[Evaluation of the efficacy and safety of Nocardia rubra cell wall skeleton immunotherapy for cervical high-risk HPV persistent infection]

Objective: To evaluate the efficacy and safety of Nocardia rubra cell wall skeleton (Nr-CWS) in the treatment of persistent cervical high-risk human papillomavirus (HR-HPV) infection. Methods: A randomized, double blind, multi-center trial was conducted. A total of 688 patients with clinically and pathologically confirmed HR-HPV infection of the cervix diagnosed in 13 hispital nationwide were recruited and divided into: (1) patients with simple HR-HPV infection lasting for 12 months or more; (2) patients with cervical intraepithelial neoplasia (CIN) Ⅰ and HR-HPV infection lasting for 12 months or more; (3) patients with the same HR-HPV subtype with no CINⅡ and more lesions after treatment with CINⅡ or CIN Ⅲ (CINⅡ/CIN Ⅲ). All participants were randomly divided into the test group and the control group at a ratio of 2∶1. The test group was locally treated with Nr-CWS freeze-dried powder and the control group was treated with freeze-dried powder without Nr-CWS. The efficacy and negative conversion rate of various subtypes of HR-HPV were evaluated at 1, 4, 8, and 12 months after treatment. The safety indicators of initial diagnosis and treatment were observed. Results: (1) This study included 555 patients with HR-HPV infection in the cervix (included 368 in the test group and 187 in the control group), with an age of (44.1±10.0) years. The baseline characteristics of the two groups of subjects, including age, proportion of Han people, weight, composition of HR-HPV subtypes, and proportion of each subgroup, were compared with no statistically significant differences (all P>0.05). (2) After 12 months of treatment, the effective rates of the test group and the control group were 91.0% (335/368) and 44.9% (84/187), respectively. The difference between the two groups was statistically significant (χ²=142.520, P<0.001). After 12 months of treatment, the negative conversion rates of HPV 16, 18, 52, and 58 infection in the test group were 79.2% (84/106), 73.3% (22/30), 83.1% (54/65), and 77.4% (48/62), respectively. The control group were 21.6% (11/51), 1/9, 35.1% (13/37), and 20.0% (8/40), respectively. The differences between the two groups were statistically significant (all P<0.001). (3) There were no statistically significant differences in vital signs (body weight, body temperature, respiration, pulse rate, systolic blood pressure, diastolic blood pressure, etc.) and laboratory routine indicators (blood cell analysis, urine routine examination) between the test group and the control group before treatment and at 1, 4, 8, and 12 months after treatment (all P>0.05); there was no statistically significant difference in the incidence of adverse reactions related to the investigational drug between the two groups of subjects [8.7% (32/368) vs 8.0% (15/187), respectively; χ²=0.073, P=0.787]. Conclusion: External use of Nr-CWS has good efficacy and safety in the treatment of high-risk HPV persistent infection in the cervix.

[Application of indocyanine green fluorescence visualization in surgical resection of abdominal wall endometriosis]

Objective: To investigate the feasibility, effectiveness and safety of indocyanine green (ICG) navigation in the surgical resection of abdominal wall endometriosis (AWE). Methods: Seven women undergoing surgery for AWE in First Affiliated Hospital of Sun Yat-sen University (from July 1, 2021 to October 1, 2021) were collected. After exposure of the focus, ICG were used intravenously (0.25 mg/kg) as fluorescent dye for the intraoperative evaluation of AWE vascularization. Resection of the AWE was guided by direct visualization of the focus under standard laparoscopy with a near-infrared (NIR) camera head. Surgical margin around the AWE (3, 6, 9 and 12 point) and the margin under the focus were obtained for postoperative pathological examination of endometriosis. Time from injection to fluorescence visualization, the proportion of fluorescence visualization, time of fully resection of AWE, side effects related to the use of ICG, perioperative complications as well as the pathological result of the surgical margins were recorded. Results: ICG fluorescence of the AWE were seen in 5 patients (5/7). The mean time from injection to fluorescence visualization was (46.7±9.8) s. The mean time of fully resection of AWE was (16.4±7.0) minutes. There were no side effects related to the use of ICG. The rate of class-A wound healing was 7/7. All of the surgical margins were confirmed endometriosis-negative by postoperative pathological examination. Conclusion: ICG fluorescence visualization could conduct accurate resection of AWE, which is clinically safe and effective.

Effectiveness of Sequential Chemoradiation vs Concurrent Chemoradiation or Radiation Alone in Adjuvant Treatment After Hysterectomy for Cervical Cancer: The STARS Phase 3 Randomized Clinical Trial

Importance

There is no current consensus on the role of chemotherapy in addition to radiation for postoperative adjuvant treatment of patients with early-stage cervical cancer with adverse pathological factors.

Objective

To evaluate the clinical benefits of sequential chemoradiation (SCRT) and concurrent chemoradiation (CCRT) compared with radiation alone (RT) as a postoperative adjuvant treatment in early-stage cervical cancer.

Design, Setting, and Participants

After radical hysterectomy at 1 of 8 participating hospitals in China, patients with FIGO (International Federation of Gynecology and Obstetrics) stage IB to IIA cervical cancer with adverse pathological factors were randomized 1:1:1 to receive adjuvant RT, CCRT, or SCRT. Data were collected from February 2008 to December 2018.

Interventions

Patients received adjuvant RT (total dose, 45-50 Gy), CCRT (weekly cisplatin, 30-40 mg/m2), or SCRT (cisplatin, 60-75 mg/m2, plus paclitaxel, 135-175 mg/m2) in a 21-day cycle, given 2 cycles before and 2 cycles after radiotherapy, respectively.

Main Outcomes and Measures

The primary end point was the rate of disease-free survival (DFS) at 3 years.

Results

A total of 1048 women (median [range] age, 48 [23-65] years) were included in the analysis (350 in the RT group, 345 in the CCRT group, and 353 in the SCRT group). Baseline demographic and disease characteristics were balanced among the treatment groups except that the rate of lymph node involvement was lowest in the RT group (18.3%). In the intention-to-treat population, SCRT was associated with a higher rate of DFS than RT (3-year rate, 90.0% vs 82.0%; hazard ratio [HR], 0.52; 95% CI, 0.35-0.76) and CCRT (90.0% vs 85.0%; HR, 0.65; 95% CI, 0.44-0.96). Treatment with SCRT also decreased cancer death risk compared with RT (5-year rate, 92.0% vs 88.0%; HR, 0.58; 95% CI, 0.35-0.95) after adjustment for lymph node involvement. However, neither DFS nor cancer death risk was different among patients treated with CCRT or RT.

Conclusions and Relevance

In this randomized clinical trial, conducted in a postoperative adjuvant treatment setting, SCRT, rather than CCRT, resulted in a higher DFS and lower risk of cancer death than RT among women with early-stage cervical cancer.

Trial Registration

ClinicalTrials.gov Identifier: NCT00806117.

Class I versus Class III radical hysterectomy in stage IB1 (tumor ≤ 2 cm) cervical cancer: a matched cohort study

Background & Aims: The long-term oncological outcome of Class I hysterectomy to treat stage IB1 cervical cancer is unclear. The aim of the present study was to compare the surgical and long-term oncological outcomes of Class I hysterectomy and Class III radical hysterectomy for treatment of stage IB1 cervical cancer (tumor ≤ 2 cm).

Methods: Seventy stage IB1 cervical cancer patients (tumor ≤ 2 cm) underwent Class I hysterectomy and 577 stage IB1 cervical cancer patients (tumor ≤ 2 cm) underwent Class III radical hysterectomy were matched with known risk factors for recurrence by greedy algorithm. Clinical, pathologic and follow-up data were retrospectively collected. Five-year survival outcomes were assessed using Kaplan-Meier model.

Results: After matching, a total of 70 patient pairs (Class I - Class III) were included. The median follow-up times were 75 (range, 26-170) months in the Class III group and 75 (range, 27-168) months in the Class I group. The Class I and Class III group had similar 5-year recurrence-free survival rates (RFS) (98.6% vs. 97.1%, P = 0.56) and overall survival rates (OS) (100.0% vs. 98.5%, P = 0.32). Compared with the Class III group, the Class I group resulted in significantly shorter operating time, less intra-operative blood loss, less intraoperative complications, less postoperative complications, and shorter hospital stay.

Conclusions: These findings suggest that Class I hysterectomy is an oncological safe alternative to Class III radical hysterectomy in treatment of stage IB1 cervical cancer (tumor ≤ 2 cm) and Class I hysterectomy is associated with fewer perioperative complication and earlier recovery.

Tripartite motif containing 62 is a novel prognostic marker and suppresses tumor metastasis via c-Jun/Slug signaling-mediated epithelial-mesenchymal transition in cervical cancer

Background

TRIM62 (tripartite motif containing 62) has been found to act as a tumor suppressor of several cancers. However, its precise biological role and related mechanism remain unknown in cervical cancer (CC).

Methods

Quantitative Real-time PCR and western blot were adopted to detect the mRNA and protein expression level of TRIM62 in both human CC cell lines and tissues. Immunohistochemistry was used to measure the TRIM62 expression in 30 normal cervical and 189 CC tissues. Univariate and multivariate Cox regression analyses and Kaplan–Meier survival analyses performed to investigate the association between TRIM62 expression and CC patients’ prognosis. The effect of TRIM62 on CC growth and metastasis was studied in vitro and in vivo. Multi-pathway reporter array were utilized to identify the potential signaling manipulated by TRIM62.

Results

TRIM62 was frequently down-regulated in both human CC cells and tissues. Low expression of TRIM62 in CC tissues was associated with aggressive clinicopathological features of CC patients. In addition, TRIM62 was also an independent poor prognostic factor for overall and disease-free survival of CC patients after surgery. Moreover, enforced expression of TRIM62 in CC cells significantly inhibited their abilities of proliferation, migration and invasion in vitro. Besides, subcutaneous xenograft tumor model and xenograft mouse metastatic model respectively displayed that TRIM62 impeded the growth and metastasis of CC in vivo. Furthermore, mechanism study exhibited that TRIM62 could suppress epithelial-mesenchymal transition (EMT) by inhibiting c-Jun/Slug signaling. The inhibitory role of TRIM62 in tumor proliferation might be through regulating cell cycle related proteins CyclinD1 and P27 by targeting c-Jun.

Conclusion

TRIM62 is a potential prognostic biomarker in CC and suppresses metastasis of CC via inhibiting c-Jun/Slug signaling-mediated EMT.

Electronic supplementary material

The online version of this article (doi:10.1186/s13046-016-0445-5) contains supplementary material, which is available to authorized users.

[Clinical analysis of efficacy and quality of life of segmental bowel resection for bowel endometriosis]

OBJECTIVE

To evaluate the efficacy and quality of life of segmental bowel resection for bowel endometriosis.

METHODS

Totally 62 symptomatic patients with bowel endometriosis undergoing segmental bowel resection were recruited. A visual analogue scale(VAS)and the 36-item short form health survey(SF-36)questionnaire were administered before and at least 1 year after surgery, respectively. Pregnancy rates were also recorded.

RESULTS

Sixty-two patients in total underwent follow-up ranging from 12 to 74 months. All patients complained of obvious pain symptoms, including dysmenorrhea, dyspareunia, pain on defecation and chronic pelvic pain. The relief of dysmenorrhea(2.9 ± 2.2 versus 7.5 ± 2.9), dyspareunia(0.7 ± 0.5 versus 4.3 ± 2.2)and pain on defecation(1.6 ± 0.7 versus 7.3 ± 1.9)after surgery was statistically significant(all P<0.01). The scores for all 8 domains of the SF-36 questionnaire were significant improved after segmental bowel resection(all P<0.01). The complication rate was 45%(28/62), including 18 cases of urinary retention, 4 rectovaginal fistulas, 2 cases of vaginal dehiscence, and 1 case each of thrombogenesis, pelvic abscess and general peritonitis. All of the patients with complications recovered well throughout follow-up. The postoperative pregnancy rate of the previous infertile patients was 6/10. Among the 6 gestational cases, 2 had labour, 2 underwent caesarean sections, one had a spontaneous natural abortion, and one underwent uterine curettage.

CONCLUSION

Segmental bowel resection could significantly relieve pain and improve quality of life for patients with bowel endometriosis.

Expression and clinical implications of enhancer of Zeste homolog 2 and p53 protein in squamous cell carcinoma and precancerous lesions in the cervix

We investigated the expression and clinical implications of enhancer of Zeste homolog 2 (EZH2) and p53 protein in cervical squamous cell carcinoma (SCC) and precancerous lesions. EZH2 and p53 expressions in SCC (168), cervical intraepithelial neoplasia (CIN)-I (19), CIN-II (35), and normal tissues (30) were detected by streptavidin-peroxidase-conjugation. The correlation between co-expression of EZH2 and p53 protein and the clinic pathological features and prognosis of SCC were discussed. The positive expression rates of EZH2 and p53 were 6.7, 37.0, and 75.6%, and 3.3, 21.1, and 39.3% in normal cervical tissues, CIN, and SCC, respectively, which were significantly different (P < 0.05). The positive expression rate of EZH2 and p53 protein in SCC patients with and without lymph node metastasis was 82.9 and 70.4% (EZH2) and 45.7 and 34.7% (p53), respectively, which was also a significant difference (P < 0.05). The progression-free survival (PFS) rates in followed-up patients (N = 143) who were EZH2- and p53-negative, EZH2- or p53-positive, and EZH2- and p53-positive were 71.3 ± 1.9, 66.1 ± 2.0, and 51.3 ± 3.8 months, respectively, which was a significant difference (P < 0.001); the overall survival among these groups was 72.9 ± 1.1, 68.6 ± 1.8, and 57.4 ± 3.4 months, respectively (P < 0.001). Multivariate analyses revealed that EZH2 expression, lymph node metastasis, and tumor staging were independent prognostic factors of SCC. EZH2 and p53, which affect lymph node metastasis and prognosis of SCC, may play a key role in the occurrence and development of SCC.

Barcoded sequencing reveals diverse intrauterine microbiomes in patients suffering with endometrial polyps

Results of this study showed that the bacterial composition in vagina (V) greatly differed from intrauterine microbiome (I). Microbiomes were present in all intrauterine samples of healthy women (Group H (I)) and patients with endometrial polyps (EP) (including Group EP (I) and Group EP/chronic endometritis (CE) (I)). Indeed, the intrauterine bacteria population in Group EP/CE (I) were more diverse than those in Groups EP (I) and H (I). The result also confirmed the bacterial composition differences between vagina and uterus as well as the intrauterine microbiome alteration in the patients, compared to the healthy. Although bacteria of Proteobacteria, Firmicutes and Actinobacteria, dominated the intrauterine microbiome in all samples, however, proportions of Firmicutes from Group EP/CE (I) and Group EP (I) were much higher than that from Group H (I), in contrast, the proportions of Proteobacteria were far lower than the healthy. At the genus level, compared to Group H (I), it is found that proportions of Lactobacillus, Gardnerella, Bifidobacterium, Streptococcus, and Alteromonas were significantly higher, and that of Pseudomonas were significantly lower in Group EP/CE (I) or Group EP (I). In addition, lower proportions of Enterobacter and Sphingomonas and a higher proportion of Prevotella were also observed in Group EP/CE (I). In conclusion, uterine microbiomes between patients with EP and the healthy are significantly different and all the potentially important variation of uterine microbes may cause EP, but not definitively related to CE. Further experiments should be performed to test these relationships to endometritis occurrence.

Pharmacologic Interventions in Preventing Ovarian Hyperstimulation Syndrome: A Systematic Review and Network Meta-Analysis

Ovarian hyperstimulation syndrome (OHSS) is a severe iatrogenic complication of controlled ovarian stimulation. Randomised controlled trials (RCTs) have proven several pharmacologic interventions to be effective in OHSS prevention, but these trials have seldom compared multiple drugs. We identified randomised controlled trials (RCTs) through June 2015 by searching databases and compared 11 intervention strategies in preventing OHSS (primary outcome) and their influence on pregnancy rate (secondary outcome). A network meta-analysis was used to evaluate the relative effectiveness among treatments and to create a rank probability table. Thirty-one RCTs were identified, including 7181 participants. Five pharmacologic interventions were superior to placebo in decreasing OHSS incidence: aspirin [relative risk (RR) 0.07, 95% credible interval (CrI) 0.01-0.30, p < 0.05], intravenous (IV) calcium [RR 0.11, 95% CrI 0.02-0.54, p < 0.05], cabergoline [RR 0.17, 95% CrI 0.06-0.43, p < 0.05], metformin [RR 0.20, 95% CrI 0.07-0.59, p < 0.05] and IV hydroxyethyl starch (HES) [RR 0.26, 95% CrI 0.05-0.99, p < 0.05]. The rank probability demonstrated aspirin (Rank 1: 36%) and IV calcium (Rank 1: 35%) to be the most efficacious. Additionally, albumin might decrease the pregnancy rate when compared with placebo [RR 0.85, 95% CI 0.74-0.97, p < 0.05]. This conclusion provides a relative standard and objective reference for choosing an OHSS prophylactic agent.

An unusual ovarian neoplasm diagnosed in a patient with rupture of unicornuate uterus during pregnancy: a case report

Unicornuate uterus is a rare disease characterized with reduced fertility, and ovarian tumor diagnosed during pregnancy is uncommon as well. These two diseases have been reported separately. However, patient suffering from both diseases has never been reported before. The authors herein report a case of a 32-year-old Chinese woman presenting with a unicornuate uterus with no horn, who suffered from acute abdominal pain and intra-abdominal hemorrhage at 26 weeks gestation. Incidentally, a borderline ovarian tumor (BOT) and rupture of uterus were found during an urgent exploratory laparotomy. During the follow-up, ovarian tumor recurred in the first year after the operation. The authors suggest that BOT with micropapillary patterns should be paid much more attention to, other than only assessing the histological type. Furthermore, they also suggest that a slightly increased in serum CA-125 value should not be ignored.

Efficacy of tension-free vaginal tape obturator and single-incision tension-free vaginal tape-Secur, hammock approach, in the treatment of stress urinary incontinence

AIM

Aim of the present study was to compare the efficacy of tension-free vaginal tape obturator and single-incision tension-free transvaginal tape Secur, hammock approach, in the treatment of stress urinary incontinence.

METHODS

Clinical data of patients who received anti-incontinence surgery between June 2008 and July 2012 were retrospectively analyzed. Efficacy and early failure rate of the tension-free vaginal tape obturator and tension-free vaginal tape-Secur hammock approach were assessed by cough test and criteria of International Consultation on Incontinence Questionnaire-Short Form. Intraoperative and postoperative complications were also computed.

RESULTS

There were 28 patients in the tension-free vaginal tape obturator group while 32 patients in the tension-free vaginal tape-Secur group. The mean operation time, intraoperative blood loss and inpatient days after surgery between the two groups showed no significant difference. The catheter retention time of the tension-free vaginal tape obturator group was longer than in the tension-free vaginal tape-Secur group. The cure rate of the tension-free vaginal tape obturator and tension-free vaginal tape-Secur groups were respectively 84% and 80%, and the recurrence rates were 14.3% and 16.7%, without significant difference. The scores of International Consultation on Incontinence Questionnaire-Short Form in two groups both decreased after surgery, but there was no difference between the two groups. There were no serious complications in the two groups.

CONCLUSION

Our study demonstrated that both tension-free vaginal tape obturator and tension-free vaginal tape-Secur can achieve a cure rate over 80% while with little complications, showing both methods are reliable to treat stress urinary incontinence.

Expression of human β-defensin-2 in the eutopic and ectopic endometrial tissues in patients with endometriosis

OBJECTIVE

To investigate the expression of human β-defensin-2 (hBD-2) in the endometrium of patients with endometriosis (EMS) and explore the potential role of hBD-2 in the pathogenesis of EMS.

DESIGN

Prospective controlled study.

SAMPLE

50 women including EMS patients undergoing laparoscopic ovarian cystectomy and non-EMS patients undergoing hysterectomy for uterine fibroids.

SETTING

Large university teaching hospital.

METHODS

Patients were divided into EMS and non-EMS groups. The gene expressions of hBD-2, interleukin (IL)-1β and tumor necrosis factor (TNF)-α in the endometrial tissues of each group were detected with real-time quantitative polymerase chain reaction (PCR), and hBD-2 protein expression with immunohistochemical method.

RESULTS

The gene expression levels of hBD-2, TNF-α, and IL-1β as well as the positive expression rate of hBD-2 protein in the ectopic endometrium of EMS patients were significantly higher than those in the eutopic endometrium of EMS and non-EMS patients (all P < 0.05). Correlation analysis showed that the gene expression levels of hBD-2 in the ectopic and eutopic endometrium of EMS patients were positively correlated with the gene expression levels of IL-1β and TNF-α (P < 0.01).

CONCLUSION

High levels of hBD-2 gene and protein expressions in the ectopic endometrium of EMS patients may be an important contributor in the pathogenesis of EMS. TNF-α and IL-1β may promote the upregulation of hBD-2 expression.

Successful management of mucinous ovarian cancer by conservative surgery in week 6 of pregnancy: case report and literature review

Purpose

The management of ovarian cancer during pregnancy is still a big challenge, mostly due to the reciprocal impacts between cancer and pregnancy. The objective of this article is to present a rare case of maternal ovarian adenocarcinoma and review published similar cases about this clinical condition.

Materials and methods

Here we report a rare case of maternal ovarian adenocarcinoma detected during gestational week 6, with good pregnancy outcome treated with conservative surgery.

Results and discussion

A case of maternal ovarian adenocarcinoma (stage I) was detected in week 6 of pregnancy receiving conservative surgery without chemotherapy. In week 39 of pregnancy, due to relapse of the cancer, the patient underwent excision of the isolated tumor, and gave birth to a healthy baby through cesarian section. After that, the patient received cytoreductive surgery associated with six chemotherapy. The patient was finally diagnosed as epithelial ovarian cancer stage IIIC, and had survived more than 5 years without relapse. The successful experience from this case suggested that pregnancy complicated with early ovarian cancer receiving conservative surgery could continue to pregnancy and the effect of cesarian section followed with cytoreductive surgery associated with six chemotherapy at full term was still satisfied.

[Bipolar coagulation used in selective feticide of monochorionic twins with one twin anomaly]

OBJECTIVE

To summarize our preliminary experience of selective feticide with bipolar coagulation in complicated monochorionic twins (MCT), and discuss the clinical application of feticide in discordant MCT.

METHODS

Three MCT with one twin anomaly, in which 2 had severe twin-twin transfusion syndrome (TTTS), stage IV, and 1 had acardiac twin, were identified in the second trimester of pregnancy. To terminate the abnormal twin and isolate the co-twin's circulation completely, selective feticide was performed by umbilical cord occlusion with bipolar coagulation under guidance of ultrasound and fetoscopy. After each invasive procedure, serial monitoring was performed, including procedural complications, Doppler of fetal middle cerebral artery and umbilical artery. Pregnancies were followed up every 2 weeks for fetal growth until delivery. After birth the placentas and the terminated fetuses were examined.

RESULT

Cord occlusion was successfully accomplished in all 3 targeted fetuses, at 21, 22 and 24 weeks of gestation respectively. One case with TTTS was complicated with rupture of the membrane in the terminated fetus the 7th day after the procedure, and a healthy baby was born at 32 weeks. The other case with TTTS delivered a boy by cesarean section at 38 weeks. The third case with TRAP is at 35 weeks of gestations and under regular follow-up. Monochorionicity was confirmed by placental examination after delivery, and the effects of bipolar coagulation were observed at the cord of terminated fetuses.

CONCLUSIONS

Umbilical cord occlusion with bipolar coagulation is an effective procedure for selective feticide in MCT with one twin anomaly. The outcome of normal fetus can be favorable.

[Timing of pregnancy after surgery for tubal pregnancy]

OBJECTIVE

To investigate the outcome of pregnancy in women after surgical treatment of tubal pregnancy and measures to improve the rate of successful postoperative pregnancy.

METHODS

A retrospective study was conducted among 424 women who underwent surgical treatment for tubal pregnancy between Jan 1999 and Jan 2004. All patients desiring a second pregnancy were followed up for 18-72 months for the outcome. Cumulative fertility and recurrence curve were compared and calculated by life-table.

RESULTS

Of the 424 women with tubal pregnancy, 177 (41.7%) had intrauterine pregnancy after the operation, while 102 (24.1%) had recurrent ectopic pregnancy. Among the 177 women with intrauterine pregnancy, 85 (48.02%) became pregnant within 6 months after the operation, 133 (75.14%) within one year, and the cumulative intrauterine pregnancy rate approached 94.92% within 2 years. But among the 102 women with recurrent ectopic pregnancy, only 10 (9.8%) were pregnant within 6 months after the operation, and 49 (48.04%) within 18 months, with a cumulative ectopic pregnancy rate of 67.65%.

CONCLUSION

For women receiving surgery for ectopic pregnancy, the chance for intrauterine pregnancy can be the greatest within 6 months after operation and reduced markedly after 2 years, when recurrent ectopic pregnancy can be likely. Early plans for pregnancy and hydrotubation following the surgery may prove beneficial for raising the chances for postoperative intrauterine pregnancy.

Immunosensor for the differentiation and detection of Salmonella species based on a quartz crystal microbalance

Immunosensors based on the microgravimetric quartz crystal microbalance (QCM) technique have been developed for the detection of Salmonella species from serogroups A, B and D. Salmonella serogroup-specific murine monoclonal antibodies, respectively, raised against these serogroups were immobilized onto the silver electrodes of piezoelectric (PZ) crystals by cross-linkage via glutaraldehyde (GA) to the electrode surfaces pre-coated with thin polyethyleneimine (PEI) layer. The specific immunosensors developed gave responses in linear ranges from 10(5) to 5x10(8) cells per ml with no significant interference from other strains of Salmonella and Escherichia coli up to 10(8) cells per ml. They showed good repeatability and excellent linear range, achieving detection limits down to 10(4) cells per ml with ability to distinguish different strains of Salmonella. These biosensors exhibited an exquisite specificity evidenced by their ability to discriminate antigens, the structures of which differ only by the isomeric form of di-deoxyhexose. The antibody-modified crystals showed no loss in activity over 4 days under storage at 4 degrees C.

Ion chromatographic determination of calcium and magnesium cations in human saliva and urine with a piezoelectric detector

In this present paper, simultaneous determination of Ca(2+) and Mg(2+) cations in saliva, urine was achieved using an ion chromatography method, in which a piezoelectric quartz crystal (PQC) sensor was used as a detector, and a solution containing tartaric acid (4 mmol 1(-1)) and ethylenediamine (2 mmol 1(-1)) as a mobile phase. Good linearities were obtained over the ranges of 0.8-500 mg 1(-1) Ca(2+) and 1.0-500 mg 1(-1) Mg(2+). The detection limits were 0.4 mg 1(-1) for Ca and 0.2 mg 1(-1) for Mg, respectively.

Simultaneous determination of nitrate and nitrite in saliva and foodstuffs by non-suppressed ion chromatography with bulk acoustic wave detector

In the present paper, nitrate and nitrite in foodstuffs and saliva were simultaneously determined using a non-suppressed ion chromatography (IC) method with a bulk acoustic wave sensor (BAW) as detector, and 1.5 mmol/L potassium hydrogenphthalate (KHP) as mobile phase. The IC-BAW method is simple, rapid and accurate. The determination limits for nitrite and nitrate are 0.20 and 0.30 mg/L, respectively. The IC-BAW is comparable and agrees with the conventional spectrophotometric method for nitrite and nitrate determination.

Determination of divalent carboxylic acids in traditional Chinese herbal and patent medicines using HPLC with double cell quartz crystal detector

A rapid, simple and sensitive high performance liquid chromatography (HPLC) method combined with a novel double cell quartz crystal (DCQC) detector is described for the determination of divalent carboxylic acids in traditional Chinese herbal and patent medicines. The chromatographic system involves the use of a muBondapak-NH2 column with 20 mM KH2PO4 (pH 3.4, adjusted by H3PO4)/acetonitrile (95:5%) as a mobile phase. The DCQC detector has a low temperature coefficient and high conductance sensitivity independent of the background from 7.2 to 2500 microS. Analysis of sample is completed without the use of an ion suppression device.

Determination of the binding parameters of drug to protein by equilibrium dialysis/piezoelectric quartz crystal sensor

A novel method, equilibrium dialysis/piezoelectric quartz crystal sensor, applied to determine the binding parameters of diethyldithiocarbamate to human plasma protein is proposed. Based on the investigation of the equilibrium reaction for the binding of drug to protein, the related theoretical equations for this binding were derived. By monitoring the frequency responses of a copper-plated piezoelectric quartz crystal sensor to drug in and out of a dialysis membrane after equilibrium, the binding parameters were determined, i.e., 0.375 micromol g(-1) for beta(p), 6.496 microM for K(dp), 141.99 L mmol(-1) for K(p), and 0.043 for N. These values were in good agreement with reference values. It was found that this method may have application for studying the characteristics of the interaction between other drugs and proteins.

Flow-injection determination of total ammonia and total carbon dioxide in blood based on gas-diffusion separation and with a bulk acoustic wave impedance sensor

A novel flow-injection (FIA) system, for the rapid and direct determination of both total ammonia (T[NH3]) and total carbon dioxide (T[CO2]) in clinical blood samples, has been developed. Samples were injected into a carrier stream of H2O, then emerged with a reagent stream, where the analyte was converted into a gaseous species and diffused across a PTFE gas-permeable membrane into an acceptor stream. The trapped NH3/CO2 in the acceptor was determined on line by a bulk acoustic wave (BAW) impedance sensor. At a through-put of 20 and 65 h(-1), the proposed system exhibited a linear frequency response up to 200 micromol l(-1) ammonium and 20 mmol l(-1) bicarbonate with a detection limit of 1.0 and 10 micromol l(-1), respectively. Results obtained for T(NH3) in serum and T(CO2) in plasma were in agreement with those obtained by the conventional glutamate dehydrogenase (GDH) method and gas-sensing electrode method, respectively. The effects of composition of acceptor stream, cell constant of conductivity electrode, sample volume, flow rate and potential interferents on the FIA signals were also discussed.

Ion chromatographic study of sodium, potassium and ammonium in human body fluids with bulk acoustic wave detection

In the present paper, determination of Na+, K+ and NH4+ in saliva and serum was carried out using an ion chromatography (IC) method with a bulk acoustic wave (BAW) sensor as detector and 2.0 mmol/l nitric acid as mobile phase. The IC-BAW method is simple, rapid and accurate. Comparison between the BAW detector and the conventional conductivity detector (CDD) was discussed. The IC-BAW showed agreement with the commonly used flame photometric method for Na+ and K+ and enzymatic method for NH4+, as well as IC-CDD for those three cations.

Determination of dipyridamole by modified extraction-gravimetry with a surface acoustic wave resonator sensor

A simple and sensitive extraction-gravimetric method for the determination of dipyridamole is presented. The method is based on the extraction of free dipyridamole with chloroform, after neutralization with a basic agent, followed by measurement of the frequency shift response of the specially designed surface acoustic wave resonator sensor after evaporation of the extractant from the surface of the resonator. The frequency shift response was proportional to the amount of dipyridamole in the range 0.065-1.12 micrograms. Experimental parameters and the effect of interfering substances on the assay of dipyridamole were also examined in this study. The method was applied to the determination of dipyridamole in tablets.

Bulk acoustic wave sensor for investigating hemorheological characteristics of plasma and its coagulation

A method of using a bulk acoustic wave (BAW) device to study the hemorheological phenomena is proposed. By measuring the resonant resistance of a BAW device, the dependence of the plasma viscosity on its composition is investigated. It has been found that during the process of the plasma coagulation, the frequency response of a BAW device is dominated by the change in plasma viscoelasticity, and useful information such as the coagulation time and the viscoelasticity of coagulated plasma can be obtained from the curve of frequency response. Based on the BAW quartz detection system, effects of fibrinogen, thrombin and some drugs on the plasma coagulation are investigated. The results show that the BAW device based on the oscillator method possesses some advantages, such as high sensitivity, simplicity of use, cost effectiveness and small sample volume for clinical hemorheological study.

Determination of lactic acid and pyruvic acid in serum and cerebrospinal fluid by ion-exclusion chromatography with a bulk acoustic wave detector

A chromatographic method base don a combination of ion-exclusion chromatography separation and bulk acoustic wave series piezoelectric quartz crystal detector quantification for the determination of pyruvic acid and lactic acid in serum and cerebrospinal fluid (CSF) was developed. The separation was carried out using a Shim-pak SCR-102H ion-exclusion column with phosphoric acid solution as eluent. The method shows an acceptable detection limit and anti-interference ability. Serum and CSF from healthy individuals and patient were analysed successfully.

Endocrine consequences of prenatal sodium depletion prepare rats for high need-free NaCl intake in adulthood

Offspring of dams that were repeatedly sodium depleted during late pregnancy (at days E14, E17, and E20) expressed high need-free 3% NaCl intake in adulthood. Need-free 3% NaCl intake was greater in females, thereby respecting the sexual dimorphism of this behavior, and was increased further by successive sodium depletion in adulthood. Offspring from dams that had been sodium depleted while receiving the angiotensin-converting enzyme inhibitor, captopril, showed a need-free NaCl intake similar to that of control rats nonneonatally sodium depleted. Trunk blood taken from dams at day E18, i.e., 24 h after the second treatment, revealed that sodium depletion produced marked increases in the dam's plasma angiotensin (ANG) II and aldosterone that were not present when dams were treated with captopril during sodium depletion, even though both groups displayed a similar hyponatremia. We therefore propose that, during prenatal sodium depletion, the activation of the angiotensin-aldosterone system rather than the loss of sodium itself is responsible for the modification in need-free NaCl intake behavior. Finally, we suggest that, during pregnancy, ANG II may have an organizational effect on the neural substrate in the fetal brain that subserves subsequent NaCl intake behavior.

Application of a series piezoelectric sensor as a detector in ion chromatography

The application of a series piezoelectric sensor as a detector for ion chromatography (IC) is investigated. The device is used with sensitive response between the series piezoelectric quartz crystal oscillation frequency and specific conductivity of liquids for ion chromatographic detection. Two platinum wires are used as conductivity electrodes and inserted oppositely in the detection cell. The dead-volume of the detection is 15 microL, the noise is less than or equal to 1 Hz, the baseline drift is 5 Hz/h, and the detection limits of F- and Na+ are 5 and 25 ng, respectively. The effects of temperature, background conductivity, cell constant of the conductivity electrode, and dead volume on the sensitivity of the detector are discussed. The detector temperature should equal that of the column. An optimum sensitivity is obtained when the cell constant is approximately 3.5 cm. The optimum range of the background conductivity of the mobile phase is 150 to 1200 microseconds. When the solution conductivity is greater than 3000 microseconds, the detector does not work satisfactorily. The proposed IC cerebrospinal fluid detection method is applied to the determination of vitamin C in apple and Zn2+, Ca2+, Mg2+, and Cu2+ in human cerebrospinal fluid.

[Effect of angiotensin on salt intake behavior of rat]

Intravenous infusion of various doses of Ang II caused significant increases of the salt intake in S-D rats as a result of natriuretic action of the drug. The phenomenon could be abolished by administration of aldosterone but unaffected by adrenalectomy. Captopril could suppress the Ang II effect. Discrepancies with a previous work on the interpretation of the action mode of Ang II were discussed.

Reaction-frequencymetric method: a new analytical technique for determination of submicromolar concentration levels of vitamin C

A new analytical technique for the assay of pharmaceutical substances at low concentration levels has been proposed and applied to the determination of vitamin C as an example of its application. It is based on the chemical reaction of vitamin C with iodine in a sodium citrate-hydrochloric acid medium, followed by measurement of the frequency change of a silver-plated piezoelectric quartz crystal. The frequency change is proportional to the vitamin C concentration from 2 x 10(-7) to 4 x 10(-6) M. The method was applied to the assay of vitamin C in pharmaceutical preparations.

Deficits in NaCl ingestion after damage to the central nucleus of the amygdala in the rat

These studies examined the NaCl intake behaviors of rats with bilateral electrolytic lesions of the central nucleus of the amygdala (CeAX). Daily need-free intake of 3% NaCl was abolished by CeAX even in rats in which it had been enhanced preoperatively by a history of repeated sodium depletions but was slightly restored by three successive postoperative sodium depletions. CeAX rats drank water but not 3% NaCl to high doses of DOCA and to the activation of cerebral angiotensin II, and expressed small but reliable salt intake (need-induced salt intake or salt appetite) after postoperative sodium depletions. Other ingestive behaviors (water drinking, intake of food and 5% sucrose) were normal. When given decreasing concentrations of NaCl solution the CeAX rats rejected them until the concentration reached 0.2%. These findings suggest that lesions to the central nucleus of the amygdala produce a global impairment in salt intake behaviors that is possibly due to an alteration in the central processing of the salt taste signal.

The anteroventral wall of the third ventricle and the angiotensinergic component of need-induced sodium intake in the rat

Because the anteroventral wall of the third ventricle (AV3V) has been implicated in the control of sodium intake it was studied in rats with damage of the AV3V region in the sodium-replete and sodium-deplete states, and when they were treated with either pulse intracerebroventricular (pICV) injection of renin to activate brain angiotensin or daily subcutaneous injections of deoxycorticosterone (DOCA). The response of rats with AV3V damage to sodium depletion was retarded and the excess sodium intake that is induced by pICV renin was absent, but their daily need-free sodium intake and the sodium intake that is induced by DOCA were essentially normal. The results suggest that the AV3V is responsible for the angiotensinergic, but not the aldosteronergic, component of the ANG II/ALDO synergy that controls need-induced sodium appetite in the rat. The integrity of the AV3V is not necessary for daily need-free sodium intake or for its enhancement by sodium depletions, suggesting that ANG II is probably not important for these phenomena. But ANG II action within the AV3V might be important for the rapid burst of sodium intake that immediately follows a period of depletion.

Transfer mechanism of quinine drug across the oil/water (O/W) interface

The transfer phenomena of quinine drug at the aqueous 1,2-dichloroethane (DCE) interface have been studied by the current-scanning polarography. The relationships between the wave height and pH of aqueous phase, concentration of quinine as well as the rate of water drop are discussed. The effect of supporting electrolyte, buffer solution and the nature of organic solvent on the polarographic wave is studied. The transfer characteristics of quinine in aqueous phase and in organic phase are compared. The mono-protonated and diprotonated quinines can both transfer at the interface so as to produce two polarographic waves. The transfer process of quinine at the interface is simultaneously controlled by diffusion and reestablishment of the disturbed protonated equilibrium of quinine. A further investigation is made by chronopotentiometry. On the basis of the theoretical analysis, the formulae of the limiting current are derived and discussed. The theoretical results are in agreement with the experimental ones. The transfer mechanism of quinine is put forward.

Extraction-frequencymetric method. A new measurement technique for determination of micro amounts of chlorpheniramine

A new measurement technique has been proposed and applied to the determination of chlorpheniramine as an example of its application. It is based on the extraction of free chlorpheniramine into carbon tetrachloride after neutralization with a basic agent, followed by measurement of the frequency change of the specially designed ring-coated piezoelectric sensor after evaporation of the extractant from the crystal surface. The frequency change is proportional to the chlorpheniramine amount in the range 0.025-1.2 microgram. The method has been applied to the determination of chlorpheniramine maleate in pharmaceutical preparations.

[Surgical treatment of benign tracheoesophageal fistula and bronchoesophageal fistula in the adults]

This article deals with experiences of surgical treatment of benign tracheoesophageal fistula and bronchoesophageal fistula in seven adults. Among them 2 cases were congenital, 2 cases were infective and 3 cases were traumatic. There were 5 males and 2 females. Their average age ranged from 24 to 53 years. The modes of operation were as follows: (1) resection of fistula, and repairing of leak in 3 cases; (2) pneumonectomy and repairing of leak in 2 cases; (3) esophagectomy through right thoracotomy and cervical reconstruction of the retrosternal esophagogastrostomy was performed in one case; (4) repairing of leak with pedicled esophagus wall in one case. Follow-up shows that the surgical treatment gives satisfactory results in these patients.

Studies on response characteristics of drug ISE's (VII)--performance and theoretical treatment of microcells connected in series

A new type of MCCS (microcells connected in series) has been constructed and its performances investigated. It has been applied to the determination of streptomycin. The sensitivity and accuracy have been increased significantly. A theoretical model for the error of determination using the MCCS has been suggested and proved experimentally using the Monte Carlo method, and the error model proposed in Ref. [1] revised.

[Surgical treatment of multiple primary carcinoma of the alimentary tract: report of 15 cases]

From March 1964 to December 1986, 26 cases of multiple primary carcinomas were treated in our clinic. Among them 15 cases (57.7%) were multiple primary carcinomas of the alimentary tract including 9 cases of synchronous carcinomas and 6 cases of metachronous carcinomas. All the cases were confirmed by operation and pathological examination. There were 12 males and 3 females. Their ages ranged from 33 to 68 years and most (86.7%) were between 50 and 68 years. The combination of involved organs were mainly esophagus and gastric cardia (11 cases) and colon and gall bladder (2 cases). The pathological combinations were squamous carcinoma and adenocarcinoma (53.3%), adenocarcinoma and adenocarcinoma (26.7%), and squamous carcinoma and carcinoma in situ (6.7%). The follow-up data showed that treatment results of multiple carcinomas of the alimentary tract were poor.

[Teratoma of the lung: report of 3 cases]

In this paper, 20 cases of teratoma of the lung (3 cases were presented and 17 reviewed) were analyzed. There were 13 males and 7 females, the age ranging from 16-47 years. The primary symptoms were: cough (19 cases, 95%), blood sputum or hemoptysis (16 cases, 80%), chest pain (12 cases, 60%), fever (7 cases, 35%) and expectoration of hair (4 cases, 20%) etc. The histogenesis, diagnosis and treatment of the disease were discussed.