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Objective: To investigate the correlation of two important inflammatory biomarkers, plasma osteopontin and neutrophil gelatinase-associated lipocalin (NGAL), with the severity and outcome of pelvic inflammatory disease (PID). Materials and methods: Sixty-one patients with PID, including 25 patients with tubo-ovarian abscess (TOA), were consecutively recruited. Their blood samples were tested for the concentrations of plasma osteopontin and NGAL using enzyme-linked immunosorbent assay. The associations of these biomarkers with TOA, length of hospitalization, and incidence of surgery were also analyzed. Results: Plasma osteopontin level was significantly increased in PID patients with TOA compared to PID patients without TOA (median 107.77 ng/mL vs. 72.39 ng/mL, p = 0.004). However, there was no significant difference for plasma NGAL. If the cutoff level of plasma osteopontin was set at 81.1 ng/mL, there was a 76.0% sensitivity and a 24.0% false negative rate in predicting TOA in PID patients. Plasma osteopontin significantly correlated with length of hospital stay (r = 0.467, p

Objective: Abruptio placentae induced by acute pancreatitis during pregnancy is very rare. We present a pregnant woman with a series of complications due to acute necrotizing pancreatitis. Case Report: Presented herein is a 21-year-old, nulliparous woman at 33 weeks' gestation. The initial episode of abdominal pain was thought to be acute appendicitis (which in actuality was identified to be acute pancreatitis) and was complicated with abruptio placentae, uteroplacental apoplexy, and intrauterine fetal demise. Sterile necrotizing pancreatitis was confirmed by computerized axial tomography and total negativity of bacterial cultures taken from blood and ascites during the hospitalization. Nonsurgical management with conservative treatment was employed and the patient recovered gradually. Conclusion: Acute pancreatitis is difficult to diagnose during pregnancy. It presents as a systemic inflammatory response syndrome resulting in hemodynamic changes and may lead to abruptio placentae. Nonsurgical conservative treatment may be useful in such patients.

The protein product of nm23-H1 gene has activity of nucleoside diphosphate (NDP) kinase, which catalyzes the phosphorylation of nucleoside diphosphates to the corresponding nucleoside triphosphates. Reductions in nm23 expression have been significantly associated with aggressive behavior in melanoma, breast, colon, and gastric carcinomas. On the contrary, high levels of nm23 gene expression are noted in the advanced stage of thyroid carcinomas and associated with significant reductions in survival for neuroblastoma and osteosarcoma patients. Although expression of nm23/NDP kinase is divergent in various malignant tumors, its reduced expression seems to be related to increased metastatic potential in most carcinoma types. However, it is hypothesized that nm23 may play a tissue-specific role, and that different regulatory mechanisms may act in different tumors. In ovarian carcinoma, nm23-H1/NDP kinase may be correlated with some clinicopathologic characteristics. In cervical cancer, nm23-H1 is probably involved in cervical carcinogenesis and correlated with some aggressive parameters. Overexpression of nm23-H1 protein may indicate poor survival for cervical cancer patients. Other than histidine 118 residue (amino acid sequence 118: histidine) concerned with NDP kinase activity of nm23-H1, serine 120 (amino acid sequence 120: serine) related activity of histidine-dependent protein phosphotransfer was recently reported to be responsible for its biological suppressive effects. To inhibit metastatic potential, nm23-H1 is also demonstrated to co-immunoprecipitate the kinase suppressor of Ras and phosphorylate it, and therefore reduce activation of the extracellular signal-regulated kinase mitogen-activated protein kinase pathway in response to signaling.

BACKGROUND: To investigate the implication of ribonucleotide reductase M2 (RRM2) in the carcinogenesis of uterine cervix and its relationship with clinicopathological characteristics and prognosis of cancer patients. METHODOLOGY AND PRINCIPAL FINDINGS: The impact of RRM2 on cell viability was investigated in SiHa cervical cancer cells after RRM2 knockdown and the addition of cisplatin, which induces inter- and intra-strand DNA crosslinks. RRM2 immunoreactivity was evaluated by semi-quantitative H score among 29 normal, 30 low-grade dysplasia, 30 high-grade dysplasia and 103 invasive cancer tissue specimens of the uterine cervix, using tissue microarrays. RRM2 was then correlated with the clinicopathological variables of cervical cancer and patient survival. A greater toxic effect on cell viability using cisplatin was reflected by the greater reduction in RRM2 protein expression in SiHa cells. The RRM2 expression in cancer tissues was higher than that in high-grade dysplasia, low-grade dysplasia or normal cervical tissues. RRM2 upregulation was correlated with deep stromal invasion, large tumors and parametrial invasion and predicted poor survival. CONCLUSIONS: RRM2 is a new molecular marker for the diagnosis and clinical outcomes of cervical cancer. It is involved in cervical carcinogenesis and predicts poor survival, and may be a potential therapeutic target including in cisplatin treatment.

Hypothesis: Single-nucleotide polymorphisms (SNP) in promoter of human nonmetastatic clone 23 type 1 (nm23-H1) may affect their binding with transcription factors and affect promoter activity as well as gene transcription. Therefore, we investigated the impact of the nm23-H1 gene polymorphisms on the neoplastic lesions of uterine cervix in mid-Taiwan women (women who live in the central area of Taiwan). We expected that women with different genotypes in nm23-H1 polymorphisms, such as rs34214448, rs 16949649, or rs2302254, may have different incidences of cervical neoplasia. Materials and Methods: In total, 366 blood samples were collected from 244 healthy women and 122 patients with cervical neoplasia to analyze 3 nm23-H1 gene single-nucleotide polymorphisms (rs34214448, rs 16949649, and rs2302254). Results: The heterozygous genotypes, TG in rs34214448 or TC in rs 16949649, were differentially distributed between patients with cervical neoplasia and normal women (Hommel adjusted P =.0440 and .0435, respectively) as compared to their homozygotes. Moreover, compared to those with wild-type homozygotes and heterozygotes, women with variant homozygotes TT in rs34214448 or CC in rs 16949649 exert different distributions between patients with cervical neoplasia and normal women (P = .058 and .058). Interestingly, we found the genotype distribution of rs34214448 has significant association with that of rs 16949649 with high consistency. Conclusions: Mid-Taiwan women with the polymorphic heterozygotes TG in rs34214448 or TC in rs 16949649 of human nonmetastatic clone 23 type 1 promoter have the tendency to develop cervical neoplasia while compared to their homozygous counterparts. However, women with variant homozygotes TT in rs34214448 or CC in rs 16949649 exhibit less tendency as compared to those with wild-type homozygotes and heterozygotes. [ABSTRACT FROM AUTHOR]

Our goal was to compare the expression of plasma monocyte chemotactic protein 1 (MCP-1) and the gene polymorphism in patients with pelvic inflammatory disease (PID) and healthy controls. The enzyme-linked immunosorbent assay (ELISA) and polymerase chain reaction--restriction fragment length polymorphism (PCR-RFLP) were, respectively, used to measure the plasma MCP-1 level and MCP-1 polymorphism in 70 healthy controls and in 64 patients with PID before and after they received routine treatment protocols. We found plasma MCP-1 was significantly elevated in patients with PID compared to that in normal controls and decreased significantly compared to that in patients with PID after they received treatment. The increased expression of plasma MCP-1 was significantly correlated with the cell counts of white blood cells (WBCs) in blood and the level of plasma C-reactive protein (CRP) of patients with PID before they received treatment. There was no association between MCP-1 -- 2518G/A SNP and its gene expression levels and PID susceptibility. Elevated plasma MCP-1 could be a biological marker for the diagnosis and to be a new strategy for target therapy of pelvic inflammatory disease. [ABSTRACT FROM AUTHOR]

The objective was to compare the expression of plasma stromal cell-derived factor 1 and the gene polymorphism in patients with pelvic inflammatory disease and healthy controls. The enzyme-linked immunosorbent assay and polymerase chain reaction--restriction fragment length polymorphism were, respectively, used to measure the plasma stromal cell-derived factor 1α level and stromal cell-derived factor 1 polymorphism in 50 healthy controls and in 44 patients with pelvic inflammatory disease before and after they received routine treatment protocols. The level of plasma stromal cell-derived factor 1α was elevated in patients with pelvic inflammatory disease compared to normal controls and decreased significantly after treatment. There were significant correlations between plasma stromal cell-derived factor 1α level and neutrophil count as well as between stromal cell-derived factor 1α level and white blood cell count in patients with pelvic inflammatory disease. There was no significantly different distribution of stromal cell-derived factor 1 genotypes between patients with pelvic inflammatory disease and normal controls. Patients with pelvic inflammatory disease having stromal cell-derived factor 1-3′ A allele were associated with significantly elevated plasma stromal cell-derived factor 1α concentration compared to patients with pelvic inflammatory disease having G/G homozygous alleles (P < .02). In normal controls, there was no significant difference in the plasma stromal cell-derived factor 1 level between individuals with and without stromal cell-derived factor 1-3′ A allele. When the cutoff level of plasma stromal cell-derived factor 1α level was determined to be 2192 pg/mL based on receiver-operating characteristic curve, the sensitivity, specificity, positive predictive value, and negative predictive value as well as accuracy were 77.3%, 88.0%, 85.0%, 81.5%, and 83.0%. In conclusion, when the cutoff level was determined to be 2192 pg/mL, plasma stromal cell-derived factor 1α level can be used to predict pelvic inflammatory disease. [ABSTRACT FROM AUTHOR]

Aim: Human telomerase reverse transcriptase (hTERT) is known to be significantly activated during immortalization, and p53 is thought to be a guardian of that apoptosis pathway in most cancer cells. The aim of this study was to assess the relationships among hTERT, p53 and various clinicopathological parameters of cervical cancer patients and overall survival. Methods: We used immunohistochemical methods to examine the expression of hTERT and p53 proteins in 45 paraffin-embedded pathological samples of early stage (IA–IIA) cervical cancer. Results: Thirty-seven of 45 (82.2%) cervical cancer slides exhibited hTERT activation. Twenty-eight of these slides with activated hTERT (75.7%) were also found to be positive for mutant p53 protein ( P < 0.05). Neither of both was found to be prognostic in Kaplan–Meier curves ( Figs 2,3 ). The survival rate varied greatly (from 86.54% to 42.86%) in a particular order: hTERT activation > mutated p53 > deep stromal invasion > pelvic nodal metastases. The findings also demonstrated that stromal invasion was no longer a significant prognostic factor ( P = 0.16), but that nodal status was an adverse prognostic with a hazard ratio of 8.48 (1.89–37.98) after adjustment. Conclusions: Although expression of both hTERT and mutant p53 increase in early stage cervical cancer, neither was found to be prognostic. Lymph node metastases was the most powerful prognostic factor associated with survival among hTERT, p53 and various clinicopathological parameters. [ABSTRACT FROM AUTHOR]

To correlate matrix metalloproteinase-2 (MMP-2) expression with cervical carcinogenesis, the authors use reverse-transcription polymerase chain reaction to detect MMP-2 mRNA expression in 10 cervical squamous cell carcinoma (SCC), 10 high-grade cervical intraepithelial neoplasia (CIN), and 10 normal tissues. They further detect MMP-2 immunoreactivity of 24 tissue cores in each SCC, high- and low-grade CINs, and a healthy subgroup on a tissue array using integrated optical density (IOD) for number and intensity of stained cells in 345 x 345 pixels. They found the mRNA expression of MMP-2 to be higher in most SSCs (9/10 samples) and high-grade CINs (7/10 samples) but lower in normal tissues. The IOD of MMP-2 was significantly higher in high-grade CIN than in normal and low-grade CIN tissue cores (P < .001 for both) and significantly higher in SCC than in high-grade CIN tissue cores (P < .001). The results show that MMP-2 upregulation confers on tumor cells the ability to degrade the subepithelial basement membrane and subsequently invade the cervix. [ABSTRACT FROM AUTHOR]

Abstract  The role of Burch colposuspension as the primary surgical treatment of stress urinary incontinence has been challenged by less invasive new surgical methods. The aim of this study was to evaluate the long-term results of Burch colposuspension in terms of subjective self-reported outcomes. Between 1993 and 1997, 159 women who underwent Burch colposuspension as the first operation for treating urodynamic stress incontinence were recruited for this study. We recorded the findings of preoperative and postoperative urodynamic studies and early postoperative complications or adverse effects related to the operation. In 2005, after a median follow-up of 10 years, telephone interviews were carried out and 152 (95.5%) women responded. Two main questions were asked of these women to evaluate the overall impression of improvement after the operation. Eighty-four (55.3%) women were dry according to their subjective reports, 55 (36.2%) women had improved, and 13 (8.5%) women had failed after an 8- to 12-year follow-up. One hundred and twenty-five (82.2%) women were satisfied with the outcome of the operation and 27 (17.8%) women were not. Among these 27 women, 16 (59.2%) women complained of urinary frequency and 9 (33.3%) women complained of urinary urgency as the reasons for their dissatisfaction. Our long-term subjective outcomes revealed that Burch colposuspension is an effective alternative surgery for urodynamic proven stress incontinence. [ABSTRACT FROM AUTHOR]

AbstractTo investigate the changes in the connective tissues located in the upper portion of the anterior vaginal wall, which are associated with anterior vaginal wall prolapse, 23 women with anterior vaginal wall prolapse were included in the study group and 15 women with normal genital support served as control group. The anterior vaginal wall tissue samples were obtained for immunohistochemical staining of collagen (type I, III, IV, V, VI), elastin, and glycoproteins from the extracellular matrix (fibronectin, vitronectin, laminin). The number of capillaries per arteriole and mitochondria numbers per smooth muscle cell were evaluated for demonstrating whether the anatomical prolapse affect on blood supply to these tissues. Collagen III was significantly less in the anterior vaginal wall of patients with anterior vaginal wall prolapse. Quantitative immunoreactivity of collagen I and III had significant positive correlations with ageing. [ABSTRACT FROM AUTHOR]

Abstract Problems relating to the erosion of sling material, through either the vagina or the urethra, have been encountered with almost all kinds of synthetic sling materials. We present four unusual cases of women using different synthetic materials and the complications that occurred. The biopsies were examined histologically and analyzed for collagen and inflammatory reactions. Four patients who underwent suburethral slingplasty previously with different sling materials required surgical management for complications, including one intravesical Ethibond migration, vaginal mucosal mesh erosion in two patients, and one proximal urethral overcorrection with intravesical erosion. We reviewed the literature regarding the amount of mesh erosion and connective tissue reaction with synthetic materials. The efficiency of mesh removal was assessed. The four patients maintained urinary continence after urethrolysis and removal of the mesh. Fibrosis and severe inflammatory reactions were found in the connective tissue adjacent to the mesh as well as the Prolene mesh. Technically, it would be easier to remove the graft of patch sling if rejection or erosion occurs. [ABSTRACT FROM AUTHOR]