[Summary of the first national conference on female stress urinary incontinence and pelvic floor dysfunction].
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Female↗
Biomedical subjects
Lan Zhu
Publications and source records attributed to Lan Zhu.
[Study on estrogen receptor around levator ani muscle for female stress urinary incontinence].
OBJECTIVE: To explore the relationship between estrogen receptor and the occurrence of stress urinary incontinence (SUI) through analysis on estrogen receptor (ER) around levator ani muscle. METHODS: The biopsy specimens around levator ani muscle were obtained from 31 subjects undergoing total vaginal hysterectomy (TVH), laparoscopic assistant hysterectomy (LAVH) and tension-free vaginal tape (TVT) procedures, who were assigned in to control, pelvic organ prolapse (POP) and SUI groups. The histological structures around levator ani muscle were examined with routine HE staining. ER in structures around levator ani muscle was evaluated by immunohistochemical staining. RESULTS: ER positive staining rate in levator ani muscle and surrounding tissues was 6.7% among total samples. ER positive staining located in nuclei of connective tissue, smooth muscle and small nerve cells. The positive rate in connective tissue, smooth muscle and small nerve cells was 1.4%, 4.7%, 5.7% in control group, 1.1%, 2.8%, 2.7% in SUI group and 4.1%, 9.5%, 11.6% in POP group, respectively. It was significantly lower in SUI group than that in control group (P < 0.01), and POP group (P < 0.01). CONCLUSIONS: There is close relationship between degeneration of pelvic support construction and deficiency in ER around levator ani muscle. ER positive staining in SUI group was significantly lower than that in POP group, suggesting that decrease of ER around levator ani muscle in POP might lead to the occurrence of SUI.
Adult↗
Mice lacking dipeptidyl peptidase IV are protected against obesity and insulin resistance.
Dipeptidyl peptidase IV (DP-IV), a member of the prolyl oligopeptidase family of peptidases, is involved in the metabolic inactivation of a glucose-dependent insulinotropic hormone, glucagon-like peptide 1 (GLP-1), and other incretin hormones. Here, we investigated the impact of DP-IV deficiency on body weight control and insulin sensitivity in mice. Whereas WT mice displayed accelerated weight gain and hyperinsulinemia when fed a high-fat diet (HFD), mice lacking the gene encoding DP-IV (DP-IV-/-) are refractory to the development of obesity and hyperinsulinemia. Pair-feeding and indirect calorimetry studies indicate that reduced food intake and increased energy expenditure accounted for the resistance to HFD-induced obesity in the DP-IV-/- mice. Ablation of DP-IV also is associated with elevated GLP-1 levels and improved metabolic control in these animals, resulting in improved insulin sensitivity, reduced pancreatic islet hypertrophy, and protection against streptozotocin-induced loss of beta cell mass and hyperglycemia. Together, these observations suggest that chronic deletion of DP-IV gene has significant impact on body weight control and energy homeostasis, providing validation of DP-IV inhibition as a viable therapeutic option for the treatment of metabolic disorders related to diabetes and obesity.
Animals↗
The role of dipeptidyl peptidase IV in the cleavage of glucagon family peptides: in vivo metabolism of pituitary adenylate cyclase activating polypeptide-(1-38).
Dipeptidyl peptidase IV (DP-IV) is a cell surface serine dipeptidase that is involved in the regulation of the incretin hormones, glucagon-like peptide (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP). There is accumulating evidence that other members of the glucagon family of peptides are also endogenous substrates for this enzyme. To identify candidate substrates for DP-IV, a mass spectrometry-based protease assay was developed that measures cleavage efficiencies (kcat/Km) of polypeptides in a mixture, using only a few picomoles of each substrate and physiological amounts of enzyme in a single kinetic experiment. Oxyntomodulin and the growth hormone-(1-43) fragment were identified as new candidate in vivo substrates. Pituitary adenylate cyclase-activating polypeptide-(1-38) (PACAP38), a critical mediator of lipid and carbohydrate metabolism, was also determined to be efficiently processed by DP-IV in vitro. The catabolism of exogenously administered PACAP38 in wild type and DP-IV-deficient C57Bl/6 mice was monitored by tandem mass spectrometry. Animals lacking DP-IV exhibited a significantly slower clearance of the circulating peptide with virtually complete suppression of the inactive DP-IV metabolite, PACAP-(3-38). These in vivo results suggest that DP-IV plays a major role in the degradation of circulating PACAP38.
Amino Acid Sequence↗
Perineal endometriosis without perineal trauma: a case report.
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Adult↗
[Clinical study about diagnosis and management on 10 women with rectovaginal endometriosis].
OBJECTIVE: To study the diagnosis and therapy of the rectovaginal endometriosis. METHODS: Descriptive retrospective study, between 1992 and 2002, 10 women with rectovaginal endometriosis were treated at the Peking Union Medical College Hospital. RESULTS: The average age were 40 years old. Six patients presented with rectal irritative symptom. Three of them complained about deep dyspareunia. Eight patients complained about mild to moderate dysmenorrhea. The recto-vaginal septum should be carefully palpated. None of these patients had either clinical or objective evidence of ovarian endometriosis, nor was there evidence of any obstructive lesions of the intestine or ureters. The CA(125) levels had a sensitivity of 20%. Ultrasonography failed to find the rectovaginal endometriotic nodules. Diagnosis of the rectovaginal endometriosis was based on symptoms, vaginal and rectal examination. The Revised American Fertility Society (rAFS) stages can not evaluate the grade of the endometriosis. Four patients were given leuprolide acetate depot at 3.75 mg, 1 ampule every 28 days, and treatment had a planned duration of 3 mouths. Follow-up evaluations were set 3 mouths later. The patients showed an improvement with respect to pain during the 3 mouths treatment course but had early pain recurrence after drug suspension. The endometriotic lesions showed a slight but reduction in size during therapy but had returned to original volume within 3 mouths after cessation of the gonadotropin-releasing hormone analog (GnRH-a) treatment. Finally, all patients required further treatment with a surgical solution. Six patients succeeded to remove the nodules by laparotomy. Four patients were failed to remove the total lesions by laparoscope and transvaginal section. CONCLUSIONS: The vaginal and rectal examination should be performed if the patients complained about tectal irritative symptom or dyspareunia. The rAFS stages had no strong association with the severity of the rectovaginal endometriosis. GnRH-a should not be considered a real therapeutic alternative to surgical treatment for patients with symptom endometriosis of rectovaginal septum. Laparotomy is efficient for the treatment of the rectovaginal endometriosis.
Adult↗
[The epidemiology of meconium stained amniotic fluid on hospital basis].
OBJECTIVE: To explore the epidemiology of meconium stained amniotic fluid pero-delivery. METHODS: 6,206 one-fetal delivery cases were divided into meconium stained amniotic fluid and normal amniotic fluid groups. Statistics were analysed on two groups using Cohort study. RESULTS: Incidence of meconium stained amniotic fluid was 16.4%. There was no significant difference on maternal medical complication between two groups. The percentage of parity, gestational week > or = 42 weeks and big birth weight were higher in meconium stained amniotic fluid group than that in normal amniotic fluid group (P < 0.001). The average Apgar score in meconium stained amniotic fluid group was lower than that in normal amniotic fluid group (P = 0.001). The percentage of stillbirth, low birth weight and transferred newborn care unit in meconium stained amniotic fluid group were higher than that in normal amniotic fluid group (P < 0.001). CONCLUSIONS: The relative factors on meconium stained amniotic fluid were maternal parity, gestational weeks > or = 42 weeks and big birth weight. No correlation between meconium stained amniotic fluid and maternal medical complication. Morbidity of newborn baby was higher in meconium stained amniotic fluid. Meconium stained amniotic fluid is a important clinical factor on evaluating pregnancy outcome.
Adult↗
[Treatment of female stress urinary incontinence with tension-free vaginal tape procedure: a report of 34 cases].
OBJECTIVE: To assess the efficiency of tension-free vaginal tape (TVT) procedure in the treatment of female stress urinary incontinence (SUI). METHODS: Thirty-four cases with proven SUI and accompanied cystocele were undergone the TVT procedure and cystocele repair simultaneously. RESULTS: Thirty-three patients were operated under local anesthesia. Mean operation time was 26.9 minutes. Mean blood loss was 29.8 ml. Thirty patients (88%) were able to micturate spontaneously 12 hours after operation and their volumes of residual urine were all less than 100 ml. They were discharged on the next day. In the remaining 4 cases (12%) an in-dwelling catheter had to be used for 3 - 11 days. The overall hospital stay averaged was 2.9 days. Patients were followed up for 1 - 21 months (average 8.3 months). According to patients self-assessment, 94% of them feel cured, 6% improved. Postoperative complications was rarely seen. CONCLUSION: TVT procedure is a mini-invasive, effective and safe surgery in the treatment of female SUI.
Adult↗
[Operative approaches, indications, and medical economics evaluation of 4180 cases of hysterectomy].
OBJECTIVE: To examine the operative approaches, major indications, and medical economic parameters of the hysterectomy. METHODS: Data on hysterectomy performed due to benign gynecological disorders in Peking Union Medical College Hospital (PUMCH) from 1996 to 2001 were reviewed. The cases were classified into three groups according to the operative approaches: total abdominal hysterectomy (TAH), vaginal hysterectomy (VH), and laparoscopic assisted vaginal hysterectomy (LAVH). The major indications, length of hospital stay, operative cost, and total medical cost were analyzed. RESULTS: Records of 4,180 women who had hysterectomies in PUMCH were examined. Operations included TAH (78.4%), LAVH (13.0%), and VH (8.6%). The use of LAVH increased from 2.4% in 1996 to 17.3% in 2001. The common indications for surgery included uterine leiomyoma (56.2%), adenomyosis (12.2%), benign ovarian tumor (9.2%), genital prolapse (7.7%), endometriosis (6.9%), atypical endometrial hyperplasia (3.0%), and cervical intraepithelial neoplasm (2.0%). The most common indications for TAH and LAVH were uterine leiomyomas and adenomyosis, whereas the most common indication for VH was genital prolapse, followed by uterine leiomyoma. The lengths of hospital stay in TAH, VH, and LAVH were (11.0 +/- 4.9) d, (10.9 +/- 3.9) d, and (8.9 +/- 3.7) d respectively. The total medical cost was (5,666.6 +/- 1,709.4) RMB Yuan for TAH, (5,027.6 +/- 1,067.0) RMB Yuan for VH, and (7,473.8 +/- 1,464.8) RMB Yuan for LAVH. CONCLUSIONS: The use of LAVH has been increasing. Although the direct medical cost for LAVH is higher than that for TAH, its indirect benefit appeares superior to TAH. The major indications for LAVH and TAH are similar, whereas the indications for VH are different from those for TAH and LAVH.
Costs and Cost Analysis↗
[Study of morphological changes in levator ani muscle of patients with stress urinary incontinence].
OBJECTIVE: To observe the the histological changes of levator ani muscle in patients with stress urinary incontinence (SUI) or pelvic organ prolapse (POP) and to determine the alteration that contributed to pathogenesis. METHODS: Biopsy specimens of levator ani muscle were obtained from 15 patients with SUI, 19 patients with POP and 3 asymptomatic control with rectal cancer during operation. Levator ani muscle's structure was examined with routine histological techniques. At the same time, fiber distribution and diameters were also measured. RESULTS: The morphological features of levator ani muscle in SUI and POP group included the muscular fiber density decreased and separated by large amounts of dense connective tissue. The mean diameter of levator ani muscle in 4 SUI patients containing striated muscle fibers was (24 +/- 9) micro m, the mean diameter in 3 POP patients was (24 +/- 5) micro m, and the mean diameter in 3 control cases was (54 +/- 11) micro m. There was no diameter difference between SUI and POP group (P > 0.05), and the mean fiber diameters of SUI and POP patients were significantly smaller than that of the control group (P < 0.05). The proportion of type I fibers in SUI and POP patients had the tendency to increase (79.6%, 97.2% and 77.2%), with relative decrease of type II fibers. In control group the mean diameter of muscle fiber decreased significantly with age and menopausal time (P = 0.000). CONCLUSIONS: There was obvious fibrosis and the muscle fiber atrophy in SUI and POP group, which resulted in the weakness of pelvic floor. The prevalence of type I fibers might be disadvantage to forceful contraction during straining. Aging also contributed to neuromuscular degeneration and then associated with urinary incontinence in elderly women.
Aged↗
Replication-incompetent adenoviral vaccine vector elicits effective anti-immunodeficiency-virus immunity.
Recent studies of human immunodeficiency virus type 1 (HIV-1) infection in humans and of simian immunodeficiency virus (SIV) in rhesus monkeys have shown that resolution of the acute viral infection and control of the subsequent persistent infection are mediated by the antiviral cellular immune response. We comparatively assessed several vaccine vector delivery systems-three formulations of a plasmid DNA vector, the modified vaccinia Ankara (MVA) virus, and a replication incompetent adenovirus type 5 (Ad5) vector-expressing the SIV gag protein for their ability to elicit such immune responses in monkeys. The vaccines were tested either as a single modality or in combined modality regimens. Here we show that the most effective responses were elicited by a replication-incompetent Ad5 vector, used either alone or as a booster inoculation after priming with a DNA vector. After challenge with a pathogenic HIV-SIV hybrid virus (SHIV), the animals immunized with Ad5 vector exhibited the most pronounced attenuation of the virus infection. The replication-defective adenovirus is a promising vaccine vector for development of an HIV-1 vaccine.
AIDS Vaccines↗
Expression of vascular endothelial growth factor and thrombospondin-1 mRNA in patients with endometriosis.
OBJECTIVE: To investigate the expression of vascular endothelial growth factor (VEGF) mRNA and thrombospondin-1 (TSP-1) mRNA in endometriosis. DESIGN: Molecular studies in human tissue. SETTING: Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, P. R. China. PATIENT(S): Patients undergoing laparoscopy for infertility or other benign gynecologic conditions. INTERVENTION(S): Biopsies were taken from endometriotic lesions (red peritoneal lesion, ovarian endometrioma, and unterosacral ligament nudule) and eutopic endometrium during laparoscopy. MAIN OUTCOME MEASURE(S): mRNA expression from endometriotic lesion and eutopic endometrium was analyzed by reverse transcriptase polymerase chain reaction (PCR) and Northern blotting. RESULT(S): Among the endometriotic lesions, red peritoneal lesions expressed higher levels of VEGF mRNA and lower levels of TSP-1 mRNA, whereas ovarian endometrioma expressed lower levels of VEGF mRNA and higher levels of TSP-1 mRNA. Eutopic endometrium of women with endometriosis had higher expression levels of VEGF mRNA and lower expression levels of TSP-1 mRNA than that of women without endometriosis. CONCLUSION(S): The expression of VEGF and TSP-1 in endometriotic lesions appears to be associated with the extent of their neovascularization. The imbalance in expression of VEGF and TSP-1 in the endometrium may play a role in the development of endometriosis.
Adult↗
Perineal endometriosis after vaginal delivery--clinical experience with 10 patients.
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Adult↗
[Clinical analysis of 11 cases with perineal endometriosis].
OBJECTIVE: To report the diagnosis and treatment of 11 cases with perineal endometriosis (PE). METHODS: Eleven patients with PE treated in our department from 1983 - 2000 years were analyzed retrospectively and were followed for 0.5 - 7.0 years. RESULTS: The incidence of PE is 0.37% of total endometriosis cases operated in our department or 0.087 per thousand of total episiotomy undergone in our delivery room during the 18 year period. Their diagnosis were confirmed clinical manifestations and pathological evidences. All except one had history of perineal tear and episiotomy. The latent period of patient who was less than 30 years old is within one year. The latent period of patient who was more than 30 years old is more than one years (P < 0.05). Complete surgical excision with a cure rate of 91% (10/11). CONCLUSIONS: PE is mainly diagnosed by clinical manifestations. Surgical excision is the first choice of treatment.
Adult↗
[Congenital vaginal atresia: report of 16 cases].
OBJECTIVE: To analyze the clinical features of congenital vaginal atresia (CVA) with normal uterine corpus and investigate the relationship between the subtypes and management. METHODS: Sixteen cases, partical atresia (type I) 10 and complete atresia (type II) 6, treated in Peking Union Medical College Hospital, during the past 16 years, were analysed retrospectively. RESULTS: Patients with type I CVA had an earlier onset of symptoms [(13.0 +/- 1.1) years of age], duration of [(3.5 +/- 2.4) months], greater pelvic masses [(7.7 +/- 3.0) cm in diameter] with lower location as compared with type II CVA [(15.5 +/- 3.4) years of age, 24.0 months, (5.3 +/- 1.0) cm in diameter, P < 0.01]. Distal colpoplasty was performed on 10 type I cases and vaginal mold was placed postoperatively. Dysmenorrhea relieved in all cases during median 21 month follow-up. Vaginal dilatation was done in 4 cases due to readhesion and constriction. One out of the 2 married patients delivered viable neonate by cesarean section. Three out of 6 type II patients were complicated with either endometriosis or hematosalpinx or double uterus. Hysterectomy with or without colpoplasty was done. While the other 3 underwent colpoplasty and cervical canalization. Only 2 had menses after operation, but 1 of the developed dysmenorrhea, ovarian endometrioma and was treated surgically again, the other 1 had hypomenorrhea. CONCLUSION: Patients with type I CVA had better outcomes after colpoplasty if they persist on placing vaginal mold. While for type II CVA, hysterectomy usually needed in most cases.
Adolescent↗
[Laparoscopic surgery in patients with hypovolemic shock due to ectopic pregnancy].
OBJECTIVE: To evaluate the feasibility and safety of operative laparoscopy for ectopic pregnancy with hypovolemic shock. METHODS: Two hundred and fifteen women with ectopic pregnancy underwent operative laparoscopy. These patients were divided into two groups. Group I included 21 patients of ectopic pregnancy with shock and intraperitoneal hemorrhage more than 1,000 ml, and group II included 194 hemodynamically stable patients with blood loss less than 1,000 ml. The clinical data of perioperative periods in two groups were analyzed. RESULTS: All patients were tube pregnancies. The rate of tube rupture was higher in group I than that in group II (81% versus 16%), the difference was statistically significant (P < 0.01). Intraabdominal blood loss was significantly higher in group I (1,775 +/- 531) ml than that in group II (133 +/- 176) ml, autologous blood transfusions were given to 95% and 9% of patients in group I and II respectively (P < 0.01). Laparoscopic salpingectomy was performed to 86% and 51% of patients in group I and II, the difference was significant. The operating time was longer in group I than in group II (50 +/- 24) and (43 +/- 24) min, but the difference was not significant. All patients had no perioperative complications. CONCLUSIONS: Operative laparoscopy in patients with hypovolemic shock can be safely and effectively performed by experienced laparoscopists with the aid of optimal anesthesia, advanced cardiovascular monitoring and autologous blood transfusion.
Adult↗
Clinical study on collagen and stress urinary incontinence.
OBJECTIVE: To investigate the histological characteristics in uterine ligaments of stress urinary incontinence (SUI) and pelvic organ prolapse (POP); to detect the alteration of collagen ultrastructure in uterine ligaments that contribute to SUI and POP; to study the relationship between collagen alteration and SUI and POP. METHODS: The cardinal ligament (Car lig.) and uterosacral ligaments (U-S lig.) samples were obtained from 73 subjects suffering from SUI, or normal controls who underwent hysterectomy. Collagen ultrastructure was examined with transmission electron microscopy (TEM). RESULTS: 1) The smooth muscle fascicles in the patients with SUI and POP were thinner. Arrangement of smooth muscle fascicles was in disorder. 2) The collagen constituting the ligaments was active in metabolism. The mean collagen fibril diameters in the SUI and POP groups were about 25% larger than that in the control groups (p < or = 0.01). 3) Histological characteristics of the Car lig. and the U-S lig. were similar. CONCLUSIONS: 1) The Car lig. and U-S lig. are homologous. Abnormalities in arrangement of smooth muscles and the collagen ultrastructure were obviously seen in SUI and POP 2) The collagen fibril diameter in the SUI and POP subgroups was significantly larger than that in the control groups. Those ligaments are probably less elastic and more likely to break. Predominance of collagen degradation during tissue repair may contribute to POP and SUI.
Adult↗
Study on nerve fiber density in anterior vaginal epithelium for stress urinary incontinence.
The aim of this study was to determine the relationship of innervation in anterior vaginal epithelium with the etiology of stress urinary incontinence (SUI). Fifty-three biopsy specimens of the anterior vaginal epithelium were obtained from 53 subjects in control, pelvic organ prolapse (POP) and SUI groups. Routine HE staining and immunohistochemical staining for protein gene product 9.5 (PGP9.5) were performed for all specimens. PGP9.5 immunoreactivity was identified in nerve fibers and cells of the epithelium and subepitheliual connective tissue of vagina. The nerve fiber profiles of vaginal epithelium in the SUI/POP groups were significantly lower than those in the control group (P < 0.05). There was no correlation between the nerve fiber profiles and parity in SUI, POP and control groups. Decrease of nerve fiber profiles in anterior vaginal epithelium might lead to the occurrence of SUI.
Adolescent↗