Comparing the efficacy and safety of three surgical approaches for total hysterectomy (TSATH): protocol for a multicentre, single-blind, parallel-group, randomised controlled trial.

INTRODUCTION: Hysterectomy is the most common surgical procedure in the field of gynaecology. The traditional multiport laparoscopy, transumbilical laparoendoscopic single-site surgery (TU-LESS) and transvaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy approaches have been implemented to varying degrees in clinical practice. At present, although their feasibility has been proven, there are no large randomised controlled studies on postoperative rehabilitation. This study aims to evaluate postoperative recovery and assess the safety and effectiveness of these three surgical approaches for total laparoscopic hysterectomy. METHOD AND ANALYSIS: This is a multicentre, randomised, single-blind, three-arm, parallel-group, interventional clinical trial. Recruitment will be carried out in five tertiary hospitals in China. Patients diagnosed with benign uterine disease or precancerous lesions will be assigned to the vNOTES group, TU-LESS group and conventional laparoscopy group at a 1:1:1 ratio. The achievement rate of comprehensive indices of enhanced recovery after surgery (ERAS) within 24 hours postoperatively will be considered the primary outcome (the comprehensive indicators of ERAS include fluid intake, passing flatus, urination after catheter removal, ambulation and a Visual Analogue Scale score ≤3.) This study will use a non-inferiority test, with a power (1-ß) of 80% and a margin of -0.15, at a one-sided α of 0.0125. The sample size will be 480 patients (including an assumed 15% dropout rate), calculated according to the primary outcome. ETHICS AND DISSEMINATION: This study was approved on 25 April 2022 by the Medical Ethics Committee of West China Second University Hospital (2022(057)), Sichuan University, Chengdu, China. All participants will be required to provide informed consent before their participation in the study. The results of the trial will be submitted for publication in a peer-reviewed journal and presented at international conferences. PROTOCOL VERSION: V.3.0, 31 August 2023. TRIAL REGISTRATION NUMBER: ChiCTR2200057405.

Efficacy of transumbilical laparoendoscopic single-site surgery versus multi-port laparoscopic surgery for endometrial cancer: a retrospective comparison study.

Background: Although single-port laparoscopy surgery has been evaluated for several years, it has not been widely adopted by gynecologic oncologists. The objective was to compare the perioperative outcomes and survival of endometrial cancer (EC) patients undergoing transumbilical laparoendoscopic single-site surgery (TU-LESS) with multi-port laparoscopic surgery (MLS). Materials and methods: This is a retrospective comparative monocentric study including patients treated between December 2017 and October 2021. The perioperative outcomes and survival of EC patients who had surgery via TU-LESS or MLS were compared, by propensity matching. Results: A total of 156 patients were included (TU-LESS vs. MLS: 78 vs. 78). The conversion rate of TU-LESS and MLS was 5.13% and 2.56%, respectively (P=0.681). The operation time was comparable between the two groups [207.5min (180-251) vs. 197.5min (168.8-225), P=0.095]. There was no significant difference between the two groups in exhaustion time, perioperative complications, or postoperative complications. While, the TU-LESS group had a shorter out-of-bed activity time [36 hours (24-48) vs. 48 hours (48-72), P<0.001] and a lower visual analog pain scale 36 hours after surgery [1 (1-2) vs. 2 (1-2), P<0.001] than the MLS group. The length of hospital stay was similar in the two groups [5(4-6) vs. 5(4-5), P=0.599]. Following surgery, 38.5% of the TU-LESS patients and 41% of the MLS patients got adjuvant therapy (P=0.744). The median follow-up time for TU-LESS and MLS cohorts was 45 months (range: 20-66) and 43 months (range: 18-66), respectively. One TU-LESS patient and one MLS patient died following recurrence. The 4-year overall survival was similar in both groups (98.3% vs. 98.5%, P=0.875). Conclusion: TU-LESS is a feasible and safe option with comparable perioperative outcomes and survival of MLS in endometrial cancer. With the growing acceptance of sentinel lymph node biopsy, TU-LESS of endometrial cancer may be a viable option for patients and surgeons.

Case Report: A rare case of gastric-type adenocarcinoma of stumps of duplicated cervices in a 49-year-old woman: A case with hidden focus confused us a lot.

Gastric-type endocervical adenocarcinoma (G-EAC) is a rare special type of cervical mucinous adenocarcinomas, and it is reported the incidence is unrelated to human papilloma virus infection. We report a rare case of G-EAC in stumps of duplicated cervices in a 49-year-old female patient. The woman complained of post-coital bleeding. She had a didelphic uterus with a duplex cervix, and had undergone subtotal hysterectomy 16 years ago. Gynecological examination revealed a normal-appearing right cervix, but the non-dominant side of the left cervix, which was buried and covered by the side wall of the left vagina, was difficult to view. After exposing, the left side cervix presented a mature appearance which was smaller than a normal cervix. Her serum carbohydrate antigen-19-9 levels was 112.59 U/ml. The right cervix's cytology was normal, whereas the left cervix had unusual glandular epithelial cells. HPV testing on both cervical smears was negative. Adenocarcinoma was identified at 3, 6, 12 o'clock at the right cervix in a colposcopy-directed punch biopsy, while no abnormality was found in the biopsy of the left cervix, nor in the curettage of the double cervices. Pelvic magnetic resonance imaging (MRI) revealed two cervical canals, with a 1.9cm×1.6cm mass inside the left cervix, and the left wall of the right cervix may be involved by the tumor of the left cervix. After much deliberation, we considered that the patient had adenocarcinoma of the left cervix stage IB1. Then, the patient underwent radical cervical resection with bilateral salpingo-oophorectomy and bilateral pelvic lymphadenectomy. Her final histopathology indicated G-EAC of the duplicated cervices. After surgery, she received concurrent chemoradiation. Currently, 29 months after the final chemotherapy was administered, the patient remains healthy. Because G-EAC with duplicated cervices is an uncommon cunning tumor with a bad prognosis, early identification and therapy are recommended to enhance the prognosis. The comprehensive evaluation of symptoms and gynecological examination with cervical cytology, colposcopy-directed punch biopsy, endocervical curettage and MRI examine together may assist in determining an accurate preoperative diagnosis.

Survival of endogenous hepatic stem/progenitor cells in liver tissues during liver cirrhosis.

AIMS: This study addressed whether endogenous hepatic stem/progenitor (HSP) cells survival were related to the injured signals during liver cirrhosis. MATERIAL AND METHODS: Liver cirrhosis was induced in C57BL/6 mice by administering diethylnitrosamine (DEN) in drinking water. Hematoxylin-eosin staining and Masson's trichrome staining were used to identify infiltrative cells and connective tissues, respectively. The inflammatory activity grade and fibrotic stage, represented as G and S respectively, and evaluated by the International Simplified Grading and Staging System (ISGSS). Endogenous HSP cells (Ng2+HSP) were identified by immunofluorescence staining with an anti-neuro/glial antigen 2 (Ng2) antibody. All data were analyzed using SPSS 22.0 and GraphPad Prism 6 and Student's t-test was performed to determine statistical significance. p-values < 0.05 were considered statistically significant. KEY FINDINGS: All mice administered oral DEN developed liver fibrosis, liver cirrhosis and hepatocellular carcinoma (HCC). During the fibrosis period, observed a positive correlation of survival of endogenous HSP (Ng2+HSP) cells with inflammatory activity. As the disease developed into the cirrhotic stage, when lost correlation of endogenous HSP cells with inflammatory activity, revealed a dramatically reduced survival rate of endogenous HSP (Ng2+HSP) cells. SIGNIFICANCE: The DEN-induced liver cirrhosis could develop into three time zone of fibrosis, cirrhosis and cancer, and the histological patterns in the model are similar to those described in humans. Dramatic survival and less apoptosis of endogenous HSP (Ng2+HSP) cells was within fibrotic state, where inflammation signals is strong, indicating such time zone (1-6 weeks) during liver cirrhosis is important for mobilizing endogenous HSP-based regeneration.

A novel bioscaffold with naturally-occurring extracellular matrix promotes hepatocyte survival and vessel patency in mouse models of heterologous transplantation.

BACKGROUND: Naïve decellularized liver scaffold (nDLS)-based tissue engineering has been impaired by the lack of a suitable extracellular matrix (ECM) to provide "active micro-environmental" support. AIM: The present study aimed to examine whether a novel, regenerative DLS (rDLS) with an active ECM improves primary hepatocyte survival and prevents thrombosis. METHODS: rDLS was obtained from a 30-55% partial hepatectomy that was maintained in vivo for 3-5 days and then perfused with detergent in vitro. Compared to nDLS generated from normal livers, rDLS possesses bioactive molecules due to the regenerative period in vivo. Primary mouse hepatocyte survival was evaluated by staining for Ki-67 and Trypan blue exclusion. Thrombosis was assessed by immunohistochemistry and ex vivo diluted whole-blood perfusion. Hemocompatibility was determined by near-infrared laser-Doppler flowmetry and heterotopic transplantation. RESULTS: After recellularization, rDLS contained more Ki-67-positive primary hepatocytes than nDLS. rDLS had a higher oxygen saturation and blood flow velocity and a lower expression of integrin αIIb and α4 than nDLS. Tumor necrosis factor-α, hepatocyte growth factor, interleukin-10, interleukin-6 and interleukin-1ß were highly expressed throughout the rDLS, whereas expression of collagen-I, collagen-IV and thrombopoietin were lower in rDLS than in nDLS. Improved blood vessel patency was observed in rDLS both in vitro and in vivo. The results in mice were confirmed in large animals (pigs). CONCLUSION: rDLS is an effective DLS with an "active microenvironment" that supports primary hepatocyte survival and promotes blood vessel patency. This is the first study to demonstrate a rDLS with a blood microvessel network that promotes hepatocyte survival and resists thrombosis.

Spore morphology and ultrastructure of an Ascosphaera apis strain from the honeybees (Apis mellifera) in southwest China.

Ascosphaera apis is an intestinally infective, spore-forming, filamentous fungus that infects honeybees and causes deadly chalkbrood disease. Although A. apis has been known for 60 y, little is known about the ultrastructure of the spores. In this study, the fine morphology and ultrastructure of an isolate, A. apis CQ1 from southwest China, was comprehensively identified by transmission electron microscopy, confocal laser scanning microscopy, scanning electron microscopy, and optical microscopy. The high sequence similarity and phylogenetic data based on nuc rDNA ITS1-5.8S-ITS2 (ITS) supported the hypothesis that the CQ1 strain is a new member of the A. apis species. Morphological observation indicated that the mature spores are long ovals with an average size of 2 × 1.2 µm and are tightly packed inside spherical spore balls. More than 10 spore balls that were 8-16 µm in diameter were wrapped and formed a spherical, nearly hyaline spore cyst of 50-60 µm in diameter. Ultrastructural analysis showed that mature spores have two nuclei with distinctly different sizes. A large nucleus with double nuclear membranes was found in the center of the spore, whereas the small nucleus was only one-fifth of the large nucleus volume and was located near the end of the spore. Numerous ribosomes filled the cytoplasm, and many mitochondria with well-defined structures were arranged along the inner spore wall. The spore wall consists of an electron-dense outer surface layer, an electron-lucent layer, and an inner plasma membrane. Chitin is the major component of the spore wall. The germinated spore was observed as an empty spore coat, whereas the protoplasts, including the nuclei, mitochondria, and ribosomes, had been discharged. In addition to these typical fungal spore organelles, an unknown electron-dense regular structure might be the growing mycelium, which was arranged close to the inner spore wall and almost covered the entire wall area.

Stereoselective synthesis of enamino ketones through an aza-Michael/hydrolysis cascade reaction.

We have developed a mild, convenient and efficient synthesis of highly functionalized (Z)-ß-enamino ketones from readily available 3,4-dihydroisoquinoline imines and ynones through an aza-Michael/hydrolysis cascade reaction. This method is also suitable for the preparation of (Z)-ß-enamino esters using alkynoates as starting materials. Complex fully substituted pyrroles can be constructed from the obtained (Z)-ß-enamino ketones. It is an attractive alternative approach for the preparation of highly functionalized enamino ketones, esters and pyrroles.

Catalyst-free synthesis of novel dimeric ß-carboline derivatives via an unexpected [2 + 2 + 2] annulation.

We report here an unexpected catalyst-free [2 + 2 + 2] annulation reaction which allows access to novel complex dimeric ß-carboline derivatives in a single step. Various substituted ynones could react with dihydro-ß-carboline imines to deliver interesting [2 + 2 + 2] annulation products in moderate to good yields. Alkynoates can also be tolerated in this system.

A survey of Chinese citizens' perceptions on farm animal welfare.

Farm animal welfare has been gradually recognized as an important issue in most parts of the world. In China, domestic animals were traditionally raised in backyard and treated as an important component of family wealth. Industrialization of animal production brings forth the farm animal welfare concerns recently in China, yet the modern concept of animal welfare has not been publicized and a comprehensive recognition on how consumers and farmers perceive animal welfare is lacking. Therefore, we conducted a survey on public opinions toward farm animal welfare in China, based on pigs (including sows, piglets, and fattening pigs), domestic fowls (including layers and broilers) and their products. From 6,006 effective questionnaires approximately two thirds of the respondents had never heard of 'animal welfare'; 72.9% of the respondents claimed that, for the sake of animal derived food safety, human beings should improve the rearing conditions for pigs and domestic fowls; 65.8% of the respondents totally or partly agreed on establishing laws to improve animal welfare; more than half of the respondents were willing, or to some extent willing, to pay more for high-welfare animal products, whereas 45.5% of the respondents were not willing or reluctant to pay more. In summary, farm animal welfare is still in its early stage of development and more efforts are needed to improve the public conception to animal welfare in the process of establishing farm animal welfare standards and legislations in China.

[Clinical and pathological analysis on ovarian granulosa cell tumors].

OBJECTIVE: To identify different clinical and pathological features for adult and juvenile granulosa cell tumors. METHODS: The clinical records of 42 patients with granulosa cell tumors of ovary, including pathological features, treatments and follow up results between April 2001 and September 2009 were reviewed. RESULTS: 1) There were 38 newly diagnosed cases after 2001, and 4 cases were relapsed cases diagnosed before 2001. The 38 cases accounted for 3.13% of ovarian cancer cases treated in our hospital. 2) Twenty nine of the 38 cases (76.3%) were Adult Type, while the other 9 (23.7%) were Juvenile Type. The median onset age were 53 and 25 years old for the Adult Type and Juvenile Type, respectively, which shows significant difference (z = -2.990, P = 0.003). 3) The most common symptoms and signs were abdominal pain (44.7%), vaginal bleeding (42.1%), and abdominal mass (76.3%). The most common complications were endometrial hyperplasia (52.6%) and hysteromyoma (21.1%). 4) Stage I, II and III comprised 73.7%, 23.7% and 2.6% of the 38 cases, respectively. Ten patients ng the underwent conservative unilateral oophorectomy or ovarian enucleation. Twenty patients underwent total abdominal hysterectomy plus bilateral salpingo-oophorectomy. Eight patients underwent cytoreductive surgery. The 42 patients had been followed up for 7 to 175 months, with 14 patients lost of contact. No death was recorded. Inhibin, calretinin, and vimentin were demonstrated to be useful for the diagnosis of granulose cell tumors. CONCLUSION: With low incidence rate, ovarian granulosa cell tumor is a low-grade malignant and functional tumor. Most are unilateral diseases. Most Adult-type granulosa cell tumors occur in middle aged and elderly people, while most juvenile granulosa cell tumors occur in adolescents and children. Acute abdomen symptom may occur but ascites are less likely to occur in patients with granular cell tumors than those with epithelial ovarian cancers. Ovarian granulosa cell tumors are usually detected early, but easily relapse. Long-term follow-up is needed.

[Studies on quality standards of radix Angelicae dahuricae].

OBJECTIVE: To work out a qualitay standard of Radix Angelicae dahuricae. METHOD: TLC and HPLC were adopted. RESULT: Four coumerin compounds were identified by TLC, and the contents of two compounds were determined by HPLC. CONCLUSION: Imperatorin, isoimperatorin, byakangelicin and oxypeucedaninhydrate can be found simultaneously in Radix Angelicae dahuricae. The contents of imperatorin and isoimperitorin are not lower than 0.1% and 0.04% respectively.

A new compound from Gastrodia elata Blume.

A new compound, alpha-acetylamino-phenylprophyl alpha-benzoylamino-phenylpropionate (1) and a known compound 4-hydroxybenzyl beta-sitosterol ether (2), were isolated from the tubers of Gastrodia elata Blume and their structures were elucidated by spectral data.

[Studies on chemical constituents of effective part of Gastrodia elata].

OBJECTIVE: To study the chemical constituents of effective part of Gastrodia elata. METHOD: The constituens were isolated by column chromatographies with silica gel and ODS, and identified by NMR, MS spectra. RESULT: Six compounds were isolated and identified. CONCLUSION: Three compounds were isolated from this plant for the first time.

[Studies on chemical constituents from the water-soluble part of root of Angelica dahurica].

OBJECTIVE: To study the chemical constituents in the root of Angelica dahurica. METHOD: The compounds were isolated and identified by column chromatography and 1H, 13C NMR data. RESULT: Eleven compounds were isolated and identified. CONCLUSION: Six compounds were isolated from this plant for the first time.

[Studies on chemical constituents of the rhizomae of Ligusticum chuanxiong].

OBJECTIVE: To study the chemical constituents of Ligusticum chuanxiong. METHOD: The constituents were separated and purified by column chromatography with silica gel and ODS, and identified by NMR, MS spectral data. RESULT: Eight compounds were isolated and identified as Ligustilide(I), 4,5-dihydro-3-butylphthalide(II), Z, Z'-6,6',7,3 alpha-diligustili-de(III), Z-6,8',7,3'-diligustilide(IV), Z'-3,8-dihydro-6,6'7,3' alpha-diligustilide(V), 4-hydroxy-3-butylphthalide(VI), ferulic acid(VII) and Xiongterpene(VIII). CONCLUSION: Compound VIII is a new compound.