Analysis of rectal injuries resulting from laparoscopic peritoneal vaginoplasty (Luohu operation)

OBJECTIVE

To explore the causes of rectal injuries during laparoscopic peritoneal vaginoplasty (Luohu operation) and assess measures that can be taken to increase safety of the operation.

MATERIALS AND METHODS

Data of patients with rectal injuries that occurred during Luohu vaginoplasty were analyzed retrospectively.

RESULTS

Three hundred and six patients received Luohu vaginoplasty. Rectal injuries occurred in 13 patients (4.2%). All patients recovered after intraoperative repair or postoperative rectovaginal fistula repair, performed within three to six months. Full display of the anatomical structures at the bottom of the pelvic cavity and successful construction of the vaginal tunnel are the two most important requirements for reducing the risk of rectal injury in laparoscopic vaginoplasty. In repair of fistulae postoperatively, it is important that resection of tissues or scars around the fistulae be avoided in order to reduce the chance of a injuries caused by diverting colostomy or colostomy closure.

CONCLUSION

Laparoscopic vaginoplasty is a generally safe procedure, but rectal injury can occur. Retaining the tissues or scars around the rectovaginal fistula can be successfully repaired, either when they are recognized during the operation or within a few months postoperatively.

Clinical analysis of 95 cases with ovarian pregnancy

BACKGROUND

Ovarian pregnancy (OP) is a rare ectopic pregnancy, in which it is very difficult to achieve preoperative diagnosis. Ovarian blood supply in OP increases which will lead to intra-abdominal bleeding, hazarding women's lives. Surgical exploration should be conducted once cases of OP are suspected.

OBJECTIVE

To investigate clinical characteristics, diagnosis, and therapy of OP.

MATERIALS AND METHODS

A retrospective study was conducted in 95 patients with OP admitted to the present hospital from January 2005 to June 2014.

RESULTS

OP accounted for 1.79% of ectopic pregnancy over the same period, of which 68.4% had a history of artificial abortion, 6.3% was treated with intrauterine contraceptive device (IUD), 87.4% had abdominal pain, 84.2% had a history of menopause, and 51.6% had vaginal bleeding. All patients had no preoperative diagnosis and underwent laparoscopic wedge resection of ovary or lesionectomy and were all were cured.

CONCLUSION

Since the cause of OP is still unknown and it has no typical clinical manifestations, the present authors adopt blood P-hCG combined with B-ultrasound to improve the preoperative diagnosis. They prefer laparoscopic wedge resection of ovary or lesionectomy, which induce higher rate of intrauterine pregnancy and lower rates of ectopic pregnancy and infertility in re-pregnancy after surgery.

Involvement of endoplasmic reticulum stress in the necroptosis of microglia/macrophages after spinal cord injury

Microglia/macrophages play a crucial role in inflammation after spinal cord injury (SCI). Although extensive studies have been performed on the mechanisms of microglia/macrophage activation and recruitment, how microglia/macrophages are eliminated remains unclear. In the present study, we observed a high-level expression of mixed lineage kinase domain-like protein (MLKL), a key molecule in the execution of necroptosis, in microglia/macrophages after SCI in mice. In vivo PI-labeling and Necrostatin-1 treatment confirmed the necroptosis of microglia/macrophages. Interestingly, our electronic microscopic (EM) study revealed that MLKL localized not only at the membrane but also on the endoplasmic reticulum (ER) of necroptotic microglia/macrophages. Furthermore, receptor-interacting protein 3 (RIP3), another necrosome component, was also found on the ER of necroptotic microglia/macrophages. And Glucose-regulated protein 78 (GRP78), an ER stress sensor, was up-regulated in MLKL-positive microglia/macrophages after SCI, suggesting a possible link between necroptosis and ER stress. In vitro, oxygen-glucose deprivation (OGD) stress induced ER stress and necroptosis in microglia. Inhibiting ER stress by 4-phenylbutyrate (4-PBA) significantly blocked the OGD-induced necroptosis of microglia. In the end, our data showed that, GRP78 and phosphorylated MLKL were co-expressed by the microglia/macrophages in the injured human spinal cord. Taken together, these results suggested that microglia/macrophages undergo an ER-stress involved necroptosis after SCI, implying that ER stress and necroptosis could be manipulated for modulating inflammation post-SCI.

Removal of an incarcerated intrauterine device in the sigmoid colon under the assistance of hysteroscope and laparoscope: a case report

BACKGROUND/AIMS

To explore the value of hysteroscope and laparoscope in removing an incarcerated or ectopic intrauterine device (IUD).

MATERIALS AND METHODS

A 33-year-old woman was admitted to the present hospital on May 22nd, 2013. An incarcerated IUD was proven by ultrasonography. An IUD had been implanted in October 2011. Clinical case report of an incarcerated IUD in the sigmoid colon.

RESULTS

An IUD was successfully removed with the assistance of hysteroscope and laparoscope.

CONCLUSION

Ultrasonography should be performed in the follow-up of the patients after IUD implantation. Ectopic or incarcerated IUD can be successfully removed with the assistance of hysteroscope and laparoscope with minimal trauma.

Transvaginal repair of rectovaginal fistula by filling with bulbocavernosus fat pad and retaining scar tissue

The authors performed transvaginal repair of rectovaginal fistual (RVF) with bulbocavernosus fat pad by incising left side of the labia majora and retained scar tissues which were formed after three months for one patient. Repair of the RVF was successful and the patient had normal diet and defecation at a week after surgery. Previous gynecological surgery performed on the patient resulted in RVF accompanied by weak rectal tissues. Retaining the tissues and scars surrounding to the fistula and filling the fistula with bulbocavernosus fat pad tissue increased rectal wall thickness and facilitated healing. The efficacy of this surgical technique will need further studies with larger patient cohorts to establish a clear success rate.

Diagnostic value of a novel fully automated immunochemistry assay for detection of ALK rearrangement in primary lung adenocarcinoma

BACKGROUND

To evaluate the diagnostic value of a novel fully automated immunohistochemistry (IHC) assay for detection of anaplastic lymphoma kinase (ALK) fusion in a large number of ALK-positive lung adenocarcinoma (ADC) patients.

PATIENTS AND METHODS

We tested 196 lung ADCs for ALK rearrangement by two IHC assays (Ventana pre-diluted ALK D5F3 antibody with the Optiview DAB IHC detection kit and Optiview Amplification kit, D5F3 by Cell Signaling Technology (CST) with Ultraview DAB detection kit by Ventana), fluorescence in situ hybridization (FISH) and real-time reverse transcription-PCR (RT-PCR). CST ALK IHC was scored using the scoring scheme of 0, no staining; 1+, faint; 2+, moderate; and 3+, strong cytoplasmic reactivity in ≥ 10% of tumor cells. As for Ventana IHC, a binary scoring system (positive or negative for ALK status) was adopted for evaluating the staining results.

RESULTS

Among 196 cases tested, 63 (32%), 65 (33%), 70 (36%), and 69 (35%) cases were ALK positive by FISH, Ventana IHC, CST IHC, and RT-PCR, respectively. The sensitivity and specificity of Ventana IHC were 100% and 98%, respectively. Two Ventana IHC-positive cases, which were also CST IHC score of 3+, showed FISH negative, but their ALK rearrangement was confirmed by RT-PCR and direct sequencing. The sensitivity and specificity of CST IHC with staining intensity score of 1+ or more were 100% and 95%, respectively. Five (25%, of 20) patients with CST IHC score of 1+ were both FISH and RT-PCR negative. The sensitivity and specificity of RT-PCR for detection of ALK fusion were 98% and 95%, respectively. The total accordance rate between ALK RT-PCR and Ventana IHC was 97%.

CONCLUSIONS

The novel fully automated IHC assay is a reliable screening tool in routine pathologic laboratories for identification of patients with ALK rearrangement for targeted therapy in lung ADC.

Transvaginal removal of ectopic pregnancy tissue and repair of uterine defect for cesarean scar pregnancy

PURPOSE

This work aimed to introduce a new surgical operation for cesarean scar pregnancy (CSP).

MATERIALS AND METHODS

Transvaginal removal of ectopic pregnancy tissue and repair of a uterine defect were performed in 17 CSP patients.

RESULTS

The new surgical operation was performed successfully in all cases.

CONCLUSIONS

The new surgery operation is safe, effective, and minimally invasive in CSP patients.

Target Identification and Validation of (+)-2-(1-Hydroxyl-4-Oxocyclohexyl) Ethyl Caffeate, an Anti-Inflammatory Natural Product

(+)-2-(1-hydroxyl-4-oxocyclohexyl) ethyl caffeate (HOEC) was isolated from Incarvillea mairei var. granditlora (Wehrhahn) Grierson. The plants of the Incarvillea genus have long been used as folk medicines for the treatment of inflammation-related diseases in China. 5-Lipoxygenase (5-LOX), a key enzyme in the arachidonic acid (AA) cascade, was identified as a potential target of HOEC by a pulldown assay, and then extensively validated by biosensor-based affinity detection, enzyme-based activity assays, cell-based AA metabolite analysis and computer-aided AA network simulation. Further in vivo studies of AA-induced ear oedema, ovalbumin (OVA)-induced lung inflammation and collagen-induced arthritis demonstrated the anti-inflammatory potency and validated the therapeutic target of HOEC. This work revealed that HOEC acted as an anti-inflammatory agent targeting 5-LOX, which not only confirmed the key role of 5-LOX in inflammation but also provided a paradigm for the exploration of natural product mechanisms of action.

RBB, a novel transcription repressor, represses the transcription of HDM2 oncogene

The p53 tumor suppressor is important in many aspects of cell biology. Tight regulation of p53 is thus imperative for maintaining cell homeostasis and preventing tumorigenesis. The stabilization and activity of p53 is primarily regulated by MDM2, which is encoded for by HDM2. However, how the expression and activity of MDM2 is regulated remains largely unknown. Here, we report a novel BTB and BEN domains-containing protein, RBB. We demonstrated that RBB is a novel transcriptional repressor binding specific DNA motif via a homodimer and interacting with the nucleosome remodeling and deacetylase (NuRD) complex. Genome wide transcription target analysis by ChIP sequencing revealed that RBB represses the transcription of a series of functionally important genes including HDM2. We showed that RBB recruits the NuRD complex to the internal promoter of HDM2 and inhibits the expression of MDM2 protein, leading to subsequent stabilization of tumor suppressor p53. Significantly, we showed that RBB suppresses cell proliferation and sensitizes cells to DNA damage-induced apoptosis. Our data indicate that RBB is a novel transcriptional repressor and an important regulator of p53 pathway.

Randomized Prospective Study of Olecranon Fracture Fixation: Cable Pin System versus Tension Band Wiring

OBJECTIVE: This prospective, randomized study compared the effectiveness of the cable pin system (CPS) versus tension band wiring (TBW) for olecranon fracture fixation. METHODS: Patients with acute transverse or slight oblique olecranon fractures were randomly divided into two groups: one fixed by CPS and the other by TBW. Clinical outcome data were collected and analysed following a mean duration of 21 months. RESULTS: The mean ± SD fracture healing time was significantly shorter in the CPS group ( n = 30; 9.73 ± 2.02 weeks) compared with the TBW group ( n = 32; 11.13 ± 2.21 weeks). One patient in the CPS group and seven patients in the TBW group experienced postoperative complications; this difference was statistically significant. The mean ± SD Mayo Elbow Performance Score in the CPS group was significantly higher (88.67 ± 6.42) than that in the TBW group (80.78 ± 11.99). Logistic regression analysis showed an association between fixation method and fracture healing time, complications and elbow function. CONCLUSIONS: Internal fixation by CPS is an effective method for olecranon fracture and is associated with a shorter healing time, fewer complications and better function than TBW.

Uterine sarcoma with abdominal wall metastasis following laparoscopy: case report

PURPOSE

This work aimed to prevent artificial implantation in laparoscopic surgery for gynecological tumors.

METHODS

A case of uterine sarcoma with abdominal wall metastasis following laparoscopy was analyzed for clinical features.

RESULTS

A diagnosis of uterine sarcoma was made in Stage IV and the previous laparoscopic surgery had caused artificial abdominal wall metastasis.

CONCLUSIONS

We need to protect the puncture port in laparoscopic surgery of gynecological tumors to prevent artificial implantation.