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Objective: To evaluate continuous improvement of portable domestic pelvic floor neuromuscular electrical stimulation on the pelvic floor function of patients with stress urinary incontinence after short-term pelvic floor electrophysiological treatment in hospital., Methods: Totally 60 women with stress urinary incontinence were recruited for this randomized controlled trial. The control group including a total of 30 patients, only received 4 weeks pelvic floor electrophysiological treatment in the hospital. Family consolidation treatment group (experimental group) including 30 patients, after 4-week treatment in hospital, received 12-week of pelvic floor neuromuscular electrical stimulation using portable electrical stimulator at home under the guidance of doctors. In post-treatment 6 months and 9 months, 1-hour pad test was measured for urine leakage, pelvic floor electrical physiological parameters were assessed, and subjective improvement of symptoms of urinary incontinence were evaluated. All these data were analysed to compare the effect of the two groups., Results: In 9 months after treatment, average change of urine leakage, the control group and experiment group were (75±24)% versus (99±3)%, the difference was statistically significant (P<0.01). In the experiment group, strength of type I muscle (4.4±0.7), strength of type II muscle (4.8±0.4) and pelvic floor dynamic pressure [(96±12) cmH(2)O, 1 cmH(2)O=0.098 kPa] were better than those of control group [3.2±1.0, 4.3±0.9, (86±10) cmH(2)O, respectively], the differences were statistically significant (P<0.01). Subjective outcome, the control group and experiment group were (6.5±2.9) versus (1.8±1.7), subjective outcome between the two groups had significant difference (P<0.01)., Conclusion: After short-term pelvic floor electrophysiological treatment in hospital, the portable domestic pelvic floor neuromuscular electrical stimulation in patients with stress urinary incontinence is helpful to continuous improvement of pelvic floor function.

Objective: To study the postpartum pelvic floor rehabilitation on the improvement of pelvic floor electrical physiological indexes and the prevention of female pelvic floor dysfunction in China., Methods: A multicenter prospective randomized controlled study was carried out. From October 2011, postpartum women in five provinces were randomly assigned into treatment group and control group. The women in treatment group received electrical stimulation and biofeedback treatment. The women in control group performed pelvic floor muscle exercise at home. When 6 months and 12 months after delivery, comparing two groups of patients with pelvic floor electrical physiological indexes and pelvic organ prolapse quantitation measurements (POP-Q), to evaluate the effect of postpartum pelvic floor rehabilitation on the prevention of pelvic floor dysfunction. Pelvic floor impact questionnaire short form (PFIQ-7) and pelvic organ prolapse/incontinence sexual questionnaire-12 (PISQ-12) were used to evaluate the influence on quality of life and sexual life., Results: Until June 2013, 324 women were participated, 124 in control group, 200 in treatment group. According to the baseline results, there was statistical significance in the results of pelvic floor electrical physiological indexes between the treatment and control groups in postpartum 6 months and 12 months; the proportion above level III of type I and type II muscle fibers strength in the treatment group, it was from 41.5% (83/200) and 40.5% (81/200) to 76.3% (145/190) and 79.5% (151/190) in postpartum 6 weeks and postpartum 6 months, increased to 80.6% (58/72) and 80.6% (58/72) in postpartum 12 months, improved significantly comparing with the control group (P < 0.01). According to Point Aa, treatment group and control group in the postpartum 6 weeks was (-2.2 ± 0.7) versus (-2.4 ± 0.6) cm, in postpartum 12 months (- 2.5 ± 1.1) versus (- 2.7 ± 0.6) cm, the improvement in treatment group was statistically significant (P < 0.01). And the other points were not significantly different (P > 0.05). There was no significant difference in the questionnaires in quality of life and quality of sexual life (P > 0.05)., Conclusion: Neuromuscular electrical stimulation and biofeedback therapy in the early postpartum period could obviously improve pelvic floor electrical physiological indexes, and is beneficial to prevent the pelvic floor dysfunction.

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.

Objective: To investigate the quality of life and sexual function of cervical cancer patients following radical hysterectomy (RH) and vaginal extension., Methods: Case-control and questionnaire- based method was employed in this study. Thirty-one patients of early-stage (I b1-I b2) cervical cancer who had undergone vaginal extension following classic RH in Peking Union Medical College Hospital from December 2008 to September 2012 were included in study group, while 28 patients with matching factors and RH only during the same period were allocated to control group. There was no significant difference between two groups in terms of clinical and demographic variables including age at diagnosis, tumor stage and follow-up time (P > 0.05). Patients were assessed retrospectively by validated self-reported questionnaires the European Organization for Research and Treatment of Cancer Cervix Cancer Module Questionnaire (EORTC QLQ-CX24) mainly for quality of life and sexual function for cervical cancer patients; the Sexual Function and Vaginal Changes Questionnaire (SVQ) further investigates sexual function and vaginal changes of patients with gynecologic malignancy at least 6 months after treatment., Results: Vaginal length acquired by pelvic examination by gynecologic oncologists during follow-up visits was (10.0 ± 1.3) cm and (5.9 ± 1.0)cm in study group and control group respectively (P = 0.000). Sixty-eight percent (21/31) of cases in study group and 64% (18/28) of cases in control group had resumed sexual activity at the time of interview, and the time interval between treatment and regular sexual activity was mean 6 months (range 3-20 months) and mean 5 months (range 1-12 months) in study and control group respectively, in which there was not statistical significance (P > 0.05). No difference was observed regarding pelvic floor symptoms (P > 0.05) while difficulty emptying bladder, incomplete emptying and constipation were most commonly reported. Both group presented with hypoactive sexual desire disorder [88% (52/59)], orgasm dysfunction [72% (28/39)] and low enjoyment or relaxation after sex [51% (20/39)], which was not statistically significant (P > 0.05). Reduced vagina size and shorter vagina was more prominent in control group (12/18) than that in study group [19% (4/21)] with statistical significance (P < 0.05), while no difference in sexual desire, vaginal lubrication, dyspareunia and sexual enjoyment (P > 0.05)., Conclusions: Patients with peritoneovaginoplasty following RH had much longer vagina and less self-perceived short vagina. Vaginal extension following RH does not worsen the pelvic floor symptoms.

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.

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.

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.

Objective: To evaluate clinical and sexual outcomes in women with severe uterine prolapsed at child-bearing period undergoing laparoscopic high uterosacral ligament suspension combined with cervical amputation., Methods: From November 2007 to March 2010, 34 patients ( ≤ 50 years old) with severe uterine prolapse (prolapse group) who had already given birth and underwent laparoscopic high uterosacral ligament suspension combined with cervical amputation in Peking Union Medical College Hospital were enrolled in this retrospective study. All patients were defined as Pelvic Organ Prolapse Quantification (POP-Q) stage III. Follow-up was performed at 1, 6, and 12 months, and then annually. Anatomic failure was defined as ≥ 1 pelvic compartment classified as POP-Q ≥ stage II.Sexual outcomes were assessed at baseline and 3-year follow-up according to validated Short-Form Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Thirty one age-matched women who underwent health examinations during the same time period were selected as a healthy control group., Results: Mean age of women at prolapse group were (39 ± 5) years and average surgery time were (51 ± 8) minutes. No severe intraoperative complications occurred, including urethral twist, bladder and rectum injury, pelvic hemotoma. All patients were followed up for more than 3 years, the mean following up period was 40 months (36-64 months). Based on stage II of POP-Q as recurrence criteria, the anatomical success and patient satisfaction rates were both 100% (34/34). POP-Q point C and D measurements were significantly higher after surgery then those at preoperative values [C:(-5.4 ± 0.6) cm versus (2.2 ± 0.7) cm, D:(-6.7 ± 0.4) cm versus (-4.0 ± 0.7) cm; P < 0.01 for all]. Three years postoperatively, 33 patients were sexually active. Among the 94% (31/33) patients who answered the PISQ-12 questionnaire, there was significant improvement in post- and preoperative total PISQ-12 scores (38 versus 26, P < 0.01) and in all three subscale PISQ-12 domains (P < 0.01 for all). The postoperative PISQ-12 score was similar to that of the control group (38 ± 6 versus 37 ± 3, P > 0.05)., Conclusion: Laparoscopic high uterosacral ligament suspension combined with cervical amputation conferred satisfying long-term anatomic and sexual function outcomes in women at child-bearing age.

Objective: To investigate the pathogenesis of endometriosis by studying endometriosis coexisting with variable genital tract anomalies and analysis the association between obstructive or non-obstructive anomalies with endometriosis., Methods: From January 2000 to April 2010, a total of 67 cases of endometriosis coexisting with genital tract anomalies undergoing treatment in Peking Union Medical College Hospital were studied retrospectively., Results: According to subtypes of concurrent genital tract anomalies, 67 cases were divided into 19 cases in obstructive group and 48 cases in non-obstructive group.(1) Age and symptoms:the mean age were (22 ± 8) years in obstructive group and (32 ± 7) years in non-obstructive group, which reached statistical difference (P < 0.05). The major symptoms were dysmenorrheal or chronic pelvic pain (14/19) and amenorrhea (8/19) in obstructive group.However, in non-obstructive group, the major symptoms were dysmenorrheal or chronic pelvic pain (31%, 15/48) and infertility (35%, 17/48) and abortion (21%, 10/48).(2) Degree and incidence of endometriosis:the moderate or severe endometriosis was 11/19 in obstructive group and 40% (19/48) in non-obstructive group, which did not show statistical difference (P > 0.05). The incidence of peritoneal endometriosis, ovarian endometriosis, adenomyosis did not show significant difference between two groups (all P > 0.05). The rate of moderate or severe endometriosis coexisting with duplex uterus, uterus bicornis and uterus septus did not show significant difference in non-obstructive group (P > 0.05)., Conclusions: The severity of endometriosis showed no association with obstructive anomalies. The results implied that there might be other factors involved in pathogenesis of endometriosis.

Objective: To evaluate the safety and efficacy of magnetic resonance-guided focused ultrasound surgery (MRgFUS) in treatment of symptomatic uterine leiomyoma among Chinese reproductive age women., Methods: From April 2010 to April 2012, 80 premenopausal women with symptomatic leiomyoma volunteered to participate in this prospective study in Department of Outpatient of Peking Union Medical College Hospital. Among 23 reproductive aged patients with size of uterus less than 16th gestational weeks, 2.5 to 10 cm of diameter of myoma, less than 10 myomas and expressing symptoms clearly were treated by MRgFUS. Treatment data, non-perfused volume ratio (NPVR) and adverse events were recorded. After treatment, patients were followed up at 1 week, 1, 3, 6, 12 and 24 months, respectively. Patients at initial screening and each time of the follow-up filled out uterine fibroid symptoms quality of life (UFS-QOL), which include symptoms severity score (SSS) and health-related quality of life (HRQL). The volumes of leiomyoma and uterine were evaluated on MRI before and after the treatment (at 6 and 12 months, respectively). Before operation, routine blood test were performed on all patients, anemia patients at 3 months and 1 year after treatment were checked with blood test., Results: (1) Treatment data and adverse events: the mean therapeutic temperature was (69 ± 7)°C, the mean treatment time was (144 ± 62) min, the mean NPVR was (62 ± 23)%. Adverse events included mild erythema(1/23), abdominal cramp (8/23), vaginal discharge (5/23), and leg numbness (4/23). (2) The rate of secondary surgery: one patient was treated by myoectomy and hysterectomy within one year following up and 4 patients chose surgical treatment during the second-year follow-up. (3) Volume change:the volumes of leiomyoma before the treatment and 6, 12 months after the treatment are 75.6(P25 = 43.8, P75 = 128.9), 52.3(P25 = 23.8, P75 = 111.2), 45.9(P25 = 26.3, P75 = 71.7) cm(3), respectively; and the volumes of uterine before the treatment and 6, 12 months after the treatment are 270.0 (P25 = 208.4, P75 = 390.3), 216.4 (P25 = 151.1, P75 = 290.0), 200.0 (P25 = 149.1, P75 = 267.6) cm(3), respectively. Both leiomyoma and uterine volumes decreased significantly after treatments (P < 0.01). (4) UFS-QOL change:the symptoms severity score (SSS) before the treatment and 3, 12 months after the treatment are (34 ± 13), (22 ± 11), (19 ± 12), which decreased significantly (P < 0.01). The health-related quality of life (HRQL) before the treatment and 3, 12 months after the treatment are (74 ± 15), (82 ± 13), (89 ± 10), which increased dramatically (P < 0.01). (5) Hemoglobin (HGB) change: eleven patients suffered from anemia before treatments, the mean HGB before treatment was (87 ± 6) g/L and were (106 ± 14) g/L 3 months after treatment, (112 ± 10) g/L 12 months after treatment. The HGB was increased significantly after treatments (P < 0.01)., Conclusions: MRgFUS is a safe and effective non-invasive management for symptomatic uterine leiomyoma in short-term follow up. But there is additional treatment ratio after MRgFUS.

Objective: To study the pathologic characteristics of eutopic endometrium in patients with endometriosis., Methods: Pathologic characteristics of eutopic endometrium were studied in 176 patients with endometriosis in Peking Union Medical College Hospital from January 2007 to December 2008 retrospectively., Results: About 72.2% (127/176) of eutopic endometrium were in proliferative phase, 19.9% (35/176) of were observed as endometrial polyp, including 32 cases with simple endometrial polyp and 3 cases with abnormal hyperplasia combined with endometrial polyp. And 4.0% (7/176) showed abnormal hyperplasia. The incidence of pathologic changes in eutopic endometrium was 22.2% (39/176). Among 53 endometriosis patients combined with infertility, the incidence of pathologic changes of eutopic endometrium was 35.9% (19/53), which was significantly higher than 16.3% in non-infertile patients (χ(2) = 8.24, P = 0.004). Among 65 cases with irregular menstruation, the incidence of endometrial polypus and endometrial hyperplasia were 20.0% (13/65) and 10.8% (7/65), which were significantly higher than 17.1% (19/111) and 0 in normal menstruation patients (χ(2) = 13.839, P = 0.003)., Conclusions: The eutopic endometrium of endometriosis were in proliferative phase state. The pathologic changes of eutopic endometrium were more in patients combined with infertility and irregular menstruation.

Objective: To evaluate the safety and efficacy of total pelvic reconstruction surgery with Prosima in treatment of pelvic organ prolapse (POP) stage III., Methods: From July 2010 to December 2011, 31 patients with POP stage III undergoing total pelvic reconstruction surgery with Prosima were enrolled in this prospective study. Among two cases complicated with stress urinary incontinence underwent transobturator tension-free vaginal tape concomitantly with total pelvic reconstruction surgery with Prosima. Clinical parameters during peri-operation were recorded and compared. Pelvic organ prolapse quantitative examination (POP-Q) and anatomic improvement in these patients after surgery were analyzed. Comparisons of pelvic floor impact questionnaire-short form 7 (PFIQ-7) and pelvic organ prolapse-urinary incontinence sexual questionnaire-short form 12 (PISQ-12) in these patients before and after surgery were used to evaluate quality of life and quality of sexual life., Results: The mean operating time was (55 ± 13) minutes, mean blood loss was (66 ± 25) ml. No severe intraoperative complications were observed. All patients were able to recover spontaneous micturation within 5 days. Two cases experienced pelvic hematoma with diameters less than 7 cm, and resolved later. Another case was urinary tract infection. At the median follow-up 6 months (1 - 15 months), the rate of anatomic success defined as the leading vaginal edge above the hymen was 94% (29/31). There were significant improvements in Aa, Ba, Ap, Bp, and C (P < 0.01) by POP-Q. Two patients showed recurrent prolapse at 3 months and 1 year after surgery, without the need of further operation. The median score of post-operative PFIQ-7 was 0 point at 6 months and 0 point at 12 months after operation, respectively, which were significantly lower than that of 50 points pre-operation (P < 0.01). And there was no significant difference in the average score of PISQ-12 before and after surgery [(30 ± 6) points versus (31 ± 4) points] (P > 0.05). The rate of mesh exposure was 16% (5/31), all the 5 cases occurred within 6 months and was cut in clinic. There was no case of de novo urinary incontinence and de novo dyspareunia., Conclusions: Pelvic reconstruction surgery with Prosima is safe and efficacy in treatment of POP stage III. It could improve quality of life remarkably without influence on sexual quality of life.

Objective: To evaluate the safety and efficacy of ischiospinous ligament fixation in treatment of stage III pelvic organ prolapse (POP)., Methods: Between March 2007 and December 2009, 65 patients with stage III POP who underwent ischiospinous ligament fixation in Peking Union Medical College Hospital were enrolled in this study. Among 21 cases complicated with stress urinary incontinence (SUI) underwent transobturator tension-free vaginal tape (TVT-O) concomitantly. Clinical parameter associated with perioperation, objective and subjective successful rate and complication were recorded., Results: The mean operating time was (71 ± 22) min and the mean blood loss was (93 ± 40) ml. No intraoperative blood transfusion and viscera injury cases were observed. All patients were able to recover spontaneous micturition. Two cases experienced pelvic hematoma with diameter of 7 cm, after conservative treatment, they all recovered later. The objective success rate was 100% at 6 weeks follow-up by POP-Q scoring. And 46.2% (30/65) were followed up at range of 1 - 3 years, recurrence rate were 10% (3/30), and however, no operation were needed. At median of 20 months, all patients were followed up by telephone, the subjective successful rate was 95.4% (62/65). At 6 weeks after operation, 6.2% (4/65) patients suffered from lower back pain and right thigh pain, visual analogue scale of pain was at range of 3 to 5, which relieved gradually after treatment and disappeared totally within 2 years. The rate of suture exposure was 10% (3/30), the new urinary incontinence 4.6% (3/65), and the new dyspareunia 12.5% (3/24)., Conclusions: Ischiospinous ligament fixation is a safe and efficacious management.

Objectives: To evaluate the benefit of using autofluorescence bronchoscopy (AFB) for the detection and localization of early invasive lung cancer., Methods: AFB and white light bronchoscopy (WLB) were performed on 198 cases of suspected lung cancer, and the relative sensitivity of WLB plus AFB compared with WLB alone., Results: Included 198 biopsy specimens, and 160 were classified as positive by pathology, including 156 invasive cancer and 4 severe dysplasia. The relative sensitivity to detect intraepithelial neoplasia of WLB + FLB versus WLB was 97.5% and 80.0% respectively, significantly (P < 0.05)., Conclusion: AFB was more sensitive than WLB in detecting preneoplastic bronchial changes and early lung cancer in high-risk subjects.

Objective: To evaluate clinical efficiency and quality-of-life outcomes in treatment of severe pelvic organ prolapse by the "Xiehe" pelvic floor reconstruction surgery., Methods: From Jun. 2006 to Dec. 2008, 277 severe pelvic organ prolapse patients with stage III to IV from 8 hospitals in China were enrolled in this prospective study. Pelvic organ prolapse quantitative examination (POP-Q) and anatomic improvement in these patients after surgery were analyzed in this interim study. Comparisons of pelvic floor impact questionnaire-short form 7 (PFIQ-7) and pelvic floor distress inventory-short form 20 (PFDI-20) in these patients before and after surgery was used to evaluate quality of life. Comparison of pelvic organ prolapse-urinary incontinence sexual questionnaire (PISQ) in these patients before and after surgery was used to evaluate quality of sexual life., Results: With a median follow-up of 14.0 months (6 - 28 months), twenty-three patients showed recurrent prolapse (8.3%, 23/277), and anatomical success (< stage 2 in the treated compartment) was 91.7% (254/277). In this series, mesh exposure or erosion rate was 6.9% (19/277). The postoperative de novo stress incontinence rate was 6.5% (18/277). The scores for PFIQ-7 and PFDI-20, and its subscales were significantly improved, the scores of before treatment were lower than those after treatment (P < 0.01). And there was no significant difference in the average score of PISQ before and after the surgery (76.6 ± 15.4 versus 75.5 ± 14.5 versus 73.6 ± 12.6, P > 0.05), but the rate of de novo dyspareunia was 11% (9/80)., Conclusions: "Xiehe" pelvic floor reconstruction surgery was safe and efficacy in treatment of pelvic organ prolapse. It could improve quality of life remarkably with less cost when compared with the traditional total pelvic floor reconstruction surgery.

Objective: To study reliability and validity of incontinence impact questionnaire short form (IIQ-7) in the Chinese population., Methods: IIQ-7 form was translated into Chinese; 74 patients with urinary incontinence completed the IIQ-7 simplified Chinese version and short-form 12-item health survey (SF-12) questionnaires. The urinary incontinence patient also ran a 1 hour pad test. Then, reliability and validity of those forms were analyzed., Results: The Cronbach's alpha of IIQ-7 simplified Chinese version was 0.824 (P<0.01). The intra-class correlation coefficient of IIQ-7 simplified Chinese version was 0.749 (P<0.01). IIQ-7 simplified Chinese version scores were negatively correlated with SF-12 scores (Spearman correlation coefficient: -0.570, P<0.01), IIQ-7 simplified Chinese version scores were positively correlated with 1 hour pad test (Spearman correlation coefficient: 0.461, P<0.01), IIQ-7 simplified Chinese version scores were also positively correlated with the course of disease (Spearman correlation coefficient: 0.235, P<0.05). Factor analysis of IIQ-7 simplified Chinese version showed good construct validity., Conclusions: The simplified Chinese version of IIQ-7 has higher reliability and validity in the Chinese population. They are highly recommended for clinical treatment and research.

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.

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.

Objective: To investigate prevalence and risk factors of pelvic organ prolapse in women underwent routine gynecologic health care in Peking Union Medical College Hospital (PUMCH)., Methods: From Jan. 2008 to Aug. 2009, 972 women underwent gynecological health care in PUMCH were enrolled in this study. Questionnaires and pelvic examinations were given. The pelvic organ prolapse quantitive examination (POP-Q) system was used as the assessment tool., Results: (1) Among all participants, the mean ages were (42 ± 10) years (range 22 to 78 years), the mean height were (162 ± 5) cm (range 142 to 180 cm), and the mean weight were (59 ± 8) kg (range 42 to 91 kg). 83.8% (815/972) of women were multipara. The mean total vaginal length (TVL) of 972 women was 8.20 cm. No women met the standard of pelvic organ prolapse, while 35.5% (345/972) of women presented mild posterior vaginal descent and 96.7% (940/972) presented mild anterior vaginal descent, all of them were asymptomatic. (2) The length of genital hiatus (gh), TVL and C, D proximal to the hymen in nullipara were (2.26 ± 0.32), (8.08 ± 0.30), (-7.08 ± 0.24) and (-8.08 ± 0.30) cm, which were significantly less than (2.33 ± 0.39), (8.22 ± 0.35), (-7.14 ± 0.28) and (-8.22 ± 0.35) cm in multipara (P < 0.05). Ap and Pb proximal to the hymen of (-2.87 ± 0.22) and (-2.87 ± 0.22) cm in nullipara were significantly larger than (-2.81 ± 0.25) and (-2.81 ± 0.25) cm in multipara (P < 0.05). When compared with nullipara, the incidence of posterior and anterior vaginal wall protrusion were increased (OR = 1.819). (3) The index of POP-P were compared among women at groups of 22 - 34 years, 35 - 49 years and more than 50 years (P < 0.05). Those index did not show statistical difference between women at group of 22 - 34 years and group of 35 - 49 years (P > 0.05). However, those in women at group of 22 - 34 years and 35 - 49 years showed statistical difference when compared with women at group of more than 50 years (P < 0.05). When compared with women at group of 22 - 34 years, the incidence of posterior and anterior vaginal wall protrusion were increased (OR = 1.713, 3.765). (4) Menopause status was associated with severities of all kinds of descent (P < 0.05) and presence of posterior vaginal protrusion (OR = 3.354)., Conclusions: Mild anterior and posterior vaginal descent by POP-Q were common among women in China. The risk of anterior vaginal descent is relatively higher than posterior vaginal descent. However, most of the women with descent are asymptomatic and need no treatment. The most important factors associated with the severity and detectable ratio of descent is parity and age.

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.

Objective: To evaluate short-term clinical effects of modified total pelvic floor reconstruction surgery in treatment of severe pelvic organ prolapse., Methods: Thirty-nine cases with severe pelvic organ prolapse including vault prolapse diagnosed by pelvic organ prolapse quantification (POP-Q) system received modified total pelvic floor reconstruction surgery. Clinical parameters associated peri-operative period and 12 months after surgery and complications were analyzed., Results: Median operation time was 70 minutes (30-240 minutes), median blood loss was 100 ml (10-200 ml). Seventy-seven percent (30/39) patients were able to micturate spontaneously in the next morning after surgery with postvoid residual volume less than 100 ml (0-650 ml). No severe intra-operative complications were recorded and the rate of postoperative morbidity was 20% (8/39). Median post-operative hospital stay was 4 days (1-11 days). The patients were followed up at median 24 months (13-29 months). According to POP-Q system evaluation, the successful rate of operation reached 100%. Two cases (5%, 2/39) were recorded as symptomatic recurrence which manifested as posterior wall prolapse within 24 months after operation. During follow-up, 8% (3/39) patients were found to have erosion within 7 months after surgery, and urgent urinary incontinence was observed in 5% (2/39) cases, while constipation occurred in 8% (3/39) cases. The most remarkable complication was dyspareunia (36%, 5/14); while 50% (7/14) experienced better sexual life after surgery., Conclusions: Modified total pelvic reconstruction is a safe, efficient and micro-invasive surgery in treatment of severe pelvic organ prolapse. However, its influence on post-operative sexual life should be concerned.

Objective: to investigate the antitumor effects of tumstatin185-191 as a single agent or combination with cisplatin (DDP) on non-small lung cancer (NSCLC) cell lines A549. In addition, the changes of the protein kinase B(Akt) and extracellular regulated protein kinase (ERK) in cultured NSCLC cells treated by tumstatin185-191 and cisplatin were evaluated., Methods: A549 cells were treated with tumstatin185-191 and cisplatin. Cell viability was assessed using the modified 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. Cell apoptosis was measured by flow cytometry. The activation of Akt and Erk were evaluated by Western blotting., Results: Tumstatin185-191 inhibited the proliferation of A549 and the IC(50) values of tumstatin 185-191 was 73.7 micromol/L. After cotreatment with 20 micromol/L tumstatin185-191, IC(50) values of cisplatin in A549 cells reduced from 5.2 micromol/L to 3.5 micromol/L, while 40 micromol/L tumstatin185-191 reduced from 5.2 micromol/L to 1.4 micromol/L. The early apoptosis rate was (19.34 +/- 0.97)% in the cotreatment group, (12.5 +/- 2.1)% in cisplatin group and (9.6 +/- 1.6)% in tumstatin185-191 group (F = 5.74, P < 0.01). The levels of phospho-Akt (p-Akt) and phospho-ERK (p-ERK) in the A549 cells were remarkably lower after being treated with tumstatin 185-191, while tumstatin 185-191 treatment whether alone, or in combination with cisplatin, had the similar effects on the protein levels of p-Akt and p-ERK in A549 cells., Conclusion: our data suggest that tumstatin185-191 might enhance the sensitivity of A549 cells to cisplatin. The effects of promoting apoptosis and downregulation of proliferation induced by tumstatin185-191 may be mediated through inactivation of the Akt and ERK pathways.

Objective: To investigate the effect of vagina reconstruction using tissue-engineering biological material (acellular dermal matrix) in an animal model., Methods: Vagina excision and vagina reconstruction with tissue-engineering biological material were performed in 12 Chinese experimental miniature pigs. The control group was matched with two of normal vagina specimens resected. At week 1, 2, 4, 6, 8, 12 after surgery, the animals were sacrificed, respectively, and the neovaginas were prepared for immunohistochemical and Van Gieson (VG) staining to evaluate the status of various layer growth of vagina. Epithelial broad spectrum of monoclonal antibodies of AE1/AE3 and alpha-actin were used to test the existence of epithelial and smooth muscle tissue by immunohistochemical staining. The ultrastructure of neovagina was studied by transmission electron microscope at week 1 and 12 after surgery. Contractile function of isolated smooth muscle of neovagina was evaluated by chemical and electronic stimulation after 12 weeks' reconstruction., Results: (1) Epithelization of 2/3 neovaginal mucosa was observed within 1 week. Only 1 - 2 layer epitheliums were observed under the light microscopy and epithelial cells with characteristics of loose and disarrangement were shown with the electron microscopy. Within 4 - 6 weeks, epithelization in mucosa of neovaginal canal was intensified to 4 - 5 layers. After 12 weeks, the differences between the neovagina and the native vagina were harldy noted either in the gross or microscopically. (2) After 4 weeks, a few smooth muscle cells were observed with VG and immunohistochemical staining, and homogeneous muscle bundle was formed. (3) After 12 weeks, similar contractile responses between neovagina and native vagina were observed when KCl and electrical stimulation with different frequency and voltage were given [(2.96 +/- 0.29) g vs. (3.14 +/- 0.30) g, (3.43 +/- 0.34) g vs. (4.65 +/- 0.73) g, (4.92 +/- 0.38) g vs. (4.89 +/- 0.44) g]., Conclusion: The tissue-engineering biological material might be an ideal graft used in the reconstruction of vagina.

Objective: To investigate the effects and related mechanisms of Tumstatin 185-191 as a single agent or in combination with cisplatin on proliferation and apoptosis in a cisplatin-resistant human lung adenocarcinoma cell line A549-DDP cells., Methods: A549-DDP cells were treated with Tumstatin185-191 and cisplatin at varying concentrations. Cell viability was assessed by a modified 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. 50% inhibiting concentration (IC(50)) values of the chemotherapeutic drugs were analyzed by MTT assay. Cell apoptosis was measured by flow cytometry. The activation of Akt and ERK was evaluated by Western blotting., Results: Tumstatin185-191 inhibited the proliferation of A549-DDP cells and its IC(50) value was 80.25 micromol/L. After cotreatment with 20 micromol/L Tum185-191, the IC(50) value of cisplatin in A549-DDP cells reduced from 77.16 micromol/L to 57.97 micromol/L, the reverse index was 1.33, while with 40 micromol/L Tumstatin185-191 the IC(50) was reduced from 77.16 to 26.40 micromol/L and the reverse index was 2.92. The early apoptosis rate was 19.5% +/- 1.1% in the cotreatment group, while 13.3% +/- 1.5% in cisplatin group and 10.2% +/- 2.0% in Tum185-191 group (F = 4.09, P < 0.05). The levels of phospho-Akt (p-Akt) and phospho-ERK (p-ERK) in the A549-DDP cells were remarkably lower after treatment with Tumstatin 185-191. The Tumstatin 185-191 treatment alone or in combination with cisplatin had a similar effect on the protein levels of p-Akt and p-ERK in A549-DDP cells., Conclusion: Our data suggest that Tumstatin185-191 may promote apoptosis, downregulate proliferation and partly reverse the drug resistance of A549-DDP cells to cisplatin. The effects induced by Tum185-191 may be mediated through inactivation of the Akt and ERK pathways.

Objective: To establish the diagnostic model for endometriosis by screening the plasma biomarkers of endometriosis using surface enhanced laser desorption/ionization time of flight mass spectrometry (SELDI-TOF-MS)coupled with bioinformatics., Methods: Plasma samples from 36 patients with endometriosis (endometriosis group) matched with 35 patients with infertility or benign ovarian tumors (control group) before laparoscopy were collected at Peking Union Medical College Hospital from January to October 2007. Plasma protein profiling were detected using SELDI-TOF-MS and protein chip and peak intensities were compared between the two groups. Biomarker Discovery Software was used for data analysis and model was build by classification and regression tree software (CART), sensitivity and specificity of the diagnostic model were verified., Results: There were 14 protein peaks abnormally expressed in endometriosis group compared with those of control group (P < 0.01). The diagnostic model composed of three protein peaks with the molecular weight of 3,956,000, 11,710,000 and 6,986,000 showed a sensitivity of 92% and specificity of 83%. In the blind test the model showed a sensitivity of 88% and specificity of 80%., Conclusions: SELDI-TOF-MS is a new approach for screening markers of endometriosis. Its clinical value deserves further investigation.

Objective: The study was to explore the safety, firmness and convenience of the fascia around the ischial spine as a new fixation site for the vaginal fornix., Methods: Between June 2007 and January 2008, detailed dissections and related measurements of the regions around the ischial spine were performed on 10 Chinese female cadavers (3 unembalmed and 7 embalmed cadavers). At the same time, the sacrospinous ligament, the fascia on the ischial spine, the iliococcygeus fascia as well as the vaginal fornix were exposed and the pull-out strength sequentially tested using a digital push-pull force gauge., Results: The fascia on the ischial spine was firm and strong, with a thickness of 3 about mm. No major vessels or nerves were observed on the ischial spine. The greatest pullout strengths of the sacrospinous ligament, the fascia on the ischial spine, the iliococcygeus fascia as well as the vaginal fornix were (102 +/- 26), (64 +/- 15), (33 +/- 8) and (32 +/- 6) N, respectively., Conclusion: The fascia at 1 cm from anterior lateral ischial spine, free of major vessels and nerves, is safe and strong and could be used as a new site for suspension in vaginal prolapse.

Objective: To investigate clinical features and management of complicated or rare vulvovaginal anomalies derived from urogenital sinus malformation., Methods: Medical documents of 6 cases with vulvovaginal anomalies treated in Department of Obstetrics and Gynecology in Peking Union Medical College Hospital in the past 10 years were reviewed retrospectively. According to embryological and anatomical characteristics, the classification system were established., Results: This kind of vulvovaginal anomalies was very rare and not enrolled into current diagnosis and treatment system. All patients had a common clinical features: menstruation bleeding and urine from the same outflow tract; and two orifices on perineum were found by bimanual examination, one orifice located under clitoris, the other orifice was anus. No vaginal vestibule and vulvar were observed between those two orifices. According to clinical features, those 6 cases were divided into 3 types: type I was persistence of distant urogenital sinus with clinical manifestation of simple labial fusion; type II was low communication between vagina and urogenital sinus (infrasphincteric), presenting with distal vaginal atresia and urethrovaginal fistula; type III was high communication (suprasphincteric) with distal vaginal atresia and more proximal urethrovaginal fistula. Type III was frequently associated with severe rectum and anus anomaly, and other malformation as well. All patients were treated by surgical correction. Basically, the principle of operation was to reconstruct perineal appearance, release the obstruction, and repair the defect and ultimately recovering the normal function. The alternative surgical methods should be considered individually., Conclusions: The vulvovaginal anomalies derived from urogenital sinus malformation were complicated clinically. To establish classification system will be benefit for clinicians to make diagnosis and choose appropriate treatment. The individualized surgery should be performed on those patients to restore the structure and function, in the mean time, the factors associated with esthetics, sex and psychics should be considered.

Objective: To reclassify the patients with former diagnosis of vulvar intraepithelial neoplasia (VIN)II, VINII-III, VINIII, Bowen disease and Bowenoid papulosis according to the 2004 modified terminology of International Society for the Study of Vulvar Disease (ISSVD) and evaluate the effects of surgical treatment., Methods: According to the 2004 modified terminology of ISSVD, a retrospective review of the histological slides of 19 cases, who diagnosed as VINII, VINII-III, VINIII, Bowen disease and Bowenoid papulosis treated in Peking Union Medical College Hospital from 1999 to 2006, were performed to reclassify by pathologist and the clinicopathologic data were also analyzed., Results: According to the 2004 modified terminology of ISSVD, all 19 cases were reclassified as usual type VIN and were belonged to the subtype of warty type except one, the only Bowen disease patient whose one of focuses belonged to the subtype of basaloid type and the other focus belonged to the subtype of warty type. The primary cure rate of extended local excision was 89% (17/19). There were two cases recurred during follow-up period, and were cured by second surgical treatment and the focuses of recurrence site were still diagnosed as warty type VIN., Conclusions: The patients with former diagnosis of VINII, VINII-III, VINIII, Bowen disease and Bowenoid papulosis are basically reclassified as usual type VIN (warty type) according to the 2004 modified terminology of ISSVD. The results showed that the diagnosis of VIN could be simplified by new terminology. The surgical excision is the good choice and combined cytologic and human papillomavirus (HPV) test during follow up is also important for patients of VIN.

Objective: To investigate the route of minimal invasive sling procedures and evaluate their safety., Methods: Tension-free vaginal tape (TVT), TVT-obturator (TVT-O) and posterior intravaginal sling (P-IVS) procedure were performed on five fresh pelvis. 4% formaldehyde was used to preserve the cadavers and colored latex was injected into the vessels. An anatomic study and measurements between the trocars and related vessels or organs were carried out., Results: There was no complication during all injections. The distance between TVT trocar and pubic vessels, the bladder, external iliac vessels and obturator vessels were 0.6, 0.6, 4.2 and 4.3 cm, respectively. Out of control of TVT trocar, the axial rotation or lateral diversion of TVT handle could injure these structures. We found during TVT-O operation, the retropubic space was not violated. The right placement of introducer was very important. When the beginning point was too deep into the anterior vaginal wall, 2.2 cm proximal to urethral meatus or on a horizontal plane with a 35 degrees angle relative to the urethral sagittal plane, the introducer would enter the retropubic space or perforate the upper posterior zone of the obturator membrane, where the obturator vessels and nerves exit the obturator canal. Based on our study, the diversion of P-IVS trocar would damage the rectum, and the pudendal vessels and nerves were relatively safe., Conclusions: The TVT trocar passes the retropubic space and may injure the important vessels or organs. The route of TVT-O inside-out operation is stable and the retropubic space is not violated. The blunt design in the P-IVS trocar tips is helpful to reduce injury.

Objective: To investigate the effect of pregnancy and spontaneous delivery on the morphologic characteristics of the levator ani muscle and innervation of the vaginal mucosa., Methods: Eight nullipara without pelvic floor dysfunction (PFD) and 64 normal primipara undergoing spontaneous delivery were enrolled in this study during July to December 2006 in Peking Union Medical College Hospital. Biopsy specimens of levator ani muscle (LAM) and anterior and posterior vaginal walls were obtained from the puerpera as well as from the 8 nullipara undergoing vaginal operation. The structures of LAM were examined with histological techniques. Vaginal mucosa specimens were examined using immunohistochemistry staining for protein gene product 9.5 (PGP 9.5), vasoactive intestinal peptide (VIP) and ne uropeptide Y (NPY), and the positive stained nerve fibers were calculated respectively., Results: The LAMs of the puerpera undergoing spontaneous delivery presented myogenetic and neurogenetic changes, both acute and chronic. Type I muscular fibers were predominant (79%) with both types increasing in diameters [(86 +/- 9) microm and (79 +/- 15) microm]. Significantly different (P < 0.05) innervation of PGP 9.5, VIP, and NPY nerve fibers was observed between epithelial lamina of anterior vaginal wall (5.9 +/- 3.3, 7.6 +/- 3.1 and 8.2 +/- 3.2, respectively) and that of posterior vaginal wall (3.8 +/- 2.9, 5.9 +/- 3.1 and 6.0 +/- 3.0, respectively), with the nerve fibers being more in epithelial lamina of anterior vaginal wall, while no difference in the innervation of nerve fibers was observed in the lamina propria. Significantly different (P < 0.05) innervation of PGP 9.5 and VIP nerve fibers was observed in the lamina propria of the anterior vaginal wall in puerperal undergoing vaginal delivery (6.9 +/- 3.2 and 4.9 +/- 2.1) compared with those in nullipara (3.9 +/- 3.6 and 3.1 +/- 1.2)., Conclusions: Pathologic changes occur in LAMs and pelvic floor nerves during labor and delivery. LAM fibers become hypertrophy to adapt to the physiological changes during pregnancy. Richer innervation of PGP 9.5 and VIP nerve fibers in the lamina propria of the anterior vaginal wall in puerpera undergoing spontaneous delivery is beneficial for dilation of the blood vessels and smooth muscles and makes preparation for delivery.

Objective: To set up the proteomic protein profiling of adenomyotic tissue and normal uterine muscle and identify the abnormally expressed proteins in adenomyotic tissue., Methods: Samples of adenomyotic tissue (adenomyosis group) and age-matched healthy uterine muscle (control group) were collected from totally 10 patients undergoing transabdominal hysterectomy for adenomyosis and cervical diseases at Peking Union Medical College Hospital from January 2007 to October 2007. The proteomics profiling of adenomyotic tissue and normal uterine tissue were established using two dimensional gel electrophoresis (2-DE) and gel staining method. The differently expressed protein spots were detected by gel comparison using image analysis software and identified using matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF-MS)., Results: In Coomassie blue stained gels there were on average (512 +/- 36) spots and compared with the reference gel the matching rate was 83.7%. In silver stained gels there were (762 +/- 54) spots and compared with the reference gel the matching rate was 81.1%. Compared with normal uterine muscle, there were 15 protein spots disregulated in adenomyotic tissue. Among them 10 protein spots were successfully identified by mass spectrometry. The functions of these disregulated proteins included cell skeleton, oxidation, apoptosis and immune reaction., Conclusions: Comparative proteomics analysis is a useful approach for the study of adenomyosis. Compared with normal uterine muscle there are abnormalities in cell skeleton, oxidation, apoptosis and immune reaction. These life processes may participate in pathophysiology of adenomyosis.

Objective: To study the clinical presentation and pathological features of rare nonepithelial vulvar tumors., Methods: The clinical data of 42 patients with nonepithelial vulvar tumors who were operated on during 1986 to 2007 in Peking Union Medical College Hospital were analyzed., Results: The average age of 42 patients was 44.1 years. There were 32 cases (76%) with a vulvar mass. Twenty one of these 42 patients (50%) complained of associated symptoms of itch and pain. Surgical treatment was the chief treatment of nonepithelial vulvar tumors, which included local excision (40, 95%), simple vulvectomy (1, 2%) and radical vulvectomy (1, 2%). Among the pathological diagnoses after operation, the most common benign histological subtypes were hidradenoma and haemangioma, while the most common malignant histological subtypes were leiomyosarcoma and aggressive angiomyxoma., Conclusions: Most of the nonepithelial vulvar tumors are mesenchymal tumors. The clinical presentation has no special characteristics. Diagnosis of nonepithelial vulvar tumors can be made based on histological inspection. Surgical treatment is the treatment of choice.

Objective: To evaluate the distribution of neuropeptide Y and its receptors in the cardinal ligament and uterosacral ligaments in women with and without pelvic organ prolapse (POP)., Methods: Sixteen patients with pelvic organ prolapse entered the study. All patients were evaluated by pelvic organ prolapse quantitation (POP-Q). Group A consisted of six patients with grade I , II POP, and group B comprised ten patients with grade III, IV POP. Eight nonfunctional ovarian tumor patients without POP were recruited as control subjects. Biopsies of cardinal ligament and uterosacral ligament were obtained from each woman during surgery. Immunohistochemical study with polyclonal antibody against a general nerve marker S-100 and neuropeptide Y was performed on paraffin-embedded sections of all the samples. In addition, mRNA levels of the human NPY-Y1 and NPY-Y2 receptors were assessed in both patients and controls., Results: (1) NPY immunoreactivities were identified in both cardinal ligament and uterosacral ligament NPY immunoreactive nerve fibers were insignificantly lower in POP patients (P > 0.05). The distribution pattern of NPY was similar in cardinal ligament and uterosacral ligament (P > 0.05). (2) mRNAs encoding the NPY-Y1 and NPY-Y2 receptors were detected in the pelvic supporting tissues. Besides the expected NPY-Y1 PCR products, an additional 97 bp long amplicon originating from an alternative splicing event was found in most tissues studied. (3) In cardinal ligaments, mRNA encoding NPY-Y1 receptor had a significant difference between group A (3.9 +/- 1.0) and B (6.0 +/- 1.5), and between control (3.4 +/- 0.9) and group B (P = 0.019, P = 0.004), while there was no significant difference between group A and controls (P = 0.082). In uterosacral ligaments, mRNA encoding NPY-Y1 receptor had no significant difference between Group A (6.0 +/- 1.1) and B (6.3 +/- 0.7), or between group A and controls (4.8 +/- 0.7; P = 0.151, P = 0.690); while there was a significant difference between group B and controls (P = 0.016). (4) mRNA encoding NPY-Y2 receptor had no significant difference between controls (0.49 +/- 0.34, 0.61 +/- 0.15), group A (0.56 +/- 0.21, 0.67 +/- 0.13) and group B (0.85 +/- 0.43, 0.69 +/- 0.21) patients in cardinal ligament and uterosacral ligaments (P > 0.05). (5) mRNA encoding NPY-Y1 (P = 0.084) and NPY-Y2 (P = 0.470) receptors had no significant difference between cardinal ligament and uterosacral ligament., Conclusions: There are NPY and NPY receptors in cardinal and uterosacral ligaments. The increased expression of NPY Y1 receptor may be related to local blood flow reduction and structural changes of pelvic supporting tissue.

Objective: To investigate the clinical efficacy and improvement of patients' quality of life in tension-free vaginal tape (TVT) and tension-free vaginal tape obturator (TVT-O) for surgical treatment of severe female stress urinary incontinence., Methods: This study was a randomized, single-blinded, controlled trial. Patients were randomized by a computer-generated randomization schedule with allocation to either TVT or TVT-O procedure. TVT procedure was performed in 35 cases and TVT-O in 34 cases. None had received surgery for urinary incontinence or was in pregnancy. Transvaginal hysterectomy and prolapse reparation were done simultaneously in some of the patients. All patients were requested to complete the Urinary Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7) as part of their pre- and postoperative assessment., Results: All patients were evaluable and the mean follow-up was 14.5 months. The mean operative time was (18 +/- 5) min in the TVT-O group, significantly shorter than in the TVT group (27 +/- 5) min (P < 0.01). The two groups did not differ significantly in perioperative blood loss, postoperative complications (including tape erosion, pain in thigh or behind pubis), postvoid residual volume, hospital stays or expenses (all P > 0.05). Sixty patients were successfully treated for stress urinary incontinence (88.6% and 85.3% for TVT and TVT-O groups, respectively). There were significant improvements in postoperative scores for both the IIQ-7 and the UDI-6 (P < 0.01), except in subscale measuring symptoms of voiding dysfunction (P > 0.05)., Conclusions: Both techniques appear to be equally effective in the surgical treatment of severe stress urinary incontinence in a short term review. Significant improvements could also be seen in patients' quality of life. However, TVT-O has a shorter operative time. No evidence of increasing risk of urethral obstruction after the operation could be found. Long term follow-ups are necessary to evaluate outcomes of different types of surgery for stress urinary incontinence.

Objective: To investigate the clinical characteristics, diagnosis and treatment of vaginal intraepithelial neoplasia (VAIN)., Methods: A retrospective study was made of 6 patients with VAIN, who were hospitalized at Peking Union Medical College Hospital from 1980 to 2006., Results: Five cases had a history of hysterectomy, two of whom were because of cervical intraepithelial neoplasia (CIN) or invasive cervical cancer. Four cases had the infection of high-risk oncogenic human papillomaviruses detected with hybrid capture II (HC-II), the other two had no record. In all patients the VAIN lesions were within the upper one third of the vagina. They were all diagnosed by colposcopic examination and directed biopsy after the abnormal cytology by thinprep cytology test (TCT). Six cases of VAIN II-III were treated by excisional surgery. One case had residual lesion and had another surgery 3 months after the first one. Two patients obtained remission at one-year follow-up, three had abnormal cytology by TCT 6 months after surgery, and one had abnormal cytology by TCT at six-month follow-up but normal at one-year follow-up., Conclusions: A history of CIN is the main risk factor for VAIN, so routine vaginal cytology is needed for the patients after hysterectomy due to CIN. Cytology, colposcopic examination and directed biopsy are the mainstays of VAIN diagnosis. Excisional surgery is recommended for the patients with VAIN II-III. Long term follow-up is necessary after treatment.

Objective: To investigate the effect of different delivery modes and related obstetric factors on the short-term function of the pelvic floor., Methods: One hundred and twenty healthy primiparae women were interviewed at 6-8 weeks postpartum, with 72 women in the vaginal delivery group and 48 women in the elective cesarean section group. Questionnaire on stress urinary incontinence and measurement of diastolic and contractive function of the pelvic floor muscles by electromyogram (EMG) were used for the evaluation and comparison., Results: The prevalence of stress urinary incontinence in the vaginal delivery group and the elective cesarean section group was 21% and 10% (P = 0. 134) ,respectively. The values of the right act, right work, and average work surveyed by EMG in vaginal delivery group were significantly lower than those in cesarean section group (right act, 12.9 +/- 0.8 vs. 17.3 +/- 1.7, P < 0.05; right work, 59 +/- 5 vs. 95 +/- 17, P = 0.02; average work, 78 +/- 5 vs. 109 +/- 15, P < 0.05). Maternal age, body mass index (BMI) before labor, incontinence during pregnancy, neonatal birth weight and longer duration of second stage were risk factors for stress urinary incontinence postpartum. Incision length of episiotomy, duration of the first stage, and BMI before and (or) after pregnancy affected function of pelvic floor muscles markedly., Conclusion: The prevalence of stress urinary incontinence after different delivery modes is similar. Some obstetric factors have effects on both stress urinary incontinence postpartum and the function of pelvic floor.