Objective: Pelvic organ prolapse (POP) affects a large proportion of adult women, but the pathogenesis of POP remains unclear. The increase in global population aging will impose a substantial medical burden. Herein, we aimed to explore the related RNAs regulating the occurrence of POP and provide potential therapeutic targets.Method: Tissue biopsies were collected from the anterior vaginal wall of six women with POP and six matched subjects without POP. The profiles of mRNAs, circRNAs, lncRNAs, and miRNAs were obtained by whole transcriptome RNA sequencing.Result: The findings revealed that 71 circRNAs, 76 known lncRNAs, 84 miRNAs, and 931 mRNAs were significantly altered (p < 0.05 and |log2FC| > 1). GO and KEGG enrichment analyses indicated that the differentially expressed genes (DEGs) were mainly enriched in the focal adhesion signaling pathway. FLT, ITGA9, VEGFD, PPP1R12B, and ROCK2 were identified as focal adhesion signaling pathway-related hub genes by protein–protein interaction network analysis. Based on the relationships between the DEGs and miRNA, lncRNA and circRNA targets, we constructed a focal adhesion signaling pathway-related ceRNA network. The ceRNA network includes hsa_circ_0002190/hsa_circ_0046843/lnc-CARMN -miR-23a-3p - ROCK2 and hsa_circ_0001326/hsa_circ_0007733/lnc-AC107959/lnc-TPM1-AS - miR-205-5p - ROCK2/PPP1R12B/VEGFD. Moreover, abnormalities in the cytoskeleton in fibroblasts from individuals with POP were observed.Conclusion: In this study, a focal adhesion signaling pathway-related ceRNA network was constructed, and this network may serve as a target for finding suitable drugs for the treatment of POP.
Objective: To investigate the learning curve of transvaginal natural orifice transluminal endoscopic hysterectomy (tVNOTEH) when using a standard operating procedure (SOP).Methods: Seventy-nine patients were treated with tVNOTEH by a single surgeon. The SOP for tVNOTEH was created after the first eight cases. Patients' perioperative data were retrospectively reviewed. Operative time (OT) was regarded as a replaceable marker for surgical competency. The learning curve was drawn using the cumulative sum method.Results: All patients completed surgeries without switching to other surgical paths.The overall mean OT was 90.23 ± 29.85 min. Four unique phases of the learning curve were identified: phase I (the exploring stage over eight cases), phase II (after adopting the SOP, acquirement of competence over 20 cases), phase III (post-learning of 19 cases, in which more difficult cases were introduced), phase IV (more adept at tVNOTEH), with OT 113.75 ± 43.07 min, 82.50 ± 25.88 min, 101.05 ± 27.83 min, 82.75 ± 25.53 min, respectively. No significant differences were found apart from OT, uterine size, and disease types.
Conclusion:Our data demonstrated four distinct phases of the learning curve of tVNOTEH. For an experienced surgeon, surgical competence in tVNOTEH can be grasped after eight cases. With SOP, surgical competence could be rapidly acquired.
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