[Endometriosis-related recurrent unilateral hemorrhagic pleural effusion: a case report].

Hemorrhagic pleural effusion (PE) is common in clinical practice. According to the guidelines, the etiological diagnosis of PE should focus on the identification of common diseases. In most cases, the etiology of PE can be determined by clinical history, physical examination, laboratory and imaging examinations, and pleural biopsy or video-assisted thoracic surgery (VAST). We reported a rare case of a 32-year-old woman with recurrent unilateral hemorrhagic pleural effusion (highly correlated with menstrual cycle) and chest pain that was diagnosed as thoracic endometriosis syndrome (TES) by pathological biopsy and immunohistochemistry. Later she underwent surgery combined with hormone therapy. During the follow-up, the right PE decreased, and she had no chest pain. Therefore, women of reproductive age with regular unilateral bloody pleural effusions should be alert to TES.

[The effect of perioperative ERAS pathway management on short-and long-term outcomes of gastric cancer patients].

Objective: To compare postoperative short-term outcomes and long-term prognosis between perioperative Enhanced Recovery After Surgery (ERAS) and conventional pathways protocols in gastric cancer patients. Methods: This is a single institute retrospective cohort study, all patients were pathologically proved to be gastric adenocarcinoma, underwent standard radical gastrectomy with D2 lymphadenectomy during the period of 2007-2012. Total 2124 cases were eligible to be analysed and divided into ERAS groups and Non-ERAS group according to the different perioperative pathway protocol. Propensity score matching method (in SPSS, 24.0 version, IBM Company) was used to balance the baseline characteristics. Two groups were matched in a 1∶1 ratio. There were 521 cases per group after matched. The short-term clinical outcomes (postoperative complications, length of hospital stay, blood loss, 30-day re-admission rate, etc.) and overall 5-year survival rates were compared between the two groups. Results: The incidence of overall postoperative complications was similar between the two groups (ERAS group=18.4%, non-ERAS group=19.4%, P=0.69), including anastomotic leakage, abdominal hemorrhage, etc. But the incidence of SSI, atelectasis, and thromboembolic disease in ERAS group was significant lower than that in Non-ERAS group. The number of lymph node harvested, operation time, intraoperative blood loss, postoperative hospital and cost in ERAS group were better than those in non-ERAS group. There were no significant differences in unplanned reoperation (ERAS group=3.1%, non-ERAS group=2.1%, P=0.33), 30 day readmission rate of discharge (ERAS group=6.1%, non-ERAS group=5.6%, P=0.69) and postoperative mortality (ERAS group=0.4%, non-ERAS group=0.2%, P=0.56) between the two groups. The 5-year overall survival rates of non-ERAS group and ERAS group were 66.2% and 72.8% respectively (P=0.007). The subgroup analysis found that 5-year OS rates of stage I were 93.4% and 92.7% (P=0.73), these of stage Ⅱ and Ⅲ were 82.2% vs 75.2% (P=0.007) and 47.6% vs 35.7% (P=0.02) in ERAS group and non-ERAS group respectively. Conclusions: Perioperative ERAS pathway management is safe and feasible for patients with gastric cancer, without increasing the incidence of complications and 30-day readmission rate. This protocol can improve the prognosis of patients with gastric cancer.

[Introduction of joint model and its applications in medical research].

In medical follow-up studies, longitudinal data and survival data are often accompanied and associated with each other, thus respective analysis of longitudinal and survival data might lead to biased results. Joint model can correct deviations, improve the efficiency of parameter estimation and provide effective inferences by simultaneously processing longitudinal and survival data. It is a popular method in medical research. Joint model has made much progress, whereas the literature about the joint model and its application is limited in China. This paper summarizes the main idea, basic framework, parameter estimation methods of random effect joint model and introduces the analysis on AIDS data set based on the R software package 'JM' to clarify the advantages of the joint model in processing medical follow-up data and promote the use of the joint model in clinical research.

Randomised trials with provision for early stopping for benefit (or harm): The impact on the estimated treatment effect.

Stopping rules for clinical trials are primarily intended to control Type I error rates if interim analyses are planned, but less is known about the impact that potential stopping has on estimating treatment benefit. In this paper, we derive analytic expressions for (1) the over-estimation of benefit in studies that stop early, (2) the under-estimation of benefit in completed studies, and (3) the overall bias in studies with a stopping rule. We also examine the probability of stopping early and the situation in meta-analyses. Numerical evaluations show that the greatest concern is with over-estimation of benefit in stopped studies, especially if the probability of stopping early is small. The overall bias is usually less than 10% of the true benefit, and under-estimation in completed studies is also typically small. The probability of stopping depends on the true treatment effect and sample size. The magnitude of these effects depends on the particular rule adopted, but we show that the maximum overall bias is the same for all stopping rules. We also show that an essentially unbiased meta-analysis estimate of benefit can be recovered, even if some component studies have stopping rules. We illustrate these methods using data from three clinical trials. The results confirm our earlier empirical work on clinical trials. Investigators may consult our numerical results for guidance on potential mis-estimation and bias in the treatment effect if a stopping rule is adopted. Particular concern is warranted in studies that actually stop early, where interim results may be quite misleading.

Hydrogen sulfide effects on ammonia removal by a biofilter seeded with earthworm casts.

Ammonia (NH3) removal efficencies were evaluated when hydrogen sulfide (H2S) and NH3 in binary mixture gases were supplied to a ceramic biofilter seeded with earthworm (Lumbricus terrestris) casts. The effect of inlet H2S concentration and space velocity (SV) on the removal of NH3 was investigated after the acclimation of the biofilter with NH3 gas. When NH3 was singly supplied to the biofilter, NH3 removal was maintained at almost 100% until inlet NH3 concentration was increased up to 600 microL L(-1) and SV up to 330 h(-1), at which the elimination capacity of NH3 was 148 g N m(-3) h(-1). When H2S was supplied simultaneously, however, the accumulation of toxic sulfide ions showed dual effects on NH3 removal efficiencies. First, no effects were observed at inlet H2S loading below 60 g S m(-3) h(-1); however, inhibition by H2S at higher loading was observed above 60 g S m(-3) h(-1). The point at which loading achieved a maximum of more than 99% NH3 removal efficiency was 139 g N m(-3) h(-1), when inlet H2S concentration was held under 100 microL L(-1), but it dropped to 76 and 30 g N m(-3) h(-1) when the inlet H2S concentration increased to 220 and 460 microL L(-1), respectively. The critical points of inlet H2S loading that guaranteed over 99% NH3 removal were determined as 100, 100, 60, and 40 g S m(-3) h(-1) at inlet NH3 concentrations of 100, 200, 400, and 600 microL L(-1), respectively. Inlet NH3 loading had synergic effects of increasing the inhibition of inlet H2S loading on the NH3 removability of the biofilter.

In vitro retrieval of epididymal sperm: a new approach to achievement of pregnancy for post-testicular azoospermia.

OBJECTIVE: To determine the efficacy of in vitro retrieval of epididymal sperm for pregnancy induction for obstructive azoospermia patients. DESIGN: Patients were divided into three groups as follows: [1] ductal obstruction with previous epivasostomy (group I); [2] ductal obstruction with previous epididymitis (group II); and [3] ductal obstruction without previous epivasostomy or epididymitis (group III). SETTING: A university teaching hospital. PATIENTS: Twenty infertile males with obstructive azoospermia. INTERVENTIONS: Epididymides were detached surgically just after harvest of oocytes from corresponding wives and severed into three pieces (caput, corpus, and cauda). Each piece was dissected and squeezed in Ham's F-10 medium to retrieve the sperm. After completion of sperm preparation, IVF of their wives' oocytes and zygote intrafallopian transfer followed. RESULTS: Overall pregnancy rate by in vitro retrieval of epididymal sperm was 35% (7 of 20). The rate for group I was 0%, or 0 of 6; for group II the rate was 0%, or 0 of 3; and for group III it was 63.6%, or 7 of 11. CONCLUSIONS: In vitro retrieval of epididymal sperm can be a new method for inducing pregnancy in surgically incorrectable obstructive azoospermia.

In vivo development of transferred mouse embryos conceived in vitro in simple and complex media.

Ovulated mouse ova were fertilized in vitro and cultured to the four-cell stage in simple medium (modified Earle's balanced salts solution, EBSS) supplemented with bovine serum albumin (BSA) and in complex media (modified Ham's F-10 medium, Gibco, Grand Island, NY) with and without human cord serum supplementation. Fertilization and cleavage to the four-cell stage were the same for the three groups. Embryos in cohorts of six were transferred into oviducts of 14 to 16 pseudopregnant recipients per group. Pregnancy rates were higher for the EBSS/BSA and Ham's F-10 groups (36%) than for the Ham's F-10/cord serum group (19%). The percentage of embryos that developed into fetuses in the pregnant recipients was also higher for the Ham's F-10 group (47%) and the EBSS/BSA group (33%) than for the Ham's F-10/cord serum group (22%). The average fetal weights 17 days after transfer for the EBSS/BSA embryo group was 659 +/- 40 mg and for the Ham's F-10 group was 666 +/- 20 mg, higher (P less than 0.05 and P less than 0.003, respectively) than for the Ham's F-10/cord serum group, which was 522 +/- 30 mg. Although all developmental parameters were lower for the in vitro conceived embryos than for a control group of in vivo developed embryos transferred directly to pseudopregnant recipients, the cord serum culture conditions were the least supportive of normal embryo development.

Variations in estrone sulfatase activity in human leukocytes.

Peripheral blood leukocytes isolated from men and women were studied for their capacity to metabolize estrone (E1) sulfate. Fresh human leukocytes (granulocytes and mononuclear cells) were incubated in phosphate buffer, pH 7.4, containing [3H]E1S for 1 h at 37 C. The samples were extracted with chloroform for measurement of the [3H]E1 formed, and the results were corrected for nonenzymatic hydrolysis. The mean E1 sulfatase activity in leukocytes isolated from normal women in the follicular phase of their cycle was 75% higher than that during the luteal [1840 +/- 179 (+/- SE) vs. 1048 +/- 101 fmol E1 micrograms protein-1 h-1; P less than 0.004] and higher than that in normal men (875 +/- 123; P less than 0.002), but was not different from that in menopausal (1349 +/- 151) or hirsute women (1700 +/- 222). In pregnant women, the mean leukocyte E1 sulfatase activity was significantly lower (861 +/- 147) than that in nonpregnant women in the follicular phase (P less than 0.003). These results suggest that progesterone may modulate E1 sulfatase activity, whereas estrogens do not.