgical approach has not been determined. CASE SUMMARY: Here we report three cases of IVL treated with different surgical approaches. All patients presented with circulation symptoms. Two patients had lower extremity edema and the other had cardiopalmus. The diagnosis of IVL was confirmed based on the imagining examinations and pathological findings. All patients underwent surgical treatment and were discharged without any complications. CONCLUSION: Preoperative examination is crucial for surgical planning and surgical approach is dependent on the patient's condition and tumor involvement.

Comparative analysis of transcervical resection and loop electrosurgical excision in the treatment of high-grade cervical intraepithelial neoplasia.

OBJECTIVE: To compare the efficacy of transcervical resection of the cervix (TCRC) and loop electrosurgical excision procedure (LEEP) in the treatment of high-grade cervical squamous intraepithelial lesions (HSIL). METHODS: A retrospective case record review was conducted of patients with HSIL treated with TCRC or LEEP at Guangdong General Hospital, Guangdong Academy of Medical Sciences and Zhujiang Hospital, Guangzhou, China, from 2009 to 2015. The clinical characteristics, cone margin statuses, clinical outcomes, and adverse events were compared between the two groups. RESULTS: Among 647 included patients, 292 (45.1%) were treated with TCRC and 355 (54.9%) with LEEP. The incidences of positive margins, persistent and recurrent lesions, and intraoperative bleeding were lower in the TCRC group than in the LEEP group (P<0.001 for all comparisons). The rates of cervical adhesions were comparable between the two groups. During TCRC, 78 (26.7%) intrauterine lesions were diagnosed; most of these had been missed by transvaginal sonography. CONCLUSION: TCRC may be an alternative method to LEEP in the treatment of HSIL. Compared with LEEP, TCRC has comparable clinical efficacy without additional adverse events. Moreover, TCRC is useful for detecting and/or removing intrauterine lesions during surgery.

The value of hysteroscopic management of cesarean scar pregnancy: a report of 44 cases.

OBJECTIVE: With the incidence of cesarean scar pregnancy (CSP) rising, the reports of serious adverse outcomes of it have increased gradually. The management of CSP remains an inadequately explored clinical field, and there is no consensus on it presently. The present study was performed to investigate the efficacy and safety of operative hysteroscopy in the diagnosis and treatment of CSP. MATERIALS AND METHODS: Forty-four patients with CSP underwent operative hysteroscopy for removal of scar ectopic pregnancy in our institution. Among them, hysteroscopy was combined with laparoscopy in two patients, three cases with massive hemorrhage were pretreated with bilateral uterine artery embolization before hysteroscopic surgery, and four patients were pretreated with mifepristone (200 mg for 3 days) and methotrexate (25 mg for 2 days). Clinical data, serum ß-human chorionic gonadotropin, myometrial thickness, residual conceptus, cesarean scar defect, operation time, blood loss, and hospital stay were recorded. RESULTS: All of the ectopic gestations were removed entirely by operative hysteroscopy. Mean operation time was 34.8±16.5 minutes (range 20-120 minutes), and mean blood loss was 35.3±24.4 mL (range 5-100 mL). The mean hospital stay was 5.0±3.01 days (range 1-19 days). Cesarean scar defect could be diagnosed in 70% (31/44) of patients, while in 20/32 cases (63%), a conceptus remained after uterine curettage only was performed. CONCLUSION: Operative hysteroscopy might be recommended as a first-line treatment modality for patients with a cesarean scar ectopic pregnancy, especially when myometrium thickness between bladder and gestational sac is more than 3 mm.

Treatment of Early Stage Endometrial Cancer by Transumbilical Laparoendoscopic Single-Site Surgery Versus Traditional Laparoscopic Surgery: A Comparison Study.

To compare the outcomes of transumbilical laparoendoscopic single-site surgery (TU-LESS) versus traditional laparoscopic surgery (TLS) for early stage endometrial cancer (EC).We retrospectively reviewed the medical records of patients with early stage EC who were surgically treated by TU-LESS or TLS between 2011 and 2014 in a tertiary care teaching hospital. We identified 18 EC patients who underwent TU-LESS. Propensity score matching was used to match this group with 18 EC patients who underwent TLS.All patients underwent laparoscopic-assisted vaginal hysterectomy, bilateral salpingo-oophorectomy, and systematic pelvic lymphadenectomy by TU-LESS or TLS without conversion to laparoscopy or laparotomy. Number of pelvic lymph nodes retrieved, operative time and estimated blood loss were comparable between 2 groups. Satisfaction values of the cosmetic outcome evaluated by the patient at day 30 after surgery were significantly higher in TU-LESS group than that in TLS group (9.6 ±â€Š0.8 vs 7.5 ±â€Š0.7, P < 0.001), while there was no statistical difference in postoperative complications within 30 days after surgery, postoperative hospital stay, and hospital cost.For the surgical management of early stage EC, TU-LESS may be a feasible alternative approach to TLS, with comparable short-term surgical outcomes and superior cosmetic outcome. Future large-scale prospective studies are needed to identify these benefits.