The maximum length of T2-dark intraplacental bands may help predict intraoperative haemorrhage in pregnant women with placenta accreta spectrum (PAS).

PURPOSE: To investigate the relationship between the maximum length of T2-dark intraplacental bands (MLTIB) and intraoperative haemorrhage in pregnant women with placenta accreta spectrum (PAS). METHODS: Between February 2018 and February 2021, 86 pregnant women with PAS who delivered in Taizhou Hospital of Zhejiang Province and underwent preoperative magnetic resonance imaging (MRI) examination were retrospectively recruited. The presence of T2-dark intraplacental bands, placental/uterine bulge, loss of retroplacental T2-hypointense line, myometrial thinning, bladder wall interruption, focal exophytic mass, and abnormal vascularization of placental bed were recorded, and the MLTIB was measured. The relative risk ratios of the MRI findings and intraoperative bleeding were measured. Receiver operating characteristic (ROC) analysis was used to evaluate the ability of the MLTIB to help predict intraoperative haemorrhage in pregnant women with PAS. RESULTS: Of the 86 pregnant women, 32 had intraoperative blood loss ≥ 1000 ml; of these, 18 had intraoperative blood loss ≥ 2000 ml. Abnormal vascularization of placental bed was associated with the highest relative risk ratio for the detection of intraoperative haemorrhage (RR = 10.66), followed by the presence of T2-dark intraplacental bands (RR = 8.02). The optimal cut-off of the MLTIB for predicting intraoperative haemorrhage (≥ 1000 ml) in pregnant women with PAS was 28.95 mm, and the AUC was 0.91 (sensitivity: 84%; specificity: 91%). The optimal cut-off of the MLTIB for predicting massive intraoperative haemorrhage (≥ 2000 ml) was 35.65 mm, and the AUC was 0.94 (sensitivity: 89%; specificity: 85%). CONCLUSION: MLTIB was related to intraoperative haemorrhage in pregnant women with PAS. An MLTIB greater than 28.95 mm is an effective predictor of intraoperative haemorrhage. An MLTIB of 35.65 mm or greater strongly suggests the possibility of massive intraoperative haemorrhage.

Impact on lower limb lymphedema of pelvic lymphadenectomy with external iliac lymph nodes left-opened distal lymphatics technique.

BACKGROUND: The aim of this study was to investigate the effect of maintaining opened distal lymphatic vessels of external iliac lymph nodes on lymphedema and lymphocyst formation of lower limbs after pelvic lymphadenectomy. METHODS: Prospective single center observational study was carried out in 83 patients with gynecological malignancies who underwent pelvic lymphadenectomy. During the operation, the distal lymphatic vessels of the external iliac lymph nodes were cut off by an ultrasound scalpel or scissors, and the proximal end was closed by bipolar coagulation. The patients were re-examined by a physical examination, ultrasound examination and inquiry of the symptoms within 2 years after the operation to check whether they had lower limb lymphedema and to analyze the presence of lymphedema and lymphocyst of lower limbs and the risk. RESULTS: The incidence of lower limb lymphedema (LLL) was 21.6% (18/83). Among the patients with LLL, 5.5% (1/18) was diagnosed with stage 0 according to the criteria of International Society of Lymphology, 83.3% (15/18) with stage 1, and 11.1% (2/18) with stage 2. Presently, there was no lymphedema diagnosed at stage 3. The incidence of lymphocyst was 7.2% (6/83). Among the patients with lymphocyst, 3.6% (3/83) occurred 1 month after operation, 2.4% (2/83) occurred 3 months after operation and 1.2% (1/83) occurred 6 months after operation. Patients with radiotherapy and abdominal infection were more likely to suffer from LLL (P<0.05). CONCLUSIONS: Maintaining opened distal lymphatic vessels of external iliac lymph nodes during pelvic lymphadenectomy is feasible, safe and with a 21.6% and 7.2% of potential lymphedema and lymphocists, respectively.

Gephyromycin C, a novel small-molecule inhibitor of heat shock protein Hsp90, induces G2/M cell cycle arrest and apoptosis in PC3 cells in vitro.

Gephyromycin C (GC), a natural compound isolated from a marine-derived actinomycete Streptomyces sp. SS13I, which exerts anti-proliferative effect on PC3 cells. However, its underlying mechanism of the anti-cancer effect remains unknown. The results of SRB assays showed that GC inhibited the proliferation of PC3 cells with an IC50 value of 1.79 ± 0.28 µM. GC also induced G2/M cell cycle arrest which was accompanied by declining levels of cyclin proteins. Possible mechanisms were investigated and it was found that GC bound to Hsp90 and caused the degradation of Hsp90 client proteins (AKT, CHK1, P53, CDK4, Raf-b, and Raf-1). The fluorescent polarization assay with FITC-labeled geldanamycin (FITC-GA) demonstrated that GC was able to compete with FITC-GA in binding to wild type Hsp90 with an IC50 of 2.15 µM. Results of a docking study also suggested that GC interacted with the N-terminal domain of Hsp90. Our results showed that GC could bind to Hsp90, which resulted in down-regulation of Hsp90 client proteins and G2/M arrest in PC3 cells. Since the antitumor effects of this kind of angucycline via targeting Hsp90 has not been reported before, our results indicate that GC is a novel inhibitor of Hsp90 from marine resources and worthy of further study.