Our study aims to investigate the roles that microRNA-214 (miR-214) plays in the epithelial mesenchymal transition (EMT) process and the development of interstitial cystitis (IC) in postmenopausal women by targeting Mitofusin 2 (Mfn2). IC bladder tissues and adjacent normal bladder tissues were collected from postmenopausal women. Immunohistochemistry (IHC) staining was conducted. The target relationship between miR-214 and Mfn2 was determined by a dual luciferase reporter gene assay. Adipose-derived mesenchymal stem cells (ADMSCs) were extracted from postmenopausal rats and assigned to the blank, mimics, miR-214 inhibitors, mimics negative control (NC), inhibitors NC, Mfn2 siRNA, miR-214 inhibitors and Mfn2 siRNA groups. Exosomes secreted by transfected ADMSCs were instilled into the bladders of postmenopausal rats. The expression of miR-214 and Mfn2 mRNA and EMT markers was assessed by qRT-PCR and western blotting. It was confirmed that Mfn2 was the target gene of miR-214 in IC. Compared with the normal bladder tissues, miR-214 decreased, but Mfn2 increased in IC bladder tissues. Compared with the blank group, the expression of miR-214 and the expression levels of N-cadherin, Fibronectin, Twist1, Snail and Vimentin mRNA and protein increased, whereas the expression levels of Mfn2, E-cadherin and ZO-1 mRNA and protein decreased in the miR-214 mimics and Mfn2 groups. The expression of MiR-214 and the expression levels of N-cadherin, Fibronectin, Twist1, Snail and Vimentin mRNA and protein decreased, whereas the expression levels of Mfn2, E-cadherin and ZO-1 mRNA and protein increased in the miR-214 inhibitors group. Our findings indicate that the inhibition of miR-214 promotes the EMT process and contributes to bladder wall fibrosis by up-regulating Mfn2, thus leading to the occurrence of IC in postmenopausal women.

Objective: To investigate the clinical efficacy of modified transperitoneal laparoscopic approach combined with transvaginal access without omental flap to repair complex vesicovaginal fistula after total hysterectomy. Methods: A total of 68 patients with high-up vesicovaginal fistula were retrospectively reviewed. In 15 cases, the surgery was completed using the laparoscopic transabdominal approach. The number of cases using other approaches included: 18 for open extraperitoneal transvesical approach, 12 for transabdominal approach, and 23 for transvaginal approach. Surgical techniques: In the laparoscopic transabdominal approach, the fistula was dissected under direct visual guidance without opening the bladder. The bladder side of the fistula was closed with a single-layer of continuous suture with 3-0 V-Loc barbed suture. The vagina side of the fistula was closed under a vaginoscope or laparoscope. Omental flap was not used in any of the 15 cases. Surgery under other approaches was conducted as reported previously. Results: In comparison with all other three approaches, the laparoscopic transabdominal approach was associated with shorter operation duration, less blood loss and shorter hospital stay. The incidence of post-surgical infection and urinary incontinence did not differ among the treatments. The rate of overactive bladder syndrome and intestinal obstruction was lower in the patients under laparoscopic transabdominal approach, whereas the rate of surgical success was higher with this approach. Conclusions: For high-up complex vesicovaginal fistula, laparoscopic transabdominal repair is a viable approach. The advantage included direct visual guidance, and therefore more efficiency. Omental flap was not needed under this approach.

Objective: To analyze treatment strategies for patients with advanced cervical carcinoma with obstructive renal failure after the failure of retrograde ureteral stent placement. Methods: We retrospectively analyzed 68 cases of advanced cervical cancer secondary with ureteral obstruction and had difficulty in indwelling retrograde ureteral stent in recent 7 years (from January, 2008 to June, 2013); after the treatments of hemodialysis, Percutaneous Nephrostomy (PCN) and laparoscopic bilateral cutaneous ureterostomy respectively, we analyzed the 24 h urine volume, renal function, electrolyte, QOL, further therapy for cervical cancer and 2-year survival rate of the patients. Result: One week after the treatments, by comparing 24 h urine volume and serum creatinine values, we found urinary diversion group (2124.8 +/- 440.7 ml, 84.0 +/- 16.5 ummol/L) was better than PCN group (1062.6 +/- 231.1 ml, 197.8 +/- 7.8 umol/L) and hemodialysis group (47.0 +/- 26.0 ml, 225.4 +/- 23.4 umol/L) and the difference was statistically significant (P<0.05). In the aspect of serum potassium, there was no significant difference between three groups (P>0.05). The radical radiotherapy probability rate and survival period (18.3 +/- 6.1 months) of urinary diversion group were better than that of the other two groups. The difference was statistically significant (P<0.05). In the aspect of 2-year survival rate, urinary diversion group (48.0%, 12/25) was better than hemodialysis group (0%, 0/20), however, there was no statistical difference (P<0.05) by comparing with the PCN group (21.7%, 5/23) (P>0.05). In the aspect of quality of life after operation, the scores of urinary diversion group were distinctly better than the others. Conclusion: For the patients with ureteric obstruction caused by advanced cervical cancer and failed in ureteral stent placement, urinary diversion surgery should be considered with priority for those who could undergo general anesthesia and laparoscopic operation to effectively and thoroughly improve the renal function of patients with long-term stability; it could provide conditions for patients receiving combined treatment for advanced cervical cancer and prolong their survival period and quality of life. If the patient could not undergo general anesthesia and laparoscopic operation, unilateral PCN and hemodialysis could be used as a temporary treatment.