Application of fluorescein combined with methylene blue in sentinel lymph node biopsy of breast cancer.

Sentinel lymph node biopsy (SLNB) for axillary lymph node staging in early breast cancer has been widely recognized. The combination of radio-colloids and dye method is the best method recognized. The reagents and equipment required in the process of the combined method are complex and expensive, so there are certain restrictions in the use of primary medical institutions. As a new tracer, fluorescent tracer technology has attracted much attention. We aimed to evaluate the feasibility and safety of fluorescein for SLNB in breast cancer. In this study, a total of 123 patients with breast cancer were divided into group A (n = 67) and group B (n = 56). The efficacy of Indocyanine green (ICG) combined with methylene blue (group A) and fluorescein combined with methylene blue (group B) in SLNB of breast cancer was compared, complications were observed at the same time. No local or systemic reactions were observed in the two groups. In group A, Sentinel lymph nodes of breast cancer were detected in 63 patients, with a detection rate of 94.0% (63/67), a false-negative rate of 7.5% (4/53). In group B, Sentinel lymph nodes of breast cancer were detected in 52 patients, with a detection rate of 92.9% (52/56), a false-negative rate of 7.5% (3/40). There was no significant difference in biopsy results between the two groups. This prospective clinical study suggests that SLNB using fluorescein and ultraviolet LED light is feasible in breast cancer patients. No adverse reactions were observed in this study, but larger studies are needed to properly assess the adverse reaction rate.

Hepatitis E virus re-infection accelerates hepatocellular carcinoma development and relapse in a patient with liver cirrhosis: A case report and review of literature.

BACKGROUND: Hepatitis E virus (HEV) superinfection is a suspected promoting factor for hepatocellular carcinoma (HCC) in patients with chronic hepatitis and cirrhosis. However, to date, very few cases of HEV-related HCC have been reported. Nevertheless, the role of HEV re-infection in cirrhotic liver without other chronic hepatitis infections has rarely been explored. CASE SUMMARY: A 53-year-old male farmer was diagnosed with liver cirrhosis and splenomegaly in August 2016, accompanied with negative HEV-IgM and positive HEV-IgG. No evidence of hepatitis B virus or hepatitis C virus infection was found. Since then the patient was evaluated for liver function and viral parameters every 3 mo. In June 2017, the patient presented severe fatigue with whole body itching and was diagnosed with HCC. Afterwards this patient experienced quick HCC development, progression, relapse, and metastasis in the following 8 mo, and presented persistent dual positivity of HEV-IgM and HEV-IgG. This patient had a long history of smoking and alcohol consumption. CONCLUSION: This unique case invokes the importance of HEV surveillance and treatment among cirrhotic patients, HCC cases, and blood donors.

Case Report of Contrast-Enhanced Ultrasound Features of Primary Hepatic Neuroendocrine Tumor: A CARE-Compliant Article.

Primary hepatic neuroendocrine tumors (PHNETs) are very rare and their clinical features and treatment outcomes are not well understood. It is difficult to reach a proper diagnosis before biopsy or resection. The aim of this study was to analyze the imaging features of PHNETs on contrast-enhanced ultrasound (CEUS). The clinical characteristics, CEUS findings, pathological features, treatment and prognosis of 6 patients with PHNET treated in our hospital were retrospectively analyzed.Most PHNETs occurred in middle-aged patients, and the most common clinical manifestation was right upper quadrant palpable mass and abdominal pain. Multiple small anechoic intralesional cavities occurred frequently in PHNET. Multilocular cystic with internal septation or monolocular with wall nodule could also be detected. On contrast-enhanced ultrasonography (CEUS), heterogeneous hyperenhancement in the arterial phase and wash-out hypoenhancement were observed in most patients, while computed tomography scanning yielded similar results. Diagnosis of PHNET was confirmed by immunohistochemical result and follow-up with the absence of extrahepatic primary sites. Five patients received surgical resection and 2 cases exhibited recurrence. Transcatheter arterial chemoembolization was performed in 1 patient with recurrence. Only 1 patient received conservative care. The median overall survival in 5 patients who underwent surgical treatment was 27 months (18-36 months). PHNET is a rare tumor, and its diagnosis is difficult. The CEUS features reported in this series may enrich the knowledge base for characterization of PHNET.

Randomized, controlled trial comparing the efficacy of intrauterine balloon and intrauterine contraceptive device in the prevention of adhesion reformation after hysteroscopic adhesiolysis.

OBJECTIVE: To compare the efficacy of heart-shaped intrauterine balloon and intrauterine contraceptive device (IUD) in the prevention of adhesion reformation after hysteroscopic adhesiolysis. DESIGN: Prospective, randomized, controlled trial. SETTING: University hospital. PATIENT(S): A total of 201 women with Asherman syndrome. INTERVENTION(S): Women were randomized to having either a heart-shaped intrauterine balloon or an IUD fitted after hysteroscopic adhesiolysis. The devices were removed after 7 days. A second-look hysteroscopy was carried out 1 to 2 months after the surgery. MAIN OUTCOME MEASURE(S): Incidence of adhesion reformation and reduction of adhesion score before and after surgery. RESULT(S): Initially 201 cases were recruited; 39 cases dropped out, resulting in 82 cases in the balloon group and 80 cases in IUD group. The age, menstrual characteristics, pregnancy history, and American Fertility Society score before surgery were comparable between the two groups. The median adhesion score reduction (balloon group, 7; IUD group, 7) and the adhesion reformation rate (balloon group, 30%; IUD group, 35%) were not significantly different between the two groups. CONCLUSION(S): The heart-shaped intrauterine balloon and IUD are of similar efficacy in the prevention of adhesion reformation after hysteroscopic adhesiolysis for Asherman syndrome. CLINICAL TRIAL REGISTRATION NUMBER: ISRCTN 69690272.

Expression and Distribution of Calcium-Binding Protein S100P in Human Placenta during Pregnancy.

BACKGROUND: S100P is a member of the S100 family of calcium-binding proteins, and it participates in pathophysiological events, such as tumor growth and invasion. Based on the striking similarities between trophoblast cells and tumor cells with regard to proliferative and invasive properties, we raised the question of whether and how S100P expresses in trophoblast cells during development. This study aimed to investigate the expression pattern of S100P in the human placenta during pregnancy development. MATERIALS AND METHODS: In this experimental study, we collected 16 first-trimester placental tissues, 10 second-trimester placental tissues, and 12 term placentas. The mRNA expression levels of S100P were detected by reverse-transcription-polymerase chain reaction (RT-PCR) and quantitative real-time PCR, the protein expression levels were detected by western blot, and the localization of S100P was measured by immunohistochemical staining. The values obtained from PCR and western blot analysis were expressed as the mean ± SD. Levene's test was used to test equal variances, and one-way analysis of variance (ANOVA) was used to evaluate differences between groups. RESULTS: Protein and mRNA expression of S100P could be detected in placenta during pregnancy, with minor higher levels in first-trimester (p>0.05). Immunohistochemical staining revealed that S100P protein was strongly expressed in syncytiotrophoblasts, and moderate expression was detected in villous cytotrophoblasts and cytotrophoblast columns. The S100P protein was localized to both cytoplasm and nuclei in syncytiotrophoblasts, while it only existed in the cytoplasm of cytotrophoblasts. CONCLUSION: S100P was strongly detected in human placenta during pregnancy. The specific expression and distribution of S100P in human placenta throughout gestation suggested that S100P function might vary with its location in the placenta.

[Influencing factors of reproduction status of patients undergoing laparoscopic myomectomy].

OBJECTIVE: To explore the influencing factors of reproduction status in women undergoing laparoscopic myomectomy (LM). METHODS: A total of 278 LM patients were recruited.We retrospectively reviewed the reproduction status of 87 pregnant cases after LM. The correlations of their pregnancy outcomes and such clinical profiles as age, operative techniques, biological characteristics of fibroids (number, type, size and location) were analyzed.No uterine rupture occurred during the gestation period. RESULTS: None of them switched to open surgery due to laparoscopic difficulties. However, one patient had a laparoscopic suture for secondary bleeding of uterine incision. At 3 months post-operation, sonography showed no heterogeneous echo, effusion and hematoma in uterine incision.Incision through uterine cavity occurred intraoperatively in 8 cases, but no intrauterine adhesion was found on hysteroscopy 3 months later. And 87 women became pregnant and the postoperative fertilization time was from 2 months to 5 years. Age influenced the postoperative pregnancy rate.Other factors such as location, number and size of fibroid had no impact on fertility. CONCLUSION: For achieving a high conception rate and guaranteeing the safety of pregnant women, a clinician should select reasonable surgical approaches, perform accurate anatomical restoration, apply strict hemostasis and choose a right time of conception.

Fertility-preserving treatment and pregnancy outcomes in the early stage of endometrial carcinoma.

OBJECTIVE: This study aimed to review the available literature on fertility-preserving treatment and pregnancy outcomes in patients with early-stage endometrial carcinoma who desired to preserve their fertility. DATA SOURCES: The PubMed database (1992-2012) was searched for the words "conservative "OR" fertility sparing "OR" fertility preserving" AND "endometrial neoplasms" (MeSH). All relevant articles in English and the relevant references were collected. STUDY SELECTION: Data from published articles about fertility-preserving treatment of endometrial cancer, including the response and recurrence rate of conservative treatment, strategies of infertility treatment, pregnancy, and obstetric outcomes, were selected. Data were mainly extracted from 41 studies, which are listed in the reference section of this review. RESULTS: Hormone therapy was the most common method used for early-stage endometrial carcinoma in patients who wished to preserve fertility. Sixty percent of the patients became pregnant after remission of the carcinoma. The percentage of patients who conceived in the assisted reproductive technology group was higher than that of the natural pregnancy group (80.0% vs. 43.2%, P < 0.01). A higher rate of preterm labor and multiple pregnancies was observed in the assisted reproductive technology group than that in the natural pregnancy group. The majority of pregnancies (71.4%) in the assisted reproductive technology group were achieved by in vitro fertilization-embryo transfer. The clinical pregnancy rate of transfer cycles in patients with endometrial carcinoma was 34.1%. CONCLUSIONS: Assisted reproductive technology is a good option in well-selected patients with early-stage endometrial carcinoma who have completed conservative treatment. In vitro fertilization-embryo transfer offers an opportunity to achieve an immediate pregnancy.

[Effects of early intervention of second-look office hysteroscopy in the prevention of adhesion reformation for moderate-severe Asherman's syndrome].

OBJECTIVE: To compare the efficacy of different time interval in the prevention of adhesion reformation after hysteroscopic adhesiolysis for moderate-severe Asherman's syndrome. METHODS: A total of 125 women with moderate-severe Asherman's syndrome undergoing hysteroscopic division of intrauterine adhesion were enrolled into this retrospective cohort study. All patients underwent second-look hysteroscopy after a certain period of the first hysteroscopic adhesiolysis, and the operation would be performed again if any adhesion existed. According to the different time interval of hysteroscopy examination, they were divided into 3 groups: A: < 1 month (n = 50), B:1-2 months (n = 39), C >2 months (n = 36). The effect of hysteroscopic adhesiolysis was evaluated by American Fertility Society (AFS) score. RESULTS: The AFS score decreased significantly after hysteroscopic adhesiolysis in each group and the normal uterine rate was up to 64.8%. The median of decreased AFS score and normal uterine rate were as follows:group A:7 point and 78%, group B:7 point and 66.7%, group C:5 point and 44.4%. And groups A and B achieved significantly (P < 0.01) greater reductions in the adhesion score than that of group C. The median time of recovery to normal uterine cavity were 1.64, 2.75 and 5.26 months in each group and great differences existed among them (P < 0.01). CONCLUSION: The time interval of second-look hysteroscopy less than 1 month offers a better prognosis in the prevention of adhesion reformation for moderate-severe Asherman's syndrome.

Outcome of conservative treatment and subsequent assisted reproductive technology for patients with early-stage endometrial adenocarcinoma and poor fertility potential.

Conservative treatment with high doses of progestin is an alternative to standard hysterectomy for young patients with early-stage endometrial adenocarcinoma who desire to preserve their fertility. Here we report a patient with well-differentiated early-stage endometrial adenocarcinoma and poor fertility potential who failed to become pregnant in two in vitro fertilization-embryo transfer cycles and suffered a relapse after conservative treatment. This case illustrates that assessment of fertility potential is critical at the time of initial evaluation and conservative treatment planning for patients with endometrial adenocarcinoma.

[Comparison of surgery for staging using laparoscopy and laparotomy in patients with endometrial cancer].

OBJECTIVE: To compare the surgical outcomes for staging by laparoscopy and laparotomy in patients with endometrial cancer, evaluate the feasibility of laparoscopic surgical treatment of endometrial cancer, compare the difference between clinical and surgical staging of endometrial cancer and elucidate the advantages and feasibility of its surgical staging. METHODS: Fifty-six patients diagnosed pre-operatively as stage I endometrial cancer were reviewed for surgery for staging. They were assigned into laparoscopic group (n = 34) and laparotomic (open) group (n = 22). The operative parameters including operating time, intra-operative blood loss, the number of lymph nodes removed, gastrointestinal recovery time, urinary catheterization time, complications and post-operative hospital stay were compared. RESULTS: The pre-operative clinical characteristics before operation between two groups were similar. No significant differences were found in age and body mass index between two groups. As compared with the open group, the laparoscopic group had a longer operation time (213 min ± 49 min vs 162 min ± 30 min, P < 0.05), less hemoglobin change (12 g/L ± 8 g/L vs 19 g/L ± 8 g/L, P < 0.05), shorter hospital stay (6.3 d ± 1.7 d vs 9.5 d ± 1.8 d, P < 0.01) and shorter gastrointestinal recovery time (1.8 d ± 0.6 d vs 2.7 d ± 1.2 d, P < 0.01). While there was no significant difference between two groups in the number of lymph nodes removed, urinary catheterization time, costs and complications. The total coincidence was 57.14% between clinical and surgical staging. CONCLUSION: Laparoscopic staging surgery is both feasible and safe in the treatment of endometrial cancer. And the surgical staging truly reflects the extent of cancer invasion and it is thus necessary for early-stage endometrial cancer.

Calcium-binding protein S100P is highly expressed during the implantation window in human endometrium.

OBJECTIVE: To investigate S100P expression and localization in human endometrium throughout the menstrual cycle. DESIGN: Experimental study. SETTING: University hospital. PATIENT(S): Eighty-four women. INTERVENTION(S): Complementary DNA (cDNA) microarray analysis was performed on human endometrium from days LH+4, LH+7, and hCG+7. Reverse transcriptase-polymerase chain reaction (RT-PCR) and Western blot analysis were used to detect the expression of S100P and of additional S100 family members, S100A4, S100A13, and S100A6. Immunofluorescence was used to detect the localization of S100P protein in LH+7 and LH+4 endometrium. MAIN OUTCOME MEASURE(S): Differential gene expression, levels of S100P messenger RNA (mRNA), and protein expression and immunofluorescent localization of S100P. RESULT(S): A statistical method, based on hierarchical clustering, identified genes whose expression varied at LH+7 compared with LH+4. We found that S100P was the fourth most up-regulated gene at LH+7. The S100P mRNA and protein levels were quite low during the proliferative phase and LH+4, but were elevated significantly at LH+7. The S100P expression at hCG+7 was lower than that at LH+7. However, the expression of S100A4, S100A13, and S100A6 did not vary throughout the menstrual cycle. CONCLUSION(S): S100P was specifically up-regulated during the implantation window. The underlying biological effects of S100P need further exploration.

[Gene expression profiles of peri-implantation endometrium in natural and superovulation cycles].

OBJECTIVE: To find valuable implantation-related genes associated with endometrial receptivity by scanning the complete genome array of endometrium at the luteal phase of superovulation cycle and the natural cycle. METHODS: Twenty endometrial samples were obtained from patients who were to undergo invitro fertilization and embryo transfer because of the ovarian or male factors, underwent real-time quantitative PCR (QPCR) to confirm the differentially expressed genes and pathological examination to confirm the stages. Five of the 20 endometrial samples from days of LH + 4, LH + 7, or HCG + 7 underwent HU133 plus2.0 microarray scanning. The other 15 samples were divided into 2 groups: 7 samples were taken on the day LH + 7, and 8 samples taken on the day HCG + 7. RESULTS: 581 genes were expressed differentially in the LH + 7 and LH + 4 samples: 395 were up-regulated and 186 were down-regulated. 320 genes were expressed differentially in the HCG + 7 and LH + 7 samples: 175 genes were up-regulated, and 145 genes were down-regulated. QPCR test showed that the expression levels of some up-regulated genes were much lower on the day HCG + 7 than on the day LH + 7, such as PAEP, S100P, SOD and GDF15. CONCLUSION: Microarray scanning provides a global gene expression spectrum of human endometrium at different phases. A set of genes are active at the implantation window phase of endometrium. These genes don't show adequate expression after superovulation, which may lead to the change of endometrial receptivity.

Effects of gonadotropin-releasing hormone antagonists on the expression of vascular endothelial growth factor and its receptors in a rat model of ovarian hyperstimulation syndrome.

BACKGROUND: Ovarian hyperstimulation syndrome (OHSS) is one of the most life-threatening complications of assisted reproduction treatments. Gonadotropin-releasing hormone antagonists (GnRHanta) are thought to be effective in preventing this complication, and some clinical trials have found lower incidences of OHSS in patients treated with GnRHanta. Our aim was to investigate the effects of GnRHanta on vascular permeability and the expression of vascular endothelial growth factor (VEGF) and its receptors in a rat model of OHSS. METHODS: An immature early OHSS rat model was established. Three ovarian stimulation protocols were used: pregnant mare serum gonadotropin/human chorionic gonadotropin (hCG) alone, with a GnRHanta, or with a gonadotropin-releasing hormone agonists (GnRHa). Blood and tissue samples were collected at 48 hours after hCG administration. Vascular permeability was evaluated by measuring the Evans-Blue content of extravasated peritoneal fluids. The expression of VEGF and its receptors, including flt-1 and KDR, were detected by reverse transcriptase-polymerase chain reaction and Western blotting. RESULTS: Treatment with both a GnRHanta and a GnRHa resulted in significant reductions in serum estradiol and peritoneal vascular permeability, as well as decreased ovarian expression of VEGF and its two receptors. However, GnRHanta treatment caused a greater reduction in serum estradiol concentrations, and in VEGF receptor mRNA expression than GnRHa. There were no significant reductions in the expression of VEGF or its receptors in extra-ovarian tissues, including the liver, lungs and peritoneum. CONCLUSION: Our results reveal that GnRHanta are more potent than GnRHa in preventing early OHSS through down-regulation of the expression of VEGF and its receptors in hyperstimulated ovaries.

[Assessment of different homeostatic methods used in laparoscopic intramural myomectomy].

OBJECTIVE: To explore the safe and effective method of hemostasis in laparoscopic hysteromyomectomy (LM). METHODS: Two hundred and eighty women with symptomatic uterine intramural fibroids undergoing LM were assigned to 4 groups, Group A undergoing fibroid pedicle ligation, Group B injected with 12 IU diluted vasopressin around the myoma, Group C injected with 20 IU oxytocin combined with pedicle ligation, and Group D injected with vasopressin combined with pedicle ligation. The operation time, amount of blood loss, operative complications, bowel deflation, post-operative hemoglobin dropping, and length of hospital stay were compared. RESULTS: The amounts of blood loss of Groups A and C were (171 +/- 146) ml and (184 +/- 140) ml, both significantly higher than those of Groups B and D [(115 +/- 70) ml and (106 +/- 73) ml, both P < 0.01]. The length of hospital stay of Group D was (2.9 +/- 0.5) d, significantly shorter than those of Groups A, B, and C [(3.1 +/- 0.7) d, (3.6 +/- 0.8) d, and (3.3 +/- 0.7) d, all P < 0.05]. The bowel deflation time of Group D was (20 +/- 6) h, significantly shorter than those of the Groups A, B, and C [(26 +/-) h, (25 +/- 7) h, and (25 +/- 8) h respectively, all P < 0.05]. The post-operative hemoglobin dropping of group D was (1.1 +/- 0.9) g/L, significantly less than those of Groups A, B, and C [(1.5 +/- 1.0), (1.4 +/- 0.8), and (1.2 +/- 0.7) g/L respectively, all P < 0.05]. CONCLUSIONS: Vasopressin (12 IU) injection around the myoma is a simple, effective, and safe homeostatic procedure during LM. Pedicle ligation can reduce advanced post-operative bleeding post-operation.

[Enucleation of benign ovarian cysts by laparoscopy].

OBJECTIVE: To evaluate the efficacy of improved laparoscopic enucleation of benign ovarian cysts. METHODS: A total of 234 cases of ovarian cysts with 271 cysts were analyzed retrospectively. 152 patients with 177 ovarian cysts (Group A) underwent the improved laparoscopic enucleation and 82 patients with 94 ovarian cysts (Group B) underwent the classic laparoscopic enucleation. The data of operative process and postoperative follow-up were compared between two groups. RESULTS: The rate of spillage of the Group A and Group B was 1.7% and 18.1% (P<0.01), respectively. The operating time was (40 +/-14)min and (47 +/- 16)min (P<0.01), respectively. The blood loss was (25 +/-17)ml and (27 +/- 19)ml (P>0.05), respectively. The bowel deflation recovery time was (18 +/- 8)h and (19 +/- 8)h (P>0.05), respectively. The length of hospital stay was (2.0 +/- 0.5)d and (2.2 +/- 0.8)d (P>0.05), respectively. CONCLUSION: Compared with classic laparoscopic procedure, the improved laparoscopic ovarian enucleation seems to be safer and more effective with shorter operating time.