Endometriosis: Lang JH

Lang JH. · No affiliation provided · Chin Med J (Engl). · Pubmed #19302735 links to  free full text

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Lang JH. · No affiliation provided · Zhonghua Fu Chan Ke Za Zhi. · Pubmed #17199915 No free full text.

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Lang JH. · No affiliation provided · Zhonghua Fu Chan Ke Za Zhi. · Pubmed #16762178 No free full text.

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Lang JH. · No affiliation provided · Zhonghua Fu Chan Ke Za Zhi. · Pubmed #15774082 No free full text.

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Deng S, Lang JH. · No affiliation provided · Zhonghua Fu Chan Ke Za Zhi. · Pubmed #15733424 No free full text.

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Li XY, Leng JH, Lang JH, Dai Y, Wang YY. · Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing 100730, China. · Zhonghua Fu Chan Ke Za Zhi. · Pubmed #19573305 No free full text.

Abstract: OBJECTIVE: To investigate the relationship between degree of endometrioma adhesions and clinical feature, surgical treatment and postoperative recurrence. METHODS: From Jan 2003 to Mar 2008, 662 patients with endometrioma undergoing laparoscopic ovarian endometrioma excision in Peking Union Medical College Hospital were studied retrospectively. All patients were classified into four groups according to the extent of adhesions: 31 cases in none adhesions group, 123 cases in mild adhesions group (filmy thickness, avascular, easily separated adhesions), 310 cases in moderate adhesions group (less than a half of ovary was adjacent to dense thickness adhesions which was difficult to separate, or above a half of ovary were adjacent to filmy thickness adhesions) and 198 cases in severe adhesions group (above a half of ovary was adjacent to dense thickness, well vascularized adhesions which was difficult to separate, and always involved the other pelvic organs, observed angiogenesis). The comparison of degree, characteristics, period of pain, lab test, surgical management and postoperative recurrence was performed among those above groups. In the mean time, risk factors and multinomial logistic regression were analyzed. RESULTS: (1) Clinical characteristics: The incidence of patients with dysmenorrhea, dyspareunia, straining feeling in anus, chronic pelvic pain and the level of CA(125) (> 35 kU/L) was remarkably higher in moderate-to-severe adhesion groups than in none-to-mild adhesions groups (P = 0.000, 0.000, 0.001, 0.006 and 0.000, respectively). Infertility rate were significantly higher in severe adhesions group (15.7%, 31/198) than none adhesions group (3.2%, 1/31), mild adhesions group (11.4%, 14/123) and moderate adhesions group (9.7%, 30/310, OR = 1.728, P < 0.05). (2) Operating time and blood loss: Operating time of each groups was as followed: (37 +/- 15) min in none adhesions group, (42 +/- 19) min in mild adhesions group, (50 +/- 20) min in moderate adhesions group and (63 +/- 22) min in severe adhesion group. Blood loss was (23 +/- 12) ml in none adhesion group, (31 +/- 27) ml in mild adhesion group, (40 +/- 32) ml in moderate adhesion group and (70 +/- 67) ml in severe adhesions group. Thicker adhesions result in longer operation time and more blood loss. (3) Combined with other disease: The ratio of patients who combined with adenomyosis or deeply infiltrating endometriosis in moderate-to-severer adhesion groups was higher than patients in none-to-mild adhesions groups (OR = 3.466, P = 0.000). (4) Postoperative recurrence: It was categorized into recurrence of pain and cyst. Moderate-to-severe adhesions was related to higher recurrence rate of pain (OR = 1.685, P = 0.046), but was irrelevant to recurrence of cyst. CONCLUSION: The more extent of endometrioma adhesions was related to severer pelvic pain symptoms, longer operating time and more blood loss. Postoperative pain recurrence rate was observed in moderate-to-severe adhesion group. Extent of adhesions was irrelevant to cyst recurrence.

Li CY, Wang HQ, Liu HY, Lang JH. · Department of Obstetrics and Gynecology, Provincial Hospital Affiliated to Shandong University, Jinan 250021. · Chin Med Sci J. · Pubmed #19180882 No free full text.

Abstract: OBJECTIVE: To investigate the clinical features and management of ureteral endometriosis. METHODS: Patients surgically and histologically diagnosed as ureteral endometriosis from January 2001 to January 2007 in Peking Union Medical College Hospital were retrospectively reviewed. RESULTS: Ten patients were diagnosed as ureteral endometriosis among 7561 cases with surgically and histologically proved diagnosis of endometriosis, with an incidence of 0.132%. Nine out of 10 patients were extrinsic ureteral endometriosis and concomitant with severe pelvic endometriosis, and the other was intrinsic ureteral endometriosis. Hormone therapy failed in 2 patients with urinary tract obstruction. Ureterolysis was performed in 6 patients and ureterectomy was performed in 4 patients. One case of ureteral recurrence was observed in a postmenopausal woman without hormonal replacement therapy who received laparoscopic ureterolysis and hysterectomy with bilateral adnexectomy. No relapse was observed in the other 9 patients. CONCLUSIONS: Ureteral endometriosis is a rare entity. The upper urinary tract should be evaluated in patients with severe endometriosis, even in postmenopausal women. The treatment of ureteral endometriosis usually requires surgery, while ureterolysis should not be performed in patients with extensive disease. As a form of adjuvant therapy of surgery, hormonal therapy is an appropriate option.

Li CY, Lang JH, Liu HY, Zhou HM. · Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China. · Chin Med J (Engl). · Pubmed #18706208 links to  free full text

Abstract: BACKGROUND: Annexin-1 was identified as an endometriosis-related protein by comparative proteomics in previous study. As an endogenous anti-inflammatory mediator, Annexin-1 has been shown to regulate the immune response, cell proliferation and apoptosis. To investigate whether Annexin-1 is involved in the pathogenesis of endometriosis, we examined the expression of Annexin-1 in eutopic endometrium of women with or without endometriosis, and detected its expression in peritoneal fluids of those with endometriosis. METHODS: Eutopic endometrium samples from twenty-five women with endometriosis and those from sixteen age-matched women without endometriosis were collected. Peritoneal fluids were obtained from ten patients with endometriosis. The expression of Annexin-1 protein in eutopic endometrium was detected by immunohistochemistry and Western blotting, and mRNA detected by real-time PCR. Annexin-1 protein in the peritoneal fluids was detected by Western blotting. RESULTS: Annexin-1 mRNA and protein were overexpressed in eutopic endometrium of endometriosis without significant differences between the proliferative and secretory phase. Immunohistochemistry showed that Annexin-1 protein was expressed mainly in endometrial glandular cells throughout the menstrual cycle. Annexin-1 protein was detected in the peritoneal fluids of all the ten patients with endometriosis. CONCLUSIONS: Annexin-1 is overexpressed in eutopic endometrium and presents in the peritoneal fluids of patients with endometriosis, and may play a role in the pathogenesis of endometriosis.

Fu CW, Zhu L, Lang JH. · Department of Gynecology and Obstetrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China. · Chin Med J (Engl). · Pubmed #17711751 links to  free full text

This publication has no abstract.

Wang HB, Zhu L, Lang JH, Liu ZF, Sun DW, Leng JH, Fan QB. · Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Beijing 100730, China. · Zhonghua Yi Xue Za Zhi. · Pubmed #17686237 No free full text.

Abstract: OBJECTIVE: To investigate the diagnosis and treatment of perineal endometriosis. METHODS: The clinical date of 30 patients with perineal endometriosis, aged 32.3 (23 approximately 44), who were admitted 1983 - 2006, operated on, and followed up for 0.5 approximately 13 years, were analyzed. RESULTS: The incidence of perineal endometriosis was 0.32% among the total endometriosis cases. Five of these 30 patients (16.7%) suffered from perineal endometriosis combined with pelvic endometriosis. The latent period was 4 months to 13 years. There was no significant difference in onset of age. All patients had cyclical and painful lesions. The level of CA125 was normal. All patients were cured after complete surgical excision. CONCLUSION: Diagnosis of perineal endometriosis can be made based on the patients' history and clinical manifestations. Surgical excision is the first choice of treatment. The recurrent rate of the cases without anal sphincter involvement is lower than that with anal sphincter invasion since the complete incision can be made. It is important to evaluate pre-operatively if the anal sphincter is involved.

Leng JH, Lang JH, Dai Y, Li HJ, Li XY. · Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing 100730, China. · Zhonghua Fu Chan Ke Za Zhi. · Pubmed #17537300 No free full text.

Abstract: OBJECTIVE: To study the relationship between pain symptoms and the clinico-pathological features of pelvic endometriosis (EM). METHODS: One hundred thirty patients with laparoscopic diagnosis of EM were studied retrospectively and the relationship between pain symptoms including dysmenorrhea, chronic pelvic pain (CPP), dyspareunia and dyschezia and the anatomical features of pelvic endometriosis were evaluated. RESULTS: One hundred (76.9%) patients with pain symptoms and 30 (23.1%) without were included in this study. The number of patients with mild, moderate and severe dysmenorrhoea was 27 (20.8%), 41 (31.5%), and 32 (24.6%), respectively. Patients with dyspareunia, CPP and dyschezia were 46 (35.4%), 45 (34.6%) and 67 (51.5%), respectively. Compared with patients without dysmenorrhea, the proportion of deep utero-sacral nodules (45.0% vs 13.3%, P=0.00), recto-vaginal nodules (16.0% vs 0, P=0.01), complete obliteration of cul-de sac (41.0% vs 10.0%, P=0.00), and lesions of DIE (51.0% vs 16.7%, P=0.00) was significantly increased in patients with dysmenorrhea. The severity of dysmenorrhea was positively correlated with nodules in uterosacral ligaments (P=0.005, r=0.302), and invasive depth of uterosacral ligaments (P=0.016, OR=5.085). Among patients with endometrioma, significantly more moderate to severe adhesions were found in patients with dysmenorrhea, compared with those patients without dysmenorrhea (29.1% vs 8.3%, P=0.029). Patients with CPP had more nodules in the utero-sacral ligaments (51.1% vs 30.6%, P=0.018) and DIE lesions (57.8% vs 35.3%, P=0.011), compared with those without. More nodules in the utero-sacral ligaments (46.3% vs 28.6%, P=0.028), recto-vaginal nodules (19.4% vs 4.8%, P=0.01), complete obliteration of cul-de sac (44.8% vs 22.2%, P=0.005) and DIE lesions (53.7% vs 31.7%, P=0.01) were found in patients with dyschezia, compared with those without. Nodules in the recto-vaginal pouch were an independent risk factor of dyspareunia. CONCLUSION: Pain symptoms including dysmenorrhea, dyspareunia, chronic pelvic pain, and dyschezia are remarkably related to endometriotic nodules at the posterior part of the pelvis or those with deep invasions.

Deng S, Dai Y, Lang JH, Leng JH, Liu ZF, Sun DW, Zhu L, Tan XJ. · Department of Obstetrics and Gynecology, PUMC Hospital, CAMS and PUMC, Beijing 100730, China. · Zhongguo Yi Xue Ke Xue Yuan Xue Bao. · Pubmed #17536280 No free full text.

Abstract: OBJECTIVE: To investigate the effects of progesterone and progestin on the expressions of regulated on activation, normal T cell expressed and secreted (RANTES) in eutopic endometrium from patients with endometriosis. METHODS: We collected the samples of endometrium from patients with endometriosis before operation or after insertion of levenorgestrel releasing intrauterine system (LNG-IUS), administration of oral medroxyprogesterone (MPA), or injection of gonadotrophic hormone releasing hormone agonist (GnRHa). Reverse transcription-polymerase chain raction was used to assay the expression of RANTES mRNA. On the other hand, progesterone (Po) and tumor necrosis factor-alpha (TNFalpha) of different concentrations and different manners were used to treat cultured cells in vitro. RANTES secretion was evaluated in the culture medium using ELISA. In order to evaluate the effect of Po on the secretion of RANTES under stimulation of TNFalpha, the cells were cultured in medium containing 100 U/ml TNFalpha and Po of different concentrations for 24 hours. After the pretreatment of Po for 48 hours at different concentrations, TNFalpha (100 U/ml, 16 h) was added to observe whether Po inhibits RANTES or not. RESULTS: The expression of RANTES mRNA in eutopic endometrium of patients with endometriosis was significantly higher than in control group (28.0 +/- 9.0 vs. 22.0 +/- 5.6, P < 0.05). Following the exposures to LNG-IUS (24.0 +/- 4.2 vs. 25.9 +/- 4.2, P > 0.05) or GnRHa (23.0 +/- 12.9 vs. 26.9 +/- 5.2, P > 0.05), the expression of RANTES mRNA had no change. MPA significantly increased the expression of RANTES mRNA (42.6 +/- 3.1 vs. 24.3 +/- 5.7, P < 0.05). Po itself had no significant effect on the secretion of RANTES. Stimulated by Po and TNFalpha at the same time, the secretion of RANTES significantly increased. After pretreatment with Po for 48 hours, the reaction of RANTES to the stimulating effect of TNFalpha was down-regulated. CONCLUSION: The eutopic endometrium of patients with endometriosis has high chemotactic activity. It may be feasible to prevent and treat endometriosis with progestins.

Deng S, Lang JH, Leng JH, Liu ZF, Sun DW, Zhu L, Tan XJ. · Department of Obstetrics and Gynecology, PUMC Hospital, CAMS and PUMC, Beijing 100730, China. · Zhongguo Yi Xue Ke Xue Yuan Xue Bao. · Pubmed #17536279 No free full text.

Abstract: OBJECTIVE: To investigate the apoptosis-related mechanisms of levenorgestrel-releasing intrauterine system (LNG-IUS), oral medroxyprogesterone (MPA), and injective gonadotrophic hormone releasing hormone agonist (GnRHa) on eutopic endometrium of patients with endometriosis. Methods We collected the samples of endometrium from patients with endometriosis before operation and after insertion of LNG-IUS, administration of oral MPA, or injection of GnRHa. The ultrastructure of endometria was observed and compared by electron microscopy. Apoptotic cells were assessed by the terminal deoxynucleotidyl transferase-mediated deoxy-UTP nick-end labeling (TUNEL) assay, and the expressions of Bax, Fas, and Fas-L mRNA were determined by semi-quantitative reverse transcription-polymerase chain raction. Results After have been exposured to LNG-IUS, the apoptotic rate of endometrial epithelial cells and stromal cells increased from (24. 4 +/- 35.0)% to (51.0 +/- 37.8)% (P = 0.027) and (35.3 +/- 30.2)% to (76.4 +/- 11.2)% (P = 0.008), respectively. The degree of apoptosis under transmission electron microscopy was in an order of GnRHa > LNG-IUS > MPA. The expression of Fas-L mRNA in eutopic endometrium of patients with endometriosis was significantly higher than that of the normal control (P < 0.05). The expressions of three apoptosis-related proteins had no significant difference. CONCLUSION: Medical treatments can increase the apoptosis of eutopic endometrial cells, and such effect was strongest in GnRHa and relatively weaker in LNG-IUS and MPA.

Wang HB, Leng JH, Zhu L, Liu ZF, Sun DW, Lang JH. · Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China. · Zhonghua Fu Chan Ke Za Zhi. · Pubmed #17331421 No free full text.

Abstract: OBJECTIVE: To establish the chick embryo chorioallantioc membrane (CAM) as a model for in vivo research on endometriosis. The model was used to investigate the mechanism of anti-vascular endothelial growth factor (VEGF) antibody for treatment of endometriosis. METHODS: Human endometrial fragments were explanted onto the CAM. Then anti-VEGF antibody was used for the endometriosis-like lesions after transplantation of human endometrial fragments. The CAM models were treated respectively as control groups and experimental groups. The terminal deoxynucleotidyl transferase-mediated biotin-deoxyuridine triphosphate (dUTP) nick end labeling (TUNEL), proliferating cell nuclear antigen (PCNA) and microvessel density (MVD) were used in vivo for analysis of anti-angiogenesis. RESULTS: The apoptosis intensity of anti-VEGF antibody treated groups (6.7 +/- 0.9, 6.9 +/- 0.8) was significantly higher than that of the control groups (5.0 +/- 0.9, 5.4 +/- 1.1; P < 0.05). The proliferation intensity was not different in these groups. Lower MVD was observed in experimental groups [(4.2 +/- 1.1), (4.9 +/- 1.2) vessels] than the control groups [(6.9 +/- 1.6), (9.1 +/- 3.0) vessels; P < 0.05]. CONCLUSIONS: CAM is an extraembryonic membrane that is commonly used in vivo for the study of angiogenesis and anti-angiogenesis. Anti-VEGF antibody can be used to accelerate apoptosis of the endometrial cells and vascular endothelium cells, but it has no effect on the proliferation of these cells.

Deng S, Lang JH, Leng JH, Liu ZF, Sun DW, Zhu L. · Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China. · Zhonghua Fu Chan Ke Za Zhi. · Pubmed #17199919 No free full text.

Abstract: OBJECTIVE: To observe the effects of levonorgestrel-releasing intrauterine system (LNG-IUS) in treatment of pain associated with endometriosis (EM) and adenomyosis (AM), and in prevention of disease recurrence. METHODS: Thirty-three cases of moderate to severe EM or AM patients received insertion of LNG-IUS immediately after conservative operation, or after recurrence of simple pain, and were self controlled respectively before and after insertion of LNG-IUS. The visual analogue scale (VAS) was compared, and the change of the lesion and the uterine size, as well as the serum steroid and CA(125) were observed. The side-effects, such as bleeding pattern were recorded. The bleeding period was compared between the cases injected with or without gonadotropin-releasing hormone agonist (GnRHa) before insertion of LNG-IUS. RESULTS: Baseline and follow-up VASs of EM were 8.09 +/- 0.21 and 1.64 +/- 1.12 (P = 0.042), of AM were 8.41 +/- 1.59 and 3.99 +/- 3.87 (P = 0.068), respectively. During nearly 2 years' follow-up, moderate dysmenorrhea recurred in only 1 case who was hyper-estrogenism at that time. Generally, irregular bleeding and spotting period were longer in this LNG-IUS treated group than those reported in literatures in which LNG-IUS was used for contraception. Persistent prolonged spotting was seen in most of the patients during 1 year follow-up. Average bleeding days in one month during the first 6 months after insertion of LNG-IUS were both around 18 days, whether using GnRHa or not. CONCLUSIONS: LNG-IUS greatly reduces pain associated with EM and AM, and delays disease recurrence. Irregular bleeding and spotting is the main side effects. Administration of GnRHa in advance does not improve the bleeding symptoms.

Cheng NH, Zhu L, Lang JH, Liu ZF, Sun DW, Leng JH, Shen K, Huang HF, Pan LY, Wu M. · Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China. · Zhonghua Yi Xue Za Zhi. · Pubmed #17064532 No free full text.

Abstract: OBJECTIVE: To study the techniques to repair the fascia layer of abdominal wall after the resection of abdominal wall endometriosis (AWE). METHODS: Fifty-five AWE patients aged 28 approximately 38 underwent resection of the lesion. After the resection a defect fascia in abdominal wall larger than 2 cm(2) was seen in 29 patients (large fascia defect group), and in the other 26 patients the fascia defect was less than 2 cm(2) (small fascia defect group). In the large fascia defect group, 11 cases underwent routine closure of the abdominal wall, 2 underwent abdominal wall reconstruction by applying tension suture, 1 case underwent fascia layer/skin tension-relieving suture, 4 cases abdominal wall reconstruction by PDS-II suture, 4 cases underwent fascia patch grafting, and 7 cases underwent abdominal wall plastic repair plus fascia patch grafting, the different techniques being selected according to the size of the defect. Routine abdominal wall closure was performed on all the 26 patients in the small fascia detect group. The features of the lesion and operation, and the outcomes were compared. RESULTS: Primary healing was achieved in all the patients. In comparison with the small fascia defect group, the mean size of the masses measured by pre-operational ultrasonography of the large fascia defect group was significantly bigger [(3.8 +/- 1.4) cm vs. (2.5 +/- 1.1 cm)], the mean size of the masses resected in operation was significantly larger [(5, 5 +/- 2.0) cm vs. (3.7 +/- 1.9) cm, P = 0.004], the operation time was significantly longer [(66 +/- 42) min vs. (35 +/- 24) min, P = 0.002], and the intra-operational blood loss was significantly more [(52 +/- 50) ml vs. (23 +/- 19) ml, P = 0.006]. Relapse occurred in 1 case in the large fascia defect group. CONCLUSION: Ultrasonography helps estimate the extension of AWE before operation. Fascia layer/skin tension-relieving suture can be used in the fascia defect of abdominal wall larger than 2 cm(2). Abdominal wall plastic repair plus fascia patch grafting is capable of repairing larger fascia layer and skin defects of abdominal wall.

Leng JH, Lang JH, Zhao XY, Li HJ, Guo LN, Cui QC. · Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing 100730, China. · Zhonghua Fu Chan Ke Za Zhi. · Pubmed #16640860 No free full text.

Abstract: OBJECTIVE: To determine the characteristics of anatomical distribution of pelvic endometriosis and the correlation between visual and histologic findings of endometriosis at laparoscopy. METHODS: A prospective study of 62 patients undergoing laparoscopy for the pelvic pain, infertility and/or pelvic masses was carried out. All lesions with the diagnosis of endometriosis laparoscopically were excised and examined pathologically. Normal-appearing peritoneal biopsies were obtained randomly. All lesions were identified by anatomical site and color of the foci. The positive predictive value (PPV), sensitivity, negative predictive value (NPV), and specificity were determined for visually identified endometriosis versus the histologic findings. RESULTS: Totally, 219 peritoneal endometriotic lesions, 54 normal peritoneal biopsies, and 71 ovarian endometriotic cysts were obtained. Peritoneal lesions tended to locate in posterior part of the pelvis (80.8%, 177/219) and in left (58.0%, 127/219) with most in black (39.2%). The PPV was 67.6%; sensitivity, 93.7%; NPV, 81.4%; and specificity, 38.3% for visual versus histologic diagnosis of peritoneal endometriosis. Lesions in black or from sacral ligaments were confirmed histologically in 94.2% and 84.7% respectively, and 80.3% (57/71) of ovarian endometriotic cysts diagnosed by laparoscopy were confirmed histologically with 43.6% in the left, 27.3% in the right; and 29.1% (16/55) in both sides of the ovary. In addition, 18.5% (10/54) of normal-appearing peritoneal biopsy were identified as endometriosis by pathological examination. Laparoscopy was confirmed to be in 100% diagnostic accordance with pathology for patients with endometriosis. CONCLUSIONS: Our study showed asymmetrical distribution of pelvic endometriosis. Peritoneal lesions in black or from sacral ligament are more likely to be histologically confirmed, and microscopic lesions are not a rare phenomenon of endometriosis.

Li Y, Lang JH. · Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing 100730, China. · Zhonghua Fu Chan Ke Za Zhi. · Pubmed #16635325 No free full text.

Abstract: OBJECTIVE: To investigate mRNA expression of matrix metalloproteinase (MMP-9) and tissue inhibitor of metalloproteinase (TIMP-1) in ectopic endometriosis tissue and uterine endometrium from women with and without endometriosis. METHODS: Thirty-eight women with endometriosis (Revised American Fertility Society classification, RAFSI-IV) were selected as study group. Thirty-eight specimens of ovarian endometrioma (ovarian chocolate cysts, OCC), 16 red peritoneal endometriotic lesions (RPL), and 35 matched eutopic endometrium (Eu) were collected from them simultaneously at the time of surgery. Twenty specimens of endometrium from reproductive women undergoing laparoscopic surgery without endometriosis were obtained as control group. The mRNA expressions of MMP-9 and TIMP-1 were detected by reverse transcription polymerase chain reaction (RT-PCR). RESULTS: Expression of TIMP-1 mRNA was detected in all samples. The level from endometriosis patients and control group was similar (2.31 +/- 1.21, 2.40 +/- 0.89). However, ectopic endometrium expressed significantly fewer TIMP-1 mRNA (OCC 1.67 +/- 0.79, RPL 1.45 +/- 0.68) compared with eutopic endometrium from both endometriosis and endometriosis-free patients (P < 0.05). The positive expression rate of MMP-9 mRNA was not distinctively different among all samples. The density of MMP-9 mRNA expression in endometrium (0.49 +/- 0.28) from endometriosis patients was similar to that in ectopic endometriosis (OCC 0.46 +/- 0.22, RPL 0.33 +/- 0.12), but was significantly higher compared with endometrium (0.29 +/- 0.12) without endometriosis (P < 0.05). CONCLUSIONS: An increase of MMP-9 mRNA expression of eutopic endometrium with endometriosis might enhance the endometrial implantation ability, thus facilitate the ectopic implantation of endometrium. Ectopic lesions express significantly less TIMP-1 mRNA, indicating they have increased invasive ability, which might facilitate the development of endometriosis.

Ding XM, Lang JH. · Department of Gynecology and Obstetrics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730. · Chin Med Sci J. · Pubmed #16261896 No free full text.

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Li ZG, Lang JH, Leng JH, Liu DY. · Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China. · Zhonghua Fu Chan Ke Za Zhi. · Pubmed #16202314 No free full text.

Abstract: OBJECTIVE: To detect the concentrations of prostaglandin E2 (PGE2) and bcl-2 in sera and peritoneal fluid of women with endometriosis. METHODS: The study group included 36 samples of peritoneal fluid and serum respectively from patients with endometriosis, and control group included 30 samples of peritoneal fluid and serum respectively from patients without endometriosis (either ovary cyst or uterine myoma). The peritoneal fluids were collected at the time of laparoscopic operation, and the sera were collected before surgery. Concentrations of PGE2 and bcl-2 were determined by enzyme linked immunosorbent assay (ELISA). RESULTS: The peritoneal fluid concentrations of PGE2 and bcl-2 in study group were significantly higher than that of control group, (1987 +/- 532) ng/L vs (386 +/- 215) ng/L, (177 +/- 53) U/L vs (86 +/- 21) U/L, (P < 0.05); and the PGE2 levels of severe endometriosis were significantly higher than that of mild endometriosis, (2221 +/- 1352) ng/L vs (1694 +/- 381) ng/L, (P < 0.01). The serum concentrations of PGE2 and bcl-2 in study group were significantly higher than that of control group, (3787 +/- 514) ng/L vs (129 +/- 97) ng/L, (96 +/- 44) U/L vs (53 +/- 40) U/L, (P < 0.01). Serum PGE2 concentrations of severe endometriosis were significantly higher than that of mild endometriosis, (964 +/- 290) ng/L vs (590 +/- 362) ng/L, (P < 0.01). CONCLUSIONS: The concentrations of PGE2 and bcl-2 in peritoneal fluid are increased in endometriosis. The concentrations of PGE2 and bcl-2 are associated with the extent of endometriosis lesions.

Wang HB, Lang JH, Leng JH, Zhu L, Liu ZF, Sun DW. · Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China. · Zhonghua Yi Xue Za Zhi. · Pubmed #16179118 No free full text.

Abstract: OBJECTIVE: To study the localization and expression of the vascular endothelial growth factor receptors (VEGFR) Fms-like tyrosine kinase (Flt-1) and kinase insert domain-containing receptor (KDR) in human ectopic and eutopic endometrium of patients with endometriosis. METHODS: Specimens of endometriosis patients, aged (38 +/- 8) years, including 37 specimens of entopic endometrium, 34 specimens of ovarian chocolate cyst, 34 specimens of ovarian chocolate cyst, 15 specimens of red peritoneal endometriosis lesions, and 4 abdominal wall endometriosis lesions were collected. Specimens of endometrium of 33 patients with other gynecological diseases, aged (36 +/- 8) years, were collected during operation and used as controls. Immunohistochemistry was used to detect the location and expression of Flt-1 and KDR protein in different tissues. Western blotting was used to detect the protein expression of Flt-1 and KDR protein in different tissues. The mRNA expressions of Flt-1 and KDR were detected by RT-PCR. RESULTS: Flt-1 and KDR were expressed in the endometrial glandular epithelium and stromal cells besides the endometrial blood vessels. The positive expression rate of Flt-1 and KDR in the ectopic endometrium of endometriosis patients were 94.3% and 91.4% respectively, both significantly higher than those in the ovarian endometrial cyst (74.3% and 77.1% respectively, both P < 0.05), and similar to those in the eutopic endometrium of the endometriosis patients (93.8% and 90.6% respectively, both P > 0.05). In the eutopic endometrium of the endometriosis patients, the Flt-1 mRNA expression level was 2.4 +/- 1.2 and the Flt-1 protein expression level was 31 +/- 17, and the KDR mRNA expression level was 3.0 +/- 1.4 and the KDR protein expression level was 36 +/- 24, all significantly higher than those in the ovarian endometrial cyst (1.5 +/- 0.9 and 1.8 +/- 1.0 for the Flt-1 and KDR mRNA expressions, and 17 +/- 6 and 20 +/- 11 for the Flt-1 and KDR protein expressions, all P < 0.05), and similar to those in the eutopic endometrium of the non-endometriosis patients (1.9 +/- 0.8 and 2.3 +/- 1.3 for the Flt-1 and KDR mRNA expressions, and 24 +/- 18 and 25 +/- 16 for the Flt-1 and KDR protein expressions, all P > 0.05) CONCLUSION: VEGF may play certain biological role in the development of endometriosis through VEGFR (Flt-1 and KDR). The expression of Flt-1 and KDR in the endometriotic lesion appears to be associated with neovascualization.

Li HJ, Leng JH, Lang JH, Wang HL, Liu ZF, Sun DW, Zhu L, Ding XM. · Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing 100730, China. · Zhonghua Fu Chan Ke Za Zhi. · Pubmed #15774085 No free full text.

Abstract: OBJECTIVE: To determine the correlative factors with recurrence of endometriosis after conservative surgery. METHODS: A cohort study was performed on 285 patients who had a minimum of 36 months of follow-up after conservative surgery for endometriosis. All patients underwent clinical interview, physical examination and ultrasonography. The factors measured included: age at surgery, age at onset of disease, gravidity, parity, tenderness nodule at cul-de-sac (yes/no), uterus mobility (movable/fixed), serum CA(125) level, type of operation (laparoscopy/laparotomy), history of operation for endometriosis (yes/no), side of endometrioma (left/right/bilateral), intraoperative revised classification American Fertility Society (r-AFS) scores, post-operative r-AFS scores, highest post-operative temperature, post-operative adjuvant therapy, post-operative gravidity and parity. The recurrent rate and its predictive factors were evaluated and the univariate, multivariate COX regression and Kaplan-Meier analyses were performed to determine the predictive factors for recurrence of endometriosis. RESULTS: The related factors and their odds ratio (OR) by univariate analysis were as follows: history of endometriosis surgery, 13.630 (P < 0.01); nodules with tenderness at cul-de-sac, 6.133 (P < 0.01); post-operative administration of clomiphene, 5.173 (P < 0.01); left endometrioma, 4.503 (P < 0.01); bilateral endometrioma, 3.709 (P < 0.01); post-operative r-AFS scores, 1.831 (P < 0.01); post-operative gravidity, 0.392 (P < 0.05); post-operative administration of progesterone for 6 months, 0.472 (P < 0.01); laparoscopic surgery, 0.567 (P < 0.05); pre-operative parity, 0.640 (P < 0.05); pre-operative gravidity, 0.759 (P < 0.05); age at onset of disease, 0.912 (P < 0.01) and age at surgery, 0.932 (P < 0.05). Meanwhile, the related factors and their odds ratio (OR) by multivariate COX analysis were as follows: history of endometriosis surgery, 8.219 (P < 0.01); bilateral endometrioma, 6.369 (P < 0.01); left endometrioma, 2.682 (P < 0.05); tenderness nodules at cul-de-sac, 2.154 (P < 0.05); post-operative administration of clomiphene, 1.860 (P < 0.05); post-operative r-AFS scores, 1.188 (P < 0.01); post-operative gravidity, 0.253 (P < 0.01); post-operative administration of progesterone for 6 months, 0.518 (P < 0.05); age at surgery, 0.937 (P < 0.01). CONCLUSIONS: The risk factors for recurrence of endometriosis include a history of endometriosis surgery, bilateral endometrioma, left endometrioma, tenderness nodules at cul-de-sac, post-operative administration of clomiphene, post-operative r-AFS scores,whereas the protective factors include the post-operative gravidity, post-operative adjuvant therapy and age at surgery.

Leng JH, Lang JH, Guo LN, Liu ZF. · No affiliation provided · Zhonghua Fu Chan Ke Za Zhi. · Pubmed #15363357 No free full text.

This publication has no abstract.

Gao JS, Leng JH, Lang JH, Liu ZF, Shen K, Sun DW, Zhu L. · Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing 100730, China. · Zhonghua Fu Chan Ke Za Zhi. · Pubmed #15196412 No free full text.

Abstract: OBJECTIVE: To investigate the ureteral injury in gynecological laparoscopies and discuss its diagnosis, treatment and prevention. METHODS: Ureteral injury in gynecological laparoscopies during the past 13 years was reviewed retrospectively. The clinical features of initial operations including the types of disease, uterine size, pelvic adhesion, operative procedures and the methods of diagnosis, treatment and prognosis of ureteral injury were studied. RESULTS: There were 8 ureteral injuries (0.14%) in 5 541 gynecological laparoscopies with seven in laparoscopically assisted vaginal hysterectomy (LAVH)/total laparoscopic hysterectomy (TLH) (0.45%) and one in non-LAVH (0.03%). The main gynecological disorders included adenomyosis, endometriosis and leiomyoma. All patients had pelvic adhesions and 4 had previous pelvic operations. Uterine enlargement was found in 7. Patients presented increased vaginal drainage, flank pain, increased volumes of vaginal discharge, nausea and vomiting, fever, edema, or peritonitis from 0 to 13 days postoperatively. Ureteral injuries were mainly diagnosed via excretory urogram (IVP). The sites of injury were near the inferior margin of the sacroiliac joint in two women and at the inferior part of ureter (near the uterine vessel, uterosacral ligament and ureterovesical junction) in 6. Two patients whose injuries were found soon after operation received ureteral repair by laparotomy successfully. Two of the six patients whose injuries were found several days later were treated with internal ureteral stenting successfully, the other four failed with ureteral stenting and received ureteral repair by laparotomy. Outcomes were good in all cases. CONCLUSIONS: Ureteral injury is an uncommon and severe complication in gynecological laparoscopies. Symptoms like abnormally increased drainage, fever, flank pain, abnormal vaginal discharge and peritonitis after operation should be paid attention to and ureteral injury be considered. Surgical repair is the primary treatment.

Guo ZR, Zhang J, Lang JH, Leng JH, Piao YS, Wang YL. · State Key Laboratory of Reproductive Biology, Institute of Zoology, Chinese Academy of Sciences, China & Bioactive Materials Key Laboratory of Ministry of Education, Life Science College, Nankai University, Tianjing 200000, China. · Zhonghua Fu Chan Ke Za Zhi. · Pubmed #15130351 No free full text.

Abstract: OBJECTIVE: The aim of this study was to demonstrate the temporal and spatial expression of estrogen receptor (ER), 17beta-hydroxysteroid dehydrogenase (17beta-HSD) in uterine endometria and the endometrial-myometrial interface (EMI) of adenomyosis and the effects of estrogen activity-related molecules on the occurrence of adenomyosis. METHODS: Thirty-three cases of normal endometria (and myometrial) and eighteen cases of endometria (and myometrial) with adenomyosis were collected. Immunohistochemical assay was performed to locate the ERalpha, ERbeta, 17beta-HSDI and 17beta-HSDII in endometria and EMI. RESULTS: The ERalpha positive cell number in glandular epithelial cells at the early proliferative phase increased evidently in adenomyosis (90%), while it was 60% in normal endometria. We found ERalpha signal in cytoplasm in glandular epithelial cells of adenomyosis endometria as well as in nucleus. Compared with normal endometrium (early proliferative phase: +; late proliferative phase: ++; late secretory phase: +), eutopic endometrium with adenomyosis exhibited a higher level of 17beta-HSDI (early proliferative phase: ++; late proliferative phase: +++; late secretory phase: ++). The intensity of 17beta-HSDIIin glandular epithelial cells of eutopic endometrium with adenomyosis (early proliferative phase: +++; secretory phase: ++++) was also higher than that of normal endometrium (early proliferative phase: - approximately ++; secretory phase: +++). Higher intensities of ERalpha, ERbeta and 17beta-HSDIand lower intensities of 17beta-HSDII were observed in EMI than in the eutopic endometrium of adenomyosis. CONCLUSIONS: The elevation of ERalpha positive cell number, 17beta-HSDI level as well as the insufficient compensation of 17beta-HSDII in eutopic endometrium with adenomyosis and the change in expression pattern of ERalpha, ERbeta, 17beta-HSDI and 17beta-HSDII in EMI lead to the local enhancement of estrogen effect, which would promote cell proliferation.