First-trimester ultrasound diagnosis and risk factor analysis of cesarean scar pregnancy after in vitro fertilization-embryo transfer.

Background: Cesarean scar pregnancy (CSP) is one of the rarest ectopic pregnancies which may be associated with life-threatening complications. Owing to the rarity of CSP, little is known about it. This study aimed to evaluate the value of the first-trimester transvaginal sonography (TVS) diagnosis and the risk factors of CSP after in vitro fertilization-embryo transfer (IVF-ET). Methods: This was a retrospective study of women undergoing IVF-ET between January 2013 and December 2018. Women who were diagnosed with a CSP using TVS and confirmed by surgery and histological examination were included. The clinical data and ultrasound findings were collected and analyzed. Univariate and multivariate logistic regression analyses were performed for evaluation of possible influence factors. Diagnostic parameters including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of TVS were calculated for the diagnosis of CSP. Results: Overall, 75,438 consecutive women who underwent IVF-ET had received TVS during this period. Of these, 4,817 women (6.4%) had a history of cesarean section and 83 cases were found to have a CSP. Due to the absence of histological data, 19 cases treated conservatively were excluded. Finally, 64 cases were included, among whom 63 cases were correctly diagnosed [including 17 cases of heterotopic CSP (HCSP)] and 1 case was missed using TVS. Another 1 case of inevitable miscarriage was misdiagnosed as a CSP. The maternal age at the initial scan [34.0 (range, 26.0-44.0) years], the infertility duration [4.0 (range, 1-12) years], and the initial diagnostic time after ET [27 (range, 20-50) days] were recorded. A gestational sac (GS) was observed in all 63 cases during ultrasound examinations, including 28 with fetal pole, 25 with a yolk sac only, and 10 with an empty sac. The sensitivity and specificity of first-trimester TVS in diagnosing CSP were 98.44% and 99.98%, respectively; the PPV and NPV were 98.44% and 99.98%, respectively. Multivariate logistic regression analysis showed thinner endometrial thickness (ET) on transfer day [adjusted odds ratio (aOR): 0.83; 95% confidence interval (CI): 0.76-0.93, P<0.001] and multiple ET (aOR 53.60, 95% CI: 5.31-1,736.00, P=0.008) were independent risk factors for CSP and HCSP, respectively. Conclusions: First-trimester TVS performed by an experienced sonographer has a high sensitivity for making the correct diagnosis of CSP after IVF-ET, which is helpful for clinical intervention and avoiding severe complications. For patients with a history of cesarean section, thinner ET on the transfer day and bigger body mass index (BMI) seem to be risk factors for CSP; single blastocyst transfer should be recommended to decrease the possibility of HCSP. The clinical significance of this study still needs to be considered.

Coping methods of college students with different personality traits when facing COVID-19 from the anxiety psychology perspective.

Objective: Based on a survey of anxiety among college students during the epidemic, this study takes anxiety as an example to study the coping methods of college students with different personality traits. Thus predicting the behavioral tendencies of college students and proposing some appropriate suggestions for the current psychological education work of college students. Method: The study was carried out during the large-scale outbreak of the COVID-19 epidemic, and the investigation lasted one month. Using the Self Rating Anxiety Scale (SAS), Eysenck Personality Questionnaire Simplified Chinese Version (EPQ-RSC), and Trait Coping Style Scale (TCSQ), an online questionnaire survey was conducted on 932 college students to analyze the mutual effects of different grades, genders, personality traits, coping methods, and other factors. Results: The research found that there was a significant gender difference in negative coping methods and anxiety among college students. Grade differences: In the comparative study of personality traits, there are gender differences in introversion and concealment dimensions and grade differences in neuroticism and concealment dimensions. There is a pairwise correlation between personality traits, coping methods, and anxiety. There is a significant positive correlation between the dimensions of psychoticism, neuroticism and anxiety; There is a significant negative correlation between introversion, concealment, and anxiety. Positive coping methods are significantly negatively correlated with anxiety, while negative coping methods are significantly positively correlated with anxiety. The positive coping style is significantly negatively correlated with the dimensions of psychoticism and neuroticism and positively correlated with the dimensions of introversion, introversion, and concealment; Negative coping methods are significantly positively correlated with the dimensions of psychoticism and neuroticism and negatively correlated with the dimensions of introversion, introversion, and concealment. Conclusion: The research results indicate that the mental health issues of college students need to be taken seriously to prevent the spread of anxiety.

Corrigendum: An endometrial receptivity scoring system evaluated by ultrasonography in patients undergoing frozen-thawed embryo transfer: a prospective cohort study.

[This corrects the article DOI: 10.3389/fmed.2024.1354363.].

An endometrial receptivity scoring system evaluated by ultrasonography in patients undergoing frozen-thawed embryo transfer: a prospective cohort study.

Introduction: Ultrasound has become a routine method for endometrial receptivity (ER) evaluation. However, there is controversy over the independent evaluation values of various ultrasound indicators. Some researchers have designed multi-indicator prediction systems, but their prediction values are uneven. To further our understanding of ER, we conducted this prospective cohort study to estimate ER noninvasively and effectively. Methods: Women who underwent the first frozen-thawed embryo transfer (FET) cycle from April 2019 to July 2021 were included in the study. On the day of transfer, transvaginal three-dimensional ultrasound examination was performed to evaluate ER, including endometrial thickness, morphology, volume, movement, blood flow and flow index. The clinical pregnancy rate was the primary outcome. Based on whether clinical pregnancy was achieved, enrolled patients were divided into pregnant and nonpregnant groups. Results: This study analyzed 197 FET patients (139 pregnancies in total, 70.5%). The protective factors for clinical pregnancy included primary infertility [adjusted odds ratio (aOR), 1.98; 95% confidence interval (CI), 1.01-3.882; p = 0.047] and more frequent endometrial peristalsis (aOR, 1.33; 95% CI, 1.028-1.722; p = 0.03). Scores of 1-2 were assigned according to the relationship between different ultrasound indicators and the clinical pregnancy rate (CPR). The ER score of the patient was the sum of the scores of the 6 items. The ER score of the pregnant group was significantly higher than that of the nonpregnant group (7.40 ± 1.73 vs. 6.33 ± 1.99, p = 0.001). The CPR increased with an increasing ER score. The CPR in the ER < 6 group was significantly lower than that in the ER >6 group (45.5% vs. 75.6%, p = 0.001). Conclusion: A noninvasive ultrasound scoring system for ER was proposed. This system may provide a non-invasive guidance perspective, in conjunction with invasive assessments currently used in clinical practice, to achieve more effective embryo transfer.

Endometrial receptivity change: ultrasound evaluation on ovulation day and transplantation day during the natural frozen embryo transfer cycle.

Objective: To obtain quantitative and comprehensive results of the changes in comprehensive ER indicators from ovulation day to transplantation day by ultrasonography during the natural frozen-thawed embryo transfer cycle (FET). Methods: This is a prospective analysis of 230 infertile women undergoing their first FET cycles from April 2019 to July 2021. To evaluate ER, ultrasound scans were performed on the days of ovulation and embryo transfer for all included patients. All included patients were divided into a pregnancy group and a nonpregnancy group according to whether clinical pregnancy was achieved. The ER changes from ovulation day to transplantation day in the overall study population (n=230), pregnancy group (n=158) and nonpregnancy group (n=72) were analyzed. Results: In the overall population, type C was predominant on ovulation day, but type B was the most common on transplantation day (P<0.001). From ovulation day to transplantation day, endometrial thickness was significantly increased (11.26 ± 2.14 vs. 11.89 ± 2.08 mm, P<0.001), but endometrial volume (4.26 ± 1.75 vs. 4.03 ± 1.62 ml, P<0.001), endometrial VI (1.34 ± 1.64 vs. 0.95 ± 1.99, P<0.001), VFI (0.47 ± 0.72 vs. 0.40 ± 1.03, P<0.001), subendometrial VI (5.04 ± 3.89 vs. 3.29 ± 2.92, P<0.001), FI (34.07 ± 4.61 vs. 33.41 ± 5.30, p=0.004), VFI (2.07 ± 2.65 vs. 1.19 ± 1.19, P<0.001) and frequency of endometrial peristalsis (2.90 ± 1.44 vs. 1.40 ± 1.41, P<0.001) were significantly decreased. In the pregnancy group, the changes in all ultrasound parameters were in the same direction as those in the overall population. In the nonpregnancy group, except for endometrial volume and VI, which showed no difference, other ultrasound parameters showed the same direction of change as those in the overall population. No significant difference was found in the pregnancy probability among the different absolute change groups. Conclusion: During a natural cycle, the morphology of the endometrium changes mostly from type C to type B, the endometrial thickness increases, and the volume decreases. The blood supply of the endometrium, the subendometrial 5 mm and the frequency of peristalsis decrease from ovulation day to transplantation day. Compared with the nonpregnancy group, the pregnancy group tended to have more obvious decreases in endometrial volume and blood flow perfusion. However, these endometrial changes do not mean that pregnancy is bound to occur. endometrial receptivity, in vitro fertilization, frozen-thawed embryo transfer, natural cycle, ultrasound evaluation, ovulation day, transplantation day.

[Application of automated breast volume scanner and mammography in differentiation of small breast lesions with BI-RADS-US 4].

OBJECTIVE: To evaluate the value of automatic breast volume scanner (ABVS) and mammography (MG) in differential diagnosis for small breast lesions with breast imaging reporting and data system ultrasound (BI-RADS-US) 4.
 Methods: ABVS and MG were performed for 103 patients with 109 breast lesions, which were classified as BI-RADS-US 4 by conventional ultrasound (US). Postoperative pathological diagnosis served as gold standard. The diagnostic efficacy for US, US combined with MG, US combined with ABVS and the combination of three methods were compared.
 Results: The sensitivity of US, US combined with MG, US combined with ABVS and the combination of three methods were 85.5%, 86.8%, 94.7% and 96.0%, respectively. The specificity for them were 66.7%, 69.7%, 81.8% and 84.9%, respectively. The accuracy for them were 79.8%, 81.6%, 90.8% and 92.7%, respectively. The area under the receiver operating characteristic (ROC) curve (AUC) for them were 0.76, 0.78, 0.88 and 0.90, respectively. The accuracy and AUC for US combined with ABVS in differential diagnosis of BI-RADS-US 4 small breast lesions were significantly higher than those of US and US combined with MG (P<0.05). There was no significant difference in sensitivity and specificity among these 3 groups (P>0.05). No significant difference was found in sensitivity, specificity, accuracy, and AUC between US combined with ABVS and the combination of three methods (P>0.05).
 Conclusion: Combination of US with ABVS can improve the diagnostic efficacy of conventional US in differential diagnosis for BI-RADS-US 4 small breast lesions, and it is superior to US combined with MG.

Clinicopathological significance of NGX6 expression in breast cancer and its relationship to angiogenesis.

OBJECTIVE: The aim was to explore clinicopathological significance of Nasopharyngeal carcinoma-associated gene 6 (NGX6) expression in breast cancer and its relationship to angiogenesis. METHODS: Clinicopathological feature of 168 patients with breast cancer were analyzed. NGX6 expression and microvessel density (MVD) in tumor tissue were measured using immunohistochemistry methods. The association of NGX6 expression with MVD and clinicopathological features was assessed. RESULTS: Among 168 cases of breast cancer, NGX6 positive expression were found in 92 (54.8%) cases and NGX6 negative expression were found in 76 (45.2%) cases. Incidence rate of large size tumor, high tumor node metastasis (TNM) stage and lymph node metastasis in NGX6 negative expression group were higher than NGX6 positive expression group in breast cancer (P=0.003, 0.007, and 0.003, respectively). MVD in NGX6 negative expression group is 22.5±4.8, MVD in NGX6 positive expression group is 15.2±4.2. MVD in the NGX6 negative expression group was significantly higher than the NGX6 positive expression group (P<0.05). CONCLUSION: The expression of NGX6 was closely associated with tumor size, TNM stage, lymph node metastasis and MVD. NGX6 is involved in metastasis and angiogenesis activity of breast cancer. The study may provide a theoretical basis for anti-angiogenic therapy of breast cancer.