[A five-year analysis of effect on transvaginal high uterosacral ligament suspension with or without native-tissue repair for middle compartment defect]

Objective: To assess the five-year effect of the transvaginal high uterosacral ligament suspension (HUS) with or without additional concomitant native-tissue anterior and (or) posterior repair in women suffering from middle compartment defect. Methods: A retrospective review of records identified 79 women who underwent transvaginal HUS with or without additional concomitant native-tissue anterior and (or) posterior repair from January 2007 to January 2018 in Fourth Medical Center, General Hospital of People's Liberation Army. The middle compartment defects were predominant in these patients with point C no less than point Ba or Bp if accompanied with anterior or posterior vaginal wall prolapse. Follow-up visits were performed 2,6 and 12 months after surgery and then annually. Anatomic results of pelvic organ prolapse (POP) was established by pelvic examination using pelvic organ prolapse quantitation system (POP-Q) staging. Funtional results were obtained by patient global impression of improvement (PGI-I) scale in POP, pelvic floor distress inventory-short form 20 (PFDI-20) and pelvic floor impact questionnaire short form (PFIQ-7). Surgical success required the fulfillment of all 3 criteria: (1) anterior or posterior vaginal wall prolapsed leading edge of 0 cm or less and apex of 1/2 total vaginal length or less; (2) the absence of POP symptoms as reported on the PFDI-20 question No.3 ( "Do you usually have a bulge or something falling out that you can see or feel in your vaginal area?" ); and (3) no prolapse reoperations or pessary use during the study period. Results: Of 79 women, 51(65%, 51/79) women completed the five-year follow-up during the study period. The median follow-up time was 5.2 years (2.8-8.3 years). The overall surgery success rate was 86% (44/51) according to above all 3 criteria. Prolapse recurrence rates were isolated anterior 8% (4/51), isolated apical 0, isolated posterior 2% (1/51) and multiple compartments 4% (2/51). Seven women (14%,7/51) developed anterior or posterior prolapse beyond the hymen with the leading edge≤1 cm. No apical prolapsed occurred. None of recurrent women underwent retreatment,including either surgery or pessary usage at last follow-up. The subjective satisfaction rate was 90% (46/51). There was a 1% (1/79) rate of intraoperative ureteral kinking and 3% (2/79) rate of postoperative morbidity. Conclusions: The transvaginal HUS for middle compartment defect offers good long-term anatomical results with excellent vault suspension. With additional concomitant native-tissue anterior and (or) posterior repair, it will be a reconstructive surgery for the majority of moderate-to-severe POP. It is minimal traumatic and worthy of being popularized for clinical application.

Abstract 4242: Systematic transcriptome analysis of small cell carcinoma of esophagus suggests a possibility for immunotherapy

Background/Aims: Small cell carcinoma of the esophagus (SCCE) is a rare and highly deadly malignancy with rapid disease progress and extensive metastasis, whereas present therapy for the cancer is limited, making the identification of a new treatment strategy an area of intense research. We previous reported the genomic characteristics and alterations of the SCCE, but the transcriptome abnormality of the cancer has not been investigated yet.

Method: we performed an RNA Sequencing on nine paired samples from patients with SCCE and conducted a series of comprehensive analysis on the data. DESeq2 and GSEA were applied on transcriptome of SCCE tumor tissue and their para-normal to identify differential expressive genes and associated pathways. Besides, with MCP-counter and a list of immunity related genes, we also compared immune signal of the expression data in pair. By applying a rigorous batch removing strategy, including preprocessing raw data in identical method and RUVSeq, transcriptome data of healthy esophageal mucosa from GTEx was involved as control samples in comparison. In addition, we applied CIBERSORT to calculate the fraction of different tumor infiltrated leukocytes (TILs) of SCCE and compare the number with those of other cancers that have been proven to be potentially responsive to immunotherapy.

Results: We identified 1486 and 1782 genes were significantly up-regulated and down-regulated in SCCE tumor tissue against their para-normal, respectively. Pathway analysis revealed the E2F Target and G2M checkpoint are significantly enriched in tumor tissue. Immune signal analysis across the samples in pair showed that in 3 out of 9 paired sample, immunity reaction upregulates in tumor tissue. T-SNE cluster across transcriptome data of SCCE tumor tissue, their para-normal and healthy esophageal mucosa showed the para-normal tissue, namely the normal tissue adjacent to tumor, is more similar to tumor tissue than the healthy. CIBERSORT analysis showed the difference in TILs fraction between SCCE and the compared cancers. For example, the relative fraction of plasma cell of SCCE is higher than those of ESCC(P=0.040), CIN type of STAD(P=0.040), while lower than those of SCLC(P=0.020). M2 macrophages is higher in SCCE than ESCC(P=0.002), EAC(P<0.001), CIN type of STAD(P<0.001), HNSCC(P<0.001), while Tregs of SCCE is lower than EAC(P=0.012) and CIN type of STAD(P=0.015). The result reflects the robust but suppressed immunity in tumor microenvironment of the cancer. Cluster with all TILs across SCCE and the compared cancers also showed the similarity of immuno-microenvironment between SCCE and small cell lung cancer.

Conclusion: In summary, our analysis provides transcriptome evidence that immunotherapy might be an efficient treatment strategy for small cell esophagus cancer.

Citation Format: Qi Zhao, Yan-xing Chen, Ying-nan Wang, Qi-nian Wu, Hui Sheng, JIa-jia Hu, Yun-xin Lu, Ze-xian Liu, Zhi-xiang Zuo, Feng Wang, Rui-hua Xu. Systematic transcriptome analysis of small cell carcinoma of esophagus suggests a possibility for immunotherapy [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 4242.

[Effectiveness of vaginal high uterosacral ligament suspension for treatment of recurrent pelvic organ prolapse]

Objective: To evaluate the indications and clinic outcomes of vaginal high uterosacral ligament suspension (HUS) for treatment of recurrent advanced pelvic organ prolapse (POP). Methods: This retrospective study analyzed 42 women with recurrent advanced POP who were referred to Fourth Medical Center of PLA General Hospital and underwent transvaginal HUS between November 2005 and January 2018. Primary surgeries included 30 vaginal colporrhaphy, 5 Manchester operation, 5 transvaginal mesh repair,2 sacrospinous ligament fixation.The median time for recurrence from primary pelvic floor repair surgery was 9 months, including 14 cases (33%, 14/42) ≤3 months (median time was 2 months) and 25 cases (67%, 28/42) longer than 3 months (median time was 18 months).The rate of recurrent prolapse in stage Ⅲ or Ⅳ was 79% (33 cases), 45% (19 cases) and 17%(7 cases) in anterior, apical and posterior compartment respectively. Results: Transvaginal high bilateral uterosacral ligaments were identified and used for successful vaginal vault suspension after vaginal hysterectomy and residual cervical resection in all 42 consecutive patients. The cases of transvaginal mesh used in anterior wall and posterior wall were 25 (60%, 25/42) and 3 (7%, 3/42) respectively. There was no major intra- and postoperative complications,such as ureter and other pelvic organ injury. The median time of follow-up was 5.3 years after transvaginal HUS. The points of pelvic organ prolapse quantification system reduced significantly and point C improved from +0.3 cm to -8.2 cm after reoperation (P<0.01). The objective cure rate were 100% (42/42) both in apex and posterior compartment,while 93% (39/42) in anterior compartment. None had reoperation or pessary usage for recurrence of prolapse. Conclusion: Transvaginal HUS with vaginal wall repair could be as a safety, cost-effective, minimal traumatic and durable procedure for recurrent POP in the most of cases.

[Study on the correlation between meteorological factors and acute otitis media in outpatients of children in Beijing]

Objective: To explore the characteristics of acute otitis media(AOM) in children in Beijing and its correlation with meteorological factors. Methods: Data were collected in 2011-2013 in the Otolaryngology Department of Capital Institute of Pediatrics. AOM in children with relevant information, such as age, sex and season, with the same period of the Beijing municipal meteorological data (the average temperature, average pressure, average wind speed, humidity and PM2.5) were compared to analysis the relationship of meteorological environmental parameters and the onset of AOM in children. Results: Annual morbidity of AOM was 7 589, 8 245, 7 242 respectively, no obvious difference(P=0.761). It was noted that one peak could be seen in December, and a valley in February, followed by August. Summer was less than the other three seasons (P<0.05). The morbidity of AOM had a small peak within one year after birth, then reached peak at the age of about 4, and then reduced gradually. In different age groups, male patients were higher than those of female. The incidence of AOM was positively correlation tendency with air pressure and PM2.5 (r=0.333, 0.093, P=0.000, 0.002), which was negatively correlation tendency with daily temperature or humidity (r=-0.327, -0.195, P=0.000, 0.000). Conclusions: The incidence of AOM of children in Beijing changes with age, and has obvious seasonal variation. There may be some correlation between the meteorological factors and the incidence of AOM in children.

[Clinical management of 110 cases of polypropylene mesh and sling exposure after reconstructive pelvic floor surgery]

Objective: To explore the clinical management and outcomes of polypropylene mesh and sling exposure after reconstructive pelvic surgery (RPS) . Methods: A total of 110 cases of mesh and sling exposure after RPS were analyzed, who admitted between Jan. 2002 and Oct. 2017 in First Affiliated Hospital of PLA General Hospital, in which 3 cases were referred from other hospitals. Mesh and sling exposures were identified in the outpatient clinic and categorized and managed according to International Continence Society and International Urogynecology Association (ICS-IUGA) classification about category, time and site (CTS) of mesh complication. Outpatient management included observation, topical estrogen use and mesh removal. Management in hospital included surgical removal of exposed mesh and repair of the resulting defects under the anesthesia. Seventy-four cases were managed in the outpatient setting, and 36 cases required inpatient management. Follow-up was consecutively performed from 1 month to 10 years. Objective outcome included the surgeon's assessment of the healing state of the vaginal mucosa. Subjective outcome was evaluated with patient global impression of improvement questionnaire (PGI-I) . Results: One hundred and ten patients with mesh exposure were classified according to the different RPS underwent. There were 95 cases from transvaginal mesh surgery, 5 cases from anti-stress urinary incontinence sling surgery, and 10 cases from sacrocolpopxy. The outpatient group healed at an average of (3.0±1.8) months. Of the 36 patients who required inpatient management, 21 cases healed completely at an average of 7 days after one surgery. The remaining 8 cases required either two or three times surgeries or conservative management. In the outpatient group, the PGI-I scale very much better was found in 65 cases (87.8%) and much better in 9 cases (12.2%) . In the inpatient surgery group, the scale was very much better in 30 cases (83.3%) , and much better in 6 cases (16.7%) . Conclusions: Among patients with mesh exposure after mesh-augmented RPS, 2/3 of patients with a CTS classification 1-3 could be managed in the office, and remaining 1/3 with CTS classification 4-6 need operation under anesthesia in hospital. If the mesh and sling exposure could be scientifically classified, according to the size, site and accompany symptoms, as well as pain, most of the mesh complications after explosure could be resolved. Using the pelvic floor repair and polypropylene mesh sling, the majority of the patients could get a better outcome, without affecting the effect of the original operation.

Eukaryotic initiation factor 4A2 (EIF4A2) expression in colorectal cancer and prediction of prognosis

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Background: Eukaryotic initiation factor 4A2(EIF4A2) is a member of the eukaryotic initiation factor 4A family and it is one of the protein-synthesis initiation factors, which are involved in the binding of messenger RNA to the ribosome. The prognostic roles of EIF4A2 in breast cancer, melanoma and lung cancer have been studied. However, the clinical significance and biologic role of EIF4A2 in colorectal cancer remain unknown. Methods: We used quantitative real-time polymerase chain reaction to compare expression of eIF4A2 mRNA between 72 paired colorectal cancer tissues and non-tumor colorectal tissues. We used immunohistochemistry to study the expression of EIF4A2 in 310 colorectal cancer patients under surgical resection, 247 of them received curative surgery. We also analyzed correlation between EIF4A2 expression and clinicopathological characteristics. The biological function of EIF4A2 on colorectal cancer cells were determined in vitro by knock-downing EIF4A2 in HCT116 and DLD1 cell lines. We performed MTT tests, colony formation assays, transwell and wound healing assays. Results: EIF4A2 mRNA was significantly higher in colorectal cancer tissues compared to the paired non-tumor colorectal tissues(P = 0.0034). Over-expression of EIF4A2 was prognostic of shorter overall survival(P = 0.002) and shorter disease-free survival(P = 0.042). Over-expression of EIF4A2 was significantly correlated with more TNM stage IV(P = 0.012). Multivariate analysis suggested EIF4A2 as an independent predictor of overall survival (hazard ratio 2.041[95% CI 1.385 to 3.008], P < 0.001) and disease-free survival (hazard ratio 1.537[95% CI 1.003 to 2.355], P = 0.049). Functionally, knockdown of EIF4A2 in HCT116 and DLD1 cell lines exerted tumor-suppressive effects by significantly inhibiting cell proliferation, colony formation,migration and invasion(P < 0.05). Conclusions: EIF4A2 is highly expressed in colorectal cancer and predicts poor prognosis. EIF4A2 could be served as a potential prognostic marker for colorectal cancer patients.

[Research Progress of the Death Caused by Insulin Intoxication]

In recent years, with the sustained increase of the incidence of diabetes in humans and the wider use of exogenous insulin, the cases of inappropriate use and overdose of insulin is growing, even the cases of suicide and homicide using insulin. Through searching the literature at home and abroad about the mechanism, clinical and case report of poisoning and death caused by insulin intoxication, this paper reviews the mechanism, clinical manifestations, pathological changes, and forensic examination.

Long non-coding RNA UICLM promotes colorectal cancer liver metastasis by acting as a ceRNA for microRNA-215 to regulate ZEB2 expression

Long non-coding RNAs (lncRNAs) are involved in the pathology of various tumors, including colorectal cancer (CRC). However, the role of lncRNA in CRC liver metastasis remains unclear. Methods: a microarray was performed to identify the differentially expressed lncRNAs between CRC tissues with and without liver metastasis. Survival analysis was evaluated using the Kaplan-Meier method and assessed using the log-rank test. In vitro and in vivo assays were preformed to explore the biological effects of the differentially expressed lncRNA in CRC cells. Results: the lncRNA UICLM (up-regulated in colorectal cancer liver metastasis) was significantly up-regulated in cases of CRC with liver metastasis. Moreover, UICLM expression was higher in CRC tissues than in normal tissues, and UICLM expression was associated with poor patient survival. Knockdown of UICLM inhibited CRC cell proliferation, invasion, epithelial-mesenchymal transition (EMT) and CRC stem cell formation in vitro as well as tumor growth and liver metastasis in vivo. Ectopic expression of UICLM promoted CRC cell proliferation and invasion. Mechanistic investigations revealed that UICLM induced its biological effects by regulating ZEB2, as the oncogenesis facilitated by UICLM was inhibited by ZEB2 depletion. Further study indicated that UICLM acted as a competing endogenous RNA (ceRNA) for miR-215 to regulate ZEB2 expression. Conclusions: taken together, our findings demonstrate how UICLM induces CRC liver metastasis and may offer a novel prognostic marker and therapeutic target for this disease.

[Long-term effectiveness of transvaginal high uterosacral ligament suspension]

Objective: To assess the long-term effectiveness of the transvaginal high uterosacral ligament suspension (HUS) in women suffering from advanced pelvic organ prolapse (POP). Methods: A retrospective review of records identified 118 women who underwent transvaginal HUS with or without additional concomitant anterior and (or) posterior repairs from June 2003 to August 2009 in the First Affiliated Hospital, General Hospital of People's Liberation Army. Of 118 women, 104 women completed the follow-up during study period; these 104 women were analysed. Follow-up visits were performed 2, 6 and 12 months after surgery and then annually. Anatomic results of POP was established by pelvic examination using pelvic organ prolapse quantitation system (POP-Q) staging. Funtional results were obtained by patient global impression of improvement (PGI-I), pelvic floor distress inventory-short form 20 (PFDI-20) and pelvic floor impact questionnaire short form (PFIQ-7). Surgical success required the fulfillment of all 3 criteria: (1) prolapse leading edge of 0 cm or less and apex of 1/2 total vaginal length or less; (2) the absence of pelvic organ prolapse symptoms as reported on the PFDI-20 question No. 3 ( "Do you usually have a bulge or something falling out that you can see or feel in your vaginal area?" ); and (3) no prolapse reoperations or pessary use during the study period. Results: The mean follow-up time was (9.1±1.5) years. The overall surgery success rate was 91.3% (95/104) according to above all 3 criteria. Prolapse recurrence rates were isolated anterior 6.7% (7/104), isolated apical 0, isolated posterior 2.9% (3/104) and multiple compartments 1.0% (1/104). Five women (4.8%, 5/104) developed bothersome vaginal bulge symptoms. None of recurrent women underwent retreatment, including either surgery or use of a pessary at last follow-up. The subjective satisfaction rate was 90.4% (94/104). PFDI-20 and PFIQ-7 scores showed a statistically significant improvement from preoperative 72 and 65 points to postoperative 17 and 9 points respectively (all P<0.01). There was a 2.9% (3/104) rate of intraoperative ureteral kinking and 3.8% (4/104) rate of postoperative morbidity. Conclusions: The transvaginal HUS for vault prolapse offers good long-term anatomical results with excellent vault suspension. With additional concomitant anterior and (or) posterior repairs, it will be a reconstructive surgery for the majority of advanced POP. It is minimal traumatic and appropriate for different type of POP, especially for the eldly patients. It is worthy of being popularized for clinical application.

Acidic and basic fibroblast growth factor expression levels in cervical cancer and their effects on tumor cell proliferation

Fibroblast growth factors (FGFs) play important roles in angiogenesis, wound healing, embryonic development, and endocrine signaling pathways. Increasingly, recent studies have reported aberrant FGF expression in various malignancies. However, the involvement of FGFs in cervical carcinoma pathogenesis remains unclear. We aimed to investigate expression of acidic (aFGF) and basic FGF (bFGF) in patients with this disease, and assess their effects on cervical cancer cell proliferation. Twenty cervical cancer patients and 10 cervical intraepithelial neoplasia (CIN) patients were recruited, and 10 cancer-free individuals were included as controls. Reverse transcription-polymerase chain reaction and western blotting were employed to detect FGF mRNA and protein levels, respectively. Furthermore, HeLa cells were treated with FGFs and subjected to thiazolyl blue tetrazolium bromide assays to quantify proliferation. Compared with CIN and normal cervical tissues, aFGF and bFGF mRNA and protein levels were significantly elevated in cervical carcinomas (P < 0.05). CIN tissues exhibited higher expression of these FGFs than normal tissues (P < 0.05). Moreover, their mRNA levels were increased in advanced cancer stages (P < 0.05), although no significant difference was detected between tumors of different differentiation grades in this regard (P > 0.05). HeLa cell proliferation increased in an aFGF- and bFGF-dose-dependent manner (P < 0.05), the latter exerting a more potent proliferative influence, with its effect peaking at 75 ng/mL. aFGF and bFGF were highly expressed in cervical cancer tissues and their levels positively correlated with clinical stage. Both facilitate proliferation of cervical carcinoma cells and are implicated in cancer pathogenesis and progression.

Chemotherapy plus bevacizumab versus chemotherapy plus cetuximab as first-line treatment for patients with metastatic colorectal cancer: Results of a registry-based cohort analysis

The present observational cohort study was designed to elucidate the efficacy and safety profile of bevacizumab or cetuximab with chemotherapy as the first-line treatment in Chinese patients with metastatic colorectal cancer (mCRC). Clinical data were collected from a single-center registry study where mCRC patients received first-line fluoropyrimidine-based chemotherapy combined with either bevacizumab (188 patients with KRAS wild-type or mutated tumors) or cetuximab (101 patients with KRAS wild-type tumors) between January 2009 and December 2013. The Kaplan-Meier method was used for survival analysis. Cox proportional hazards model was used for estimating the prognostic and predictive values of clinicopathological characteristics. No statistically significant difference was observed between the bevacizumab and cetuximab groups in terms of median progression-free survival (PFS) (10.6 vs 8.7 months, P = 0.317), median overall survival (OS) (27.7 vs 28.3 months, P = 0.525), or overall response rate (43.1% vs 53.5%, P = 0.108). For the subset of patients with peritoneal dissemination, bevacizumab-based triplet appears to be superior to cetuximab-based triplet as measured by PFS (9.6 vs 6.1 months) and OS (26.3 vs 12.7 months), but not for patients without peritoneal dissemination (PFS, 10.6 vs 9.1 months; OS, 27.9 vs 30.7 months) (all unadjusted and adjusted interaction P < 0.05). Our study suggests that bevacizumab- or cetuximab-based regimens have similar effectiveness as first-line treatment of mCRC in Chinese population. Patients with peritoneal dissemination were likely to gain more benefit from bevacizumab than cetuximab treatment. Future prospective studies are required to further confirm these results.

[The clinical characteristics and surgical options of congenital laryngeal saccular cysts]

Objective:To evaluate the clinical characteristics and surgical options for CLSCs.Method: Thirty-two CLSC patients underwent a total of 59 surgeries were recruited for this study. Needle aspiration was performed in 18 cases and excision of the roof in 9 cases. Except 1 case of open operation through cervical approach, 31 cases were underwent endoscopic procedure using CO₂ laser and microsuturing of the wound surfaces.Result: The time of recurrence depended on surgical approaches: 5-12 days for needle aspiration and 1-10 months for excicing roof of the cyst. No recurrence was found after the complete resection of the cyst wall using a CO₂ laser and microsuturing of the wound surfaces via an endoscopic procedure and open operation.Conclusion:CO₂ laser and microsuturing of the wound surfaces via an endoscope is a effective approach to cure and prevent recurrence of CLSCs.

Exceptional material requirement for reproduction in mouse oocytes

Limited information on oocytes and fertilization prevents the efficient therapy of patients with infertility. The most important reason for this lack of understanding is a deficiency in research dedicated to oocytes and fertilization. Currently, we are concerned with the role of nutrition in the process of oocyte development to better understand the relationship between nutrition and infertility. The aim of this study was to explore the relationship between some exceptional materials and infertility to elucidate the role of these materials in oocyte development. We used proteomic analysis to identify numerous nutrition-related proteins in three developmental stages: the germinal vesicle stage, the metaphase II-arrested stage, and the fertilized oocyte-zygote stage. Specific proteins were abundantly expressed during the three stages. These proteins included astacin-like metalloendopeptidase, selenium-binding proteins, and other proteins involved in metabolic and signaling pathways. Other proteins were involved in the citrate cycle, the electron transport chain, the urea cycle, fatty acid metabolism, and the insulin signaling pathway. Almost all these proteins exhibited different expression levels in the three stages. The results of the present study provide a better understanding of the molecular mechanisms of early embryonic development and suggest new treatment methods for infertility.

Metabolic activation of mitochondria in glioma stem cells promotes cancer development through a reactive oxygen species-mediated mechanism

Introduction

Cancer stem cells (CSCs) possess characteristics associated with normal stem cells, specifically the abilities to renew themselves and to give rise to all cell types (differentiation). It is assumed that induction of differentiation in CSCs would reduce their ability to form tumors. What triggers CSC differentiation and the role of “differentiation” in tumorigenesis remain elusive.

Methods

Glioma stem cell (GSC) lines and subcutaneous as well as orthotopic xenografts established from fresh surgical specimens of glioblastoma multiforme were used.

Results

Exposure of GSCs to serum activates mitochondrial respiration and causes an increase in mitochondrial reactive oxygen species (ROS) as well as oxidative stress responses, leading to the appearance of differentiation morphology and a deceased expression of CSC markers. Chemical perturbation of the mitochondrial electron transport chain causes ROS increase and further downregulation of stem cell markers, while antioxidant N-acetyl-cysteine reduces ROS and suppresses the differentiation of GSCs. Surprisingly, the serum-induced differentiated GSCs exhibit greater ability to form tumor in both orthotopic and subcutaneous xenograft models, which can be suppressed by N-acetyl-cysteine. Mitochondrial ROS from the serum-stimulated cells triggered the activation of nuclear factor-kappa-B (NFκB) pathway, which is a potential mechanism for the promotion of tumorigenesis.

Conclusion

This study suggests that ROS generated from active mitochondrial respiration in the presence of serum is critical in CSCs activation, which promotes tumor development in vivo.

Electronic supplementary material

The online version of this article (doi:10.1186/s13287-015-0174-2) contains supplementary material, which is available to authorized users.

De novo symptoms and their impact on life quality in patients following transvaginal reconstructive pelvic surgery with polypropylene mesh

OBJECTIVE

To study the de novo symptoms and their impact on life quality in patients that underwent transvaginal reconstructive pelvic surgery (RPS) with polypropylene mesh.

MATERIALS AND METHODS

From May 2004 to March 2011, 114 severe pelvic organ prolapse (POP) patients with Stage III-IV by POP-Q system underwent RPS with polypropylene mesh. Patients completed pelvic floor distress inventory short form (PFDI-20) and pelvic floor impact questionnaire short form (PFIQ-7) preoperatively and repeated them at two and six months, and one year postoperatively.

RESULTS

Ninety-six (84%, 96/114), 85 (75%, 85/114), and 77 (68%, 77/114) patients, respectively, completed the questionnaires at two months, six months, and one year postoperatively. All patients had POP-Q staging scoring < or = I at one year after surgery. Nineteen (19.8%, 19/96) patients had mesh exposure at two and six months (7.8%, 6/77) at one year follow-up. Most vaginal and pelvic symptoms, urinary and obstructive defecation bothersome symptoms improved significantly at two months postoperatively and this improvement was maintained at the one year follow-up. Mean score of PFDI-20 and PFIQ-7 all improved significantly postoperatively at two and six months and at one year follow-up (p < 0.01). Fifty percent (48/96) of patients had postoperative de novo symptoms at the two months follow-up predominantly presented with bothersome vaginal discharge (35.4%, 34/96) and pelvic muscle symptoms (20.8%, 20/96). Patients with de novo symptoms had higher postoperative mean POPDI-6 and POPIQ-7 scores (p < 0.05) than those without at the two month follow-up, but no significant difference was seen at the six month and at one year follow-ups. Patients with bothersome vaginal discharge had higher vaginal mesh exposure rate (41.2%, 14/34) than patients without (8.1%, 5/62) (p = 0.0003). One year after operation, 77 (68%) patients completed the non-validated satisfaction questionnaire. Seventy-four (96%, 74/77) patients said that they were either 'very satisfied' or 'satisfied' with the outcome of their surgery, while three (4%, 3/77) reported unsatisfactory results.

CONCLUSIONS

De novo symptoms were common after transvaginal RPS with polypropylene mesh, but most of them were moderate and resolved within six months postoperatively and seldomly had a long-term negative impact on their quality of life. The impact of dyspareunia on patients' sexual function requires further research.

[Combination of GP regimen and Kanglaite in the treatment of advanced non-small cell lung cancer]

BACKGROUND

Chemotherapy is a common way to treat advanced non-small cell lung cancer (NSCLC). The response rate of chemotherapy is only 20%-50%, and the side effects are serious. To improve efficacy and quality of life and to reduce side effects of chemotherapy become main tasks of clinical researches. The aim of this study is to evaluate GP regimen alone and GP regimen combined with Kanglaite on the efficacy, side effects and the improvement of quality of life in the treatment of advanced NSCLC.

METHODS

Randomly fifty patients with NSCLC in stage III and IV were treated by GP regimen combining with Kanglaite, and fifty patients were treated with GP regimen alone. Kanglaite was used on the first day of each chemotherapy cycle for consecutive 10 days, and the dosage was 200ml/d. GP regimen included gemcitabine 1000mg/m² on 1st and 8th days and cisplatin 80mg/m² on 2nd day. The treatment was repeated every three weeks. The efficacy, side effect and quality of life were compared after two cycles of chemotherapy.

RESULTS

Response rate was 52% in combining group and 32% in control group. The rates were different between the two groups (Chi-square=4.04, P < 0.05). Quality of life in combining group was significantly higher than that in control group after treatment (t=2.8, P < 0.05). The incidence of side effects in combining group was lower than that in control group, and the degree was also slighter.

CONCLUSIONS

Kanglaite in combination with GP regimen can be used for the treatment of advanced NSCLC. It can improve efficacy and the quality of life, and reduce the side effect of chemotherapy.

[Primary hepatocarcinoma treated by traditional Chinese medicine combined with transcatheter arterial chemoembolization]

OBJECTIVE

To observe the effect of traditional Chinese medicine (TCM) combining transcatheter arterial chemoembolization (TACE) in patients with primary hepatocarcinoma (PHC), and its influence on patients' immunity, quality of life and adverse reaction.

METHODS

Sixty-seven patients with mid-advanced stage PHC were assignd to two groups: the 35 patients in Group 1 treated with TCM combined TACE and the 32 in Group 2 treated with TACE alone. TACE with Gemzar (GEM) and Cisplatinum (DDP) were applied once in both groups, and followed by conventional post-operational management as hydration. The TCM used was prescribed according to syndrome differentiation. Peripheral blood T-lymphocyte subsets and natural killer (NK) cells of patients were measured before treatment (as the base line) and at the end of the 1st and 4th week after treatment (W1, W4), patients' quality of life (QOL) was estimated at the sametime by Karnofsky sore (KPS). Moreover, CT or MRI examination was performed at end of the 4th week to evaluate the short-term efficacy of treatment.

RESULTS

Short-term efficacy analyses showed that the effective rate was 51.4% (18/35) in Group 1 and 37.5% (12/32) in Group 2, showing insignificant difference between them (P > 0.05). The levels of CD3+, CD4+, CD4+/CD8+, NK cells actionties and KPS score reduced slightly in both groups at W1, with no significant intergroup difference; but at W4, they did show significant differences between groups, and all indices in both groups were significantly different to those of the baseline and at W1 (P < 0.05 or P < 0.01). Aduerse reaction occurred were mainly fever, digestive reaction and lowering of peripheral white blood cell counting, platelet counting, etc. and the incidence of fever in Group 1 was lower than in Group 2.

CONCLUSION

TCM treatment combined with TACE can enhance the immunity and QOL of PHC patients, and alleviate the adverse reaction of chemotherapeutic agents.

Duodenal acid-induced gastric relaxation is mediated by multiple pathways

In this study, we used an in vivo anesthetized rat model to investigate the mechanisms responsible for duodenal acid-induced inhibition of gastric motility. Intraduodenal infusion of HCl produced a rate-dependent decrease in intragastric pressure. Infusion of HCl at 2 ml/h produced a physiological plasma secretin level and elicited a decrease in intragastric pressure of 3.0 +/- 0. 2 cmH20. Infusion of rabbit secretin antiserum reduced the acid-induced inhibition of gastric motility by 85 +/- 5%, suggesting mediation mainly by endogenous secretin. Administration of the cholecystokinin (CCK)-A antagonist MK-329 caused only a modest 10 +/- 3% reduction in gastric relaxation, whereas the serotonin antagonist ICS-205930 had no effect. In contrast, immunoneutralization with the secretin antibody caused only a 15% reduction in the relaxation evoked by a higher rate of HCl infusion (3 ml/h), whereas MK-329 and ICS-205930 caused a 20 +/- 4% reduction and no reduction, respectively. Bilateral truncal vagotomy or perivagal application of capsaicin completely abolished gastric relaxation in response to low rates (1-2 ml/h) of 0.1 N HCl infusion but only partially affected gastric relaxation in response to a higher infusion rate (3 ml/h). These observations indicate that multiple pathways mediate the duodenal acid-induced inhibition of gastric motility. At low rates of HCl infusion, gastric relaxation is mediated primarily by endogenous secretin, which acts through vagal afferent pathways. At higher rates of HCl infusion, gastric relaxation is mediated by endogenous secretin, CCK, and possibly by the direct action of HCl on vagal afferent pathways or yet unidentified neuropathways.

[A comparable study on characteristics of HBsAg carriers in rural areas of Shanghai, Tianjin and Taiyuan]

A seroepidemiological study on HBV infection was carried out in the villages of Changbei, Shanghai, Beihu, Tianjing and Xipu, Taiyuan, July-October 1993. The positivity rates of HBsAg in these villages were 6.4%, 3.4%, 4.8%, respectively. Compared with those in Beihu and Xinpu village, HBsAg carriers in Changbei village had significant fectures as follows: 1. They were much older than those in Beihu and Xipu villages. 2. The positivity rate of male was much greater than that in female. 3. The positivity rate of HBeAg was lower, anti-HBe was higher than those in Beihu and Xipu village. 4. Those of low titre were much more common than those of high titre. A series of analysis indicated that all those festures were related with the large-scale HBV vaccination in adolescents of Changbei village in recent years.

[Clinico-pathological and immunohistochemical features of malignant lymphoma of the Waldeyer's ring--a report of 191 cases]

This paper presents 191 cases of malignant lymphoma of the Waldeyer's ring. It comprised 21% of all the malignant lymphomas diagnosed in our hospital, 1964-1989, and ranked first in the extranodal malignant lymphomas. The locations of these tumors were: tonsil (in 127 cases), nasopharynx (in 62) and base of tongue (in 2). Cervical lymph nodes were frequently involved. Thirty cases, including polymorphic, clear cell and lymphoblastic lymphomas, were examined by PAP immunohistochemical method and were all shown to be of T-cell type. Owing to the bizarre appearance of the tumor cells, varied histological architecture and diverse modes of invasion they were often misdiagnosed as anaplastic or poorly differentiated carcinoma. Malignant granuloma was also one of the diagnostic problems because of the ulcer formation. Occasionally, as the tumor base was infiltrated by large amount of inflammatory cells, they could also be misdiagnosed as inflammatory lesions. Consequently, we believe that the immunohistochemical method should be considered as an important supplementary method of diagnosis.

Evidence for a glutamatergic neural pathway in the myenteric plexus

The objective of this study was to determine whether L-glutamate (L-Glu) may serve as a neurotransmitter candidate in the guinea pig myenteric plexus. We observed that [3H]Glu and gamma-[3H]aminobutyric acid were synthesized from [3H]glutamine and released from neurons of the myenteric plexus during K+ and 1,1-dimethyl-4-phenylpiperazinium-evoked depolarization in a concentration-dependent manner. Muscle tension studies performed on ileal longitudinal muscle-myenteric plexus (LM-MP) preparations revealed that L-Glu [mean effective dose (ED50) 2.5 x 10(-5) M] produced concentration-dependent contractions, which were unaffected by hexamethonium but abolished by tetrodotoxin, atropine, and magnesium, suggesting that L-Glu acts via N-methyl-D-aspartate (NMDA)-type receptors that stimulate a cholinergic neural pathway unaffected by ganglionic blockade. In addition, L-Glu (ED50 4 x 10(-5) M) and NMDA (ED50 2 x 10(-4) M) stimulated concentration-dependent release of [3H]acetylcholine (ACh) from LM-MP sections, which was inhibited by tetrodotoxin, magnesium, and the NMDA receptor antagonist D-2-amino-5-phosphonovaleric acid (AP-5). L-Glu-mediated release of [3H]ACh was enhanced by theophylline (10-6 M) and 3-isobutyl-1-methylxanthine (1 mM) and was significantly reduced by the adenylate cyclase inhibitor, 2',5'-dideoxyadenosine (10(-4) M) and somatostatin-14 (10(-6) M), which inhibits adenosine 3',5'-cyclic monophosphate (cAMP)-dependent cholinergic transmission in the myenteric plexus. These studies suggest that L-Glu may serve as an excitatory neurotransmitter in the myenteric plexus via its action on NMDA-type receptors, which are coupled to cAMP-dependent release of ACh.

Mechanism of action of peptide YY to inhibit gastric motility

The pathway by which peptide YY inhibits upper gastrointestinal motility is largely unknown and prompted this investigation. Muscle tension and [3H]acetylcholine release studies were performed on isolated muscle strips and slices obtained from the guinea pig stomach. Peptide YY [0.1-1000 nmol/L; concentration of half-maximal effect (EC50), 6 nmol/L] caused concentration-dependent relaxation of longitudinally oriented muscle strips that was unaffected by hexamethonium but was blocked by atropine and tetrodotoxin, suggesting that the peptide inhibited postganglionic cholinergic neurotransmission. In addition, peptide YY (1 mumol/L) reduced by 42% +/- 6% electrically stimulated muscle contractions that were blocked by atropine and tetrodotoxin, providing additional evidence that the peptide inhibits release of acetylcholine. Next, the effect of peptide YY on potassium-evoked release of [3H]acetylcholine and whether the peptide inhibits cyclic adenosine monophosphate-dependent release of acetylcholine were examined. Peptide YY (1 mumol/L) inhibited KCl (35 mmol/L)-evoked release of [3H]acetylcholine by 58% +/- 6%. The inhibitory action of peptide YY was unaffected by antagonists for dopamine-2, alpha-2, and opiate receptors that are known to mediate presynaptic inhibition. In addition, peptide YY reduced half-maximal forskolin and cholera toxin-evoked release of acetylcholine by 45% +/- 6% and 42% +/- 8%, respectively, suggesting that the peptide can inhibit cyclic adenosine monophosphate-dependent release of acetylcholine. This effect of peptide YY was reversed by pertussis toxin which prevents activation of the inhibitory guanine nucleotide binding protein coupled to adenylate cyclase. In summary, peptide YY inhibited basal and stimulated cholinergic neurotransmission in the guinea pig stomach. In addition, peptide YY antagonized cyclic adenosine monophosphate-mediated release of acetylcholine through a pertussis toxin-sensitive mechanism.

Mechanisms regulating somatostatin release and somatostatin-induced acetylcholine release from the myenteric plexus

The present studies were performed to characterize the molecular form(s) of somatostatin present in the myenteric plexus and to examine some aspects of the regulatory mechanisms underlying somatostatin release and somatostatin-induced release of acetylcholine from this tissue. We observed the following: (1) Somatostatin-like immunoreactivity (SLI) is present in the myenteric plexus of the guinea pig ileum with somatostatin-14 being the predominant molecular form. (2) Somatostatin-like immunoreactivity is released from isolated myenteric ganglia after stimulation with veratridine or the ganglionic agonist dimethylphenylpiperazinium (DMPP). (3) Calcium entry via the N-type channel appears to play a dominant role in DMPP-induced release of SLI. (4) Somatostatin regulates its own release via a pertussis toxin-sensitive mechanism. (5) Under basal conditions somatostatin-14 stimulates release of acetylcholine in a concentration-dependent manner. (6) Calcium entry via L-type channels is associated with the release of acetylcholine evoked by somatostatin-14.