Management of persistent caesarean scar pregnancy after curettage treatment failure.

BACKGROUND: Caesarean scar pregnancy (CSP) is a late serious complication of caesarean section. The incidence of CSP has increased worldwide in recent years. Early diagnosis and prompt therapy are crucial to avoid catastrophic complications. There are various strategies for CSP treatment, but there is no consensus on the best management for CSP. Dilation and curettage (D&C) and hysteroscopy are common and effective treatments with their advantages and disadvantages. No in-depth study of the clinical effects of hysteroscopic management of CSP after D&C treatment failure has been conducted. The purpose of this study is to evaluate the effectiveness and safety of hysteroscopic removal of residual CSP tissue (persistent CSP) as a rescue after failed D&C management. METHODS: This is a retrospective clinical research study. Forty-five patients underwent operative hysteroscopy to remove the residual gestational tissue in the caesarean scar after failed D&C treatment. The clinical characteristics and outcomes of hysteroscopic surgeries of 45 CSP cases were investigated. All data analyses were conducted with SPSS 17.0. RESULTS: Forty-three CSP cases after unsuccessful curettage treatment were successfully treated by operative hysteroscopy. The estimated intraoperative blood loss was 20.00 (10.00-500.00) mL, the hysteroscopic operating time was 20.00 (15.00-45.00) min, the decline of serum ß-hCG the day after surgery was 71.91 ± 14.05%, the total hospitalisation time was 7.87 ± 2.26 days, the medical cost was 13,682.71 ± 3553.77 China Yuan (CNY), the time of bleeding after surgery was 7.42 ± 2.48 days, and the time of serum ß-hCG resolution after surgery was 13.84 ± 9.83 days. Follow-up after discharge demonstrated that there were no severe complications for any patients. CONCLUSIONS: Hysteroscopy therapy could treat persistent CSP effectively and safely after curettage treatment failure. Therapy should be individualised, and the risks and cost of the hysteroscopy procedure and anaesthesia must be considered and fully discussed with the patients before surgery.

Research on the expression of integrin ß3 and leukaemia inhibitory factor in the decidua of women with cesarean scar pregnancy.

BACKGROUND: Cesarean scar pregnancy (CSP) is a late serious complication of cesarean section. There has been an increase in the incidence of CSP worldwide in recent years. It's a life-threatening condition because of the high risk of uncontrolled hemorrhage and uterine rupture. The mechanism of CSP is still unclear. The endometrial receptivity might be different in the cesarean scar between CSP and normal pregnancies. Endometrial expression of integrin ß3 and LIF positively correlates with endometrial receptivity and embryo implantation. The purpose of the study is to explore the mechanism of CSP. METHODS: The EnVision two-step immunohistochemical staining technique was used to detect the expression of integrin ß3 and LIF in the decidua of women with CSP (20 cases) and normal pregnancies (20 cases). The distribution and staining intensity of integrin ß3 and LIF in the two groups were observed. Observation of the staining were done using microscope within five randomly selected high-power fields (HPF, 10 × 40). All data analyses were conducted with SPSS 17.0 and the statistical significance was set at P <0.05. RESULTS: The decidua in the different parts of both two groups that stained with the anti-integrin ß3 and anti-LIF antibody: most of the integrin ß3 and LIF positive cells were located in glandular epithelium. The expression intensity of integrin ß3 in the cesarean scar in CSP group was significant higher than the uterine cavity in CSP group and the cesarean scar in normal pregnancy group. It's similar with the uterine cavity in normal pregnancy group. The expression intensity of LIF in the cesarean scar in CSP group was significant higher than the uterine cavity in CSP group and the cesarean scar in normal pregnancy group. It's significant lower than the uterine cavity in normal pregnancy group. CONCLUSIONS: The decidual integrin ß3 and LIF might play an important role in the mechanism of CSP. The increase expression of integrin ß3 and LIF in the cesarean scar decidua might be associated with embryo implantation in cesarean scar. The occurrence of CSP might be related to the changes of endometrial receptivity in local cesarean scar.

Bismuth sulfide thin films with low resistivity on self-assembled monolayers.

Using self-assembled monolayers (SAMs), highly crystalline bismuth sulfide thin films with low electrical resistivity have been prepared from aqueous solution at low temperature (40-70 degrees C). The nucleation and growth process of Bi2S3 thin films was investigated in detail by XPS, AES, SEM, XRD, SAED, and HRTEM. Solution conditions have marked effects on the microstructure, growth rate, and mechanism of Bi2S3 films. Increased solution temperature resulted in a higher growth rate and a shorter induction time due to a higher supersaturation degree. In the solution of pH 1.12, homogeneous nucleation and the attachment process dominated the formation of Bi2S3 films. In contrast, at pH 0.47 Bi2S3 thin films were formed via heterogeneous nucleation and growth. The c-axial orientation of bismuthinite films was enhanced with the increase of reaction time. By controlling the solution supersaturation and reaction duration, highly crystalline Bi2S3 films composed of closely packed and coalescent crystallites could be realized, whose dark electrical resistivity could reach as low as 0.014 Omega cm without any post-treatment.