Outcomes of prophylactic lauromacrogol injection versus non-injection in patients with endogenous cesarean scar pregnancy treated by hysteroscopic surgery: a retrospective cohort study.

BACKGROUND: This study aimed to investigate the efficacy of hysteroscopic surgery for endogenous cesarean scar pregnancy (CSP) and the value of prophylactic ultrasound-guided local injection of lauromacrogol. METHODS: This retrospective study included 131 patients diagnosed with endogenous CSP who underwent hysteroscopic surgery at the Hangzhou Fuyang Women and Children Hospital between January 2018 and May 2022. Lauromacrogol (10-20 mL) was administered within 24 h preoperatively using an ultrasound-guided vaginal injection to 78 patients (L group) versus not administered to 53 patients (non-L group). Their clinical data and outcomes were analyzed. RESULTS: Mean gestational age, gestational mass size, and uterine scar thickness and median preoperative blood ß-human chorionic gonadotropin levels of the non-L versus L groups were 46.26 versus 45.01 days, 2.05 versus 2.39 cm, 0.35 versus 0.32 cm, and 19850.0 versus 26790.0 U/L, respectively (P > 0.05 for each). The non-L and L groups had similar success rates (98.1% vs. 98.7%, P = 1.0). Complications related to lauromacrogol administration, including abdominal pain, massive bleeding, and bradycardia, were experienced by 46.2% (36/78; P < 0.001) of L group patients. The non-L had a significantly shorter mean hospital stay (4.85 ± 1.12 vs 5.44 ± 1.08 days) and lower total cost (6148.75 ± 1028.71 vs 9016.61 ± 1181.19) (P < 0.01). CONCLUSIONS: Hysteroscopic surgery is effective and safe for patients with endogenous CSP. Prophylactic lauromacrogol injection increases the incidence of complications and costs. Direct hysteroscopic surgery can reduce pain and financial burden in patients with endogenous CSP and save medical resources for other patients.

Intergenic region polymorphism analysis: a novel genotyping method for Klebsiella pneumoniae.

AIMS: The ability to distinguish between Klebsiella pneumoniae strains is critical for outbreak investigations. A new typing method, intergenic region polymorphism analysis (IRPA), was developed, validated, and the discriminatory power was determined by comparison with multiple-locus variable-number tandem repeat analysis (MLVA) in this study. METHODS AND RESULTS: This method is based on the idea that every IRPA locus (polymorphic fragment of intergenic regions present in one strain but not in other strains or different fragment sizes in other strains) could divide strains into different genotypes. A 9-loci IRPA scheme was designed to type 64 K. pneumoniae isolates. Five IRPA loci were identified that conferred the same level of discrimination as the 9-loci initially examined. Among these K. pneumoniae isolates, 7.81% (5/64), 6.25% (4/64), 4.96% (3/64), 9.38% (6/64), and 1.56% (1/64) were capsular serotypes K1, K2, K5, K20, and K54, respectively. The discriminatory power of the IRPA method was better than that of MLVA expressed in Simpson's index of diversity (SI) at 0.997 and 0.988, respectively. The congruent analysis of the IRPA method and MLVA showed moderate congruence between the two methods (AR = 0.378). The AW indicated that if IRPA data are availabl, one can accurately predict the MLVA cluster. CONCLUSION: The IRPA method was found to have higher discriminatory power than MLVA and allowed for simpler band profile interpretation. The IRPA method is a rapid, simple, and high-resolution technique for molecular typing of K. pneumoniae.

Potential genetic polymorphisms predicting polycystic ovary syndrome.

Polycystic ovary syndrome (PCOS) is a heterogenous endocrine disorder with typical symptoms of oligomenorrhoea, hyperandrogenism, hirsutism, obesity, insulin resistance and increased risk of type 2 diabetes mellitus. Extensive evidence indicates that PCOS is a genetic disease and numerous biochemical pathways have been linked with its pathogenesis. A number of genes from these pathways have been investigated, which include those involved with steroid hormone biosynthesis and metabolism, action of gonadotropin and gonadal hormones, folliculogenesis, obesity and energy regulation, insulin secretion and action and many others. In this review, we summarize the historical and recent findings in genetic polymorphisms of PCOS from the relevant publications and outline some genetic polymorphisms that are potentially associated with the risk of PCOS. This information could uncover candidate genes associating with PCOS, which will be valuable for the development of novel diagnostic and treatment platforms for PCOS patients.

Preoperative Measurement of Tibial Resection in Total Knee Arthroplasty Improves Accuracy of Postoperative Limb Alignment Restoration.

BACKGROUND: Accuracy of implant placement in total knee arthroplasty (TKA) is crucial. Traditional extramedullary alignment instruments are fairly effective for achieving the desired mean tibial component coronal alignment. We modified the traditional tibial plateau resection technique and evaluated its effect on alignment restoration. METHODS: Two hundred and eighty-two primary TKAs in our hospital between January 2013 and December 2014 were enrolled in this retrospective study. Group A consisted of 128 primary TKAs performed by one senior surgeon. Preoperative measurement of the tibial resection was conducted on radiographs, and the measured thicknesses of the lateral and medial plateau resection were used to place the tibial alignment guide. Group B consisted of 154 primary TKAs performed by the other senior surgeon, using a traditional tibial plateau resection technique. In all patients, an extramedullary guide was used for tibial resection, and preoperative and postoperative full-leg standing radiographs were used to assess the hip-knee-ankle angle (HKA), femoral component alignment angle (FA), and tibial component alignment angle (TA). A deviation ≥3° was considered unsatisfactory. Data were analyzed by unpaired Student's t-test. RESULTS: The mean postoperative HKA and TA angles were significantly different between Groups A and B (178.2 ± 3.2° vs. 177.0 ± 3.0°, t = 2.54, P = 0.01; 89.3 ± 1.8° vs. 88.3 ± 2.0°, t = 3.75, P = 0.00, respectively). The mean postoperative FA was 88.9 ± 2.5° in Group A and 88.9 ± 2.6° in Group B, and no significant difference was detected (t = 0.10, P = 0.92). There were 90 (70.3%) limbs with restoration of the mechanical axis to within 3° of neutral alignment and 38 (29.7%) outliers (>3° deviation) in Group A, whereas there were 89 (57.8%) limbs with restoration of the mechanical axis to within 3° of neutral alignment and 65 (42.2%) outliers (>3° deviation) in Group B. The severity of the preoperative alignment deformity was a strong predictor for postoperative alignment. CONCLUSIONS: Using conventional surgical instruments, preoperative measurement of resection thickness of the tibial plateau on radiographs could improve the accuracy of conventional surgical techniques.

[[INFLUENCES OF PREOPERATIVE SEVERE LOWER LIMB DEFORMITY ON PROSTHESIS INSTALLATION AND ALIGNMENT RESTORATION IN TOTAL KNEE ARTHROPLASTY].

OBJECTIVE: To investigate the effect of preoperative valgus or varus deformity on the prosthesis installation and alignment restoration in total knee arthroplasty (TKA). METHODS: Between January 2012 and December 2013, 198 patients (245 knees) with osteoarthritis underwent primary TKA, and the clinical data were retrospectively analyzed. There were 23 males and 175 females, with the average age of 67 years (range, 43-90 years). Single knee and double knees were involved in 151 and 47 cases respectively. The disease duration was from 1 month to 30 years (mean, 8.99 years). The anteroposterior X-ray films of whole lower limbs were taken, and the femorotibial angle (FT) was measured before operation and at 1 week after operation; the mechanical femoral angle (MF) and the anatomical tibial angle (AT) at 1 week after operation were measured. The correlation analysis was made for pre- and post-operative FT, MF, and AT. According to the valgus or varus deformity before operation, all patients were divided into 5 groups: ≥ 20 degrees varus (group A), 10-20 degrees varus (group B), ≤ 10 degrees varus (group C), < 10 degrees valgus (group D), and ≥ 10 degrees valgus (group E), and the above indicators were compared between groups. And the rate of the good limb alignment was recorded after operation. RESULTS: The pre- and post-operative FT were (171.53 ± 9.12) and (177.38 ± 3.57)degrees respectively, and postoperative MF and AT were (89.00 ± 2.68) and (88.62 ± 2.16) respectively. Preoperative FT was associated with postoperative FT and MF (r = 0.375, P = 0.000; r = 0.386, P = 0.000), but it was not correlated with AT (r = 0.024, P = 0.710). Postoperative FT was associated with MF and AT (r = 0.707, P = 0.000; r = 0.582, P = 0.000). Postoperative FT was significantly increased when compared with preoperative FT in each group (P < 0.05). There were significant differences in preoperative FT between groups (P < 0.05). There were significant differences in postoperative FT when compared group A with groups B, C, D, and E (P < 0.05), and when compared groups B and C with groups D and E (P<0.05), but there was no significant difference between groups B and C, and between groups D and E (P > 0.05). The rate of good alignment was 70.2% (172/245); it was 27.8% (5/18), 66.0% (62/94), 74.4% (67/90), 88.9% (32/36), and 85.7% (6/7) in groups A, B, C, D, and E respectively, showing significant differences between groups (P < 0.05). There was no significant difference in postoperative AT between groups (P > 0.05). Except for between group D and group E (P > 0.05), significant difference in MF was shown between the other groups (P < 0.05). CONCLUSION: The more severe deformity of lower limb before TKA, the higher risk of deviation for prosthesis installation and poor alignment in TKA.

[IMAGING ANALYSIS OF ACETABULAR CUP POSITIONS IN TOTAL HIP ARTHROPLASTY FOR ADULTS WITH ACETABULAR DYSPLASIA].

OBJECTIVE: To investigate the influence of the degree of acetabular deformity and the learning-curve on the acetabular cup positions in total hip arthroplasty (THA) for adults with developmental dysplasia of hip (DDH). METHODS: Between January 2008 and December 2015, 130 patients (144 hips) with DDH underwent primary THA, and the clinical data were analyzed retrospectively. Fifty-three patients (59 hips) were admitted before 2012, and 77 patients (85 hips) were treated after 2012. There were 32 males and 98 females, aged from 31 to 83 years (mean, 61). Unilateral replacement was performed in 116 cases and bilateral replacement in 14 cases. Of 144 hips, 48 hips were rated as Crowe type I, 57 hips as type II, and 39 hips as type of III/IV. The standard pelvic radiograph was taken within 1 week after operation. The mediCAD software was adopted to measure the angle of anteversion and abduction, bony coverage, and the distance between true rotating center and optimal rotating center to the connection of teardrops and the horizontal distance between two centers to evaluate the qualified rate of acetabular cup positions. RESULTS: Compared with the patients with the same type in 2013-2015 group, the anteversion angle and qualified rate of acetabular cup position significantly decreased in patients with Crowe I (P<0.05); the horizontal distance significantly increased and qualified rate of acetabular cup position significantly decreased in patients with Crowe II (P<0.05); and the anteversion angle significantly decreased and the horizontal distance significantly increased in patients with Crowe III/IV (P<0.05) in 2008-2012 group. But no significant difference was shown in the other indexes (P>0.05). In all Crowe types, the vertical distance between the true rotating center and the optimal rotating center increased with the degree of acetabular deformity in both 2008-2012 group and 2013-2015 group, showing significant difference (P<0.05), but no significant difference was found in the other indexes (P>0.05). CONCLUSIONS: For adults with acetabular dysplasia, there are high potential risks for unsatisfactory acetabular cup positions during primary THA. So it is necessary to evaluate acetabular deformities and to sum up operative experience so as to improve the accuracy of cups installation.

[CHONDROGENESIS-SPECIFIC MICRORNA EXPRESSION PATTERN ANALYSIS IN CHONDROGENIC DIFFERENTIATION OF HUMAN ADIPOSE-DERIVED STEM CELLS].

OBJECTIVE: To investigate the microRNA (miRNA) expression profile during chondrogenic differentiation of human adipose-derived stem cells (hADSCs), and assess the roles of involved miRNAs during chondrogenesis. METHODS: hADSCs were harvested and cultured from donors who underwent elective liposuction or other abdominal surgery. When the cells were passaged to P3, chondrogenic induction medium was used for chondrogenic differentiation. The morphology of the cells was observed by inverted phase contrast microscopy. Alcian blue staining was carried out at 21 days after induction to access the chondrogenic status. The expressions of chondrogenic proteins were detected by ELISA at 0, 7, 14, and 21 days. The miRNA expression profiles at pre- and post-chondrogenic induction were obtained by microarray assay, and differentially expressed miRNAs were verified by real-time quantitative PCR (qRT-PCR). The targets of the miRNAs were predicted by online software programs. RESULTS: hADSCs were cultured successfully and induced with chondrogenic medium. At 21 days after chondrogenic induction, the cells were stained positively for alcian blue staining. At 7, 14, and 21 days after chondrogenic induction, the levels of collogen type II, Col2a1, aggrecan, Coll0a1, and chondroitin sulfate in induced hADSCs were significantly higher than those in non-induced hADSCs (P<0.05). Eleven differentially expressed miRNAs were found, including seven up-regulated and four down-regulated. Predicted target genes of the differentially expressed miRNAs were based on the overlap from three public prediction algorithms, with the known functions of regulating chondrogenic differentiation of stem cells, self-renewal, signal transduction, intracellular signaling cascade, and cell cycle control. CONCLUSION: A group of miRNAs and their target genes are identified, which may play important roles in regulating chondrogenic differentiation of hADSCs. These results will facilitate the initial understanding of the molecular mechanism of chondrogenic differentiation in hADSCs and subsequently control hADSCs differentiation, and provide high performance seed cells for cartilage tissue engineering.

[Investigation of fibrous cultural materials by infrared spectroscopy].

Cultural fibrous material includes both important categories, i. e. textile and paper, consisting of precious cultural materials in museum, such as costume, painting, and manuscript. In recent years more and more connoisseur and conservator's concerns are, through nondestructive method, the authenticity and the ageing identification of these cultural relics especially made from fragile materials. In this research, we used attenuated total reflection infrared spectroscopy to identify five traditional textile fibers, alongside cotton, linen, wool, mulberry silk and tussah silk, and another five paper fibers alongside straw, wheat straw, long qisong, Chinese alpine rush and mulberry bar, which are commonly used for making Chinese traditional xuan paper. The research result showed that the animal fiber (wool, mulberry silk and tussah silk) and plant fiber (cotton and linen) were easier to be distinguished by comparing the peaks at 3 280 cm-1 belonging to NH stretching vibration and a serious peaks related to amide I to amide III. In the spectrum of wool, the peak at 1 076 cm-1 was assigned to the S-O stretching vibration absorption of cystine in wool structure and can be used to tell wool from silk. The spectrum of mulberry silk and tussah silk seems somewhat difficult to be identified, as well as the spectrum of cotton and linen. Five rural paper fibers all have obvious characteristic peaks at 3 330, 2 900 cm-1 which are related to OH and CH stretching vibration. In the fingerprint wavenumber range of 1 600 - 800 cm, the similar peaks also appeared at 1 370, 1 320 cm-1 and 1 162, 1 050 cm-1, both group peaks respectively are related to CH and CO vibration in the structure of cellulose and hemicellulose in paper fibers. Although there is more similarity of the infrared spectroscopy of these 5 paper fibers, some tiny difference in absorbance also can be found at 3 300 cm-1 and in the fingerprint range at 1 332, 1 203, and 1 050 cm-1 which are related to C-O-C vibration in cellulose. Moreover, in order to explore direct and simple method to identify different materials with similar spectrum,. the principal component analysis (PCA) was applied to separate cotton and linen, mulberry silk and tussah silk, as well as five paper fibers. To eliminate and reduce the spectral scattering caused by sample uneven surface roughness, the multiplicative scatter correction (MSC) has been applied based on total spectral data. The result showed that the score plot using the first two principal components can effectively categorize both group textiles of cotton and linen, as well as mulberry silk and tussah silk, and they have similar chemical structure. For five paper fibers, the PCA was applied in different spectral range (918-550, 1 280-918, 1 700-1 280 and 3 800-2 800 cm-1), and the best result appeared in the range from 3 800 to 2 800 cm-1, in which the five paper fibers can be well categorized. This research showed that infrared spectroscopy combined with principal component analysis has great potential advantage on identifying fibrous materials with similar structure.

Overproduction of alkaline polygalacturonate lyase in recombinant Escherichia coli by a two-stage glycerol feeding approach.

This work aims to achieve the overproduction of alkaline polygalacturonate lyase (PGL) with recombinant Escherichia coli by a two-stage glycerol feeding approach. First, the PGL coding gene from Bacillus subtilis WSHB04-02 was expressed in E. coli BL21 (DE3) under the strong inducible T7 promoter of the pET20b (+) vector. And then the influence of media composition, induction temperature, and inducer isopropyl ß-D-1-thiogalactopyranoside (IPTG) concentration on cell growth and PGL production was investigated. Finally, a two-stage glycerol feeding strategy was proposed and applied in a 3-L fermenter, where cultivation was conducted at a controlled specific growth rate (µset=0.2) during pre-induction phase, followed by a constant glycerol feeding rate of 12 ml h(-1) at post-induction phase. The total PGL yield reached 371.86 U mL(-1), which is the highest PGL production by recombinant E. coli expression system.

[Effect of femoral offset reconstruction on pelvic stability during gait after total hip arthroplasty].

OBJECTIVE: To investigate the effect of femoral offset reconstruction on pelvic stability during gait after total hip arthroplasty. METHODS: According to the inclusion criteria, 29 patients undergoing unilateral total hip arthroplasty between January 2000 and December 2005 were selected. There were 10 males and 19 females with an average age of 64.3 years (range, 33-75 years). The affected hips included 15 left hips and 14 right hips. The follow-up time was from 5 to 10 years (mean, 7.7 years). The Harris score was 90 to 100 (mean, 97) at last follow-up. The femoral offset ratio (FOR) was calculated by measuring the femoral offset of the bilateral hips on radiograph, and then the patients were divided into 2 groups: group A (the femoral offset of diseased hip was less than that of normal hip, n=10) and group B (the femoral offset of diseased hip was greater than that of normal hip, n=19). The pelvis kinematic variables were measured by three-dimensional gait analysis to collect the magnitude of pelvic oblique angle (POA). RESULTS: In group A, the FOR was 0.81 +/- 0.08 and the POA was (-0.42 +/- 0.91) degrees. In group B, the FOR was 1.27 +/- 0.15 and the POA was (1.02 +/- 0.94) degrees. For the normal hip, the POA was (1.15 +/- 0.85) degrees. The POA was significantly less in group A than in group B and the normal limb (P < 0.05). The difference in POA had no significance between group B and the normal hip (P > 0.05). The POA was positive relative with FOR (r = 0.534, P = 0.003), and the regression equation was y = -2.551 + 2.781x. CONCLUSION: The femoral offset reconstruction is crucial to improve hip abductor function and gait.

[Clinical analysis of revision after primary hip replacement in the early stage].

OBJECTIVES: To analyze the reason of revisions no more than 5 years after primary hip replacement, and to discuss the methods how to prevent and manage. METHODS: Retrospectively review 11 cases with revision no more than 5 years after primary total hip replacement from January 2002 to June 2007. The reasons for revision were as follows: 2 cases were recurrent dislocation due to malposition of acetabular prosthesis; 5 cases were loosening of acetabular prosthesis; 1 case was abrasion of the native acetabulum by bipolar femoral head; 2 cases were periprosthetic femoral fractures and 1 case was periprosthetic infection. The average follow-up time was 36 months. Each patient was assessed according to Harris hip score. The revision procedures including liner only, acetabular prosthesis only, or both acetabular prosthesis and femoral prosthesis depending on the reasons for revision, two-stage revision was performed on 1 case with periprosthetic infection. RESULTS: The average of Harris hip score was increased from 46 (28 to 62) preoperatively to 86 (75 to 96) at follow up. The complication occurred in 2 cases: one was postoperative haematoma formation who was performed further surgery for clearance of haematoma, another was slight instability of the hip joint who was accepted skin traction for 3 weeks. CONCLUSIONS: The main reason for revision after primary total hip replacement is related to uncorrected insert of acetabular prosthesis. Improving surgical technique of insert of acetabular prosthesis is important in primary total hip replacement.