Emergency internal iliac artery temporary occlusion after massive hemorrhage during surgery of cesarean scar pregnancy: A case report.

BACKGROUND: Cesarean scar pregnancy (CSP) is rare but may result in uterine rupture during pregnancy or massive hemorrhage during abortion procedures. Awareness of this condition is increasing, and most patients with CSP are now diagnosed early and can be managed safely. However, some atypical patients are misdiagnosed, and their surgical risks are underestimated, increasing the risk of fatal hemorrhage. CASE SUMMARY: A 27-year-old Asian woman visited our institution because of abnormal pregnancy, and she was diagnosed with a hydatidiform mole through trans-vaginal ultrasound (TVS). Under hysteroscopy, a large amount of placental tissue was found in the scar of the lower uterine segment, and a sudden massive hemorrhage occurred during the removal process. The bilateral internal iliac arteries were temporarily blocked under laparoscopy, and scar resection and repair were rapidly performed. She was discharged in good condition 5 d after the operation. CONCLUSION: Although TVS is widely used in the diagnosis of CSP, delays in the diagnosis of atypical CSP remain. Surgical treatment following internal iliac artery temporary occlusion may be an appropriate management method for unanticipated massive hemorrhage during CSP surgery.

A review of the current state of the computer-aided diagnosis (CAD) systems for breast cancer diagnosis.

Breast cancer is one of the most common cancers affecting females worldwide. Early detection and diagnosis of breast cancer may aid in timely treatment, reducing the mortality rate to a great extent. To diagnose breast cancer, computer-aided diagnosis (CAD) systems employ a variety of imaging modalities such as mammography, computerized tomography, magnetic resonance imaging, ultrasound, and histological imaging. CAD and breast-imaging specialists are in high demand for early detection and diagnosis. This system has the potential to enhance the partiality of traditional histopathological image analysis. This review aims to highlight the recent advancements and the current state of CAD systems for breast cancer detection using different modalities.

Overexpression of PBK/TOPK relates to poor prognosis of patients with breast cancer: a retrospective analysis.

BACKGROUND: PDZ-binding kinase/T-lymphokine-activated killer cell-derived protein kinase (PBK/TOPK) is a potential prognostic indicator for patients with breast cancer. The objective of the present study was to explore the relationship between PBK/TOPK expression and clinicopathological indicators as well as the survival of patients with breast cancer. METHODS: Immunohistochemical staining was used to detect the expression of PBK/TOPK in 202 cases of breast cancer tissues. The relationship between PBK/TOPK and clinicopathological parameters was evaluated using Spearman's rank-order correlation. The difference in PBK/TOPK expression among different molecular types was analyzed with the chi-square test. Kaplan-Meier analysis was used to create a survival curve and the log rank test was used to analyze the overall survival (OS) and disease-free survival (DFS). Prognostic correlation was assessed using univariate and multivariate Cox regression analyses. RESULTS: Among 202 breast cancer samples, PBK/TOPK was expressed ("+" and "++") in 182 samples (90.1%). In addition, the histological grade, TNM stages, lymph node metastasis, estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER-2), and Ki-67 were positively associated with PBK/TOPK expression. With regard to the molecular type, the expression of PBK/TOPK is different. The expression level of PBK/TOPK was negatively correlated with both the OS and DFS of breast cancer patients. The difference in the above results is meaningful (P < 0.05). CONCLUSIONS: PBK/TOPK is overexpressed in breast cancer, and the expression is closely related to the clinicopathological characteristics of the disease. Breast cancer patients with high expression of PBK/TOPK have a poor prognosis. Therefore, healthcare providers can optimize breast cancer management using this indicator.

Prognostic value of baseline genetic features and newly identified TP53 mutations in advanced breast cancer.

Approximately 30% of breast cancer (BC) patients suffer from disease relapse after definitive treatment. Monitoring BC at baseline and disease progression using comprehensive genomic profiling would facilitate the prediction of prognosis. We retrospectively studied 101 BC patients ultimately experiencing relapse and/or metastases. The baseline and circulating tumor DNA-monitoring cohorts included patients with baseline tumor tissue and serial plasma samples, respectively. Samples were analyzed with targeted next-generation sequencing of 425 cancer-relevant genes. Of 35 patients in the baseline cohort, patients with TP53 mutations (P < 0.01), or CTCF/GNAS mutations (P < 0.01) displayed inferior disease-free survival, and patients harboring TP53 (P = 0.06) or NOTCH1 (P = 0.06) mutations showed relatively poor overall survival (OS), compared to patients with wild-type counterparts. Of the 59 patients with serial plasma samples, 11 patients who were newly detected with TP53 mutations had worse OS than patients whose TP53 mutational status remained negative (P < 0.01). These results indicate that an inferior prognosis of advanced breast cancer was potentially associated with baseline TP53, CTCF, and NOTCH1 alterations. Newly identified TP53 mutations after relapse and/or metastasis was another potential prognostic biomarker of poor prognosis.

Treatment Patterns and Outcomes of Elderly Patients With Potentially Curable Esophageal Cancer.

OBJECTIVES: The proportion of elderly patients with esophageal cancer (EC) is increasing due to prolonged life expectancy and aging process. The aim of the study is to explore the optimal treatment strategy for elderly patients (aged ≥70 years) with locally advanced EC. METHODS: Eligible patients with cT2-4aNxM0 EC were identified in the Surveillance, Epidemiology, and End Results database from 2010 to 2016. Treatment patterns were divided into six groups: surgical resection (S), chemoradiotherapy (CRT), trimodality therapy (CRT+S), radiotherapy (RT), chemotherapy (CT), or observation with no treatment (Obs). Survival between groups was compared using the log-rank test, and the Cox proportional hazards model was used to identify factors associated with overall survival (OS). RESULTS: A total of 2917 patients with potentially curable EC were identified. Of all the patients included, 6.7%, 51.8%, 18.0%, 9.4% and 3.6%received S, CRT, CRT+S, RT, and CT, respectively, whereas 10.6% underwent Obs. The 3-year OS estimates were 30.2% (95% confidence interval [CI]: 23.5-38.9%), 25.4% (95% CI: 22.8-28.3%),44.3% (95% CI: 39.3-49.9%), 11.4% (95% CI: 7.7-17.0%), 16.1% (95% CI: 9.1-28.3%), and 5.6% (95% CI: 3.2-9.8%) for S, CRT, CRT+S RT, CT, and Obs (p<0.001), respectively. Overall, patents underwent CRT+S had the longest OS, compared to other treatment patterns, and the survival difference was not significant between patients receiving CRT and S (p=0.12) in the elderly population. However, the survival benefits of trimodality therapy over CRT gradually weakened with the increase in age, and became statistically non-significant for EC patients aged ≥80 years (p=0.35). Multivariate analysis showed that treatment patterns, age, sex, tumor grade, T stage, N stage, and marital status were significantly associated with OS. CONCLUSION: Generally, the use of trimodality therapy was associated with the longest OS, the survival benefits were comparable between CRT and S alone, and CRT was superior to RT or CT alone in elderly patients with curable EC. For patients intolerable to surgery or aged ≥80 years, definitive CRT should be considered as a preferable option.

The efficacy and safety of metformin combined with simvastatin in the treatment of polycystic ovary syndrome: A meta-analysis and systematic review.

BACKGROUND: Several previous randomized controlled trials (RCTs) evaluated the efficacy of metformin combined with simvastatin in the treatment of polycystic ovary syndrome (PCOS), yet the results of the researches are not consistent. It is necessary to conduct a meta-analysis to explore the efficacy and safety of metformin combined with simvastatin in the treatment of PCOS, to provide evidence supports for the treatment of PCOS. METHODS: We searched PubMed, EMbase, Cochrane Library, China National Knowledge Infrastructure, Wanfang, and Chinese biomedical literature databases online to identify the RCTs evaluating the efficacy of metformin combined with simvastatin in the treatment of PCOS. Standardized mean difference (SMD) and 95% confidence interval (95% CI) were calculated to evaluate the synthesized effects. RESULTS: Nine RCTs with a total of 746 PCOS patients were included. The synthesized results indicated that the combined use of metformin and simvastatin are more beneficial to reduce the total cholesterol (SMD -2.66, 95% CI -3.65 to -1.66), triglycerides (SMD -1.25, 95% CI -2.02 to -0.49), low density lipoprotein (SMD -2.91, 95% CI -3.98 to -1.84), testosterone (SMD -0.64, 95% CI -1.13 to -0.15), fasting insulin (SMD -1.17, 95% CI -2.09 to -0.26) than metformin alone treatment in PCOS patients (all P < .001), and there was no significant difference in the high density lipoprotein (SMD -0.05, 95% CI -0.56-0.46), luteinizing hormone (SMD -0.58, 95% CI -1.66 to -0.50), follicle stimulating hormone (SMD 0.41, 95% CI -0.78-1.59), prolactin (SMD -1.38, 95% CI -2.93-0.17), fasting blood sugar (SMD 0.23, 95% CI -0.52-0.97), and insulin sensitivity index (SMD -0.17, 95% CI -0.48-0.15) between experimental and control groups (all P > .05). CONCLUSIONS: Metformin combined with simvastatin is superior to metformin alone in the treatment of PCOS patients with more advantages in improving the levels of sex hormones, blood lipids, and blood sugar. However, the safety of this therapy still needs to be further explored in clinical studies with high-quality and large samples.

The m6A methyltransferase METTL3 promotes the stemness and malignant progression of breast cancer by mediating m6A modification on SOX2.

PURPOSE: We aimed to uncover the role of METTL3 in stimulating the stemness and progression of breast cancer (BCa) through mediating N6-methyladenosine (m6A) modification on SOX2 mRNA. METHODS: METTL3 levels in 48 paired BCa and adjacent normal ones were examined. Kaplan-Meier method was introduced for assessing the prognostic value of METTL3 in BCa. Regulatory effects of METTL3 on invasive and migratory abilities in MCF-7 cells were evaluated by Transwell assay. Besides, the protein levels of SOX2 and tumor stem cell markers CD133 and CD44 in MCF-7 cells affected by METTL3 were determined by Western blot. In addition, the potential interaction between METTL3 and SOX2 was ascertained through RIP (RNA-Binding Protein Immunoprecipitation) assay. Moreover, the interaction between IGF2BP2 and SOX2 influenced by METTL3 was verified by RIP assay as well. RESULTS: METTL3 was upregulated in BCa tissues, especially in T3-T4 or those accompanied with lymphatic metastasis. BCa patients expressing a high level of METTL3 suffered worse prognosis. Knockdown of METTL3 downregulated protein levels of SOX2, CD133 and CD44 in MCF-7 cells. Moreover, invasive and migratory abilities were attenuated in BCa cells with METTL3 knockdown. Silencing of IGF2BP2 markedly downregulated SOX2. RIP assay confirmed the binding between METTL3 and SOX2 mRNA, and knockdown of METTL3 decreased the enrichment of SOX2 in anti-IGF2BP2. Interestingly, overexpression of SOX2 partially reversed the regulatory effects of downregulated METTL3 on MCF-7 cells. CONCLUSIONS: METTL3 is upregulated in BCa, and it promotes the stemness and malignant progression of BCa through mediating m6A modification on SOX2 mRNA.

Circ_0061825 Acts as a miR-593-3p Sponge to Promote Breast Cancer Progression by Regulating FGFR3 Expression.

BACKGROUND: Breast cancer (BC) remains the most common malignancy among women. Circular RNAs (circRNAs) have been demonstrated to play important roles in human cancers, including BC. In this study, we sought to identify the precise parts of circ_0061825 (circRNA trefoil factor 1, circ_TFF1) in BC pathogenesis. METHODS: The expression levels of circ_0061825, miR-593-3p and fibroblast growth factor receptor 3 (FGFR3) were detected by quantitative real-time polymerase chain reaction (qRT-PCR) or Western blot. Circ_0061825 was characterized using ribonuclease (RNase) R digestion, actinomycin D and subcellular fractionation assays. Cell viability, colony formation, migration, invasion, cell cycle progression and apoptosis were evaluated using Cell Counting Kit-8 (CCK-8), colony formation, wound-healing, transwell and flow cytometry assays, respectively. Targeted relationships among circ_0061825, miR-593-3p and FGFR3 were determined by a dual-luciferase reporter assay. Animal studies were used to assess the impact of circ_0061825 in tumor growth in vivo. RESULTS: Our data indicated that circ_0061825 was overexpressed in BC tissues and cells, and it was mainly localized in the cytoplasm of BC cells. Circ_0061825 knockdown hampered BC cell viability, colony formation, migration, invasion, cell cycle progression and enhanced cell apoptosis in vitro and weakened tumor growth in vivo. Mechanistically, circ_0061825 functioned as a molecular sponge of miR-593-3p, and circ_0061825 knockdown repressed BC cell malignant progression in vitro by miR-593-3p. FGFR3 was a direct target of miR-593-3p, and circ_0061825 modulated FGFR3 expression through sponging miR-593-3p. Moreover, miR-593-3p overexpression hindered BC cell malignant progression in vitro by down-regulating FGFR3. CONCLUSION: Our current work provided evidence that circ_0061825, an up-regulated circRNA in BC, regulated BC malignant progression at least in part through targeting the miR-593-3p/FGFR3 axis, illuminating a novel therapeutic target for BC management.

Effect of reproductive health education on health literacy of hospitalized female adolescents / 中国学校卫生

Objective@#To explore the effect of reproductive health education on health literacy of hospitalized female adolescents,and to provide reference for the protection of their physical and mental health.@*Methods@#A total of 102 female adolescents who were hospitalized in department of gynaecology from January 2019 to December 2019 were selected for reproductive health education and questionnaire survey.@*Results@#There were 65 cases of unplanned pregnancy (4 cases of tubal pregnancy), 18 cases of gynecological tumor (1 case of ovarian malignancy), 11 cases of gynecological inflammation (1 case of tubal abscess), and 8 cases of abnormal uterine bleeding (2 cases of blood transfusion).Eighty-six patients (84.3%) were treated surgically, 7 cases had their ovaries and/or fallopian tubes removed. After reproductive health education,health literacy of menstruation and ovulation, reproductive organ tumor, gynecological inflammation(inducing factors,clinical manifestations,harmfulness), harm of premature sexual life, scientific contraception, sexually transmitted diseases(types,transmission routes,preventioe measures), abortion hazard(short-term and longterm complications) and necessity of health examination improved significantly(χ2=14.8, 25.1, 15.7, 30.6, 18.6, 25.9, 31.1, 17.8, 19.1, 15.2, 40.1, 58.6, 69.8, P<0.05).@*Conclusion@#The lack of reproductive health knowledge of female hospitalized adolescents may lead to unplanned pregnancy, tumor, inflammation and abnormal uterine bleeding.Reproductive health education can significantly improve the health literacy of female adolescents and ensure their physical and mental health.

Impact of PDCA cycle on contraceptive methods after induced abortion in female college students / 中国学校卫生

Objective@#To explore the effect of plan-do-check-act (PDCA) cycle on contraceptive methods after induced abortion in female college students.@*Methods@#A total of 456 unmarried female college students who underwent artificial abortion in Tongde Hospital of Zhejiang Province from January 2018 to May 2019 were selected. These students were randomly divided into control group (n=228) and intervention group(n=228). Students from the control group accepted Post Abortion Care (PAC) service, while the intervention group accepted the management of PDCA cycle on basis of PAC services.@*Results@#In the intervention group, the rate of highly effective contraception immediately after abortion and six months after abortion were 91.23% and 71.17% respectively, while in the control group were 82.89% and 60.00%, the intervention group was higher than the control group(χ2=7.03, 5.98, P<0.05). The rate of unsafe contraceptive in the intervention group six months after abortion was 3.60%, while in the control group was 20.00%, the intervention group was lower than the control group(χ2=28.35, P<0.05).@*Conclusion@#The PDCA cycle can effectively improve the utilization rate of high efficiency contraceptive methods after induced abortion in college students, reduce the rate of unsafe contraceptive six months after abortion, and it is helpful to reduce the incidence of short-term unplanned pregnancy after abortion.

Evaluation of the post-abortion care services for unmarried female college students’ reproductive health effect / 中国学校卫生

Objective@#To understand the influence of post-abortion care (PAC) on the reproductive health of unmarried female college students,and to provide scientific basis for reproductive health education.@*Methods@#A total of 486 unmarried female college students who received artificial abortion voluntarily due to unwanted pregnancy and had complete follow-up data were investigated by questionnaires before and six months after the operation from July 2017 to June 2018 in the Tongde hospital of Zhejiang Province.@*Results@#There were 248 patients with abortion history, including 15 patients with abortion frequency ≥3 times.72 cases of high-risk abortion, the high-risk factors were re-abortion within half a year and the number of abortion ≥3 times; After PAC intervention, the awareness rate on menstruation and ovulation knowledge, scientific contraceptive knowledge, prevention of sexually transmitted diseases knowledge(types of diseases,raltes of transmission and preventive measures), and the harm of abortion knowledge(short-term and longterm complications), was higher than before(χ2=21.42, 69.65, 71.09, 52.80, 63.25, 187.59, 356.02, P<0.05). Before intervention, only 53.7% (261/486) of female college students used medium and low efficiency contraceptive measures, only 0.4% (2/486) were high-efficiency contraceptive measures. After intervention, all of them used contraceptive measures, The rate of effective contraceptive measures in the immediate and six months after operation was 85.4% (415/486) and 68.3% (332/486) respectively, which was significantly higher than before(χ2=786.10, P<0.05).@*Conclusion@#PAC service for female college students can improve awareness rate of sexual and reproductive health, enhance effective contraceptive measures, reduce the risk of repeated abortion.

Polar Ocean Observations: A Critical Gap in the Observing System and Its Effect on Environmental Predictions From Hours to a Season.

There is a growing need for operational oceanographic predictions in both the Arctic and Antarctic polar regions. In the former, this is driven by a declining ice cover accompanied by an increase in maritime traffic and exploitation of marine resources. Oceanographic predictions in the Antarctic are also important, both to support Antarctic operations and also to help elucidate processes governing sea ice and ice shelf stability. However, a significant gap exists in the ocean observing system in polar regions, compared to most areas of the global ocean, hindering the reliability of ocean and sea ice forecasts. This gap can also be seen from the spread in ocean and sea ice reanalyses for polar regions which provide an estimate of their uncertainty. The reduced reliability of polar predictions may affect the quality of various applications including search and rescue, coupling with numerical weather and seasonal predictions, historical reconstructions (reanalysis), aquaculture and environmental management including environmental emergency response. Here, we outline the status of existing near-real time ocean observational efforts in polar regions, discuss gaps, and explore perspectives for the future. Specific recommendations include a renewed call for open access to data, especially real-time data, as a critical capability for improved sea ice and weather forecasting and other environmental prediction needs. Dedicated efforts are also needed to make use of additional observations made as part of the Year of Polar Prediction (YOPP; 2017-2019) to inform optimal observing system design. To provide a polar extension to the Argo network, it is recommended that a network of ice-borne sea ice and upper-ocean observing buoys be deployed and supported operationally in ice-covered areas together with autonomous profiling floats and gliders (potentially with ice detection capability) in seasonally ice covered seas. Finally, additional efforts to better measure and parameterize surface exchanges in polar regions are much needed to improve coupled environmental prediction.

miRNA-21 promotes proliferation and invasion of triple-negative breast cancer cells through targeting PTEN.

MicroRNAs (miRNAs) are small single-stranded RNAs that bind to the 3'UTR of the mRNAs of target genes. They can target multiple genes and regulate translation or degradation of the mRNA. miRNAs target genes in a tissue-specific manner, and the role of a particular miRNA varies according to tumor origin or even subtype within the same cancer. This study evaluated the effect of miR-21 expression in triple-negative breast cancer (TNBC) tissues and MDA-MB-468, a cell line derived from TNBC tissues. miR-21 was consistently upregulated in TNBC and MDA-MB-468 cells compared to normal tissues. Inhibition of miR-21 by miR-21 antisense oligonucleotides decreased the proliferation, viability, and invasiveness of MDA-MB-468 cells and enhanced apoptosis. Furthermore, we confirmed that PTEN was downregulated by miR-21 in MDA-MB-468 cells. The results indicated that PTEN may mediate the oncogenic properties of miR-21 in TNBC. In summary, miR-21 was upregulated in TNBC tissues and cells, and promoted the proliferation and invasion of MDA-MB-468 cells, but negatively regulated the expression of PTEN protein. Inhibition of miR-21 or overexpression of PTEN protein could be promising strategies for the treatment of patients with TNBC.

Association between the methylation status of the MGMT promoter in bone marrow specimens and chemotherapy outcomes of patients with acute myeloid leukemia.

The O(6)-methylguanine-DNA methyltransferase (MGMT) gene is a tumor suppressor gene that is associated with the risk of developing acute myeloid leukemia (AML). However, the association between the methylation status of the MGMT promoter and the chemotherapeutic outcomes of patients with AML remains unknown. In the present study, 30 bone marrow samples derived from patients with AML were collected prior and subsequent to chemotherapy. The methylation status of the MGMT promoter in the bone marrow specimens was determined by methylation-specific polymerase chain reaction. The results indicated that the methylation status of the MGMT promoter was influenced by different chemotherapeutic regimens. The MGMT methylation status of M4 patients (3 out of 6) were more chemosensitive, compared with that of patients with other AML subtypes (M1, 1 out of 3; M2, 0 out of 8; M3, 3 out of 7; M5, 0 out of 3; and M6, 1 out of 3). Age-based analysis revealed that the group aged ≤60 years (7 out of 24 patients) exhibited more methylation changes than patients aged >60 years (1 out of 6). Male patients (4 out of 13) were more susceptible to chemotherapy-induced methylation changes than female patients (4 out of 17). Thus, the methylation status of the MGMT promoter may serve as a potential biomarker to predict the therapeutic outcomes in male AML patients. However, further studies in larger sample sets are required to confirm the present findings.

Breast cancer in 30-year-old or younger patients: clinicopathologic characteristics and prognosis.

BACKGROUND: The number of 30-year-old or younger patients with breast cancer is increasing. The aim was to describe the clinicopathological features and prognosis of 30-year-old or younger patients with breast cancer. METHODS: We reviewed the records of 1,406 consecutive patients aged ≤50 years with first diagnosis of invasive breast cancer referred to surgery from March 2001 to March 2009. A total of 105 patients were aged ≤30 years (group I) and 1,301 were aged 31-50 years (group II). RESULTS: Compared with patients of group II, patients of group I had a higher percentage of tumors classified as estrogen receptors (ER) negative (P < 0.001) and progesterone receptors (PR) negative (P = 0.043), with a Ki-67 labeling index ≥20% of the cells (P = 0.011). There was no difference between the two groups for pT and pN, histology, endocrine therapy, and chemotherapy. The 5-year survival of group I was 67.5% as compared with 75.3% for group II (P = 0.003). CONCLUSIONS: Compared with patients aged between 31 and 50 years, patients aged ≤30 years have a greater chance of having an endocrine-unresponsive tumor and a significantly poor prognosis.

Sucrose-induced hypocotyl elongation of Arabidopsis seedlings in darkness depends on the presence of gibberellins.

In this study, the effects of sucrose on hypocotyl elongation of Arabidopsis seedlings in light and in dark were investigated. Sucrose suppressed the hypocotyl elongation of Arabidopsis seedlings in light, but stimulated elongation in dark. Application of paclobutrazol (PAC, a gibberellin biosynthesis inhibitor) impaired the effects of sucrose on hypocotyl elongation, suggesting that endogenous GAs is required for sucrose-induced hypocotyl elongation in the dark. Exogenous GA(3) application reversed the repression caused by PAC application, indicating that exogenous GA(3) could substitute, at least partially, for endogenous GAs in sucrose-induced hypocotyl elongation. In addition, we found that GA 3-oxidase 1 (GA3ox1), encoding a key enzyme involved in endogenous bioactive GA biosynthesis, was up-regulated by sucrose in the dark, whereas GIBBERELLIN INSENSITIVE DWARF 1a (AtGID1a), encoding a GA receptor and playing an important role during GAs degradation to DELLA proteins (DELLAs, repressors of GA-induced plant growth), was down-regulated. These results imply that endogenous bioactive GA levels are expected to be enhanced, but the degradation of DELLAs was inhibited by sucrose in dark. Thus, our data suggest that the sucrose-induced hypocotyl elongation in the dark does not result from GA-induced degradation of DELLAs. We conclude that sucrose can stimulate hypocotyl elongation of Arabidopsis seedlings in the dark in a GA-dependent manner.