Construct validity and prevalence rate of borderline personality disorder among Chinese adolescents.

The construct of borderline personality disorder (BPD) among adolescents is a controversial topic. No research has examined the BPD construct among Chinese adolescents because the Chinese Classification of Mental Disorders-III rejects BPD as a valid diagnostic category. The present study explored the construct validity and prevalence of BPD among Chinese adolescents in Hong Kong. A total of 4,110 high school students completed the McLean Screening Instrument for borderline personality disorder (MSI-BPD) and other measures assessing various BPD traits twice over a one-year period. DSM-IV-TR BPD criteria set as measured by the MSI-BPD demonstrated good internal consistency, concurrent validity and test-retest reliability. Confirmatory factor analysis of the MSI-BPD revealed four theoretically meaningful factors, namely affect dysregulation, impulsivity, interpersonal disturbances, and self/cognitive disturbances. Prevalence rate of BPD, according to a stringent simulated diagnostic procedure used in this study, was estimated to be 2% among Chinese adolescents in Hong Kong. Findings support that BPD is a valid clinical construct among Chinese adolescents. More research on BPD among the Chinese population is warranted.

Comparison of the different types of "laparoscopic total hysterectomy".

STUDY OBJECTIVE: To review the operative outcomes among different types of laparoscopic total hysterectomy (LH) classified according to the Munro and Parker classification system. DESIGN: Prospective observational cohort study (Canadian Task Force classification II). SETTING: 6 major public hospitals in Hong Kong. PATIENTS: 143 patients underwent LH in a 6-month period. INTERVENTIONS: Type I to type IV LH according to the Munro and Parker classification system. MEASUREMENTS AND MAIN RESULTS: We studied 56 type I, 49 type II, 25 type III, and 13 type IV LH. The median operative time was 105 minutes, which was significantly longer in the type IV LH group (160 minutes). The median blood loss was significantly higher in the type I LH group (300 mL). The incidence of urinary tract infection in type I LH was 8.9%, which was significantly higher than other LH groups. The overall operative complication rate was 20.3%, which was highest in the type III hysterectomy group (36%), although the difference did not reach statistical significance among the various types of hysterectomy groups. CONCLUSION: There has been a change from abdominal hysterectomy to LH in the past decades, and it is time for us to explore the best type of LH. Our findings suggest that type I LH is associated with significantly more blood loss and urinary tract infection; whereas type IV LH is associated with significantly longer operating time. However, we still cannot conclude which is the best type of LH until results from a randomized controlled trial will become available.

Expression of maspin in endometrioid adenocarcinoma of endometrium.

Maspin is a member of the serpin family, whose expression is altered in neoplasia and malignancies of many tissues. Underexpression of maspin has been reported in breast and prostatic cancers, but in some cancers such as ovarian, colorectal and pancreatic carcinoma, it was found to be up-regulated. This study aimed at demonstrating the expression of maspin in human endometrial tissue and searching for any altered expression in endometrioid adenocarcinoma of the endometrium compared to normal endometrium. The expression level of the maspin gene was studied using reverse transcriptase-polymerase chain reaction (RT-PCR) performed on RNA extracted from 34 endometrial cancer samples (including 24 with FIGO stage I disease and 10 with FIGO stage III disease) and 28 normal endometrium in proliferative or secretory phases. Immunohistochemical staining was also performed on 10 cases of endometrial cancer (6 FIGO stage I cases and 4 FIGO stage III cases) as well as 15 normal endometrium. Semi-quantitative RT-PCR revealed that the expression of maspin was significantly up-regulated in both stage I (p<0.01) and stage III (p<0.01) endometrial cancer compared with normal endometrium. However, no significant difference in maspin expression was demonstrated between stage I and stage III endometrial cancer. Immunostaining of all tissue sections revealed an immunopositive signal in the nuclei of the normal or cancerous endometrial glandular cells. In 60% of the cancer cases, cytoplasmic staining was also evident. Our results suggested that there is up-regulated expression of maspin in endometrioid endometrial adenocarcinoma. Cytoplasmic immuno-expression of maspin is common in endometrial cancer. It may play a role in the malignant transformation of human endometrial tissue.

Ovarian fibroma: a review on the clinical characteristics, diagnostic difficulties, and management options of 23 cases.

AIM: We review clinical characteristics, diagnostic difficulties, and our experience in the surgical management of ovarian fibromas. METHOD: Twenty-three women with the operative diagnosis of an ovarian fibroma managed between January 1995 and August 2004 were reviewed retrospectively. RESULTS: These patients comprised 1% of all benign ovarian tumors seen over this study period. The median age was 45 years, and 11 patients (47.8%) were postmenopausal. The main presenting symptom was abdominal pain (43.5%). The diagnosis of an ovarian fibroma or a solid ovarian tumor was correctly made preoperatively in only 5 patients (21.7%). All patients underwent surgical treatment: 18 by laparotomy and 5 by laparoscopy. All tumors were unilateral, and the median size was 13 cm. Fourteen patients underwent conservative surgery, and 9 had total abdominal hysterectomy with bilateral salpingo-oophorectomy. Two cases of fibrosarcoma were reviewed on the final pathology. CONCLUSIONS: Gynecologists should be aware of this group of ovarian tumors despite their uncommon occurrence. There are clinical clues to differentiate an ovarian fibroma from uterine fibroid and ovarian malignancy. Surgical removal of these solid ovarian tumors is recommended because of the low probability of malignancy. Minimal-access surgery is an option, especially when the tumor is of moderate or small size.

Expression of maspin in gestational trophoblastic disease.

BACKGROUND: Maspin is a tumor suppressor gene whose expression is altered in neoplasia and malignancies of many tissues. In the human placenta, the maspin gene is expressed in trophoblastic cells and might act as an inhibitory regulator of trophoblastic invasion. Hence, in gestational trophoblastic disease (GTD), where there is increased propensity for invasion in the trophoblastic tissue, we hypothesized that maspin expression would be decreased. The present study aimed at investigating the expression of maspin in GTD and its prognostic significance. METHODS: Using immunohistochemical staining, we firstly studied the expression of maspin in hydatidiform moles, with gestational age-matched normal first trimester placenta used as control. A total of 38 cases of hydatidiform moles were studied, including 20 complete moles (CM) and 18 partial moles (PM). Among them, 10 cases of the CM group and 8 cases of the PM group subsequently developed gestational trophoblastic neoplasia (GTN). Immunostaining was also performed on tissue from 4 cases of choriocarcinoma and 5 cases of placental site trophoblastic tumor. Reverse transcriptase-polymerase chain reaction (RT-PCR) was further performed on RNA extracted from 10 hydatidiform moles (5 with GTN and 5 without) and 6 normal first-trimester placentae. RESULTS: In all tissue sections, nuclear expression of immunostaining signal was demonstrated, mainly in the cytotrophoblasts. The percentage of trophoblastic nuclei stained in both complete and partial moles was significantly lower than that in normal first-trimester placenta (P < 0.001). However, there was no significant difference in immunostaining between complete and partial moles (P > 0.05). There was also significantly lower expression of maspin in those cases subsequently developing GTN than those which did not (P = 0.01). Immunostaining on choriocarcinoma and placental site trophoblastic tumor showed reduced expression of maspin in all the tumor cells. Reverse transcriptase-polymerase chain reaction revealed that the expression of maspin was consistently down-regulated in all the hydatidiform mole samples. CONCLUSIONS: Our results suggest that there is down-regulated expression of maspin in gestational trophoblastic diseases, and the down-regulation is more prominent in cases developing gestational trophoblastic neoplasia. This may play a role with prognostic significance in the pathogenesis and malignant transformation of hydatidiform moles.

Increased messenger RNA expression of vascular endothelial growth factor and its receptors in the implantation site of the human oviduct with ectopic gestation.

OBJECTIVE: To compare the mRNA expression of vascular endothelial growth factor (VEGF) and its receptors (KDR and flt-1) in the implantation and nonimplantation sites of the human oviduct with ectopic gestation. DESIGN: Prospective observational study. SETTING: University-based Obstetrics and Gynecology Department. PATIENT(S): Ten women undergoing laparoscopic salpingectomy for tubal pregnancy. INTERVENTION(S): The mucosal layer was isolated from the implantation and nonimplantation sites of the oviduct tissue with ectopic gestation. Semiquantitative reverse transcriptase-polymerase chain reaction was performed. MAIN OUTCOME MEASURE(S): The differences in the mRNA expression of VEGF and its receptors between the implantation and nonimplantation sites of the oviduct tissue. RESULT(S): The mRNA expression of VEGF and its receptors, both KDR and flt-1, was significantly higher in the implantation site of the human oviduct with ectopic gestation compared with the nonimplantation site. CONCLUSION(S): The results suggest that VEGF may be the angiogenic factor responsible for the implantation and placentation of an ectopic pregnancy in the oviduct.