[A comparison between endoscopic CO2 laser cauterization and open neck surgery in the treatment of congenital piriform fistula]

Objective: To compare the efficacy, advantages and disadvantages of endoscopic CO₂ laser cauterization (ECLC) and open neck surgery in the treatment of congenital pyriform sinus fistula (CPSF). Methods: From September 2014 to March 2017, 80 cases with confirmed diagnosis of CPSF received initial treatment at Guangdong Provincial People's Hospital were prospectively analyzed, including 34 males and 46 females, aged 18 to 672 (194.17±141.18) months. They were consecutively divided into endoscopic group and open-surgery group, with 40 cases in each group. Both groups of patients received surgical treatment under general anesthesia. The endoscopic group was treated by endoscopic CO₂ laser cauterization, and the open-surgery group underwent the following surgery: first, we performed suspension laryngoscopy examination to confirm the presence of fistula in the bottom of the piriform fossa, then open-neck resection of congenital piriform sinus fistula with recurrent laryngeal nerve and/or lateral branch of superior laryngeal nerve anatomy plus partial thyroidectomy were performed. The data between the two groups were compared, including the operative time, intraoperative blood loss, postoperative pain, average length of stay, neck cosmetic scores, complications and cure rates. All patients were followed up in outpatient clinics. Statistical analysis was performed using SPSS 20.0 software. P<0.05 indicates that the difference is statistically significant. Results: All patients were successfully completed the operation. The operative time, intraoperative blood loss, postoperative pain and average length of hospital stay in the endoscopic group were significantly less than those in the open group [(27.4±5.5) min to (105.8±52.5) min, (0.6±0.5) ml to (33.6±41.5) ml, (1.7±0.9) points to (4.6±0.7) points, (5.9±2.9)d to(8.9±3.3)d, t values were-9.400, -5.031, -16.199, -4.293, P values were all<0.01]; The neck cosmetic score in the endoscopy group was significantly greater than that of the open group [(9.9±0.4) against (5.8±0.9) points, t=25.847, P<0.01]. Compared with the open group (15.0%, 6/40), the complication rate of the endoscopic group (7.5%, 3/40) was not statistically significant (χ²=0.50, P>0.05). Three months after the first treatment, the cure rate in the endoscopic group (82.5%, 33/40) was significantly lower than that in the open-neck group (100.0%, 40/40), χ²=5.64, P<0.05. The follow-up time was 12 months after the last treatment. Eighty cases were followed up and none was lost to follow-up. During the follow-up period, the cure rate of the endoscopy group (97.5%, 39/40) was compared with that of the open group (100.0%, 40/40), and the difference was not statistically significant. Conclusions: In the treatment of CPSF, the two-surgical method each has their advantages. Compared with open-neck surgery, ECLC is simpler, repeatable. ECLC has shorter time in operation and hospital stay, less complications, and less postoperative pain and more precise cosmetic results. It could be preferred for the initial treatment of CPSF and relapsed cases after cauterization. But subject to relatively low cure rate of one-time cauterization and uncertain long-term efficacy, it cannot completely replace the open-neck surgery at present.

[Clinical and imaging characteristics of patients with primary cardiac angiosarcoma]

Objective: To investigate the clinical, cardiac imaging characteristics and prognosis of patients with primary cardiac angiosarcoma. Methods: The clinical data of 14 patients hospitalized with primary cardiac angiosarcoma from January 2001 to December 2017 in Peking Union Medical College Hospital were collected and analyzed. Metastatic cardiac angiosarcoma was not included in this study. Patients were followed up post discharge per telephone call or clinical visit. Results: Of the 14 patients, 8 were males and 6 were females, average age was 48 years. The main clinical symptoms were shortness of breath (8/14), hemoptysis (6/14), fever (5/14), chest pain (4/14) and cough (3/14). Imaging examinations showed that the tumors of 8 patients were located in the right heart and 6 in the pericardial cavity. Tumors in the right heart often infiltrate the atrial wall and cause pericardial effusion (7/8). Tumors in the pericardium were characterized by recurrent bloody pericardial effusion (6/6), prone to progressive constrictive pericarditis (3/6), pericardial fluid cytology was often negative (6/6). MRI showed heterogeneous high signal intensity (cauliflower aspect) on T2-weighted image and heterogeneous enhancement with a"sunray" aspect at the perfusion study. At the time of diagnosis, 8 patients developed lung or adrenal metastasis (8/14). The median survival was only 305 days. Conclusions: Primary cardiac angiosarcoma is a rare disease with non-specific clinical manifestation and poor prognosis. Imaging examinations may help diagnosis. The high invasiveness and the easy-to-metastasis feature of the tumor contribute to the poor prognosis of cardiac angiosarcoma.

Endovascular treatment of visceral aneurysms and pseudoaneurysms

Visceral artery aneurysm (VAA) is a rare and potentially life-threatening condition, defined as true artery aneurysms and pseudoaneurysms of splanchnic circulation and renal artery. This study reports our experience in the diagnosis and endovascular treatment of visceral artery aneurysms (VAAs) over a 10-year period. Between 2008 and 2018, a total of 24 VAAs in 21 patients were diagnosed by clinical symptoms and a combination of imaging techniques, such as Doppler ultrasound, computed tomography angiogram, and catheter angiogram. All patients underwent endovascular treatment to exclude aneurysms. Oral antiplatelet medicine was administered, and imaging examination was performed during follow-up. Technical success was achieved in all 21 patients, and no periprocedural complications occurred. Endovascular coiling alone was employed in 10 aneurysms. Coiling was combined with gelfoam in 2 aneurysms. Coiling was assisted by stent in 4 aneurysms. Covered stents were deployed in 8 aneurysms individually. Clinical symptoms disappeared or highly improved in all patients after treatment. None of the patients showed recurrent symptoms after discharge. However, two cases with new aneurysms after 6 and 8 months, respectively, and one case with in-stent thrombosis after 12 months were reported during follow-up. This study may justify the efficacy of percutaneous endovascular coil embolization and stent deployment. It also provides beneficial experience about how to choose appropriate various endovascular strategies based on both clinical symptoms and aneurysm anatomy condition.

[Comparison and application of postprandial and fasting blood lipid levels in 839 physical examinees in Beijing]

Objective: To investigate the feasibility of application of non-fasting dyslipidemia cutoff values in community population. Methods: Self-control study was used. 839 physical examinees (292 males and 547 females) were recruited in clinical laboratory of Guang'an men Hospital from January to October 2018. The median (interquartile range) of age was 60 (54, 66) years. Blood samples were collected before and at 4 h after a standard breakfast. Comparison of fasting and postprandial lipoprotein levels was performed using Paired-Samples T Test or Two-Related-Samples Wilcoxon. The changes of 4-hour postprandial blood lipid levels and the percentages of postprandial dyslipidemia according to different stratification of fasting dyslipidemia were performed using one-way ANOVA and χ² test, respectively. Results: Compared with fasting, 4-hour postprandial total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), non-high density lipoprotein cholesterol (non-HDL-C), apolipoprotein A1 (ApoA1) and apolipoprotein B (ApoB) decreased slightly, postprandial triglyceride (TG) increased by 0.72 mmol/L, and postprandial remnant-like lipoprotein cholesterol (RLP-C) increased by 0.27 mmol/L (t or Z values = 10.26,22.94,24.22,4.71,16.61,26.92,-23.58,-19.35, P<0.05, respectively). According to the non-fasting dyslipidemia cut-off values recommended by the European consensus, there were 10%, 16.6%, 10.1%, 12.3%, 30% and 34.9% of the population in the appropriate levels of fasting TC, LDL-C, HDL-C, non-HDL-C, TG and RLP-C distributed in elevated levels of postprandial, respectively. The changes of 4-hour postprandial TC, LDL-C, non-HDL-C and HDL-C increased with the elevation of fasting level (F=9.50,6.18,8.07,3.86,P<0.01), and the maximum changes of TC≤3.5%, LDL-C≤6.8%, non-HDL-C≤2.9%, HDL-C≤6.3%; the change of 4-hour postprandial TG increased slightly first and then decreased significantly (51.3% vs. 57.9% vs. 39.2%, F=19.05, P<0.01); the change of 4-hour postprandial RLP-C decreased (50.8% vs. 33.2%, F=10.40, P<0.01). The cut-off values of 4-hour postprandial dyslipidemia were TC ≥5.1 mmol/L, LDL-C ≥3.2 mmol/L, HDL-C ≤0.9 mmol/L, non-HDL-C ≥4.0 mmol/L and RLP-C ≥1.0 mmol/L. The cut-off values of borderline elevated and elevated TG levels were ≥2.2 mmol/L and ≥3.4 mmol/L, respectively. Conclusions: The cut-off values of postprandial dyslipidemia including TC, LDL-C, HDL-C, non-HDL-C and RLP-C were preliminarily established in community population, which could be applied to the routine lipid profile evaluation in the physical examination population. And it might be needed that postprandial TG was managed hierarchically according to different cut-off values.

[The impact of ambient temperature exposure on emergency calls-a time series analysis based on data of Xuchang and Zhengzhou]

Objective: To investigate the effect of hourly ambient temperature exposure on emergency calls in Xuchang city and Zhengzhou city. Methods: The hourly meteorological data, air pollution data and emergency calls of Xuchang city and Zhengzhou city were collected from January 1, 2017 to October 31, 2019. A distributed lag non-linear model was used to calculate the excess relative risk (ERR). The lag effect and cumulative effect of extreme temperature exposure on emergency calls were evaluated. Results: The relationship between hourly temperature exposure and emergency calls was a U-shaped curve. In Xuchang city and Zhengzhou city, both low and high temperatures would increase the number of hourly emergency calls. The earliest effect of low temperature occurred at a lag of 22 h and 52 h, with ERR values (95%CI) about 0.20% (0.00%, 0.39%) and 0.11% (0.00%, 0.22%), respectively. The earliest effect of high temperature occurred at a lag of 0 h with ERR values about 1.59% (1.09%, 2.09%) and 1.45% (1.22%, 1.69%), respectively. High temperature had the greatest impact on the number of emergency calls of cardiovascular disease at a lag of 4-8 h. The cumulative ERR values (95%CI) of the two cities were 8.70% (4.98%, 12.75%) and 3.89% (2.61%, 5.22%), respectively. Conclusion: High temperature exposure could increase the number of emergency calls within a few hours, while the effect of low temperature would not occur until 22 hours later.

[Perioperative safety and feasibility of simultaneous off-pump coronary artery bypass grafting with non-cardiac surgical procedures of moderate-to-severe severity]

Objective: To examine the perioperative safety and feasibility of simultaneous off-pump coronary artery bypass grafting (OPCAB) with non-cardiac surgical procedures of moderate-to-severe severity. Methods: The perioperative results of 54 patients underwent simultaneous OPCAB with non-cardiac surgical procedures from September 2013 to January 2019 at Department of Cardiac Surgery, Peking University First Hospital were assessed retrospectively. There were 46 males and 8 females, aging (65.8±8.8) years (range: 41 to 85 years). All simultaneous non-cardiac surgical procedures, including vascular (n=1), thoracic (n=26), general (n=12) and urologic surgical procedures (n=15), were assessed to be of moderate-to-severe grade by operative severity scoring system. Perioperative results were compared between the OPCAB patients who underwent simultaneous non-cardiac surgical procedures (n=54) and 1∶2 matched patients who underwent isolated OPCAB performed most recently by the same cardiac team with similar procedures accordingly (n=108), using t test, Mann-Whitney U test, χ² test or Fisher exact test. Results: All baseline factors were matched between the two groups, with no significant difference on European system for cardiac operative risk evaluation (EuroSCORE) Ⅱ (1.185(0.758)% vs. 1.215(0.905)%, Z=‒0.036, P=0.972). No perioperative death was observed in the two groups. Although patients underwent simultaneous non-cardiac surgical procedures showed prolonged operation duration time ((324.9±97.1) minutes vs. (166.7±36.7) minites, t=11.564, P<0.01) and increased intraoperaive blood loss ((462.2±269.6) ml vs. (304.5±177.8) ml, t=3.866, P<0.01), primary postoperative complications, including perioperative myocardial infarction, atrial fibrillation, perioperative stroke, acute renal failure, wound infection, and bleeding reoperation did not show significant differences between the two groups (all P>0.05), while total blood transfusion volume, mechanical ventilation time and intensive care unit residence time also showed no significant differences between the two groups (all P>0.05). Conclusion: Simultaneous OPCAB with non-cardiac surgical procedures of moderate-to-severe severity in patients with operative indications are safe and feasible, and are not associated with increased postoperative risks when compared with isolated OPCAB.

[Progress of PD-1/PD-L1 inhibitors in the treatment of small-cell lung cancer]

Small cell lung cancer (SCLC) is a neuroendocrine tumor, which accounts for about 15% of all lung cancers. SCLC is characterized by rapid growth and tendency to widespread metastasis at the initial stage. Although high response rates to first-line chemotherapy are observed, most patients relapse less than few months. In the past 5 years, some clinical trials found that the immune checkpoint inhibitors (ICIs) were effective in SCLC, especially programmed cell death 1/ligand 1 (PD-1/L1). Given this situation, the treatment patterns of SCLC have changed. This article briefly reviews the researches and studies of ICIs in the treatment of SCLC to provide reference to the clinicians.

[Analysis of the clinical value of ultrasound attenuation parameters in evaluating liver steatosis degree in patients with chronic liver disease]

Objective: To evaluate the clinical value of ultrasound attenuation parameters (UAP) in diagnosing the liver steatosis degree in patients with chronic liver disease, and to explore the relevant factors that affect UAP detection values. Methods: 130 cases with chronic liver disease diagnosed as liver steatosis by liver biopsy during January 2014 to May 2019 were selected from the Hepatology Department of Integrated Traditional Chinese and Western Medicine of the Third Hospital of Hebei Medical University. UAP and liver stiffness (LSM) were detected by iLivTouch, and the body mass index (BMI) was calculated. Simultaneously, serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), γ-glutamyltransferase (GGT), total bilirubin (TBil), triglycerides (TG), total cholesterol (TC), low-density lipoprotein (LDL) levels and peripheral platelet (PLT) counts were measured. The correlation between UAP and liver steatosis was analyzed based on the liver histopathological results. SPSS 21.0 statistical software was used for statistical analysis. Receiver operating characteristic curve (ROC) was used to analyze the accuracy and specificity of UAP in the diagnosis of liver steatosis in patients with chronic liver disease. Spearman's rank correlation analysis was used to study the relevant factors affecting UAP value. Results: The histopathological changes of liver biopsy showed that there were 43 cases of grade F1, 47 cases of F2, 32 cases of F3 and 8 cases of F4. UAP and BMI (r = 0.363, P < 0.001), and UAP and liver steatosis degree (r = 0.380, P < 0.001) were positively correlated. BMI and the liver steatosis degree were independent predictors of UAP value. The cut-off points for UAP to diagnose liver steatosis degree were 276 dB/m for F≥2, 288 dB/m for F≥2, 293 dB/m for F≥3, and F = 4, respectively. The sensitivity and specificity was 0.379, 0.500, 0.750, and 0.930, 0.922, 0.836, respectively. Conclusion: Ultrasonic attenuation parameters cannot only determine the presence or absence of liver steatosis in patients with chronic liver disease, but also can better assess the liver steatosis degree.

[Epidemiological characteristics of imported malaria cases in Fujian Province from 2014 to 2018]

OBJECTIVE

To analyze the epidemiological characteristics of imported malaria cases in Fujian Province from 2014 to 2018, so as to provide scientific basis for the development of the control strategy for imported malaria.

METHODS

The epidemiological data of malaria cases in Fujian Province from 2014 to 2018 were retrieved from the Notifiable Disease Reporting System and Parasitic Disease Information Reporting System of Chinese Center for Disease Control and Prevention, and the classification, origin of infections, temporal distribution, spatial distribution, population distribution, reporting institutions and diagnosis were analyzed.

RESULTS

A total of 540 overseas imported malaria cases were reported in Fujian Province from 2014 to 2018, and all cases were laboratory-confirmed, including 398 cases with falciparum malaria, 88 cases with vivax malaria, 38 cases with ovale malaria, 14 cases with malariae malaria and 2 cases with mixed infections. There were 90.56% (489/540) of the imported malaria cases with infections in 27 African countries, 5.92% (32/540) with infections in 5 Asian countries and 3.52% (19/540) with infections in one Oceania country. There was no significant seasonal distribution of the cases, and the imported malaria cases were predominantly detected in Fuzhou City (80.00%, 432/540) and at ages of 20 to 49 years (81.48%, 440/540). Initial diagnosis was predominantly at the city-level medical institutions, and 77.96% (421/540) were diagnosed as malaria at the initial diagnosis institutions. The median duration from onset to initial diagnosis was 2 days and 70.19% (379/540) were diagnosed within 3 days of onset. The interval between initial diagnosis and definitive diagnosis was 0 day, with 85.37% (461/540) definitively diagnosed within 3 days of initial diagnosis.

CONCLUSIONS

Overseas imported malaria is a continuous problem challenging the malaria elimination programme of Fujian Province. Improving the healthcare-seeking awareness and the diagnostic capability of healthcare workers, and intensifying the monitoring and management of malaria among overseas labors are strongly recommended.

Abstract 2220: Non-clinical tumor models reveal broad combination potential of ICOS agonist antibodies

Unprecedented rates of durable clinical responses have been observed for antibody-based therapeutics targeting immune checkpoint proteins such as cytotoxic T lymphocyte antigen-4 (CTLA-4) or programmed death receptor-1 (PD-1). Nonetheless, a significant number of patients fail to respond, highlighting the need for alternative and complementary immunotherapeutic interventions for cancer. Inducible T-cell costimulator (ICOS/CD278) is a CD28 superfamily receptor that is predominantly expressed on effector and cytotoxic T cells shortly after T cell receptor (TCR) activation. In addition to promotion of T cell and B cell collaboration, ICOS signaling (via ICOS ligand [ICOSL] or antibody-based crosslinking) has been shown to improve T cell antitumor activity, survival, durable tumor rejection. To support the clinical development of GSK3359609 (a hIgG4 ICOS agonist antibody) several in vivo combination studies were conducted using a tool anti-mouse ICOS agonist antibody (clone 7E.17G9). Analogous with the Fc-based characteristics of a human IgG4 antibody, the anti-mouse ICOS tool antibody exhibited significant antitumor activity when grafted on a murine IgG1 (or Fc-reduced) backbone. Using an in vivo models of breast cancer (EMT6, BALB/c), the murinized ICOS tool antibody demonstrated potent antitumor activity alone (tumor growth inhibition [TGI] of 40-60%) in combination with immune checkpoint inhibitors (ICI) targeting PD-1 and CTLA-4 (TGI of 100% and 90%, respectively). Antitumor activity was associated with increased total T cell infiltration into the tumor, a higher tumor CD8/Treg cell ratio, and broad increases in T cell activation markers (e.g. CD25, CD69, Granzyme B, perforin, and PD-1). The cancer immunity cycle posits that multiple points of intervention exist for cancer immunotherapy, many of which should be considered in order to identify complementary therapeutic strategies. With this in mind, and consistent with ICI, antitumor activity was observed in combination with innate immune modulators (e.g. TLR4 agonist) and chemo/cytotoxic (e.g. carboplatin and paclitaxel) therapies in different syngeneic tumor models. Altogether these data underscore the broad utility of ICOS agonist antibodies as a reliable combination partner for cancer immunotherapy.

Citation Format: Jeremy D. Waight, Meixia Bi, David Kilian, Christopher Hopson, Shu-Yun Zhang, Sara Brett, Sapna Yadavilli, Tianqian Zhang, Hong Shi, Kenneth W. Hance, Marc Ballas, Axel Hoos. Non-clinical tumor models reveal broad combination potential of ICOS agonist antibodies [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 2220.

[Endoscopic features and clinical correlation analysis of 24 patients with Cronkhite-Canada syndrome]

Objective: To clarify the endoscopic changes prior to corticosteroid therapy in Cronkhite-Canada syndrome (CCS) patients and to explore the correlation between endoscopic features and clinical characteristics. Methods: A total of 24 CCS patients who were hospitalized in Peking Union Medical College Hospital from January 1999 to June 2019 and underwent gastroscopy and colonoscopy before corticosteroid therapy were retrospectively enrolled. The endoscopic images were re-interpreted. The demographic characteristics, clinical manifestations, laboratory tests and histopathological data were collected and analyzed. Results: Of all 24 patients, 15 (62.5%) were male and 9(37.5%) were female, with an average age of (59±10) years and disease course of 6 (1~36) months. Based on the endoscopic findings, the percentages of stomach, colon, duodenum, rectum and terminal ileum involvement were 100%, 100%, 95.7%, 66.7% and 50.0% respectively. Gastric involvement was more severe in the lower part of the body and the antrum of the stomach, while the cardia and the fundus were spared in 5 (20.8%) cases. Colonic involvement was more severe in the right colon. No patient showed remarkable esophageal involvement. The typical appearance under endoscopy were diffuse mucosal hyperemia and edema with polyps or nodular changes. The lesions may have mulberry-like or imbricate changes in severe cases. Lymphatic dilation in the duodenum was found in 47.8% patients. Most of the polyps were pedunculated or sub-pedunculated, with occasionally seen sessile polyps in the colon. The pit patterns of the 12 resected colon polyps in 11 patients could be classified as Kudo type Ⅲ(S), Ⅲ(L), Ⅳ and Ⅴ(I), among which 2 tubular adenomas had the Kudo type Ⅲ(L). Other resected polyps were hyperplastic polyps or CCS polyps. The disease duration prior to diagnosis was positively correlated with the maximum diameter of colon polyps (r=0.625, P=0.006). Serum albumin levels in patients with whole stomach involvement were significantly lower than those in patients with cardia spared [(29±8) g/L vs (37±5) g/L, P=0.034]. Conclusions: The typical initial endoscopic finding of CCS is multiple polyps or nodular changes on the background of diffuse hyperemia and edema lining the gastric, duodenal and colonic mucosa. Lymphatic dilatation in the duodenum could also be found. Some endoscopic features are correlated to clinical characteristics.

[Clinical and coagulation characteristics in 7 patients with critical COVID-2019 pneumonia and acro-ischemia]

Objective: To investigate the clinical and coagulation characteristics in patients with critical Coronavirus disease 2019 (COVID-19) and acro-ischemia. Methods: The retrospective study included 7 critical COVID-19 patients with acro-ischemia in an intensive care unit (ICU) in Wuhan, from Feb 4 to Feb 15, 2020. The clinical and laboratory data before and during the ICU stay were analyzed. Results: The median age of 7 patients was 59 years and 4 of them were men. Three patients were associated with underlying comorbidities. Fever, cough, dyspnea and diarrhea were common clinical symptoms. All patients had acro-ischemia presentations including finger/toe cyanosis, skin bulla and dry gangrene. D-dimer, fibrinogen and fibrinogen degradation product (FDP) were significantly elevated in most patients. Prothrombin time was prolonged in 4 patients. D-dimer and FDP levels progressively elevated consistent with COVID-2019 exacerbation. Four patients were diagnosed with disseminated intravascular coagulation (DIC) . Low molecular weight heparin (LMWH) was administrated in 6 patients, which reduced D-dimer and FDP rather than improved clinical symptoms. Five patients died finally and the median time from acro-ischemia to death was 12 days. Conclusions: Coagulation parameters should be monitored closely in critical COVID-2019 patients. The timing and protocol of anticoagulation therapy are still under investigation based on more clinical data.

[Clinical application of vitrification freezing of oocytes]

Objective: To evaluate the effect of oocyte vitrification on embryo quality and developmental potential. Methods: From January 2014 to December 2017, 30 cases of oocytes vitrification in the reproductive center of Sir Run Run Shaw hospital were collected as the frozen group, due to failure of sperm extraction or inability to obtain sufficient sperm at the ovum pick-up-day because of oligoospermia or azoospermia. 220 cases of fresh oocytes from the same period were selected as the fresh group. The fertilization rate, embryo rate, pregnancy rate, implantation rate and live birth rate of the two groups were compared retrospectively. Results: The survival rate of oocyte resuscitation was 91.4% (180/197). In the frozen group, 24 cases were transferred with 14 pregnancies, while in the fresh group, 31 cases were transferred with 18 pregnancies. The number of 2PN fertilized eggs, 2PN embryos and 2PN high-quality embryos in the frozen group was significantly lower than that in the fresh group (3.7±2.5 vs 7.3±4.8), (3.3±2.5 vs 7.2±4.8), and (1.2±1.8 vs 2.9±2.7) (all P<0.05). The fertilization rate of the frozen group was 77.2% (115/149) and the high-quality embryo rate was 36.6% (37/101), lower than that of the fresh group 77.6% (1 637/2 109) and 40.9% (651/1 591) (P>0.05).The pregnancy rate of the frozen group was 58.3% (14/24) higher than that of the fresh group 58.1% (18/31), the implantation rate of each mature oocyte and the live birth rate of each mature oocyte were 10.8% (15/138) and 10.8% (15/138), both higher than that of the fresh group 9.6% (21/218) and 8.7% (19/218) (all P>0.05). Conclusions: Vitrification cryopreservation of oocytes may lead to a decrease in embryo quality, but embryo development potential is still considerable. Higher pregnancy rate, implantation rate and live birth rate may be obtained.

[The clinical efficacy of laparoscopic cornuotomy on interstitial tubal pregnancy which diameter was shorter than 3 cm]

Objective: To investigate the clinical efficacy of Laparoscopic cornuotomy on Interstitial Tubal Pregnancy (IP) which diameter was shorter than 3 cm. Methods: The women who had IP under 3 cm diameter were selected from January, 2016 to December, 2018 at the Department of Gynecology, JiaXing Maternity and Child Health care Hospital. A total of 32 IP patients were divided into two groups. They were all treated with laparoscopic surgery. 17 patients were in study group, conducted by a cornuotomy and suturing the cornual.15 patients were in control group, conducted by a cornual resection and suturing the cornual. Patients' genenral conditions were not significantly different(all P values>0.05). The peri-surgical data and the related clinical data were compared in the two groups. Results: All the 32 patients were successfully treated by laparoscopic surgery. The mean operating time was significantly shorter for cornuotomy than for cornual resection[ (33±6) min vs (53±9) min, P<0.05].Changes in blood loss[(45±5) ml vs (50±7) ml]、the total hospital stays[ (4.4±1.4) d vs (4.6±1.4) d] and the recovery time of HCG[(16±5) d vs (15±5) d] were not significantly different between the two groups (all P values>0.05) . There were no persistent ectopic pregnancy and uterine rupture happened in two groups. Compared with the control group,the interval time to pregnancy was shorter[ (8±3) m vs (16±4) m, P<0.05] and the number of full-term pregnancy cases were more (9 vs 3, P<0.05). Conclusion: The Laparoscopic cornuotomy was feasible and safe on interstitial tubal pregnancy which diameter was shorter than 3cm. It deserved popularization in the clinical work and regarded as one of selection operative treatment on interstitial heterotopic pregnancy.

[Clinical and coagulation characteristics of 7 patients with critical COVID-2019 pneumonia and acro-ischemia]

Objective: To investigate the clinical and coagulation characteristics of the critical Coronavirus disease 2019 (COVID-19) patients with acro-ischemia in the intensive care unit (ICU). Methods: The retrospective study included 7 critical COVID-19 patients with acro-ischemia in a single center in Wuhan, from Feb 4 to Feb 15, 2020. The clinical and laboratory data before and during the ICU stay were analyzed. Results: The median age of 7 patients was 59 years and 4 of them were men. 3 of them were associated with underlying comorbidities. Fever, cough, dyspnea and diarrhea were common clinical symptoms. All patients had acro-ischemia presentations including finger/toe cyanosis, skin bulla and dry gangrene. D-dimer, fibrinogen and fibrinogen degradation product (FDP) were significantly elevated in most patients. Prothrombin time (PT) were prolonged in 4 patients. D-dimer and FDP levels increased progressively when COVID-2019 exacerbated, and 4 patients were diagnosed with definite disseminated intravascular coagulation (DIC). 6 patients received low molecular weight heparin (LMWH) treatment, after which their D-dimer and FDP decreased, but there was no significant improvement in clinical symptoms. 5 patients died finally and the median time from acro-ischemia to death was 12 days. Conclusions: The existence of hypercoagulation status in critical COVID-2019 patients should be monitored closely, and anticoagulation therapy can be considered in selected patients. More clinical data is needed to investigate the role of anticoagulation in COVID-2019 treatment.