Aim: To compare outcomes after laparoscopic ovarian cystectomy versus fenestration/coagulation or laser ablation for the treatment of endometriomas. Methods: Studies were identified by searching the PubMed, EMBASE, SCOPUS, and Cochrane Central Register of Controlled Trials databases using the terms ovarian, endometrioma or endometriosis, cystectomy, fenestration, coagulation, laser, and ablation or vaporization. The outcomes of interest were recurrence of signs/symptoms and endometrioma, reoperation, pregnancy, and ovarian reserve. Results: Seven studies were included. The risk of recurrence of signs/symptoms after surgery was significantly lower for laparoscopic cystectomy compared with fenestration/coagulation [risk ratio (RR): 0.29; 95% CI: 0.15-0.55; I² = 0%; p < 0.001], as was the risk of recurrence compared with fenestration/coagulation (RR: 0.50; 95% CI: 0.26-0.97; I² = 0%; p = 0.04) and laser vaporization (RR: 0.33; 95% CI: 0.12-0.88; I² = 0%; p = 0.03). The risk of pregnancy was significantly higher for cystectomy compared with fenestration/coagulation (RR: 2.64; 95% CI: 1.49-4.69; I² = 0%; p < 0.001), but not laser vaporization (RR: 0.92; 95% CI: 0.30-2.80; p = 0.89). There were inadequate data for the meta-analysis of ovarian reserve. Conclusions: Our findings suggest that cystectomy provides better outcomes than fenestration/coagulation or laser ablation regarding recurrence of symptoms and endometrioma as well as pregnancy rate (fenestration/coagulation only). Further studies are needed to clarify the effect of these surgical approaches on ovarian reserve.

This study analyzed mechanism of saponins regulating fatty alcohol oxidase (FAO) to reduce myocardial remodeling and control heart failure. 30 Sprague-Dawley (SD) rats were randomly and equally assigned into control group, model group, and saponin group, followed by analysis of myocardial tissue pathology, cyclic guanosine monophosphate (cGMP), Recombinant Human Protein (PKG), Peroxisome proliferator-activated receptors (PPAR-α) expression levels, and cell apoptosis. Compared to control group, cGMP, PKG, PPAR-α, uncoupling protein 3 (UCP3), and cluster of differentiation 36 (CD36) mRNA levels in the model group were significantly decreased (P <0.001) and elevated in the saponin group (P <0.05). Oxidation rates of adenosine triphosphate (ATP), phosphocreatine/ATP, and palmitic acid in the model group were significantly decreased (P <0.001) and elevated in the saponin group (P <0.05). Apoptosis and level of Cleaved caspase-3 were significantly reduced in the model group (P <0.001) and increased in the saponin group (P <0.05). Levels of cGMP, PKG, PPAR-α, UCP3 and CD36 in the model group decreased (P <0.001) and increased in the saponin group (P <0.001), but lower than in the control group. Relative to the model group, Brain Natriuretic Peptide (BNP) level was significantly increased in the inhibitor group and decreased in the agonist group (P <0.001). Saponins activate cGMP-PKG signaling pathway, up-regulating cGMP and PKG, promoting PPAR-α expression, inhibiting myocardial cell necroptosis, thereby reducing inflammatory infiltration of myocardial cells, improving connective tissue hyperplasia, and reducing myocardial injury and myocardial remodeling, thus play an anti-heart failure role.