Comparison of prone with lithotomy position in removal of posterior myoma in transvaginal natural orifice endoscopic surgery: a prospective cohort study

OBJECTIVE

Vaginal natural orifice transluminal endoscopic surgery (vNOTES) is considered to have the advantages of completely scarless, less postoperative pain, earlier flatus, and faster postoperative recovery. However, posterior myoma are relatively difficult to operate through vNOTES in the conventional lithotomy position. Thus, we innovated the application of prone position in removal of posterior myoma in vNOTES. The aim of this study is the comparison of myomectomy outcomes of patient for single posterior myoma in prone and lithotomy position.

DESIGN

A single-center, prospective study.

SETTING

A university teaching hospital.

PATIENTS

A total of 81 patients with posterior myoma who underwent myomectomy in vNOTES from January 2021 to December 2022.

INTERVENTIONS

The patients underwent myomectomy in vNOTES in prone or lithotomy position.

MEASUREMENTS AND MAIN RESULTS

Among the patients who underwent vNOTES myomectomy, 29 (35.8%) were in the lithotomy position group, and 52 (64.2%) in the prone position group. Of note, 4 (4.9%) patients underwent a conversion to LESS during the operation-3 in the lithotomy and 1 in the prone position group. And a patient in lithotomy position group underwent re-surgery for hemostasis due to postoperative pelvic bleeding. Compared with the lithotomy position, prone position significantly shortens the operation time (12.3, 95% CI: 6.811,17.761. p=0.009) without increasing the complications and postoperative discomfort of patients.

CONCLUSION

Compared to the lithotomy position, the prone position provides greater convenience for operation and exhibits a lower rate of surgical conversion during the removal of single posterior myomas via vNOTES. Further, for patients selecting vNOTES, surgeons need to conduct sufficient preoperative evaluation, timely hemostasis during surgery, and timely surgical conversion if necessary to ensure patient safety.

Gasless transvaginal natural orifice transluminal endoscopic surgery for hysterectomy and salpingectomy on a robot platform with flexible devices in a porcine model

In this report, we described a new technique of gasless V-NOTES for hysterectomy and salpingectomy on a robotic platform with flexible devices in a porcine model. As a result, the gynecological procedures were successfully completed. The total operative time was 110 min, while the docking time was 10 min. The estimated blood loss was estimated to be 10 mL with no intraoperative complications. It revealed that gasless V-NOTES for hysterectomy and salpingectomy on a robotic platform with flexible devices appeared to be feasible and safe in the porcine model and has the potential for clinical use in human beings.

Effect of quercetin on granulosa cells development from hierarchical follicles in chicken

1. The bioflavonoid quercetin is a biologically active component, but its functional regulation of granulosa cells (GCs) during chicken follicular development is little studied. To investigate the effect of quercetin on follicular development in laying hens, an in vitro study was conducted on granulosa cells from hierarchical follicles treated with quercetin.2. The effect of quercetin on cell activity, proliferation and apoptosis of granulosa cells was detected by CCK-8, EdU and apoptosis assays. The effect on progesterone secretion from granulosa cells was investigated by enzyme-linked immunosorbent assay (ELISA). Expression of proliferating cell nuclear antigen (PCNA) mRNA and oestrogen receptors (ERs), as well as the expression of steroid acute regulatory protein (StAR), cytochrome P450 cholesterol side chain cleavage enzyme (P450scc) and 3β-hydroxysteroid dehydrogenase (3β-HSD) mRNA during progesterone synthesis, were measured by real-time quantitative polymerase chain reaction (RT-qPCR). PCNA, StAR and CYP11A1 protein expression levels were detected using Western blotting (WB).3. The results showed that treatment with quercetin in granulosa cells significantly enhanced cell vitality and proliferation, reduced apoptosis and promoted the expression of gene and protein levels of PCNA. The levels of progesterone secretion increased significantly following quercetin treatment, as did the expression levels of StAR and CYP11A1 using the Western Blot (WB) method.4. The mRNA expression levels of ERα were significantly upregulated in the 100 ng/ml and 1000 ng/ml quercetin-treated groups, while there was no significant difference in expression levels of ERβ mRNA.

Analysis and suggestions on the complications in 2000 cases of transvaginal natural orifice transluminal endoscopic surgery: Can it be a conventional surgery?

OBJECTIVE

To reflect on the complications of transvaginal natural orifice transluminal endoscopic surgery (vNOTES), identify the corresponding risk factors, and provide caution to surgeons when performing this novel surgery.

METHODS

A retrospective study was carried out among 2000 patients in our hospital who underwent vNOTES between May 2019 and May 2022. Perioperative complications were stratified in chronological order and divided into those developed while establishing the vNOTES approach, during surgery, postoperatively, and 1 month after discharge. The complications were classified based on the Modified Clavien-Dindo classifications. The causes of each type III/IV complication were analyzed.

RESULTS

Of the 2000 patients, 88 (4.4%) experienced complications, which is not higher than that reported in laparoendoscopic surgery in previous studies. Grade I, II, III, IV, and V complications developed in 19 (0.95%), 57 (2.85%), 11 (0.55%), 1 (0.05%), and 0 (0%) patients, respectively. Complications were developed while establishing the approach platform, during the surgery, postoperatively, and within 1 month after discharge in 5 (0.25%), 30 (1.50%), 50 (2.50%), and 3 (0.15%) patients, respectively. Eight patients (0.4%) underwent conversion, including five cases of rectal injury repair.

CONCLUSION

The summarized suggestions were divided into three levels. Considering the security and effectiveness of vNOTES, it can be routinely used in various gynecologic operations. However, surgeons should focus on preoperative evaluation, strictly conduct preoperative disinfection, conform to prompt conversion during surgery, call for the presence of experienced doctors, and have routine use of antibiotics to prevent postoperative infections.

TRIAL REGISTRATION

ChiCTR2100053483.

Transvaginal natural Orifical transluminal Endoscopy for sacrocolpopexy: A case series report

Background

To describe the surgical technique and operative outcomes of transvaginal natural orifice transluminal endoscopic surgery (V-NOTES) for sacrocolpopexy with or without robotic surgical system in patients with pelvic organ prolapse (POP).

Methods

Patients with POP undergoing traditional transvaginal natural orifice transluminal endoscopic surgery (TV-NOTES) or robotic transvaginal natural orifice transluminal endoscopic surgery (RV-NOTES) for sacrocolpopexy performed by one surgeon from Sep 2020 to Jan 2023 in our hospital were included in this study. The baseline demographics and operative outcomes were collected and analyzed. In addition, some surgical skills were presented. The operative outcomes of V-NOTES for sacrocolpopexy performed by three beginners were also presented.

Results

Eight patients who underwent TV-NOTES, and two patients who underwent RV-NOTES were included in this study. The mean operative time was 180 ± 49 min, and the estimated blood loss was 107 ± 82 ml for these ten cases. Particularly, the operative time of the two patients who underwent RV-NOTES was 275 and 132 min, while the estimated blood loss (EBL) was 100 and 50 ml respectively. During the follow-up period, no mesh exposure and recurrence were observed. In addition, five cases of TV-NOTES for sacrocolpopexy by beginners were all successfully completed.

Conclusion

Both TV-NOTES and RV-NOTES appeared to be feasible and safe for sacrocolpopexy.

Does transvaginal natural orifice transluminal endoscopic surgery affect female sexual function?: a prospective cohort study

BACKGROUND

To evaluate the effect of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) on female sexual function.

METHODS

The trial was registered at the Chinese Clinical Trial Registry (ChiCTR2100050887, 07/09/2021). In this prospective cohort study, we prospectively analyzed the data of the female sexual function index (FSFI) questionnaire of 130 patients who underwent laparoscopy in Chengdu Women's and Children's Central Hospital due to gynecological benign diseases. The patients were assigned to the vNOTES group and the control group (underwent traditional laparoscopic surgery or transumbilical laparoendoscopic single-site surgery).

RESULTS

There were 4 cases dropout in the vNOTES group and 2 cases dropout in the control group. There was no difference in the ages (31.70 ± 5.02 vs. 30.37 ± 5.74, P>0.05), BMI (body mass index, 21.76 ± 3.16 vs. 23.30 ± 2.69, P>0.05), Education level, surgical types, and FSFI scores (22.31 ± 2.25 vs. 21.55 ± 3.38) between the vNOTES group and the control group before surgery. There was no difference in FSFI scores six months postoperation between the vNOTES group and the control group (21.61 ± 3.22 vs. 20.99 ± 3.26, P>0.05), and there was no difference in FSFI scores pre- and six months postoperation in vNOTES group (21.61 ± 3.22 vs. 22.31 ± 2.25, P>0.05). The time to start sexual life after surgery in the vNOTES group was later than that in the control group (39.34 ± 0.71 d versus 37.86 ± 0.69 d, P < 0.05).

CONCLUSIONS

vNOTES has no significant adverse effect on female sexual function, however, the time to start sexual life after vNOTES is later than that after trans-abdominal laparoscopy.

Epidemic history investigation: a new method of finding close contacts

Introduction

Coronavirus disease 2019 has become a major global public health concern in December 2019. However, finding and excluding close contacts of COVID-19 infectors is a critical but difficult issue. This study aimed to introduce a new method of epidemiological investigation named space-time companions, which was adopted in Chengdu, China, in November 2021.

Methods

An observational investigation was conducted during a small outbreak of COVID-19 in Chengdu, China in November 2021. A new method of epidemiological investigation called space-time companion was adopted in this outbreak, which was defined as the one who stayed in the same spatiotemporal grid (range: 800 m * 800 m) with the confirmed COVID-19 infector for more than 10 min in the last 14 days. A flow chart was used to describe the screening process of space-time companions in detail and illustrate the space-time companion epidemic management method.

Results

The COVID-19 epidemic outbreak in Chengdu was effectively controlled for approximately one incubation period (14 days). After four rounds of space-time companions screening, more than 450,000 space-time companions were screened, including 27 COVID-19 infectors. Moreover, in the subsequent rounds of nucleic acid testing for all people in the city, no infected person were found proving the end of this epidemic outbreak.

Conclusion

The space-time companion provides a new idea for screening close contacts of the COVID-19 infector and other similar infectious diseases, which can serve as a supplement to traditional epidemiological history surveys to verify and avoid missing close contacts.

SLC7A11-associated ferroptosis in acute injury diseases: mechanisms and strategies

Ferroptosis is a kind of iron-dependent renewal programmed death. Its main mechanism is to catalyze the unsaturated fatty acids highly expressed on the cell membrane under the effect of divalent iron, to produce lipid peroxidation, thus inducing cell death. SLC7A11 is a known iron death-related factor. It has been proved that iron death is involved in the occurrence and development of acute diseases, but the specific mechanism is unknown. The purpose of this review is to highlight the regulatory properties of SLC7A11 and gain a deeper understanding of its role in ferroptosis-related acute injury diseases. This is a narrative review. PubMed was used as the main source to randomly implement literature search strategy to index Scopus articles. No specific terms are used. Studies have shown that SLC7A11 may affect the sensitivity of cells to iron ptosis by regulating it at the transcriptional or post-transcriptional level, which is related to the pathology of many acute injury diseases, such as acute lung injury (ALI), acute kidney injury (AKI), acute liver injury, myocardial ischemia-reperfusion injury, and acute cerebral hemorrhage. In order to clarify this point, more and more researchers turn their attention to the study of the specific mechanism between SLC7A11 and ferroptosis-related acute injury diseases. In summary, this review summarized some specific mechanisms by which ferroptosis could be controlled by SLC7A11 and clarified the underlying mechanisms of a series of diseases caused by SLC7A11-associated ferroptosis. It also provided more scientific justification for the clinical application of targeting ferroptosis in preventing and treating various diseases.

[The effect of Wendler Glottoplasty to elevate vocal pitch in transgender women]

Objective: To evaluate the effect of Wendler Glottoplasty to elevate vocal pitch in transgender women. Methods: The voice parameters of pre-and 3-month post-surgery of 29 transgender women who underwent Wendler Glottoplasty in department of otorhinolaryngology head and neck surgery of Beijing Friendship Hospital from January, 2017 to October, 2020 were retrospectively analyzed. The 29 transgender women ranged in age from 19-47 (27.0±6.3) years old. Subjective evaluation was performed using Transsexual Voice Questionnaire for Male to Female (TVQ^MtF). Objective parameters included fundamental frequency (F₀), highest pitch, lowest pitch, habitual volume, Jitter, Shimmer, maximal phonation time (MPT), noise to harmonic ratio (NHR) and formants frequencies(F1, F2, F3, F4). SPSS 25.0 software was used for statistically analysis. Results: Three months after surgery, the score of TVQ^MtF was significantly decreased [(89.9±14.7) vs. (50.4±13.6), t=11.49, P<0.001]. The F₀ was significantly elevated [(152.7±23.3) Hz vs. (207.7±45.9) Hz, t=-6.03, P<0.001]. Frequencies of F1, F2 and F3 were significantly elevated. No statistical difference was observed in the frequencies of F4. The highest pitch was not significantly altered while the lowest pitch was significantly elevated [(96.8±17.7) Hz vs. (120.0±28.9) Hz, t=-3.71, P=0.001]. Habitual speech volume was significantly increased [(60.0±5.2) dB vs. (63.6±9.6) dB, t=-2.12, P=0.043]. Jitter, Shimmer, NHR and MPT were not obviously altered (P>0.05). Conclusions: Wendler Glottoplasty could notably elevate the vocal pitch, formants frequencies and degree of vocal femininity in transgender women without affecting phonation ability and voice quality. It can be an effective treatment modality for voice feminization.

How many missed abortions are caused by embryonic chromosomal abnormalities and what are their risk factors?

Introduction: Though embryonic chromosome abnormalities have been reported to be the most common cause of missed abortions, previous studies have mainly focused on embryonic chromosome abnormalities of missed abortions, with very few studies reporting that of non-missed abortion. Without chromosome studies of normal abortion samples, it is impossible to determine the risk factors of embryo chromosome abnormalities and missed abortion. This study aimed to investigate the maternal and embryonic chromosome characteristics of missed and non-missed abortion, to clarify the questions that how many missed abortions are caused by embryonic chromosomal abnormalities and what are their risk factors. Material and methods: This study was conducted on 131 women with missed or non-missed abortion from the Longitudinal Missed Abortion Study (LoMAS). Logistic regression analysis was used to identify the association between maternal covariates and embryonic chromosomal abnormalities and missed abortions. Data on the characteristics of women with abortions were collected. Results: The embryonic chromosome abnormality rate was only 3.9% in non-missed abortion embryos, while it was 64.8% in missed-abortion embryos. Assisted reproductive technology and prior missed abortions increased the risk of embryonic chromosome abnormalities by 1.637 (95% CI: 1.573, 4.346. p = 0.010) and 3.111 (95% CI: 1.809, 7.439. (p < 0.001) times, respectively. In addition, as the age increased by 1 year, the risk of embryonic chromosome abnormality increased by 14.4% (OR: 1.144, 95% CI: 1.030, 1.272. p = 0.012). Moreover, advanced age may lead to different distributions of chromosomal abnormality types. Conclusion: Nearly two-thirds of missed abortions are caused by embryonic chromosomal abnormalities. Moreover, advanced age, assisted reproductive technology, and prior missed abortions increase the risk of embryonic chromosomal abnormalities.

Optimal diagnostic fever thresholds using non-contact infrared thermometers under COVID-19

Fever screening is an effective method to detect infectors associated with different variants of coronavirus disease 2019 (COVID-19) based on the fact that most infectors with COVID-19 have fever symptoms. Non-contact infrared thermometers (NCITs) are widely used in fever screening. Nevertheless, authoritative data is lacking in defining "fever" at different body surface sites when using NCITs. The purpose of this study was to determine the optimal diagnostic threshold for fever screening using NICTs at different body surface sites, to improve the accuracy of fever screening and provide theoretical reference for healthcare policy. Participants (n = 1860) who were outpatients or emergency patients at Chengdu Women's and Children's Central Hospital were recruited for this prospective investigation from March 1 to June 30, 2021. NCITs and mercury axillary thermometers were used to measure neck, temple, forehead and wrist temperatures of all participants. Receiver operating characteristic curves were used to reflect the accuracy of NCITs. Linear correlation analysis was used to show the effect of age on body temperature. Multilinear regression analysis was used to explore the association between non-febrile participant's covariates and neck temperature. The mean age of participants was 3.45 ± 2.85 years for children and 28.56 ± 7.25 years for adults. In addition 1,304 (70.1%) participants were children (≤12), and 683 (36.7%) were male. The neck temperature exhibited the highest accuracy among the four sites. Further the optimal fever diagnostic thresholds of NCITs at the four body surface measurement sites were neck (36.75 °C, sensitivity: 0.993, specificity: 0.858); temple (36.55 °C, sensitivity: 0.974, specificity: 0.874); forehead (36.45 °C, sensitivity: 0.961, specificity: 0.813); and wrist (36.15 °C, sensitivity: 0.951, specificity: 0.434). Based on the findings of our study, we recommend 36.15, 36.45, 36.55, and 36.75 °C as the diagnostic thresholds of fever at the wrist, forehead, temple and neck, respectively. Among the four surface sites, neck temperature exhibited the highest accuracy.

Transvaginal natural orifice endoscopic surgery for myomectomy: Can it be a conventional surgery?

Introduction

As a new minimally invasive surgery, transvaginal natural orifice transluminal endoscopic surgery (vNOTES) has been proved to be suitable for the treatment of a variety of gynecological benign diseases. However, compared with other minimally invasive surgeries that have been widely used, such as conventional multiport laparoscopy and transumbilical laparoendoscopic single-site surgery (LESS), their advantages and disadvantages and how to choose are still unknown. The purpose of our study is to compare the advantages and disadvantages of the three minimally invasive surgeries in myomectomy and to provide theoretical basis for the wider development of vNOTES surgery.

Material and methods

This retrospective study included 282 patients at our hospital who underwent laparoscopic myomectomy from May 2021 to March 2022. Based on the surgical approach, patients were classified into multiport, transumbilical LESS, and vNOTES groups. The patients’ demographic characteristics and follow-up data were collected during the perioperative period and at 1 month postoperatively.

Results

Among the three procedures, vNOTES had the shortest anal exhaust time but also the highest postoperative infection rate. Multiple linear regression analysis showed that the operative time increased by 3.5 min for each 1 cm increase in myoma, and intraoperative bleeding increased by approximately 12 ml. The average duration of single pores increased by 25 min compared to that of multiports, and the operative duration increased by 10.48 min for each degree of adhesion.

Conclusions

For gynecologists who have mastered vNOTES, this procedure has the same efficacy and safety as the two existing minimally invasive surgeries in myomectomy, but it shows obvious advantages in postoperative recovery.

Sentinel Lymph Node Mapping and Staging Surgery via Gasless Transvaginal Natural Orifice Transluminal Endoscopic Surgery: A Case Report of Patient with Endometrial Cancer Patient and Comorbid Rheumatic Heart Disease

Patient: Female, 43-year-old

Final Diagnosis: The stage 1A endometrioid adenocarcinoma and RHD pathology, including the cardiac function of class II, severe MS, and pulmonary hypertension

Symptoms: Irregular vaginal bleeding for more than 1 month

Medication:—

Clinical Procedure: —

Specialty: Surgery

POS1332 TOWARD SAFER GLUCOCORTICOID THERAPY OF POLYMYALGIA RHEUMATICA

Background

SPI-62 is a potent 11β-hydroxysteroid dehydrogenase type 1 (HSD-1) inhibitor entering Phase 2 development as adjunctive therapy to prednisolone in polymyalgia rheumatica, as well as for treatment of Cushing’s syndrome and autonomous cortisol secretion. HSD-1, an intracellular enzyme, activates glucocorticoids in target tissues in which glucocorticoid medicines are associated with morbidity including liver, adipose, muscle, and skin. In Phase 1 clinical trials SPI-62 was generally well tolerated and associated with maximal liver and brain HSD-1 inhibition.

Objectives

To demonstrate mitigation by SPI-62 of corticosterone (CORT) adverse effects in mouse.

Methods

C57BL/6 male mice (age 7 weeks; n=14 per group) were administered CORT (100 g/mL in drinking water) and SPI-62 (by gavage in 0.5% HPMC; 0, 1, or 10 mg/kg/day or 10 mg/kg twice daily) for 35 days. A control group received no CORT or SPI-62. Body weight was assessed daily and food consumption twice weekly. Whole body muscle and fat amounts were measured at Days 0, 14, and 28 using an EchoMRI-130H body composition analyzer. Blood samples for fasting glucose and insulin were obtained at Days 1 (pre-dose), 15, 29, and 35. An open field test was conducted on Day 22. A grip strength test was performed on Day 28. After sacrifice on Day 36, gonadal, subcutaneous, retroperitoneal, and mesenteric fat, quadriceps, and tibialis anterior were dissected and weighed, and skin was formalin fixed and paraffin embedded.

Results

One control mouse died due to accidental gavage injury. Two mice who received CORT + 0.5% HPMC died on Days 11 and 19. CORT resulted in increased food consumption which was normalized by SPI-62 in a dose-dependent manner. CORT-treated mice showed reduced body weight gain for 2 weeks then accelerated body weight gain. SPI-62 prevented body weight gain acceleration in a dose-dependent manner. CORT effects on dermal thickness and structure were less prominent in mice who also received SPI-62. No effect of CORT or SPI-62 was observed in the open field test. SPI-62 prevented CORT adverse effects of insulin resistance, increased adiposity, skeletal myoatrophy, and grip strength reduction (Table 1).

Table 1.

Observed percentage difference of treatment group mean, compared to control group mean, in CORT-treated mice

SPI-62 treatmentnone1 mg/kg1x/day10 mg/kg1x/day10 mg/kg2x/dayHOMA-IR Day 15+422+428+104+8HOMA-IR Day 29+788+472+204+14HOMA-IR Day 35+3620+1270+324+92Body fat content Day 14*+110+72-13-7Body fat content Day 28*+166+102+63-12Gonadal fat weight*+151+74+39-1Subcutaneous fat weight*+471+121+83+7Retroperitoneal fat weight*+227+89+36+25Mesenteric fat weight*+240+133+124+71Body muscle content Day 14*-10-70+1Body muscle content Day 28*-15-8-6+3Quadriceps weight*-54-43-24-16Tibialis anterior weight*-35-29-5+5Grip strength-12+16+15+26

*Normalized by body weight.

Conclusion

SPI-62 prevented several CORT adverse effects in mouse, demonstrating that blockade of local intracellular glucocorticoid activation by a HSD-1 inhibitor in target tissues can mitigate glucocorticoid toxicity. These results suggest that SPI-62 has potential to similarly mitigate adverse effects of glucocorticoid medications in human. A placebo-controlled Phase 2 clinical trial has been initiated to compare prednisolone effects with and without SPI-62. Up to 48 patients diagnosed with polymyalgia rheumatica, on stable prednisolone 10 mg daily for at least 2 weeks, and with stable disease inactivity based on acute phase biomarkers will continue prednisolone 10 mg daily for 4 weeks, during which they will receive SPI-62 or placebo for 2 weeks each. Acute phase and other immune function biomarkers, symptom measures, and biomarkers of prednisolone adverse effects will be assessed at baseline and after each 2-week period. After analysis of data from a first cohort of 12 patients the prednisolone dose might be adjusted, in blinded fashion, during the SPI-62 period to maintain equipotency on acute phase biomarker suppression.

Disclosure of Interests

Xingyu Pan: None declared, Qiongqiong Hou: None declared, Jiahui Xu: None declared, Yake Ma: None declared, Jiawen Li: None declared, Min Li: None declared, Jing Su: None declared, Xuerou Shi: None declared, William Bracken Consultant of: Sparrow Pharmaceuticals, David Katz Shareholder of: Sparrow Pharmaceuticals, Employee of: Sparrow Pharmaceuticals

[Construction of a nomogram model for predicting 2-year survival rate of small cell lung cancer based on more comprehensive variables]

Objective: To construct a novel prognostic nomogram model based on more comprehensive variables for patients with small-cell lung cancer (SCLC). Methods: The data of 722 patients with SCLC confirmed by pathology in Affiliated Cancer Hospital of Shanxi Medical University from January 2015 to December 2018 were retrospectively analyzed [including 592 males and 130 females, aged from 23 to 82(61±9) years]. A random seed count of 133 was used to divide those patients into training set (n=422) and validation set (n=300). Kaplan-Meier was used for survival curves analysis and univariate Log-rank test was used for evaluating the influence of clinical variables on the prognosis of sclc, variables with P<0.05 in univariate analysis were included in a multivariate Cox regression model. The nomogram was constructed based on the variables which P<0.05 in multivariate analysis. Receiver operating characteristic (ROC) curve, calibration by Integrated Brier score (IBS) and clinical net benefit by decision curve analysis (DCA) were used to evaluate model discriminative power, prediction error value, and clinical net benefit, and compared with the American Joint Committee on Cancer 8th TNM. Results: Male, abnormal monocyte (MON) counts, abnormal neuron specific enolase (NSE), abnormal cytokeratin 19 fragment (Cyfra211), M1a stage, M1b stage, M1c stage, radiotherapy (RT), chemotherapy ≥4 cycles and prophylactic cranial irradiation (PCI) were prognostic factors for SCLC[HR(95%CI)=1.39(1.00-1.92), 1.29(1.02-1.63), 1.41(1.11-1.80), 2.02(1.48-2.76), 1.09(0.77-1.55), 1.44(0.94-2.22), 2.01(1.49-2.71), 0.75(0.57-0.98), 0.40(0.31-0.51)and 0.42(0.26-0.68), respectively, all P<0.05]. The area under ROC curve (AUC) of the nomogram in training set and validation set were 0.814(95%CI: 0.765-0.862)and 0.787 (95%CI: 0.725-0.849), which were higher than TNM [0.616(95%CI: 0.558-0.674) and 0.648(95%CI: 0.581-0.715)].The calibration curve showed a good correlation between the nomogram prediction and actual observation for the 2-year overall survival (OS). IBS indicted a lower prediction error rate (training set: 0.132 vs 0.169; validation set: 0.138 vs 0.169). DCA showed a wider threshold range than TNM (training set: 0.01-0.96 vs 0.01-0.85, validation set: 0.01-0.94 vs 0.01-0.86) and a greater improvement of the clinical net benefit (in training set the nomogram had a greater clinical benefit than TNM in the range of 0.19-0.96, and remained in validation set in the range of 0.19-0.94). Conclusion: The established nomogram model for predicting 2-year OS in patients with SCLC based on 8 variables, including gender, MON, NSE, Cyfra211, M stage, RT, CT cycles and PCI can be used for an more accurately prognosis prediction and reference for therapeutic regimen selection.

[Clinical analysis of 234 esophageal foreign bodies]

Objective: To explore the clinical characteristics and treatment methods of esophageal foreign body. Method: The clinical data of 234 patients with esophageal foreign bodies admitted to our department from January 2015 to August 2018 were retrospectively analyzed, including course time, foreign body types, surgical methods, imaging manifestations and treatment related complications. Result: The diagnosis of esophageal foreign bodies was confirmed by esophageal CT or esophageal barium meal X-ray examination before operation in 234 patients. Course time varied from 3 hours to 7 days, and the jujube nucleus was the most common food-borne foreign body.223 patients underwent esophagoscopic exploration and foreign body removal under general intravenous anesthesia, 11 of them had no definite esophageal foreign body, 22 had esophageal perforation and periesophagitis. After removal of foreign body, the nasogastric feeding tube was inserted. About 10 days later, the nasogastric feeding tube was removed when they got healthy. Nine cases underwent cervical abscess incision and drainage under general anesthesia. The average postoperative hospital day was 11 days. Conclusion: The rigid esophagoscopy is a safe and effective method for the esophageal foreign bodies. And neck abscess incision must be necessary,when they suffered from esophageal perforation with neck abscess and other serious complications.

[Role of sleep apnea monitoring management platform in the treatment of patients with obstructive sleep apnea hypopnea syndrome]

Objective:To investigate the clinical significance and value of the sleep apnea monitoring management platform in the treatment of patients with obstructive sleep apnea hypopnea syndrome (OSAHS) by comparing with the traditional continuous positive airway pressure (CPAP) card reader mode.Method:A total of 48 severe adult OSAHS patients from Department of Otorhinolaryngology Head and Neck Surgery-Sleep Medical Center of the Third People's Hospital of Honghe during the period of Nov. 2015 to Aug. 2016 were collected in this prospective study. All of them were diagnosed by PSG and treated with nasal continuous positive airway pressure. They were randomly divided into group A (n=24) and group B (n=24). Group A and B were treated with the traditional CPAP card reader mode and the sleep apnea monitoring management platform respectively. During the follow-up, the compliance, mean blood oxygen saturation, titration pressure, Epworth sleepiness scale after 1, 3, 6 and 12 month treatment were compared between two groups. Ttest was used to analyze the difference. Statistical significance was set at P <0.05.Result:Statistical analysis showed that there were significant difference in the compliance of using CPAP, mean blood oxygen saturation and Epworth sleepiness scale score between the two groups (P < 0.05), but the titration pressure had no difference between the two groups (P>0.05).Conclusion:Compared the sleep apnea monitoring management platform with traditional CPAP card reader mode in the treatment of OSAHS patients, the former could solve the problems during the CPAP use in time, improve the compliance of using CPAP, and which could increase the efficacy of CPAP. Thus, the sleep apnea monitoring management platform is of more clinical value and deserve promotion.

[Analysis of olfactory dysfunction after endoscopic and microscopic endonasal transsphenoidal surgery for pituitary adenoma]

Objective:To analyze the clinical data of patients with olfactory dysfunction after endoscopic or microscopic endonasal transsphenoidal approach,and to screen out the possible related factors,to guide clinical diagnosis and treatment,and to improve the patients' quality of life.Method:In the retrospective study,we analyze patients' data,and follow up them with telephone,records the olfactory levels before and after surgery. In the prospective study,five odors were applied to test the olfactory function before the surgery,then one week,3 weeks and 6 weeks after that. The results were statistically analyzed.Result:In the retrospective study,olfactory dysfunction occurred in 67.74%,47.37%in MTS group and ETS group. The olfactory disorder had no significant difference (P>0.05) among MTS group and ETS group after surgery. And the analysis of factors showed no significant difference. In the prospective study,there is significant difference between the preoperative results and postoperative results about the operative side and nonoperative side in ETS group and MTS group (P<0.05). In all results,there is no significant difference between operative side and nonoperative side in ETS group and MTS group (P>0.05).Conclusion:There is olfactory dysfunction after transsphenoidal surgery to resect pituitary adenomas. To prepare the nasal condition well preoperatively,protect the nasal structure intraoperatively and aplicate appropriate treatment postoperatively may reduce the incidence of olfactory disorder.

Clinical and Imaging Characteristics of Arteriopathy Subtypes in Children with Arterial Ischemic Stroke: Results of the VIPS Study

BACKGROUND AND PURPOSE

Childhood arteriopathies are rare but heterogenous, and difficult to diagnose and classify, especially by nonexperts. We quantified clinical and imaging characteristics associated with childhood arteriopathy subtypes to facilitate their diagnosis and classification in research and clinical settings.

MATERIALS AND METHODS

The Vascular Effects of Infection in Pediatric Stroke (VIPS) study prospectively enrolled 355 children with arterial ischemic stroke (2010-2014). A central team of experts reviewed all data to diagnose childhood arteriopathy and classify subtypes, including arterial dissection and focal cerebral arteriopathy-inflammatory type, which includes transient cerebral arteriopathy, Moyamoya disease, and diffuse/multifocal vasculitis. Only children whose stroke etiology could be conclusively diagnosed were included in these analyses. We constructed logistic regression models to identify characteristics associated with each arteriopathy subtype.

RESULTS

Among 127 children with definite arteriopathy, the arteriopathy subtype could not be classified in 18 (14%). Moyamoya disease (n = 34) occurred mostly in children younger than 8 years of age; focal cerebral arteriopathy-inflammatory type (n = 25), in children 8-15 years of age; and dissection (n = 26), at all ages. Vertigo at stroke presentation was common in dissection. Dissection affected the cervical arteries, while Moyamoya disease involved the supraclinoid internal carotid arteries. A banded appearance of the M1 segment of the middle cerebral artery was pathognomonic of focal cerebral arteriopathy-inflammatory type but was present in <25% of patients with focal cerebral arteriopathy-inflammatory type; a small lenticulostriate distribution infarct was a more common predictor of focal cerebral arteriopathy-inflammatory type, present in 76%. It remained difficult to distinguish focal cerebral arteriopathy-inflammatory type from intracranial dissection of the anterior circulation. We observed only secondary forms of diffuse/multifocal vasculitis, mostly due to meningitis.

CONCLUSIONS

Childhood arteriopathy subtypes have some typical features that aid diagnosis. Better imaging methods, including vessel wall imaging, are needed for improved classification of focal cerebral arteriopathy of childhood.

[The research progress of LGR4 in the eye development and related diseases]

LGR4, also known as GPR48, is a member of the leucine-rich, G protein-coupled receptor family. It is widely expressed in tissues of the reproductive system, urinary system, sensory organs, digestive system, and central nervous system. LGR4 plays an important role in the development of various organs and cancer development and progression by modulating multiple signaling pathways. Recent studies have revealed that LGR4 is related with many kinds of human diseases such as gastrointestinal carcinomas. Eye development is a dynamic process regulated by a number of growth factors and cytokines. LGR4 is extensively expressed in the eyes in a finely tuned spatiotemporal pattern. Mice lacking LGR4 have been found to display anterior segment dysgenesis, including microphthalmia, iris hypoplasia, iridocorneal angle malformation and corneal dysgenesis, cataract and other defects. Here we review the role of LGR4 in the eye development and related molecular mechanisms. (Chin J Ophthalmol, 2017, 53: 236-240).

Evolution and heterogeneity of non-hereditary colorectal cancer revealed by single-cell exome sequencing

Recently single-cell whole-exome sequencing (scWES) has deeply expanded and sharpened our knowledge of cancer evolution and subclonality. Herein, with scWES and matched bulk whole-exome sequencing (bulk WES) on two colorectal cancer (CRC) patients with normal or adenomatous polyps, we found that both the adenoma and cancer were of monoclonal origin, and both shared partial mutations in the same signaling pathways, but each showed a specific spectrum of heterogeneous somatic mutations. In addition, the adenoma and cancer further developed intratumor heterogeneity with the accumulation of nonrandom somatic mutations specifically in GPCR, PI3K-Akt and FGFR signaling pathways. We identified novel driver mutations that developed during adenoma and cancer evolution, particularly in OR1B1 (GPCR signaling pathway) for adenoma evolution, and LAMA1 (PI3K-Akt signaling pathway) and ADCY3 (FGFR signaling pathway) for CRC evolution. In summary, we demonstrated that both colorectal adenoma and CRC are monoclonal in origin, and the CRCs further diversified into different subclones with heterogeneous mutation profiles accumulating in GPCR, PI3K-Akt and FGFR signaling pathways. ScWES provides evidence for the importance of mutations in certain pathways that would not be as apparent from bulk sequencing of tumors, and can potentially establish whether specific mutations are mutually exclusive or occur sequentially in the same subclone of cells.

The antibody-based CA125-targeted maintenance therapy for the epithelial ovarian cancer: a meta-analysis

OBJECTIVES

To assess the effect and toxicity of CA125-targeted antibody used as maintenance therapy for advanced epithelial ovarian cancer (EOC).

MATERIALS AND METHODS

Two reviewers searched PubMed, Medline, Embase, VIP databases, and the references of selected articles for randomized controlled trials comparing maintenance CA125-targeted antibody treatment with placebo/observation. One-, two-, three-, and five-year overall survival (OS) and progression free survival (PFS) were collected. Incidence and severity of adverse events were extracted. Meta-analysis of combined risk ratio (RR) for OS , PFS, and toxicity were conducted.

RESULTS

Four trials including 1,259 women were identified. Meta-analysis showed the combined RR was 1.02 (95% CI, 0.85-1.22) for three-year OS and 0.98 (95% CI, 0.70-1.39) for the three-year PFS. This review found that abagovomab and oregovomab caused toxicity no more than placebo.

CONCLUSIONS

CA125-targeted antibody used as maintenance therapy alone is not more effective than placebo but they were safe as maintenance therapy.

A longitudinally split rabbit segmental gracilis to simulate penile erectile function: anatomic basis and animal models

OBJECTIVE

The gracilis was once applied in reconstructing erectile function but its appearance was bulky. We aimed to design a model meeting the requirements of both reducing volume and retaining function.

MATERIALS AND METHODS

The gracilis muscles of 6 rabbits were harvested, applied colorful vascular perfusion and modified Sihler's intramuscular nerve staining. According to their intramuscular nerves and blood vessels, 9 rabbit right gracilis muscles were then longitudinally split into two halves. The anterior muscle bundle was selected as the functional unit and blood supply.

RESULTS

The intramuscular nerves and vessels were simultaneously presented on a same specimen. Their relationship suggested gracilis muscle to be composed of two relatively independent subunits. The reconstructed penis survived well, simulating erectile action satisfactorily.

DISCUSSION

The penis model reconstructed with longitudinally split rabbit segmental gracilis myocutaneous flap had met the requirements of both restoring erectile function and improving the appearance.

The impact of oral consumption of Lactobacillus plantarum P-8 on faecal bacteria revealed by pyrosequencing

Lactobacillus plantarum P-8 (Lp-8) is a novel probiotic bacterium showing beneficial effects in human. The current study is a follow-up work of a previous clinical trial, and it aimed at understanding the mechanism of the observed desirable effects by evaluating the change in faecal bacterial structure at phylogenetic level. The genomic DNAs used for 16S rRNA polymerase chain reaction (PCR)-pyrosequencing were obtained from the previous clinical trial. Briefly, 33 recruited subjects were given a single daily oral dose of Lp-8 (6×1010 cfu) for 4 weeks. Faecal genomic DNAs were extracted from samples collected before (day 0) and after (day 28) Lp-8 consumption from the subjects. Our results show that the consumption of Lp-8 did not result in major change in the faecal bacterial structure by principal coordinate analysis. However, multivariate analysis of variance and analysis of UniFrac metric distances at day 0 and day 28 revealed significant difference in the faecal bacterial structure upon Lp-8 treatment. Thus, the difference lied on the less abundant rather than the predominant lineages. At genus level, the relative abundance of 5 Firmicutes genera (Leuconostoc, Lactobacillus, Sporacetigenium, Blautia and Staphylococcus) significantly increased after Lp-8 consumption, whereas 3 Proteobacteria genera (Shigella, Escherichia and Enterobacter) decreased (P<0.05). 60 key responding lineages could be identified at operational taxonomic unit (OTU) level by redundancy analysis. Among them, the abundance of 18 OTUs showed significant difference (P<0.05), while 12 OTUs exhibited modest change (0.05<P<0.01) upon treatment. Our study identified a shift in the faecal bacterial structure upon Lp-8 administration, which may explain some of the previously observed beneficial effects.

Reduction of Lactobacillus in the milks of cows with subclinical mastitis

Clinical and subclinical bovine mastitis are the most frequent diseases encountered on dairy farms worldwide, which cause significant economic loss and veterinary cost. The mastitic disease status is associated with increases in both milk bacterial pathogens and somatic cell count (SCC). Although it is well established that the mastitic pathogens generally correlate with the milk SCC, to our knowledge, the correlation between the probiotic genus, Lactobacillus, and the mastitic causative bacteria and SCC have not been determined previously. Thus, in this study, milk samples from 12 mild and 28 severe subclinical mastitic dairy cows were collected from the same farm. The overall milk bacterial load was quantified with the total plate count method. The Lactobacillus genus and 4 common clinical and subclinical mastitic pathogens (Escherichia coli, Staphylococcus aureus, Streptococcus agalactiae, and Trueperella pyogenes) in the sampled milk were enumerated by quantitative PCR. Mild and severe subclinical mastitic samples were distinctly separated on the principal component analysis score plot generated based on the quantities of these 5 target bacteria, suggesting that clear differences existed in the microbiological composition between the two sample groups. Based on comparison with the pairwise Mann-Whitney test, the mild subclinical mastitic dairy cows had a significantly higher amounts of lactobacilli (P=0.0175), but lower E. coli (P=0.0002), S. aureus (P<0.0001), S. agalactiae (P=0.0001) and T. pyogenes (P=0.0044) quantities, while an opposite trend occurred in the severe subclinical mastitic group. The negative correlation between Lactobacillus and the pathogenic bacteria, as well as the SCC, was confirmed with Spearman correlation analysis. Data generated from the current study may hint to a close relationship between Lactobacillus and the health of bovine udder.

The construction of cDNA library and the screening of related antigen of ascitic tumor cells of ovarian cancer

OBJECTIVE

To construct the cDNA library of the ascites tumor cells of ovarian cancer, which can be used to screen the related antigen for the early diagnosis of ovarian cancer and therapeutic targets of immune treatment.

MATERIALS AND METHODS

Four cases of ovarian serous cystadenocarcinoma, two cases of ovarian mucinous cystadenocarcinoma, and two cases of ovarian endometrial carcinoma in patients with ascitic tumor cells which were used to construct the cDNA library. To screen the ovarian cancer antigen gene, evaluate the enzyme, and analyze nucleotide sequence, serological analysis of recombinant tumor cDNA expression libraries (SEREX) and suppression subtractive hybridization technique (SSH) techniques were utilized. The detection method of recombinant expression-based serological mini-arrays (SMARTA) was used to detect the ovarian cancer antigen and the positive reaction of 105 cases of ovarian cancer patients and 105 normal women's autoantibodies correspondingly in serum.

RESULTS

After two rounds of serologic screening and glycosides sequencing analysis, 59 candidates of ovarian cancer antigen gene fragments were finally identified, which corresponded to 50 genes. They were then divided into six categories: (1) the homologous genes which related to the known ovarian cancer genes, such as BARD 1 gene, etc; (2) the homologous genes which were associated with other tumors, such as TM4SFI gene, etc; (3) the genes which were expressed in a special organization, such as ILF3, FXR1 gene, etc; (4) the genes which were the same with some protein genes of special function, such as TIZ, ClD gene; (5) the homologous genes which possessed the same source with embryonic genes, such as PKHD1 gene, etc; (6) the remaining genes were the unknown genes without the homologous sequence in the gene pool, such as OV-189 genes.

CONCLUSION

SEREX technology combined with SSH method is an effective research strategy which can filter tumor antigen with high specific character; the corresponding autoantibodies of TM4SFl, ClD, TIZ, BARDI, FXRI, and OV-189 gene's recombinant antigen in serum can be regarded as the biomarkers which are used to diagnose ovarian cancer. The combination of multiple antigen detection can improve diagnostic efficiency.

Synthesis and Interfacial Properties of Dialkylbenzenesulfonates for Producting Low Interfacial Tensions

A new method of synthesis a series of pure dialkylbenzene sulfonates is described. The benzene ring carries a major alkyl substituent, consisting of a linear chain of sixteen carbon atoms long, and one additional methyl group. Products are charactered by EI-MS and 1H NMR. Experimental investigations have been conducted to explore the interfacial tension behavior of crude oil with dialkylbenzenesulfonates. The effects of various parameters such as surfactant concentration, salinity concentration on the interfacial tension of crude oil-water were investigated in detail. The transient low interfacial tensions in crude oil/alkali system were caused by the synergistic effects between surfactant and the active species generated at interface, but surfactant molecules plays the dominant role at equilibrium.

Is symptom relief associated with reduction in gastric retention after gastric electrical stimulation treatment in patients with gastroparesis? A sensitivity analysis with logistic regression models

BACKGROUND

Enterra gastric electrical stimulation (GES) is an alternative treatment for gastroparesis (GP) when standard medical therapy fails. The aims of this study were to evaluate the association between total symptom score (TSS) and reduction in gastric retention (GR) after GES by GP etiology and to examine the sensitivity of the association to varying cutpoints used to define GR and TSS improvement.

METHODS

Gastric retention assessed with a standardized (99m) Tc radio-labeled egg meal and TSS measured by a five-point Likert scale in 221 GP patients treated with Enterra GES therapy for at least 1 year were analyzed. Bivariate chi-square test and multivariable logistic regression with all possible cutpoints were used to assess the consistency of association and quantitate the relationship across three GP etiologies.

KEY RESULTS

Symptom relief in diabetic GP was more likely attributable to GR reduction as indicated by the consistently significant odds ratios (P < 0.01) across all cutpoints. The association in idiopathic GP was inconclusive because odds ratios were sensitive to cutpoints with P-values ranging from 0.01 to 0.47. No association was found for patients with post surgical gastroparesis (P > 0.1 for all cutpoints). Patient age, gender, baseline TSS and baseline GR had no significant effect at 5% level on clinical improvement regardless of cutpoints for GR.

CONCLUSIONS & INFERENCES

Association between clinical improvements and GR reduction following GES treatment depends on patient etiology and was able to be demonstrated in diabetic GP. The association for idiopathic GP was inconclusive and no such association was found for post surgical GP across all possible cutpoint combinations.

Diaphragmatic hernia during pregnancy: a case report with a review of the literature from the past 50 years

Diaphragmatic hernia is a rare complication during pregnancy. Only 30 reports have been published on this subject in English between 1959 and 2009. Due to misdiagnoses and management delays, diaphragmatic hernia usually presents itself as a life-threatening emergency. Here, we present a case report of a patient with a traumatic diaphragmatic hernia who became acutely symptomatic during pregnancy. The diaphragmatic hernia was managed successfully, and we describe the presentation, management and outcome of this case. We also present a review of all of the reported cases of diaphragmatic hernias complicating pregnancy that have been published in English during the past 50 years.

A Bayesian hierarchical assessment of gastric emptying with the linear, power exponential and modified power exponential models

BACKGROUND

Many studies assessed gastric retention over time utilizing different models, mostly with scintigraphic measures at varied endpoints from limited number of normal volunteers. With a standardized 4-h gastric emptying (GE) protocol, we compared model fit by the linear, power exponential (PE), and modified power exponential (MPE) models to contrast differences in GE among different groups based on clinical diagnosis and gender.

METHODS

We retrospectively collected 320 patient records with four consecutive hourly scintigraphic measures of percent intragastric residual at the Kansas University Medical Center. We obtained parameter estimates with the Bayesian hierarchical models using informative priors from previous research.

KEY RESULTS

The PE or MPE model captured the time dependent GE rate better than the linear model. The estimated GE rates more than doubled for those without gastroparesis compared to patients diagnosed with gastroparesis. Males tended to empty gastric content faster but were not significantly different from females at the 5% level.

CONCLUSIONS & INFERENCES

The point estimates and 95% credible interval for GE rates obtained with the PE and MPE models may provide an alternative diagnostic tool for clinicians since it utilizes gastric emptying scintigraphy measures at multiple endpoints which may be sensitive to different aspects of the disease. No agreement in lag phases was obtained by the three models based on respective definitions from previous researches, but similar results would be obtained with the PE and MPE models if both defined lag phase by back projecting the regression lines to the same gastric retention level.

Clinical application of a novel sliver nanoparticles biosensor based on localized surface plasmon resonance for detecting the microalbuminuria

In order to explore the clinical application of the nanobiosensor based on localized surface plasmon resonance (LSPR), we used our LSPR biosensor to detect the microalbuminuria in this work. The sliver nanoparticles were fabricated by using nanosphere lithography. The anti-human albumin antibody was immobilized on the sensor surface by amine coupling method. The different concentrations of commercial albumin and albumin in urine samples from three mild preeclampsia patients were determined according to the peak of LSPR extinction spectra. Under optimum conditions, our results showed that the biosensor displayed a detection limit of 1 ng/ml and wide dynamic range of 1 ng/ml to 1 μg/ml. Furthermore, the microalbuminuria of three patients was determined by our biosensor within a short assay time, without sample purification. This biosensor proposed herein is easy to prepare and could be used for low-cost, rapid, label-free, and sensitive screening of the microalbuminuria. This approach provides a promising platform for developing clinical diagnostic applications.