A previously healthy 3-year-old female with hypertension, proteinuria, and hypercalciuria.

A 3-year-old female patient with no significant medical history presented to her pediatrician with foamy urine. Initial testing revealed moderate proteinuria on qualitative testing, although she was incidentally noted to have severe hypertension (240/200 mmHg). Physical examination of the carotid and femoral areas revealed significant systolic vascular murmurs. Labs showed elevated serum creatinine, hypokalemia, metabolic alkalosis, elevated renin and aldosterone and hypercalciuria. Echocardiography identified ventricular hypertrophy. Computed tomography (CT) of the abdomen and magnetic resonance angiography of the head showed multiple tortuous or interrupted arteries and multiple calcifications in the renal sinus area. B-mode ultrasonography suggested thickening of the carotid and femoral artery walls, with numerous spotted calcifications. Genetic testing revealed that ABCC6 had a complex heterozygous mutation (exon 24: c.3340C > T and intron 30: c.4404-1G > A). Our panel of experts reviewed the evaluation of this patient with hypertension, proteinuria, hypercalciuria, and vascular abnormalities as well as the diagnosis and appropriate management of a rare disease.

Effects of predictive nursing interventions on pressure ulcer in older bedridden patients: A meta-analysis.

To evaluate the effect of predictive nursing interventions on pressure ulcers in elderly bedridden patients by meta-analysis. Applied computer searches of PubMed, Embase, Google Scholar, Cochrane Library, China National Knowledge Infrastructure and Wanfang databases for randomised controlled trials (RCTs) on the effect of predictive nursing in preventing pressure ulcers in elderly bedridden patients from the database inception to November 2023. Two researchers independently screened the literature, extracted data and performed quality assessment based on inclusion and exclusion criteria. Stata 17.0 software was utilised for data analysis. Eighteen RCTs involving 6504 patients were finally included. The analysis revealed the implementation of predictive nursing interventions had a significant advantage in reducing the incidence of pressure ulcers in elderly bedridden patients compared with conventional nursing (odds ratio [OR] = 0.20, 95% confidence interval [CI]: 0.15-0.28, p < 0.001), while the patients' satisfaction with nursing care was higher (OR = 3.70, 95% CI: 2.99-4.57, p < 0.001). This study shows that the implementation of a predictive nursing interventions for elderly bedridden patients can effectively reduce the occurrence of pressure ulcers and significantly improve patients' satisfaction with nursing care, which is worthy of clinical promotion and application.

Effect of quality nursing intervention on wound healing in patients with burns: A meta-analysis.

This meta-analysis aimed to explore the effects of quality nursing intervention on wound healing in patients with burns. A computerised search was conducted for randomised controlled trials (RCTs) on the effect of quality nursing intervention on wound healing in patients with burns in the PubMed, Embase, Google Scholar, Cochrane Library, China National Knowledge Infrastructure and Wanfang databases from the date of database inception to November 2023. Two researchers independently screened the literature, extracted data and performed quality assessment based on the inclusion and exclusion criteria. Stata 17.0 software was used for the data analysis. Twenty-nine RCTs involving 2637 patients with burns were included. The meta-analysis revealed that compared with conventional nursing, the implementation of quality nursing intervention in patients with burns significantly shortened the wound healing time (standardised mean difference [SMD] = -2.93, 95% confidence interval [CI]: -3.44 to -2.42, p < 0.001). The incidence of wound infections (odds ratio [OR] = 0.14, 95% CI: 0.07-0.27, p < 0.001) and complications (OR = 0.16, 95% CI: 0.11-0.23, p < 0.001) was also reduced significantly. This meta-analysis shows that applying quality nursing interventions in patients with burns can significantly shorten the wound healing time and reduce the incidence of wound infection and complications, thus promoting early patient recovery.

[Genetic analysis of two children with sporadic neurofibromatosis type 1 complicated with nephrotic syndrome].

OBJECTIVE: To explore the genetic basis for two children with sporadic neurofibromatosis type 1 (NF1) complicated with nephrotic syndrome (NS). METHODS: Clinical data of the children were collected. Both children were subjected to high-throughput sequencing, and candidate variants were verified by Sanger sequencing. RESULTS: Both children had café-au-lait macules, subaxillary freckle and Lisch nodules. Child 1 also had congenital tibiofibular pseudarthrosis on the left side. Genetic testing revealed that child 1 has harbored a heterozygous c.844C>T variant in the exon 8 of the NF1 gene, whilst child 2 has harbored a heterozygous c.1246C>T variant in the exon 11 of the NF1 gene. Both children were diagnosed with NF1 and have developed pronounced proteinuria, hypoalbuminemia, hypercholesterolemia and pitting edema at the ages of 3 and 10, respectively. Renal biopsy of child 2 has revealed minimal change nephropathy, and the diagnosis of nephrotic syndrome was established. Child 1 was treated with glucocorticoid, and child 2 was treated with glucocorticoid in combination with mycophenolate mofetil. The NS was relieved with no recurrence during 1 year's follow-up. CONCLUSION: NF1 combined with NS is rare in the clinical settings. The prognosis of children with NF1 combined with minimal change nephropathy is relatively good. Detection of NF1 gene variant can facilitate early identification and diagnosis of NF1.

Expression of adipokines in children with primary nephrotic syndrome and its association with hyperlipidemia. / åŽŸå‘æ€§è‚¾ç— ç»¼åˆå¾æ‚£å„¿è„‚è‚ªå› å­çš„è¡¨è¾¾åŠä¸Žé«˜è„‚è¡€ç—‡ç›¸å ³æ€§ç ”ç©¶.

OBJECTIVES: To study the expression of adipokines in children with primary nephrotic syndrome (PNS) before and after treatment and its correlation with blood lipids, as well as the role of adipokines in PNS children with hyperlipidemia. METHODS: A total of 90 children who were diagnosed with incipient PNS or recurrence of PNS after corticosteroid withdrawal for more than 6 months were enrolled as subjects. Thirty children who underwent physical examination were enrolled as the control group. Venous blood samples were collected from the children in the control group and the children with PNS before corticosteroid therapy (active stage) and after urinary protein clearance following 4 weeks of corticosteroid therapy (remission stage). ELISA was used to measure the levels of adipokines. An automatic biochemical analyzer was used to measure blood lipid levels. RESULTS: Compared with the control group, the children with PNS had a significantly lower level of omentin-1 in both active and remission stages, and their level of omentin-1 in the active stage was significantly lower than that in the remission stage (P<0.001). For the children with PNS, the level of chemerin in the active stage was significantly higher than that in the remission stage, and the children with PNS in the active stage had a significantly higher level of chemerin than the control group (P<0.001). For the children with PNS, atherogenic index of plasma, atherogenic coefficient (AC), castelli risk index-1 (CRI-1), castelli risk index-2 (CRI-2), and non-high-density lipoprotein in the active stage were significantly higher than those in the remission stage (P<0.001), and these indices in the children with PNS in the active stage were significantly higher than those in the control group (P<0.001). The children with PNS in the remission stage had significantly higher atherogenic index of plasma, AC, CRI-1, and non-high-density lipoprotein than the control group (P<0.001). Compared with the control group, the children with PNS in the remission stage had significantly higher serum levels of total cholesterol, triglyceride, high-density lipoprotein, low-density lipoprotein, apolipoprotein B, and apolipoprotein A (P<0.01). In the children with PNS, the ratio of omentin-1 before and after corticosteroid therapy was positively correlated with that of high-density lipoprotein, 24-hour urinary protein excretion, and high-density lipoprotein/apolipoprotein A before and after treatment, and it was negatively correlated with the ratio of AC and CRI-1 before and after treatment (P<0.05). The PNS children with low omentin-1 levels in the active stage had significantly higher levels of CRI-1, CRI-2, AC, and apolipoprotein B/apolipoprotein A ratio than those with high omentin-1 levels (P<0.05). CONCLUSIONS: Omentin-1 may be associated with disease activity, dyslipidemia, and proteinuria in children with PNS. Blood lipid ratios may be more effective than traditional blood lipid parameters in monitoring early cardiovascular risk in children with PNS.

[Analysis of a sib-pair with Finnish type congenital nephrotic syndrome due to variant of NPHS1 gene].

OBJECTIVE: To detect genetic variant in a sib-pair with Finnish type congenital nephrotic syndrome (CNF). METHODS: Clinical data of the sib-pair was reviewed. Coding regions of the NPHS1 gene was analyzed for the sib-pair and both parents. RESULTS: The sister and brother respectively developed severe proteinuria 1 month and 28 days after birth, in addition with low serum albumin, hypercholesterolemia and severe edema, which were suggestive of CNF. Genetic testing identified that the sib-pair has both carried two heterozygous variants of NPHS1 gene, namely c.2605G>C (p.P869>A) and c.-61G>A, for which their father and mother were heterozygous carriers. CONCLUSION: The c.2605G>C (p.869P>A) and c.-61G>A variants of the NHPS1 gene probably underlay the CNF in both sibs. The c.2605G>C(p.869P>A) was unreported previously.

Routine ß-Human Chorionic Gonadotropin Monitoring for Single-Dose Methotrexate Treatment in Ectopic Pregnancy.

STUDY OBJECTIVE: To evaluate an alternative monitoring protocol without day 4 ß-human chorionic gonadotropin (ß-hCG) measurement for predicting the need for a repeated methotrexate (MTX) dose in patients undergoing single-dose MTX therapy for ectopic pregnancy (EP). DESIGN: Single-center retrospective study (Canadian Task Force classification II-3). SETTING: University-affiliated hospital. PATIENTS: Included in the study were 184 EP patients treated with MTX between January 2009 and December 2016. INTERVENTIONS: Single-dose MTX treatment (50 mg/m2). MEASUREMENTS AND MAIN RESULTS: The patients were treated with repeated doses of MTX every 7 days, if necessary, according to Stovall's protocol, or with laparoscopic surgery in cases of tubal rupture. The success of a single-dose of MTX according to the alternative measure was defined as a >50% decrease in the ß-hCG level between days 1 and 7 in clinically stable patients. The sensitivity, specificity, false-negative rate, false-positive rate, and attributable risk of this new monitoring measure were calculated and compared with the traditional regimen. The new protocol had a sensitivity and specificity of 100% and 88.7%, respectively, for predicting a required second dose in patients whose day 1 ß-hCG levels were <2000 mIU/mL. For patients with day 1 ß-hCG level ≥2000 mIU/mL, both monitoring regimens had the same efficiency. CONCLUSIONS: The new monitoring model without the day 4 ß-hCG measurement may offer both patients and clinicians multiple options to monitor single-dose MTX therapy for selected EP patients, with a comparable clinical efficiency to Stovall's protocol and less expense and follow-up burden to patients.

A prospective randomly controlled clinical trial on azithromycin therapy for induction treatment of children with nephrotic syndrome.

UNLABELLED: A prospective study was designed to evaluate the efficacy of azithromycin (AZM) when combined with prednisone therapy compared with prednisone therapy alone in children with primary nephrotic syndrome (PNS) undergoing induction treatment. A prospective randomly controlled clinical trial was conducted. Randomization was performed to select the research subjects who were composed of children with PNS and treated with AZM combined with prednisone (the intervention group) and with prednisone alone (the control group). A total of 211 randomly selected patients with PNS received either AZM combined with prednisone (n = 106) or prednisone alone (n = 105) for 6 months. At three months in the follow-up period, 12 patients were lost to follow up (intervention group, 7; control group, 5), and 6 patients had a transient hypocomplementemia (intervention group, 4 ; control group, 2). AZM was administered at a dose of 10 mg/kg q.d (1 dose per day) for three consecutive days. The median duration before remission was 6 days in the intervention group and 9 days in the control group (p < 0.0001). Relapse rate differed among the groups at 3 months (11.6 vs. 21.4 %, p = 0.049). No difference in relapse rate was observed between the two groups within 4 to 6 months and at 6 months (p = 0.168, 0.052). After 4 weeks of treatment, steroid resistance occurred in 1 out of 95 (1.05 %) patients in the intervention group and in 10 out of 98 (10.2 %) patients in the control group (p = 0.006). After 8 weeks of treatment, no difference was found in steroid resistance between two groups (1/95 vs. 3/98, p = 0.327). During follow-up at 6 months, no difference was exhibited by the two groups on frequent relapse rates (p = 0.134). CONCLUSION: If a course of AZM is added to the glucocorticoid-induced treatment among children with PNS, then the sensitivity of prednisone increases. This increase consequently reduces duration to remission and decreases relapse. However, further studies are necessary to confirm these results.

Clinical characteristics and treatment of Herlyn-Werner-Wunderlich syndrome.

OBJECTIVE: To investigate the clinical characteristics and treatment of the Herlyn-Werner-Wunderlich syndrome (HWWS). METHODS: Sixty-one patients diagnosed with HWWS were retrospectively analyzed. HWWS is categorized into three types in China. RESULTS: Age at presentation of all the cases was after menarche. The most common clinical presentations were dysmenorrhea for type I and vaginal discharge for types II and III. Clinical presentations of types II and III may not occur until reproductive age. HWWS occurred on the right in 39/61. Excision of the obstructed vaginal septum was the treatment utilized in this cohort. After surgery, subsequent pregnancies were ipsilateral in 52.9 %. CONCLUSIONS: Clinical presentation in untreated HWWS suggests the anatomic anomaly. Early recognition and treatment can reduce symptoms. Pregnancies occur in both the affected and unaffected uterus.

[Total hysterectomy of laparoendoscopic single site surgery].

OBJECTIVE: To explore the operation skills of laparoendoscopic single site surgery (LESS) of total hysterectomy, to expand the application of LESS in the field of in gynecologic surgery. METHODS: A total of 23 cases of total hysterectomy were completed under laparoendoscopic single site surgery in Peking Union Medical College Hospital from January 2012 to August 2013, applying with combination of the traditional laparoscopic and special LESS apparatuses, intelligent electronic coagulation and excision device and the self-fixed absorbable sutures (V-LOC). The datas of the patients during the operations and the follow-up were recorded and analyzed. RESULTS: Twenty-three cases LESS-TH are accomplished. The weight of uterus was (230+38) g. The operation time was (73+22) minutes, with the intraoperative blood loss (99 ± 53) ml. The postoperative intestinal function recovery time was (13+4) hours, and postoperative hospitalized time was (1.8 ± 0.6) days, with the postoperative pain visual analogue scale 3.9 ± 1.6. There were no complications reported during intraoperative and postoperative time. All of our patients was finished the follow-up from 14 d to 2 months. As usual, vaginal discharge is normal, wound healed well, most of the wounds healing (19/23) hidden in umbillicus, no obvious scar, vaginal stub wound healed well. CONCLUSIONS: (1) LESS can accomplish total hysterectomy of uterus of gestational age less than 8 weeks safely and effectively. (2) Combination of traditional laparoscopic and special LESS appatatuses, the use of intelligent energy devices and V- LOC to suture vaginal stub could make the total hysterectomy by LESS much easier and safer.

[Comparative study on transumbilical laparoendoscopic single-site surgery and the three-port laparoscopy in treatment of ovarian cystectomy].

OBJECTIVE: To investigate clinical outcome of laparoendoscopic single-site compared with traditional three-port in treatment of ovarian cystectomy. METHOD: From February 2012 to June 2013, 54 patients with ovarian cyst were randomized to the single-site group (n = 24) or the three-port group (n = 30) in Peking Union Medical College Hospital. The outcome of laparoscopic single-site and three-port ovarian cystectomy were evaluated. Operation time, blood loss, surgical complications, postoperative pain score, postoperative analgesic requirements, length of hospital stay, cosmetic satisfaction score, postoperative recovery and total cost were compared between both groups. RESULTS: No difference was found in blood loss, length of hospital stay, complications and total cost between the two groups (P > 0.05). Operation time was (31 ± 10) minute in three-port group and (40 ± 19) minute in single-site group. Visual analogue pain score was 5.6 ± 1.7 in three-port group and 2.7 ± 1.4 in single-site group, cosmetic satisfaction score was 92.5 ± 2.5 in three-port group and 97.4 ± 1.5 in single-site group. Those clinical parameter reached statistical difference (all P < 0.05). CONCLUSION: Laparoendoscopic single site surgery approach is feasible and safe to treat benign ovarian cyst disease. And it offers decreased pain and offer improved cosmesis.

[Ovarian teratoma associated with anti-N-methyl-D-aspartate receptor encephalitis: a report of 5 cases and review of the literature].

OBJECTIVE: To report the clinical features of ovarian teratoma in patients with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis. METHODS: The clinical information of five female patients with ovarian teratoma and anti-NMDAR encephalitis in Peking Union Medical College Hospital and Beijing Tiantan Hospital affiliated to Capital Medical University from June 2011 to May 2013 were obtained. Relevant literatures were reviewed. RESULTS: The initial symptoms varied from respiratory prodromes or emotional incentives before the onset of psychiatric symptoms. Patients always presented with psychosis, bizarre dyskinesia and seizures. Antibodies to NMDAR in serum and cerebrospinal fluid (CSF) were positive; The psychiatric symptoms were dramatically relieved by tumor reception and immunotherapy which occurred in inverse order of symptom development. No evidence of tumor recurrence was observed during a short-time follow-up after the surgery. CONCLUSIONS: Ovarian teratoma with anti-NMDAR encephalitis always presents with psychiatric symptoms which could be misdiagnosed as psychiatric diseases. Patients respond to tumor resection and immunotherapy.

[Primary pelvic retroperitoneal tumors: clinical analysis of 36 cases].

OBJECTIVE: To explorer the diagnostic rationales for primary pelvic retroperitoneal tumors and summarize their clinical characteristics and treatments. METHODS: The clinicopathological data of total of 36 patients with primary pelvic retroperitoneal tumor, who visited Peking Union Medical Collage Hospital, Chinese Academy of Medical Sciences because of pelvic mass from January 1986 and September 2013 were analysed retrospectively. And their clinical manifestations, accessory examination, surgical findings, postoperative pathological results and prognosis were summarized. RESULTS: Among the 36 patients, twenty-nine cases were treated by gynecology department firstly, 7 cases were treated by surgical department firstly. Only 7 cases complained abdominal expanding while others had no uncomfortable complains before the discovery of the tumor. Among 27 cases who took color Doppler ultrasonography examination, only 3 cases reminded that the tumors might come from the pelvic retroperitoneal space. CT and MRI results were respectively 6/16 and 3/6, that the tumor might come from the pelvic retroperitoneal space. The level of CA125 of 18 cases were tested before the surgery: 17 out of 18 cases were normal or elevated lightly. The tumors of 8 cases were excised incompletely because of the blood vessels around the tumors and the close relationship between the tumors and the pelvic wall, while other's were excised completely. Among the 25 cases that had operation at the gynecological department, ten cases underwent operations collaboratively with surgical department; two cases had complications of urinary system injures. Postoperative pathological examinations revealed there were 28 cases (78%, 28/36)with benign lesions including 11 schwannoma, 6 leiomyoma, 3 teratoma, 1 lymphangioleiomyoma, 1 neurofibroma, 1 paraganglioma, 2 fibromatosis, 1 aggressive angiomyxoma, 1 mucinous cystadenoma and 1 solitary fibrous tumor; and 8 cases(22% , 8/36)with malignant lesions including 3 leiomyosarcoma, 2 liposarcoma, 2 adenocarcinoma and 1 squamous carcinoma. During the follow-up period, 28 cases whose tumors were excised completely had no recurrence. While, 3 out of 8 cases excised incompletely recurred. CONCLUSIONS: Primary pelvic retroperitoneal tumors have no typical manifestations, CT and MRI are more accurate. Surgery is a key for retroperitoneal tumors. Considering the complexity of the anatomy of the pelvic retroperitoneal space and the resulted difficulties of the surgeries, multidisiciplinary cooperation is needed and important.

Large-Scale, Abrasion-Resistant, and Solvent-Free Superhydrophobic Objects Fabricated by a Selective Laser Sintering 3D Printing Strategy.

Manufacturing abrasion-resistant superhydrophobic matters is challenging due to the fragile feature of the introduced micro-/nanoscale surface roughness. Besides the long-term durability, large scale at meter level, and 3D complex structures are of great importance for the superhydrophobic objects used across diverse industries. Here it is shown that abrasion-resistant, half-a-meter scaled superhydrophobic objects can be one-step realized by the selective laser sintering (SLS) 3D printing technology using hydrophobic-fumed-silica (HFS)/polymer composite grains. The HFS grains serve as the hydrophobic guests while the sintered polymeric network provides the mechanical strength, leading to low-adhesion, intrinsic superhydrophobic objects with desired 3D structures. It is found that as-printed structures remained anti-wetting capabilities even after undergoing different abrasion tests, including knife cutting test, rude file grinding test, 1000 cycles of sandpaper friction test, tape test and quicksand impacting test, illustrating their abrasion-resistant superhydrophobic stability. This strategy is applied to manufacture a shell of the unmanned aerial vehicle and an abrasion-resistant superhydrophobic shoe, showing the industrial customization of large-scale superhydrophobic objects. The findings thus provide insight for designing intrinsic superhydrophobic objects via the SLS 3D printing strategy that might find use in drag-reduce, anti-fouling, or other industrial fields in harsh operating environments.

The clinical features and management of perineal endometriosis with anal sphincter involvement: a clinical analysis of 31 cases.

BACKGROUND: The aim of this study was to investigate the appropriate measures for diagnosing and treating perineal endometriosis (PEM) with anal sphincter involvement. METHODS: Between January 1992 and April 2011, the clinical features, diagnosis and management of 31 patients who were diagnosed with PEM with anal sphincter involvement at the Peking Union Medical College Hospital were retrospectively analyzed using their clinical records. A range of 6-78 months of outpatient follow-up after surgery were conducted for these 31 patients but was extended by telephone interviews with 29 patients conducted in December 2011. RESULTS: All 31 patients had a history of vaginal delivery. The level of serum CA(125) was elevated in only 2 (6.5%) cases. All cases received surgical treatment, which included narrow excision (NE, close to the edge of the endometrioma) with primary sphincteroplasty (PSp) for 30 cases and incomplete excision (IE) for 1 case. Of the 30 cases in the NE group, 20 (66.7%) received hormone therapy preoperatively. Up until December 2011, there was one recurrence (3.6%) of PEM in the NE group. PEM relapse occurred in the IE patient 6 years after the initial IE surgery. Perineal abscesses were found in one patient post-operatively. No complaint of dyspareunia and no fecal incontinence episodes were observed during follow-up. CONCLUSIONS: Based on our own experience, NE and PSp may be indicated for the treatment of PEM with anal sphincter involvement.

Enhanced Photocatalysis of Black TiO2/Graphene Composites Synthesized by a Facile Sol-Gel Method Combined with Hydrogenation Process.

In this study, in situ TiO2 was grown on the surface of graphene by a facile sol-gel method to form black TiO2/graphene composites with highly improved photocatalytic activity. The combination of graphene and TiO2 was beneficial to eliminate the recombination of photogenerated electron holes. The self-doping Ti3+ was introduced, accompanied by the crystallization of amorphous TiO2, during the hydrogenation process. Consequently, the narrowed bandgap caused by self-doping Ti3+ enhanced the visible light absorption and thus made the composites appear black. Both of them improved the photocatalytic performance of the synthesized black TiO2/graphene composites. The band structure of the composite was analyzed by valence band XPS, revealing the reason for the high visible light catalytic performance of the composite. The results proved that the black TiO2/graphene composites synthesized show attractive potential for applications in environmental and energy issues.

Multi-Material Additively Manufactured Magnetoelectric Architectures with a Structure-Dependent Mechanical-to-Electrical Conversion Capability.

Multi-material additive manufacturing has become a promising trend in fabricating advanced functional architectures due to its controllable design of diverse material species and novel structures. It remains challenging to endow the multi-material components with a mechanical-to-electrical conversion capability. This study reports on multi-material selectively laser sintered magnetoelectric architectures that can convert mechanical energy to electricity in a structure-dependent manner. The principal aim is to establish a relationship between the electrical output and the printed structures by fabricating a series of porous architectures with diverse structural parameters. The findings show that the output voltage increases with the decrease of the elastic modulus and the increase of the magnetic height, which has been analyzed by numerical simulation. Owing to the mechanical-to-electrical conversion capability, a pair of multi-material printed sneakers with the functionalities of power generation and gait analysis has been prepared. The voltage output reaches as high as ≈2 V, which can lighten a light-emitting diode lamp when a user is running. The described solution in this work has offered an exploration framework for the design, fabrication, and application prospects of multi-material additively manufactured architectures.

[Diagnosis and treatment of ureter endometriosis].

OBJECTIVE: To investigate strategies of diagnosis and treatment of ureter endometriosis. METHODS: From 1983 to 2010, the cases registered in Peking Union Medical College Hospital and confirmed as ureter endometriosis by surgery were enrolled in this study. Clinical manifestations, pre-operative examinations, surgical categories and routes, surgical and pathological findings, post-operative medical treatment, relapse and relating factors were collected and studied. RESULTS: Totally 46 patients with ureter endometriosis underwent one or two surgeries. Forty-eight per cent (22/46) of patients were not be diagnosed with ureter endometriosis pre-operatively, and 46% (21/46) only presented dysmenorrhea or even no symptoms. Ureterolysis (72%, 33/46) and laparotomy (63%, 29/46) were the most common surgical category and surgical approach. There were 64% (25/39) of patients had left ureter involved and 80% (37/46) had extrinsic ureter endometriosis. Fifteen per cent (7/46) of patients had relapsed disease with median recurrent time of 24 months (13-49 months), and they all received second surgeries. Logistic regression analysis showed that only gonadotropin releasing hormone analogue agents were related with recurrence when compared with those patients without medical treatment post-operatively significantly (OR=23.2, 95%CI: 2.4-221.7, P=0.002). CONCLUSIONS: Ureter endometriosis was related with reproductive tract endometriosis. It has insidious process resulting in difficulty for early diagnosis. It's important to treat pelvic deep infiltrating endometriosis and ovarian endometrioma to prevent ureter from further involvement. Post-operative treatment of pelvic endometriosis is the key point of preventing relapse of ureter endometriosis.

[Microarray analysis of gene expression profiles in pelvic organ prolapse].

OBJECTIVE: To identify the differentially expressed genes in cardinal ligament between patients with pelvic organ prolapse (POP) and postmenopausal women without POP by Human Genome Expression Chip and explore the potential molecular mechanism involved in POP. METHODS: From January to May, 2007, cardinal ligament samples were obtained from 3 postmenopausal patients with POP-Q stage III and 3 postmenopausal patients underwent hysterectomy due to other benign gynecologic diseases without POP in Peking Union Medical College Hospital. HE and Masson's trichrome staining was used to verify tissue origin and inspect histological changes. Those differentially expressed genes in cardinal ligaments were identified by Human Genome Chip and further interrogated with Gene Ontology (GO) and Pathway Analysis. Those remarkable expressed genes were confirmed by qRT-PCR. RESULTS: Alterations of ligament architecture in POP patients included disarrangement and collapse of smooth muscle bundles and collagen fibers. A total of 179 differentially expressed genes were screened between POP and non-POP cardinal ligament tissue, including 20 functional unknown genes. A total of 107 genes were upregulated in POP group, while 72 genes downregulated. Those differentially genes were revealed associated with multiple functional proteins and metabolic pathways by biological analysis. Among these, Wnt signaling pathway exhibited the most remarkable changes. Real-time quantitative PCR showed the genes of COL1A1, DKK1, SFRP1, FZD5, WNT16b in POP group (2.98+/-1.40, 3.03+/-0.48, 8.13+/-4.42, 5.19+/-3.50, 12.40+/-3.88) were upregulated significantly compared with non-POP group (1.09+/-0.08, 1.20+/-0.18, 0.41+/-0.51, 0.87+/-0.24, 1.40+/-0.47; P<0.05). CONCLUSIONS: The pathophysiology of POP is complex and associated with multiple functional proteins and metabolic pathways. Among these, the antagonist DKK1, SFRP1 in Wnt signaling pathway may contribute to a neurodegenerative role in POP development.

[Characteristics and trends of surgical management on endometriosis: a review of cases from Peking Union Medical College Hospital from 1983 to 2009].

OBJECTIVE: To investigate the characteristics and trends of surgical management on endometriosis in Peking Union Medical College Hospital From 1983 to 2009. METHODS: The medical documents of patients with endometriosis diagnosed by surgical pathology were studied retrospectively in Peking Union Medical College Hospital (PUMCH). The ratio of different surgical approaches (laparoscopic and laparotomic surgery) and surgical categories (conservative, semi-radical or radical surgery) were compared in all the cases with endometriosis to investigated alterations trends of approaches and methods of surgery. RESULTS: Totally integrated records of 13 972 patients underwent surgeries on endometriosis were reviewed and consisted of 24.974% (13,972/55,945) of all gynecologic surgeries. 59.490% of cases (8312/13,972) were treated by laparoscopic approach, which were significantly higher than the rate of 37.700% (15,824/41,973) of laparoscopic approaches in the other gynecologic diseases (P < 0.01). The proportion of laparoscopic surgeries in all endometriosis surgery was 67.31% (947/1407) between 2005 and 2009, which were significantly higher than 55.98% (510/911) of laparoscopic surgeries between 2000 and 2004 (P < 0.01). Conservative surgery (i.e., with uterus and ovaries intact) consisted of 64.014% (8663/13,533) of endometriosis surgeries. The proportion of conservative surgeries was 66.24% (4176/6304) between 2005 and 2009. The proportion of laparoscopic approaches consisted of 81.10% (7026/8663) of conservative surgeries and 26.30% (1281/4870) of semi-radical or radical surgeries (P < 0.01). The average number of annual surgeries, the average number of annual laparoscopic surgeries and its proportion in endometriosis, and the average number of annual conservative surgeries and its proportion in pelvic endometriosis between 2005 - 2009 were all increased significantly than those at range of 1983 to 1999 and 2000 to 2004. The rate of severe complication 0.351% (49/13,972) was observed in all endometriosis surgeries. CONCLUSION: Surgery was the major treatment of endometriosis in PUMCH, laparoscopic surgery was the major approach and conservative surgery was the major surgery type.