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Robotic surgeries have been used frequently for benign diseases in gynecology. However, the advantage of robotic surgery for huge uterus is unclear.We analyzed surgical outcomes of 527 patients who underwent robotic hysterectomies for benign diseases, separating uterine sizes into five groups by every 250 g.Median operative time in the five groups was 123 minutes (250 g), 130 minutes (250-500 g), 144 minutes (500-750 g), 180 minutes (750-1000 g), and 170 minutes (1000 g). Median estimated blood loss was 50, 100, 100, 200, and 400 mL in the five groups, respectively. The incidence of intraoperative complications did not correlate with uterine weight.Operative time, estimated blood loss, and the incidence of conversion to laparotomy increased with uterine size during robotic hysterectomies, especially evident in a uterus750 g.

Background The purpose of this study was to evaluate the feasibility of robotic surgery and compare its surgical outcomes with those of laparoscopic surgery and laparotomy, with regard to performing staging surgery to manage ovarian cancer. Methods One hundred and thirty-eight women who received surgical staging procedures for treatment of stage IA–IIIC epithelial ovarian cancer and borderline tumours were retrospectively included in the study. All enrolled cases were reviewed for patient demographics, peri-operative parameters, complications and survival. Results The operation time and blood loss was significantly reduced in the robotic and laparoscopic groups. Moreover, robotic surgery was associated with decreased postoperative pain score. The length of hospital stay and time to full diet resumption were also shortened for those who underwent robotic and laparoscopic procedures. Survival analysis and complication rates were similar between the two groups. Conclusion Robotic surgery is a feasible alternative in managing ovarian cancer as long as there is careful consideration given to patient selection. Copyright © 2015 John Wiley & Sons, Ltd.

Paramagnetische Effekte ermoglichen einzigartige Einblicke in die Struktur und Dynamik von Biomolekulen. Um diese nutzbar zu machen, wurde eine Methode entwickelt, in welcher ein Lanthanoid-Tag an ein Reporterprotein angebracht wird, das anschliesend an das Zielprotein bindet und dadurch paramagnetische Effekte im Zielprotein hervorruft. Dieser Ansatz bietet einen Zugang zu einer grosen Zahl paramagnetischer Effekte auf der Basis unabhangiger Molekulausrichtungen in hochmolekularen Proteinen unbekannter 3D-Struktur.

Uterine rupture during near-term pregnancy is a life-threatening condition. A 31-year-old pregnant woman with a breech presentation at the gestation age of 35(+2) weeks had complained of a dull abdominal pain for days. She was treated 2 years ago with bilateral uterine artery ligation and hysterotomy for removal of the retained placenta. An aggravation of abdominal pain occurred suddenly 4 h after hospitalization. The cardiotocogram showed a fetal heart beat with loss of variability, but increasing deceleration. An urgent cesarean section was performed because of suspected placenta abruption. After successful delivery of the fetus, a protruding placental tissue was found on the fundal uterine wall. We performed wedge resection of the ruptured uterine wall with the aid of an intrauterine muscle injection of 20 IU oxytocin, a local injection of diluted vasopressin (1:60) into the myometrium around and into the rupture site, an intramuscular injection of 0.2 mg methylergonovine, and primary repair of the defect, but in vain. Cesarean hysterectomy was used to control the intractable bleeding. The accumulated blood loss was more than 10,000 mL. The final pathology confirmed placenta percreta with uterine rupture. Luckily, both mother and fetus recovered well and were discharged 7 days later. We concluded that women with retained placenta and/or postpartum hemorrhage managed by previous hysterotomy and uterine artery ligation still need careful prenatal care, since the possibility of re-occurrence of the placenta percreta is easily overlooked and may result in a further life-threatening situation, such as the uterine rupture in this case.

Aim: Our aim was to assess the role of surgical intervention for symptom control and reproductive performance improvement in the management of subfertile women with symptomatic extensive uterine adenomyosis. Methods: Sixty-five subfertile women with pathology-proven extensive uterine adenomyosis, who were treated with conservative surgery or medical treatment with 6-month gonadotrophin-releasing hormone (GnRH) agonist or combination therapy, were retrospectively reviewed and their data analyzed. Twenty-eight women received conservative surgery with/without GnRH agonist (group A), and 37 received 6-month GnRH agonist therapy only (group B). Follow-up evaluations, including subjective symptoms (a self-reported 6-point verbal numeric rating scale and an analgesic usage score for dysmenorrhea) and objective parameters (serum CA125 level, and uterine size), and clinical pregnancy and successful delivery rates were made semi-annually over the ensuing 3 or more years. Results: The women in group A had higher serum CA125 levels, more infertile years, and a larger uterine size. Subjective symptom control and objective parameters were better in group A during the entire 36-month follow up compared with those in group B. Cumulative 3-year clinical pregnancy and successful delivery rates were significantly higher in group A, compared with those in group B (46.4% [13/28] versus 10.8% [4/37], P = 0.002, and 32.1% [9/28] versus 8.1% [3/37], P = 0.022, respectively). Conclusion: Conservative surgery or combination therapy provides more effective and longer durable symptom control in the management of symptomatic women with extensive uterine adenomyosis, compared with GnRH agonist alone. Reproductive performance was also better in patients treated with conservative surgery with/without GnRH agonist.

Several cases in which uteruses have been preserved in women with placenta percreta have been reported. We herein report a 38-year-old woman with a history of previous cesarean section who was admitted with lower abdominal pain and vaginal bleeding at 31 weeks of gestation. An urgent exploratory laparotomy revealed active bleeding from the uterine rupture on the posterior uterine wall. A female infant weighing 1560 g, with Apgar scores of 1, 1, and 3 at 1, 5, and 10 min, respectively, was delivered, and the placenta was removed. We performed bilateral uterine vessel occlusion, followed by wedge resection of the ruptured uterine wall with the aid of an intrauterine muscle injection of 20 IU oxytocin, a local injection of diluted vasopressin (1:60) into the myometrium around and into the rupture site, and an intramuscular injection of 0.2 mg methylergonovine, primary repair of the defect, and an additional 24-h postoperative oxytocin infusion (30 IU in 5% dextrose 500 mL) to preserve the uterus successfully. Although the overall blood loss was 3700 mL, no disseminated intravascular coagulopathy occurred after the patient had received adequate blood transfusion. The postoperative pathological diagnosis was placenta percreta with uterine rupture. The patient and her baby were discharged uneventfully. In some cases of spontaneous uterine rupture secondary to placenta percreta, we can preserve the uterus by performing bilateral uterine vessel occlusion and wedge resection of the ruptured uterine wall.

A series of novel 6,7,8,9-tetrahydro-2-(2-aryloxypyrimidin-4-yl)-2H-[1,2,4]triazolo[4,3-a]azepin-3(5H)-ones were designed and efficiently synthesized. Their structures were determined by IR, 13C and 1H NMR, mass spectroscopy, and elemental analysis. These compounds were screened for herbicidal activities against rape and barnyard grass. Compounds 5a-5f and 5m exhibited moderate herbicidal activity against rape. In addition, the synthesis of the intermediate 1-(azepan-2-ylidene)-2-(2-chloropyrimidin-4-yl)-hydrazine (3) was studied and the reason for the low yield in the initial procedure is discussed as well.

Can the coupling effect among different amino acid components be used to improve the prediction of protein structural classes? The answer is yes according to the study by Chou and Zhang (Crit. Rev. Biochem. Mol. Biol. 30:275-349, 1995), but a completely opposite conclusion was drawn by Eisenhaber et al. when using a different dataset constructed by themselves (Proteins 25:169-179, 1996). To resolve such a perplexing problem, predictions were performed by various approaches for the datasets from an objective database, the SCOP database (Murzin, Brenner, Hubbard, and Chothia. J. Mol. Biol. 247:536-540, 1995). According to SCOP, the classification of structural classes for protein domains is based on the evolutionary relationship and on the principles that govern the 3D structure of proteins, and hence is more natural and reliable. The results from both resubstitution tests and jackknife tests indicate that the overall rates of correct prediction by the algorithm incorporated with the coupling effect among different amino acid components are significantly higher than those by the algorithms without using such an effect. It is elucidated through an analysis that the main reasons for Eisenhaber et al. to have reached an opposite conclusion are the result of (1) misusing the component-coupled algorithm, and (2) using a conceptually incorrect rule to classify protein structural classes. The formulation and analysis presented in this article are conducive to clarify these problems, helping correctly to apply the prediction algorithm and interpret the results.

Various polycyclic arenes are efficiently synthesized using different (alkenylphenyl)carbonyl compounds as starting materials.

The majority of cases of placenta accreta are unanticipated and initially identified intraoperatively. Although color Doppler ultrasound is adequate for the evaluation of placenta accreta in the third trimester, ultrasound diagnosis in the first trimester has never been reported. To our knowledge, this is the first case of placenta accreta detected at 9 weeks' gestation by ultrasound. Placenta accreta with intraplacental lacunae can be identified together with a loss of the hypoechogenic retroplacental myometrial zone. Based on this case, we found that early diagnosis of placenta accreta in the first trimester by ultrasound is possible.

A variety of 2,5-disubstituted pyrrolidines is synthesized by radical cyclization of various N-4- and N-5-alkenyl and alkynyl N-benzoyloxysulfonamides.

This article presents a full account of intramolecular vinylic substitution reactions of bromoalkenes having an acetylthio moiety, which give sulfur-containing heterocycles such as dihydrothiophene, tetrahydrothiopyran, and 2-alkylidenethietane derivatives. The reaction pathways of the substitution reactions were investigated by theoretical and experimental studies.

Various 2-alkylidenethietanes were synthesized by intramolecular nucleophilic substitution reactions at an sp2 carbon of vinyl halides with thiolate moieties. The reaction pathway of the substitution reactions was confirmed as a very rare SNVπ mechanism by theoretical and experimental studies.

A mathematical model of the tryptophan operon is analyzed to investigate the regulatory effects of feedback repression and the demand for tryptophan in the cell. In this model, feedback repression is considered to be a two-step process. First, the endproduct tryptophan combines with the inactive repressor produced by the regulatory genes to yield an active complex. This complex subsequently binds to the operator and prevents transcription of the structural genes into mRNA. The demand for tryptophan in the cell is modeled by a hyperbolic saturation function of the Michaelis-Menten type. Results are obtained for the expression of the tryptophan operon in Escherichia coli and their applicability to tryptophan production by microbial fermentation is discussed. It is shown that, depending on the strain level of the operon and the rate of utilization of tryptophan in the cell, an overproduction of tryptophan can be achieved under stable operating conditions; in other circumstances, the operon may become stable or unstable, and may lead to a periodic synthesis.

A series of 2-(3-(trifluoromethyl)-5-(alkoxy)-1H-pyrazol-1-yl)-4-aryloxypyrimidine derivatives were designed and synthesized. The structures of all the title compounds were confirmed by 1H NMR and elementary analysis. These compounds were screened for herbicidal activity against rape and barnyard grass. Compound B13 exhibited moderate herbicidal activity.

A series of novel 6,7,8,9-tetrahydro-2-(2-aryloxypyrimidin-4-yl)-2H-[1,2,4]triazolo[4,3-a]azepin-3(5H)-ones were designed and efficiently synthesized. Their structures were determined by IR, 13C and 1H NMR, mass spectroscopy, and elemental analysis. These compounds were screened for herbicidal activities against rape and barnyard grass. Compounds 5a-5f and 5m exhibited moderate herbicidal activity against rape. In addition, the synthesis of the intermediate 1-(azepan-2-ylidene)-2-(2-chloropyrimidin-4-yl)-hydrazine (3) was studied and the reason for the low yield in the initial procedure is discussed as well.

This retrospective study collected the surgical tissues and the clinical records of 197 surgically treated patients with microinvasive carcinoma of the cervix, which was defined as a limited microinvasion not more than 3 mm in depth regardless of lymph-vascular involvement. Depth of invasion was 1 mm or less in 13.2% and 1.1 to 3 mm in 86.8%. The mean age was 47.2 years. About half of the patients were asymptomatic but suspected cytologically. Random cervical biopsy alone was inadequate for diagnosis. Cone biopsy demonstrated an accuracy of 94% in diagnosis, but failed to eliminate microinvasive carcinoma in 23.0% of the hysterectomy specimens. In 14 cases, the invasion was more extensive in the uterus than in the cone. A positive correlation has been found between the diagnostic rate of conization and the depth of stromal invasion. Cervical conization, while relatively accurate in assessing the existence of stromal invasion that characterizes microinvasion, failed to diagnose those with deeper stromal invasion, especially beyond 1 mm. The recommended approach in diagnosing microinvasion is careful colposcope-directed cone biopsy and proper examination of the conization specimen in order to exclude the possibility of more advanced disease.