Unlocking Fast Potassium Ion Kinetics: High-Rate and Long-Life Potassium Dual-Ion Battery for Operation at -60 °C.

Energy storage devices operating at low temperatures are plagued by sluggish kinetics, reduced capacity, and notorious dendritic growth. Herein, novel potassium dual-ion batteries (PDIBs) capable of superior performance at -60 °C, and fabricated by combining MXenes and polytriphenylamine (PTPAn) as the anode and cathode, respectively, are presented. Additionally, the reason for the anomalous kinetics of K+ (faster at low temperature than at room temperature) on the Ti3C2 anode is investigated. Theoretical calculations, crossover experiments, and in situ XRD at room and low temperatures revealed that K+ tends to bind with solvent molecules rather than anions at subzero temperatures, which not only inhibits the participation of PF6 - in the formation of the solid electrolyte interphase (SEI), but also guarantees co-intercalation behavior and suppresses undesirable K+ storage. The advantageous properties at low temperatures endow the Ti3C2 anode with fast K+ kinetics to unlock the outstanding performance of PDIB at ultralow temperatures. The PDIBs exhibit superior rate capability and high capacity retention at -40 °C and -60 °C. Impressively, after charging-discharging for 20,000 cycles at -60 °C, the PDIB retained 86.7 % of its initial capacity. This study reveals the influence of temperatures on MXenes and offers a unique design for dual-ion batteries operating at ultralow temperatures.

Comparison of endoscopic submucosal dissection outcomes between early gastric cardiac and non-cardiac cancers: a retrospective single-center study.

OBJECTIVES: This study aims to compare the efficacy of endoscopic submucosal dissection (ESD) between early gastric cardiac cancer (EGCC) and early gastric non-cardiac cancer (EGNCC), and investigate associated risk factors for non-curative resection. METHODS: Early gastric cancer (EGC) patients who underwent ESD from January 2015 to September 2020 in Beijing Friendship Hospital were consecutively enrolled. The clinical, histopathological and endoscopic data were retrospectively analyzed. The study was registered in Chinese Clinical Trial Registry (ChiCTR1800017117). RESULTS: Among 500 patients with 534 EGC lesions, 117 patients with 118 lesions were allocated to the EGCC group, and 383 patients with 416 lesions to the EGNCC group. The rates of en bloc resection, complete resection and curative resection in the EGCC group were 97.5%, 78.8% and 71.2%, respectively, significantly lower than those in the EGNCC group (99.8%, 94.5% and 90.4%, p = .010, <.001 and <.001). Among non-curative resected lesions, EGCC had more cases in both endoscopic curability (eCura) C-1 and C-2 groups than EGNCC (10.2% and 18.6% vs. 2.4% and 7.2%, p < .001). Multivariate analysis showed that tumor size (OR 2.393, 95% CI 1.388-4.126) and submucosal invasion (OR 11.498, 95% CI 3.759-35.175) were risk factors for non-curative resection in the EGCC group. For EGCC larger than 3 cm, none achieved curative resection, 86.7% were classified as eCura C-2 and 46.7% exhibited deep submucosal infiltration. CONCLUSIONS: The curative resection rate of ESD for EGCC was lower than that for EGNCC. ESD for EGCC larger than 3 cm should be cautiously considered.

Phage Display-Derived Peptides and Antibodies for Bacterial Infectious Diseases Therapy and Diagnosis.

The emergence of antibiotic-resistant-bacteria is a serious public health threat, which prompts us to speed up the discovery of novel antibacterial agents. Phage display technology has great potential to screen peptides or antibodies with high binding capacities for a wide range of targets. This property is significant in the rapid search for new antibacterial agents for the control of bacterial resistance. In this paper, we not only summarized the recent progress of phage display for the discovery of novel therapeutic agents, identification of action sites of bacterial target proteins, and rapid detection of different pathogens, but also discussed several problems of this technology that must be solved. Breakthrough in these problems may further promote the development and application of phage display technology in the biomedical field in the future.

Reducing the incidence of stroke-associated pneumonia: an evidence-based practice.

BACKGROUND: Pulmonary infection is a frequent complication among stroke patients and adversely affects clinical outcomes, increases the length of hospitalization stay and costs, and aggravates the financial burden of the national medical health system. Early identification and management of high-risk patients are necessary and imperative to reduce the incidence of stroke-associated pneumonia (SAP). AIM: The evidence-based practice project evaluated the effectiveness of a standard care bundle intervention in preventing the occurrence of SAP. METHODS: The project was conducted in a neurology department of a teaching hospital. Given the variation in assessment and management standards, evidence-based practice (EBP) methodology was used to establish a process for quality improvement. A thorough literature search was conducted to identify evidence-based interventions to manage and prevent SAP. Thorough critiques of the literature and synthesis of the evidence were completed. A systematic management flow and care bundle interventions were established. The care bundle included interventions, such as the utilization of tools for SAP risk screening; dysphagia screening and rehabilitation; feeding modification, oral care, airway management, position management, and the nursing techniques of traditional Chinese medicine. RESULTS: A significant improvement was observed in preventing SAP in patients in the postimplementation group compared with those in the preimplementation group (14.0% vs. 37.2%, p = 0.025). In addition, significantly lower duration of hospitalization, lower rate of aspiration, and improvements in albumin and oral hygiene were found after the implementation of the care bundle. CONCLUSIONS: Evidence-based care bundles successfully empower nurses to reduce the incidence of SAP. The management flow of SAP prevention could be promoted to other units of the neurology department in the future. The results of the project reflect positively on the capacity to implement EBP in an acute care setting for stroke. The EBP methodology can be utilized to solve other clinical problems.

Efficacy of oral steroid gel in preventing esophageal stricture after extensive endoscopic submucosal dissection: a randomized controlled trial.

BACKGROUND AND AIMS: Esophageal stricture is a distressing issue for patients with early esophageal cancer following extensive endoscopic submucosal dissection (ESD), and the current steroid-based approaches are unsatisfactory for stricture prophylaxis. We evaluated the efficacy of oral hydrocortisone sodium succinate and aluminum phosphate gel (OHA) for stricture prophylaxis after extensive ESD. METHODS: Patients undergoing > 3/4 circumferential ESD were randomized to either the endoscopic loco-regional triamcinolone acetonide injection (ETI) plus oral prednisone group or the OHA group. The primary endpoint was incidence of esophageal stricture, and the secondary endpoints included adverse events (AEs) and endoscopic balloon dilations (EBDs). RESULTS: The incidence of esophageal stricture in OHA group (per-protocol analysis, 9.4%, 3/32; intention-to-treat analysis, 12.1%, 4/33) was significantly less than that of control group (per-protocol analysis, 35.5%, 11/31, P = 0.013; intention-to-treat analysis, 39.4%, 13/33, P = 0.011). Two sessions of EBD were necessary to release all strictures in the OHA group, while the similar EBDs (median 2, range 1-4) for 11 of the control. Operation-related AEs included infection (control vs. OHA group = 9.7% vs. 31.3%, P = 0.034), operation-related hypokalemia (19.4% vs. 31.3%, P = 0.278), perforation (3.2% vs. 3.1%), post-ESD hemorrhage (6.5% vs. 0%), and cardiac arrhythmia (0% vs. 6.3%). Steroid-related AEs included steroid-related hypokalemia (16.1% vs. 25%) and bone fracture (3.2% vs. 0%). Multivariate logistic regression analysis demonstrated that OHA was an independent protective factor for stricture (OR 0.079; 95%CI 0.011, 0.544; P = 0.01) and mucosal defect > 11/12 circumference was an independent risk factor (OR 49.91; 95%CI 6.7, 371.83; P < 0.001). CONCLUSIONS: OHA showed significantly better efficacy in preventing esophageal stricture after > 3/4 circumferential ESD compared to ETI plus oral prednisone.

Amphipathic dendritic poly-peptides carrier to deliver antisense oligonucleotides against multi-drug resistant bacteria in vitro and in vivo.

BACKGROUND: Outbreaks of infection due to multidrug-resistant (MDR) bacteria, especially Gram-negative bacteria, have become a global health issue in both hospitals and communities. Antisense oligonucleotides (ASOs) based therapeutics hold a great promise for treating infections caused by MDR bacteria. However, ASOs therapeutics are strangled because of its low cell penetration efficiency caused by the high molecular weight and hydrophilicity. RESULTS: Here, we designed a series of dendritic poly-peptides (DPP1 to DPP12) to encapsulate ASOs to form DSPE-mPEG2000 decorated ASOs/DPP nanoparticles (DP-AD1 to DP-AD12) and observed that amphipathic DP-AD2, 3, 7 or 8 with a positive charge ≥ 8 showed great efficiency to deliver ASOs into bacteria, but only the two histidine residues contained DP-AD7 and DP-AD8 significantly inhibited the bacterial growth and the targeted gene expression of tested bacteria in vitro. DP-AD7anti-acpP remarkably increased the survival rate of septic mice infected by ESBLs-E. coli, exhibiting strong antibacterial effects in vivo. CONCLUSIONS: For the first time, we designed DPP as a potent carrier to deliver ASOs for combating MDR bacteria and demonstrated the essential features, namely, amphipathicity, 8-10 positive charges, and 2 histidine residues, that are required for efficient DPP based delivery, and provide a novel approach for the development and research of the antisense antibacterial strategy.

Significance of the 'line sign' in the diagnosis of congenital imperforate anus on prenatal ultrasound.

BACKGROUND: The prenatal diagnosis of foetal imperforate anus is difficult. Most previous studies have been case reports. To provide useful information for diagnosing foetal imperforate anus, a retrospective review of diagnostic approaches was conducted. Ultrasonography was performed in 19 cases of foetal imperforate anus from 2016 to 2019 at our prenatal diagnostic centre. The prenatal sonographic features and outcomes of each case were collected and evaluated. RESULT: The anal sphincter of a normal foetus shows the 'target sign' on cross-sectional observation. Of the 19 cases of imperforate anus, 16 cases were diagnosed by the ultrasound image feature called the 'line sign'. 1 case with tail degeneration was low type imperforate anus with the irregular 'target sign' not a real 'target sign'. There was two false-negative case, in which the 'target sign' was found, but irregular. CONCLUSION: In this study, we find that the anus of a foetus with imperforate anus presents a 'line sign' on sonographic observation. The absence of the 'target sign' and then the presence of the 'line sign' can assist in the diagnosis of imperforate anus. The 'line sign' can be used as a secondary assessment to determine the type of the malformation following non visualization of the 'target sign'. The higher the position of the imperforate anus is, the more obvious the 'line sign'. It is worth noting that the finding of the short 'line sign' and irregularr 'target sign' can not ignore the low type imperforate anus.

Longibramides A-E, Peptaibols Isolated from a Mushroom Derived Fungus Trichoderma longibrachiatum Rifai DMG-3-1-1.

Five new peptaibols, longibramides A-E (1-5) with 11 amino acid residues, were isolated from a fungus Trichoderma longibrachiatum Rifai DMG-3-1-1, which was isolated from a mushroom Clitocybe nebularis (Batsch) P. Kumm collected from coniferous forest in the subboreal area of northeast China. The structures of longibramides A-E were determined by their spectroscopic data (NMR and MS-MS spectra), their absolute configurations were determined by X-ray diffractions and Marfey's analyses. The X-ray diffractions of longibramides A, B, and the similar CD spectra of A-E showed that they all had α-helix conformations. Longibramides B and E showed moderate cytotoxicities against BV2 and MCF-7 cells and also showed some inhibitory effects against methicillin-resistant Staphylococcus aureus MRSA T144. L-trans-Hyp was not commonly found in natural peptaibols, which was the 6th or 10th amino acid residue in longibramides C-E. The X-ray diffractions of longibramides A and B afforded the accuracy conformations of their secondary structures, which maybe help to interpret the structure-activity relationships of the family of peptaibols in the future.

The Effect of Sacubitril-Valsartan in Heart Failure Patients With Mid-Range and Preserved Ejection Fraction: A Meta-Analysis.

BACKGROUND: The effect of sacubitril-valsartan in heart failure patients with mid-range (HFmEF) and preserved (HFpEF) ejection fractions remains unclear. This study aimed to investigate the clinical benefits of sacubitril-valsartan in HFmEF and HFpEF patients. METHODS: PubMed, EMBASE, Cochrane Library, and China National Knowledge Infrastructure were searched from inception to 29 February 2020 to identify pertinent articles. Studies meeting the inclusion criteria were included and analysed. RESULTS: Six (6) studies, with a total of 5,503 patients, were included. Compared with angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, sacubitril-valsartan significantly reduced the rate of HF hospitalisation (risk ratios, 0.84; 95% CI, 0.77-0.91; p<0.001) and improved the New York Heart Association class (risk ratios, 1.25; 95% CI, 1.10-1.43; p=0.001) in HFmEF and HFpEF patients. Both the cardiovascular mortality and all-cause mortality were not significantly decreased by sacubitril-valsartan. In addition, there were no significant between-group differences in the N-terminal pro-B-type natriuretic peptide and left ventricular ejection fraction changes. Regarding safety, sacubitril-valsartan was likely to increase the risk of hypotension, but the incidence of serum creatinine elevation was significantly lower in the sacubitril-valsartan group than in the angiotensin-converting enzyme inhibitors and angiotensin receptor blockers group. CONCLUSIONS: This meta-analysis suggests that sacubitril-valsartan may be an effective and safe strategy with which to improve the clinical symptoms and reduce HF hospitalisation in HFmEF and HFpEF patients.

Outer membrane protein A (OmpA) as a potential therapeutic target for Acinetobacter baumannii infection.

Acinetobacter baumannii (A. baumannii) is an important opportunistic pathogen causing serious nosocomial infections, which is considered as the most threatening Gram-negative bacteria (GNB). Outer membrane protein A (OmpA), a major component of outer membrane proteins (OMPs) in GNB, is a key virulence factor which mediates bacterial biofilm formation, eukaryotic cell infection, antibiotic resistance and immunomodulation. The characteristics of OmpA in Escherichia coli (E. coli) have been extensively studied since 1974, but only in recent years researchers started to clarify the functions of OmpA in A. baumannii. In this review, we summarized the structure and functions of OmpA in A. baumannii (AbOmpA), collected novel therapeutic strategies against it for treating A. baumannii infection, and emphasized the feasibility of using AbOmpA as a potential therapeutic target.

Poly (ADP-ribose) polymerase (PARP) inhibitor regimens for ovarian cancer in phase III randomized controlled trials: a network meta-analysis.

INTRODUCTION: We aimed to evaluate poly (ADP-ribose) polymerase (PARP) inhibitor (PARPi) regimens in BRCA-mutated ovarian cancer for patients responsive to front-line platinum (bevacizumab and olaparib, veliparib and chemotherapy, olaparib) or platinum-sensitive relapsed (olaparib, rucaprib, niraparib) patients in phase III randomized controlled trials. METHODS: A network meta-analysis was utilized to generate the direct and indirect comparisons. The primary outcomes for network meta-analysis were efficacy (hazard ratios for progression-free survival in BRCA mutation cohort) and toxicity (odds ratios for all grade 3-4 adverse events). The American Society of Clinical Oncology (ASCO) value framework was used to assess the cost-effectiveness of the PARPi regimens. RESULTS: Network meta-analysis indicated no statistically significant differences in efficacy and toxicity among the assessed upfront or relapsed PARPi regimens (95% CI included 1). The ASCO value framework indicated that current PARPi regimens were similar in clinical benefits, toxicity, and net health benefit in the upfront (bevacizumab and olaparib, veliparib and chemotherapy, olaparib) and relapsed setting (olaparib, rucaprib, niraparib). The addition of bevacizumab to olaparib ($353.72) increased the cost per unit net health benefit for patients compared with olaparib monotherapy ($260.57). The upfront PARPi regimens had lower toxic scores than the regimens used at relapse. CONCLUSIONS: The choice of PARPi regimens both in the upfront and relapsed setting should consider not only efficacy and toxicity but also costs in BRCA mutation patients. Current combining PARPi regimens are not recommended for such patients in the upfront setting from the cost-effective perspective. Upfront PARPi regimens are less toxic than those used at relapse.

Comparison of laparoscopic versus open radical hysterectomy in patients with early-stage cervical cancer: a multicenter study in China.

INTRODUCTION: Recently, the safety of minimally invasive surgery in the treatment of cervical cancer has been questioned. This study was designed to compare the disease-free survival and overall survival of abdominal radical hysterectomy and laparoscopic radical hysterectomy in patients with early-stage cervical cancer. METHODS: A total of 1065 patients with early-stage cervical cancer who had undergone abdominal/laparoscopic radical hysterectomy between January 2013 and December 2016 in seven hospitals were retrospectively analyzed. The 1:1 propensity score matching was performed in all patients. Patients with tumor size ≥2 cm and <2 cm were stratified and analyzed separately. Disease-free survival and overall survival were compared between matched groups. After confirming the normality by the Shapiro-Wilks test, the Mann-Whitney U test and the χ2 test were used for the comparison of continuous and categorical variables, respectively. The survival curves were generated by the Kaplan-Meier method and compared by log-rank test. RESULTS: After matching, a total of 812 patients were included in the disease-free survival and overall survival analyses. In the entire cohort, the laparoscopic radical hysterectomy group had a significantly shorter disease-free survival (HR 1.65, 95% CI 1.00 to 2.73; p=0.048) but not overall survival (HR 1.60, 95% CI 0.89 to 2.88; p=0.12) when compared with the abdominal radical hysterectomy group. In patients with tumor size ≥2 cm, the laparoscopic radical hysterectomy group had a significantly shorter disease-free survival (HR 1.93, 95% CI 1.05 to 3.55; p=0.032) than the abdominal radical hysterectomy group, whereas no significant difference in overall survival (HR 1.90, 95% CI 0.95 to 3.83; p=0.10) was found. Additionally, in patients with tumor size <2 cm, the laparoscopic radical hysterectomy and abdominal radical hysterectomy groups had similar disease-free survival (HR 0.71, 95% CI 0.24 to 2.16; p=0.59) and overall survival (HR 0.59, 95% CI 0.11 to 3.13; p=0.53). CONCLUSION: Laparoscopic radical hysterectomy was associated with inferior disease-free survival compared with abdominal radical hysterectomy in the entire cohort, as well as in patients with tumor size ≥2 cm. For the surgical treatment of patients with early-stage cervical cancer, priority should be given to open abdominal radical hysterectomy.

The application of prenatal ultrasound in the diagnosis of congenital duodenal obstruction.

BACKGROUND: The purpose of this research is to summarize the prenatal ultrasound characteristics of congenital duodenal obstruction (CDO), especially in the diagnosis of duodenal diaphragm and annular pancreas. At present, few researchers have summarized the specific ultrasound features of duodenal diaphragm and annular pancreas. METHODS: In this study, a retrospective analysis of 40 patients diagnosed with CDO between January 2016 and December 2019 was carried out. Data on the diagnosis, ultrasound images and outcomes of the patients were gathered, and the features of the patients were analyzed. RESULTS: The results showed that there were 17 patients (42.5%) of congenital duodenal diaphragm, all with a 'rat tail' sign on the ultrasound images. Moreover, there were 4 patients (10.0%) of CDO caused by annular pancreas, all with a 'pliers' sign on the ultrasound images. We summarized the imaging features of the 'rat tail' sign and the 'pliers' sign. CONCLUSION: The main conclusion of this study was that the 'rat tail' sign could be used as an indirect ultrasound feature to diagnose duodenal diaphragm. The 'pliers' sign could be used as a direct ultrasound feature in the diagnosis of annular pancreas in CDO.

A high Glasgow prognostic score (GPS) or modified Glasgow prognostic score (mGPS) predicts poor prognosis in gynecologic cancers: a systematic review and meta-analysis.

PURPOSE: The Glasgow Prognostic Score or modified Glasgow Prognostic Score (GPS/mGPS), a novel inflammatory indicator, which acts as a prognostic predictor in various cancers. However, these results are still controversial. In this meta-analysis, we aimed to investigate the prognostic role of GPS/mGPS in patients with gynecologic cancers. METHODS: We explored eligible studies by searching the databases PubMed, the Cochrane Library, EMBASE, and Web of Science. The hazard ratio (HR) and odds ratios (OR) with 95% confidence intervals (CIs) were extracted to investigate the correlation between GPS/mGPS and overall survival (OS) and progression-free survival (PFS). Additionally, we performed subgroup analyses to detect the potential heterogeneity in our study. RESULTS: 11 studies involving 2830 patients were enrolled in this meta-analysis. The results revealed that a high GPS was significantly related to a shorter OS (pooled HR = 1.94; 95% CI = 1.54-2.43; P < 0.001) and PFS (pooled HR = 1.92; 95% CI = 1.56-2.35; P < 0.001) in patients with gynecologic cancers. Moreover, mGPS also predicted poor OS (pooled HR = 1.67; 95% CI = 1.41-1.96; P < 0.001) and PFS (pooled HR = 1.73; 95% CI = 1.47-2.04; P < 0.001) in gynecologic cancers patients. CONCLUSION: A higher GPS/mGPS is correlated with poor survival outcomes in patients with gynecologic cancers. Pretreatment GPS/mGPS is a valid prognostic predictor in gynecologic cancers.

Risk of recurrence of uterine leiomyomas following laparoscopic myomectomy compared with open myomectomy.

PURPOSE: To determine whether or not the risk of recurrence of uterine leiomyoma (UL) was different between laparoscopic myomectomy (LM) and open myomectomy (OM). METHODS: This study combined a multicenter cohort study with a meta-analysis. The cohort study included women aged 18-44 years with 1-3 leiomyomas who underwent LM or OM for UL at one of three teaching hospitals. The meta-analysis included trials comparing recurrence rates of UL between OM and LM. RESULTS: A total of 396 patients (LM: n = 83; OM: n = 313) were recruited in the cohort study. For women aged 18-44 years with 1-3 leiomyomas, surgical approach (LM vs. OM) was not an independent risk factor of UL recurrence (31.3% vs. 34.2%, P = 0.571), and the reoperation rate of UL was similar between the LM and OM (2.4% vs. 4.2%, P = 0.726). A total of 2566 patients were meta-analyzed. The recurrence of UL was similar between LM and OM when the patients had ≤ 5 leiomyomas (OR 1.10; 95% CI 0.76-1.61; P = 0.610; I2 = 0%), while the recurrence rate in LM group was higher when the patients had > 5 leiomyomas (OR 1.50; 95% CI 1.14-1.97; P = 0.004; I2 = 38%). CONCLUSION: From the meta-analysis, the recurrence rate of UL was similar between LM and OM when the patients had ≤ 5 leiomyomas, while the recurrence of LM was higher when the number of leiomyomas was > 5. The cohort study partially supported this conclusion and it further proved the reoperation rate of UL was also similar among women aged 18-44 years with ≤ 3 leiomyomas. Therefore, OM should be considered for patients with > 3 or 5 leiomyomas if myomectomy has already been chosen.

Pretreatment thrombocytosis predict poor prognosis in patients with endometrial carcinoma: a systematic review and meta-analysis.

BACKGROUND: Several previous studies have confirmed that thrombocytosis was related to reduced survival in many solid tumors. However, the prognostic significance of thrombocytosis in endometrial carcinoma (EC) was still controversy. Therefore, we conducted this study to assess the prognostic value of thrombocytosis in EC. METHODS: The database including PubMed, MEDLINE, EMBASE, and Web of Science was searched to explore available literature. Above all, the hazard ratio (HR), odds ratios (OR) with 95% confidence intervals (CIs) was used to investigate the correlation between thrombocytosis and overall survival (OS) and disease-free survival (DFS). Moreover, the association between thrombocytosis and patient clinicopathological characteristics was explored. Publication bias and sensitivity analysis also were conducted in this study. RESULTS: Overall, 11 studies involving 3439 patients were contained in this study. The results revealed that pretreatment thrombocytosis was significantly related to a decreased OS (pooled HR = 2.99; 95% CI = 2.35-3.8; P < 0.001) and DFS (pooled HR = 2.86; 95% CI = 2.27-3.6; P <  0.001) in patients with EC. Moreover, thrombocytosis was correlated with adverse clinicopathological parameters. CONCLUSIONS: Pretreatment thrombocytosis is an adverse prognostic marker in patients with EC.

Systemic immune-inflammation index predicts prognosis in patients with epithelial ovarian cancer: A retrospective study.

OBJECTIVE: The study aimed to investigate the prognostic value of the systemic immune-inflammation index (SII) in patients with epithelial ovarian cancer (EOC). METHODS: A total of 553 EOC patients were retrospectively analyzed. 250 patients from West China Second University Hospital were assigned into the discovery cohort and 283 patients from The Affiliated Hospital of Southwest Medical University were assigned into the validation cohort. The correlation between SII and survival were analyzed using Cox regression analyses and Kaplan-Meier method. Prediction accuracy was evaluated with the receiver operating characteristics (ROC) curve. RESULTS: The high SII (≥612) was correlated with advanced FIGO stage, lymph node metastasis, and tumor recurrence. In univariate Cox regression, patients with high SII (≥612) had a significantly shorter progression-free survival (PFS) and overall survival (OS) compared to low SII patients (<612) in both cohorts. In multivariate Cox regression analysis, SII was an independent prognostic indicator for PFS (HR = 7.61, 95% CI 3.34-17.35, P < 0.001) and OS (HR = 6.36, 95% CI 2.64-15.33, P < 0.001) in the discovery cohort. These results were verified in the validation cohort. CONCLUSION: High SII was correlated with poor survival in patients with EOC. The SII was an independent prognostic factor for patients with EOC.

Comparison of Major Clinical Outcomes Between Transvaginal NOTES and Traditional Laparoscopic Surgery: A Systematic Review and Meta-analysis.

BACKGROUND: The advent of transvaginal natural orifice transluminal endoscopic surgery (transvaginal NOTES) aims to minimize surgical trauma and reduce recovery time. MATERIALS AND METHODS: Clinical trials comparing transvaginal NOTES and traditional laparoscopy were identified by searching EMBASE, MEDLINE, and Web of Science (from 2004 to March 2018). Major outcomes evaluated were risk of postoperative complications and secondary outcomes were pain on postoperative day (POD) 1, POD2, and POD3, time needed for full recovery, risk of intraoperative complications, the duration of surgery, and hospital stay. The results of the meta-analysis are presented as standardized mean difference (SMD) and risk difference (RD) with 95% confidence intervals (CIs). RESULTS: Thirteen trials with 1340 patients were identified. There were no statistical differences for risk of complications between transvaginal NOTES and traditional laparoscopy (intraoperative complications: RD -0.01, 95% CI -0.03 to 0.01; P = 0.37; postoperative complication: RD -0.02, 95% CI -0.05 to 0.01; P = 0.148). The pain score was lower in transvaginal NOTES on POD1 (SMD: -0.71, 95% CI: -1.30 to -0.11, P = 0.019), on POD2 (SMD -0.41, 95% CI -0.75 to -0.07; P = 0.018), and on POD3 (SMD -0.43, 95% CI -0.63 to -0.23; P < 0.001). Patients in transvaginal NOTES needed much shorter time to fully recover after surgery (SMD -1.36, 95% CI -1.84 to -0.87; P < 0.001). In addition, patients underwent transvaginal NOTES had less pain and shorter time of recovery. CONCLUSIONS: It is recommended that patients have cholecystectomy, adnexectomy, and appendectomy using transvaginal NOTES as it is safe and minimally invasive.

Molecular expression characteristics confirm the malignancy concealed by morphological alterations in endometrial cancer after fertility-preserving treatment.

PURPOSE: Fertility-preserving treatment (FPT) has been widely used for young patients with early stage endometrial cancer (EC). However, the literature on the effectiveness and safety of FPT remains controversial. The aim of this study was to investigate malignant transformation in EC after FPT by immunohistochemistry (IHC). METHODS: A retrospective analysis of pre- and post-treatment biopsy specimens from 24 patients with grade 1 endometrioid adenocarcinoma (EAC) or complex atypical hyperplasia (CAH) was performed. The expression levels of ARID1A, PTEN, and ß-catenin were assessed by IHC. RESULTS: The protein expression levels of ARID1A, PTEN, and ß-catenin were not significantly different between pre- and post-treatment specimens. However, there was a significant difference between pre-treatment and normal specimens as well as between post-treatment and normal specimens. The protein expression of ß-catenin was significantly increased in patients with progression compared with those without progression after FPT. CONCLUSION: The morphologic normalization of patients with EC after FPT may not be accompanied by the absence of tumor malignancy, and ß-catenin may serve as a biomarker for the response to FPT. These results may contribute to a better understanding of the malignant transformation of EC after FPT and the optimization of treatment strategies for young patients with birth plans.

Single-incision laparoscopic hysterectomy using conventional laparoscopic instruments: initial experience with 25 cases.

PURPOSE: To evaluate the feasibility and safety of single-incision laparoscopic hysterectomy using conventional instruments. METHODS: Twenty-five patients undergoing single-incision laparoscopic hysterectomy (SI-LAH) using conventional instruments at West China Second University Hospital between July, 2017 and December, 2017 were selected for participation. Another 25 cases undergoing traditional multi-port laparoscopic hysterectomy (MP-LAH) matched with similar uterine size were selected as controls. Characteristics and clinical data of patients including operative time, estimated blood loss, hospital stay, catheter retention time, and intraoperative and postoperative complications were compared between the two groups. RESULTS: The baseline characteristics of the two groups were comparable. The estimated blood loss was less in SI-LAH with respect to MP-LAH (30 mL [range 20-50] vs 50 mL [range 10-200], P < 0.05), with no statistically significant difference in terms of decrease of hemoglobin level (17 g/dL [range 2-24] vs 18 g/dL [range 5-28], P > 0.05). There were no significant differences between the two groups in terms of operative time (150 min [range 85-225] vs 145 min [range 100-220], P > 0.05), intraoperative injury, catheter retention time, time to exhausting, postoperative hospital stay. In all cases, no additional port incision was needed and no conversion to laparotomy was necessary in two groups. No patient had development of intraoperative or postoperative complications. After a follow-up of 2 months, no incisional hernia occurred in all patients. CONCLUSIONS: Single-incision laparoscopic hysterectomy using conventional instruments is a feasible and safe technique for patients with uterine size less than 12 weeks of pregnancy and no serious pelvic adhesion, requiring for more experienced skill of surgeons.