Liver stiffness measurements with supersonic shear wave elastography in the diagnosis of biliary atresia: a comparative study with grey-scale US.

OBJECTIVES: To prospectively assess the diagnostic performance of supersonic shear wave elastography (SSWE) in identifying biliary atresia (BA) among infants with conjugated hyperbilirubinaemia by comparing this approach with grey-scale ultrasonography (US). METHODS: Forty infants were analysed as the control group to determine normal liver stiffness values. The use of SSWE values for identifying BA was investigated in 172 infants suspected of having BA, and results were compared with the results obtained by grey-scale US. The Mann-Whitney U test, unpaired t-test, Spearman correlation and linear regression were also performed. RESULTS: The success rates of SSWE measurements in the control and study group were 100% (40/40) and 96.4% (244/253), respectively. Age, direct bilirubin, and indirect bilirubin all significantly correlated with SSWE in the liver (all P < 0.001). Linear regression showed that age had a greater effect on SSWE values than direct or indirect bilirubin. The diagnostic performance of liver stiffness values in identifying BA was lower than that of grey-scale US (area under the receiver operating characteristic curve [AUC], 0.790 vs 0.893, P < 0.001). CONCLUSIONS: SSWE is feasible and valuable in differentiating BA from non-BA. However, its diagnostic performance does not exceed that of grey-scale US. KEY POINTS: • SSWE could be successfully performed in an infant population. • For infants, the liver stiffness will increase as age increases. • SSWE is potentially useful in assessing infants suspected of biliary atresia. • SSWE is inferior to grey-scale US in identifying biliary atresia.

A real-world pharmacovigilance study of cardiac adverse events induced by sugammadex in the FDA adverse event reporting system.

BACKGROUND: Sugammadex is a novel agent that reverses neuromuscular blockade during general anesthesia. Recent case reports have raised concerns regarding potential cardiac adverse events (CAEs). However, no large-scale real-world studies have yet evaluated the potential link between sugammadex and CAEs. RESEARCH DESIGN AND METHODS: Data from the FDA Adverse Event Reporting System were obtained. The association between sugammadex and CAE was evaluated using reporting odds ratio, proportional reporting ratio, Bayesian confidence propagation neural network, and multi-item gamma Poisson shrinker methods. Serious outcomes resulting from sugammadex-related CAEs were assessed, and complications associated with CAEs were evaluated. RESULTS: Nineteen CAEs were identified and classified into two categories: cardiac arrhythmias and coronary artery disorders. The most frequent CAEs were bradycardia (n = 202), cardiac arrest (n = 119), tachycardia (n = 30), and Kounis syndrome (n = 22). Subgroup analysis based on age, sex, and weight revealed parallel findings. The CAEs most likely to result in serious consequences were pulseless electrical activity and cardiac arrest. The most common concurrent adverse effects with CAEs were hypotension (n = 51), anaphylactic reactions (n = 46), and anaphylactic shock (n = 23). CONCLUSION: This study suggests a potential link between sugammadex and CAEs, highlighting the need for careful monitoring and personalized risk assessment, especially in patients with cardiovascular risk factors.

[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.

[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.

[Changes in peripheral hemogram among workers with short-term lead exposure].

OBJECTIVE: To examine the effect of short-term occupational lead exposure on the inflammatory response system in blood among workers. METHODS: A total of 255 lead-exposed workers (length of service ≤1 year) at an electronics factory in Dongguan, China (exposure group), as well as 205 managers without any occupational exposure at another factory (control group), were included in the study. Occupational physical examination was done to get peripheral blood counts. The blood lead levels of workers were determined by atomic absorption spectrometry. The relationship between blood lead and peripheral hemogram was analyzed using SPSS software. RESULTS: The exposure group had blood lead levels of 0.07∼1.70 µmol/L, falling within the normal range. The leukocyte count, percentage of granulocytes, and absolute value of granulocytes were significantly higher in the exposure group than in the control group, and the results remained unchanged after adjustment for age and sex (P < 0.05). There were no significant differences in red blood cell count and hemoglobin value between the two groups (P > 0.05). CONCLUSION: Short-term occupational lead exposure may increase the counts of inflammatory cells in blood, but it has little effect on red blood cells and hemoglobin.

[Risk factors associated with twin pregnancy in double embryo transfer].

OBJECTIVE: To explore the risk factors associated with twin pregnancy in double embryo transfer. METHODS: A retrospective analysis was performed for 2970 double embryo transfer cycles, including 1984 cycles of fresh embryo transfer and 986 cycles of frozen-thawed embryo transfer (FET). Multiple factor Logistic regression was used. The twin pregnancy rate was studied in group of age < 35 or age ≥ 35 years old, in group of zero, single or double high-quality embryos transferred and group of fresh embryo transfer or FET cycles. RESULTS: (1) There was a significantly negative correlation between women's age and twin pregnancy according to the analysis of multiple factor Logistic regression (P < 0.01). And a significantly positive correlation existed between the number of high-quality embryos transferred, FET and twin pregnancy (P < 0.01); (2) the twin pregnancy rate of both fresh embryo transfer and FET cycles was higher in group of age < 35 years than that in group of age ≥ 35 years (16.0% vs 8.0%, P < 0.01; 26.9% vs 14.2%, P < 0.01); (3) the twin pregnancy rate of fresh embryo transfer cycles with double high-quality embryos transferred was higher than that with zero or single high-quality embryos transferred (19.1% vs 5.4%; 19.1% vs 11.0%, P < 0.01); the twin pregnancy rate of FET cycles with double high-quality embryos transferred was also higher than that with zero or single high-quality embryos transferred (32.7% vs 10.8%; 32.7% vs 20.7%, P < 0.01); (4) the twin pregnancy rate of FET cycles was significantly higher than that of fresh embryo transfer cycles (24.7% vs 14.9%, P < 0.01). CONCLUSION: Women's age, the number of high quality embryos transferred and FET are risk factors associated with twin pregnancy. At reproductive centers with a mature technique of FET, we recommend performing single high-quality embryo transfer in FET cycles to reduce the occurrence of twin pregnancy.

[Analysis of low-quality embryo transfer strategy in in vitro fertilization and embryo transfer cycle].

OBJECTIVE: To investigate the transfer strategy of low-quality embryo in in vitro fertilization and embryo transfer (IVF-ET) cycle. METHODS: A retrospective analysis was performed for the clinical data of 621 IVF-ET cycles under controlled ovarian hyperstimulation, including 574 fresh embryo transfer (ET) cycles (Group T1) and 47 frozen-thawed embryo transfer (FET) as the first ET cycles (Group C1). Logistic regression was used to model the probability of clinical pregnancy rate based on the cycle-specific factors. RESULTS: The clinical pregnancy rate was significantly higher in Group C1 than Group T1 [38.3% (18/47) vs 22.1% (127/574), P < 0.05]. Multivariate logistic regression analysis revealed that patient age and ET method were significantly associated with the clinical pregnancy rate. After adjusting for patient age, the clinical pregnancy rate remained significantly higher in Group C1 than Group T1 (OR: 2.107, 95%CI: 1.128 - 3.939, P < 0.05). CONCLUSION: The use of FET instead of fresh ET may improve the clinical pregnancy rate in low-quality embryo cycles.

[Analysis of risk factors for triplet pregnancy after a simultaneous transfer of triplicate embryos].

OBJECTIVE: To analyze the risk factors for triplet pregnancy after a simultaneous transfer of triplicate embryos. METHODS: The investigators carried out a retrospective analysis of 769 cycles in which three embryos were transferred in one treatment cycle, including 298 fresh embryo transfer (ET) cycles and 471 frozen-thawed ET (FET) cycles. The impact of patient age and the number of good embryos transferred on the rates of clinical pregnancy and triplet pregnancy was studied according to different cycle types. RESULTS: (1) The rates of clinical and triplet pregnancy were significantly higher in the FET group (P < 0.05) than those in the fresh ET group; (2) all patients with a triplet pregnancy in the fresh ET group (n = 6) were younger than 35 years old (P < 0.01). There was no significant difference between the subgroups in the FET cycle according to patient age (P > 0.05); (3) when none, 1, 2 or 3 good embryos were transferred in the fresh ET cycle, the clinical pregnancy rates were 28.3%, 46.7%, 50.6% and 58.7% and the triplet pregnancy rates 0, 2.3%, 4.7% and 6.8% respectively. A similar clinical pregnancy rate (P > 0.05) and a significantly lower triplet pregnancy rate (P < 0.05) were observed when 1 good embryo was transferred versus 2 good embryos (P < 0.05). When 0, 1, 2 or 3 good embryos were transferred in the FET cycle, the clinical pregnancy rates were 38.9%, 54.8%, 59.7%, 63.9% and the triplet pregnancy rates 0, 5.0%, 13.8%, 15.8% respectively. A similar clinical pregnancy rate (P > 0.05) and a significantly lower triplet pregnancy rate (P < 0.05) were observed when 1 good embryo was transferred versus two good embryos (P < 0.05). All triplet pregnancies occurred in cycles in which more than 1 good embryo was transferred (P < 0.05). CONCLUSION: The patients have more triplet pregnancies in the FET cycle than in the fresh ET cycle. In the FET cycle, the patient age is irrelevant. It is recommended that no more than 2 embryos should be transferred. Selective single blastocyst embryo transfer is preferable if there are more than 2 good embryos available for transfer. No more than 2 embryos should be transferred in the fresh ET cycle if good embryos are available and a patient is under 35 years old.

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.

[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.

[Fertilizing ability, cleavage potential and inheritance risk of globozoospermia].

OBJECTIVE: To explore the fertilizing ability, cleavage potential and inheritance risks of globozoospermia. METHODS: A globozoospermic patient was diagnosed by sperm morphological staining and transmission electron microscope. From his wife the investigators obtained 26 oocytes in which 6 oocytes were donated and the other 19 (in 20) MII oocytes injected into 19 round-headed sperms. Six donated oocytes accepted in vitro fertilization (IVF). This patient's chromosome and microdeletion in AZFa, AZFb and AZFc in Y chromosome were checked through 6 sequence tag sites of sY84, sY86, sY127, sY134, sY254 and sY255. RESULTS: Only 4 (in 19) were normally fertilized and cleaved. All 6 donated oocytes were normally fertilized and cleaved. The fertilizing rate was significantly higher than that of this patient (100% vs 21.1%, P < 0.01). But the cleavage rate has no statistical difference (100% vs 100%, P > 0.05). This patient had normal chromosome (46, XY) and there was no deletion in Y chromosome. His wife became pregnant after accepting two thawed embryos and then gave birth to a boy whose chromosome was normal (46, XY). The acceptor also gave birth to a healthy boy after accepting two thawed embryos. CONCLUSIONS: Despite a lower fertilizing rate, intracytoplasmic sperm injection is still an effective therapy for globozoospermic infertility.

[Clinical analysis of Metzenbaum scissors in transcervical incision of a complete septate uterus].

OBJECTIVE: To evaluate the clinical efficacy of Metzenbaum scissors in the transcervical incision of a complete septate uterus. METHODS: Eight patients with a complete septate uterus were identified and recruited. The age range was 24 to 39 years old. After diagnosis by hysteroscopy, the transcervical incision was performed by Metzenbaum scissors and followed by hysteroscopic incision of corporal portion. The associated diseases were treated using laparoscopy. RESULTS: All patients were successfully treated and the operation duration was 5 - 10 minutes. The postoperative period was uneventful and there was no perforation, pelvic organ damage or water intoxication. Three months later, hysteroscopy revealed no uterine scarring or adhesion. And the shape of uterine cavity was normal. CONCLUSION: Using Metzenbaum scissors for transcervical incision of cervical portion of complete septate uterus, followed by hysteroscopic incision of corporal portion, is convenient, fast and safe. This approach has no effect upon the growth of endometrium.

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.

[Study of the best embryo transfer strategy in frozen-thawed embryo transfer cycle].

OBJECTIVES: To study the relationship of the number and quality of embryos transferred with clinical pregnancy rate and multiple pregnancy rate in frozen-thawed embryo transfer (FET) cycle. METHODS: Retrospective analysis of the clinical data of 995 FET cycles. Patients were stratified as age < 35 or > or = 35, Both groups' clinical pregnancy rate and multiple pregnancy rate were compared according to the number of embryos and high-quality embryos transferred. RESULTS: (1) The clinical pregnancy rates were 50.0%, 56.6% and 56.5%, and twin pregnancy rates were 6.3%, 43.8% and 30.6% respectively in < 35 group when one, two or three embryos were transferred. There is not any significantly statistic difference among these subgroups (P > 0.05). However, the twin pregnancy rate in one-embryo transferred subgroup was significantly lower than that of two-embryo transferred subgroup (P < 0.05). Moreover, the clinical pregnancy rate was not different among single high-quality embryo transferred subgroup and other high-quality embryo transferred subgroups, the multiple pregnancy rate was lower than the others. (2) The clinical pregnancy rates were 0, 47.3% and 53.8%, and twin pregnancy rates were 0, 25.7% and 25.7% respectively in > or = 35 group when one, two or three embryos were transferred. The clinical pregnancy rate and twin pregnancy rate between two-embryo and three-embryo transferred subgroups were not significantly different (P > 0.05). Moreover, the clinical pregnancy rate was not different among two-embryo transferred containing one high-quality embryo subgroup and other high-quality embryo transferred subgroups, the multiple pregnancy rate was lower than the others. CONCLUSIONS: There is a close relationship between the number and quality of embryos transferred and clinical pregnancy rate, multiple pregnancy rate in FET cycles. For the patient aged < 35, we recommend performing single high-quality embryo transfer in order to reduce the multiple pregnancy. For the patient aged > or = 35, two-embryo transfer containing one high-quality embryo is enough to obtain a satisfied clinical pregnancy rate and an acceptable multiple pregnancy rate.

[Frozen-thawed embryo transfer (FET) versus fresh embryo transfer in clinical pregnancy rate during in vitro fertilization-embryo transfer].

OBJECTIVE: To investigate whether frozen-thawed embryo transfer (FET) instead of fresh embryo transfer for the first embryo transfer (ET) in a controlled ovarian hyperstimulation (COH) cycle improves the in vitro fertilization-ET clinical pregnancy rate. METHODS: The investigators retrospectively analyzed the clinical data of 1341 IVF-ET cycles under COH, including 1169 fresh ET cycles (Group T1) and 172 FET cycles as the first embryo transfer in COH cycle (Group C1). Logistic regression was used to model the probability of clinical pregnancy rate based on age, ET method and other cycle-specific factors. RESULTS: The clinical pregnancy rate was significantly higher in Group C1 than in Group T1 (63.4% vs 49.4%, P < 0.01). Multivariate logistic regression analysis revealed significant associations between the number of high-quality embryos transferred, patient age and ET method in clinical pregnancy rate. After adjusting for the number of high-quality embryos transferred and age, the clinical pregnancy rate remained significantly higher in Group C1 than in Group T1 (odds ratio: 1.75, 95% confidence interval: 1.25 - 2.46; P < 0.01). Significant differences were found in age (< 35 years old) and the number of retrieved oocytes (> or = 15). CONCLUSION: Using FET instead of fresh embryo transfer can improve the clinical pregnancy rate and the efficiency of IVF-ET.

[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.

[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.

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.

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.