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Background: Delayed postpartum hemorrhage is rare, with an incidence of 0.5% to 2.0% in all pregnancies. The most important causes are placental remnants, infections, and placental bed subinvolution. Postpartum choriocarcinoma, a highly malignant complication of pregnancy, is a rare condition that can be easily misdiagnosed as other common causes, such as gestational remnants, and delays the diagnosis., Methods: Four patients visited our clinic complaining of delayed postpartum hemorrhage, combined with respiratory and neurological symptoms in 2 cases. Two cases were confirmed by histopathological examination and in addition, medical history, elevated human chorionic gonadotropin (hCG) level, and imaging findings help confirm the diagnosis of delayed postpartum hemorrhage caused by postpartum choriocarcinoma in other cases. Individualized combination chemotherapies were prescribed. In the light of massive cerebral metastasis in case 2, intrathecal methotrexate injection combined with whole-brain radiotherapy was prescribed., Results: Due to the absence of routine monitoring of β-hCG following full-term delivery, there was widespread metastasis at the time of diagnosis. Three patients got complete remission and there is no sign of recurrence. One patient had relapse and widespread metastasis and died at home 6 months after the last chemotherapy., Conclusion: It is important to be aware of the possibility of choriocarcinoma in patients with delayed postpartum hemorrhage. Clinicians should improve the recognition of choriocarcinoma following full-term delivery, emphasize the monitoring of β-hCG, comprehensively analyze the general condition of patients, and conduct standardized and individualized chemotherapy protocols., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Objective: To investigate the short-term efficacy and safety of different chemotherapy regimens combined with thalidomide, in the treatment of low-income patients with newly diagnosed HIV-associated diffuse large B-cell lymphoma., Methods: A retrospective analysis was performed on 42 patients with HIV-DLBCL who were admitted to the Infectious Diseases Department of Yunnan Provincial Infectious Diseases Hospital from January 2018 to December 2020. 14 cases (including 1 case in stage II and 13 cases in stage III/IV) were treated with R-CHOP, 24 cases (including 1 case in stage II and 23 cases in stage III/IV) were treated with R-DAEPOCH, and 4 cases (including 1 case in stage II and 3 cases in stage III/IV) were treated with EPOCH. All patients were treated with thalidomide. The ART regimen was adjusted. At least 1 and up to 6 intrathecal injections were given during chemotherapy, and cotrimoxazole was taken orally to prevent infection. The clinical efficacy was evaluated after 4 cycles of chemotherapy, and adverse events were evaluated at each cycle of chemotherapy., Results: All patients received 1-8 cycles of chemotherapy. CR (64.2 %) was achieved in 9 patients in R-CHOP group, and 5 patients died. In the R-DAEPOCH group, 17 patients achieved CR (70.8 %) and 7 died. In the EPOCH group, 2 patients reached CR (50 %) and 2 died. The main adverse reactions were grade II and above myelosuppression., Conclusion: Combined treatment with thalidomide can improve the prognosis of low-income patients with newly diagnosed HIV-DLBCL., Competing Interests: We declare that we have no financial and personal relationships with other people or organizations that can inappropriately influence our work, there is no professional or other personal interest of any nature or kind in any product, service and/or company that could be construed as influencing the position presented in, or the review of, the manuscript entitled., (© 2024 The Author(s).)

Background: Patient follow-up is an essential component of hospital management. In the current information era, the patient follow-up scheme is expected to be replaced by Internet technology. This study constructed a cloud follow-up platform for gynecological chemotherapy patients and assessed its cost-effectiveness and patients' feedback., Methods: A total of 2,538 patients were followed up using a cloud follow-up system between January and October 2021. Prior to this, 690 patients were followed manually via telephone calls. Patients' characteristics, follow-up rate, satisfaction, and session duration were compared between the cloud follow-up and manual follow-up groups. In addition, the read rate of health education materials in the cloud follow-up group was analyzed., Results: General information, including age, education attainment, cancer stage, and disease category, and follow-up rate (cloud: 6,957/7,614, 91.4%; manual: 1,869/2,070, 90.3%; P = 0.13) did not significantly differ between the two groups. The follow-up satisfaction of the cloud follow-up patients was significantly better than that of the manual follow-up group (cloud: 7,192/7,614, 94.5%; manual: 1,532/2,070, 74.0%; P<0.001). The time spent on the follow-up was approximately 1.2 h for 100 patients in the cloud follow-up group and 10.5 h in the manual follow-up group. Multivariate analysis indicated that the cloud follow-up group had significantly greater follow-up satisfaction (odds ratio: 2.239, 95% CI: 1.237 ~ 5.219). Additionally, the average follow-up duration of the cloud follow-up group decreased by 9.287 h (coefficient: -9.287, 95% CI: -1.439~-0.165). The read rate of health education materials was 72.9% in the cloud follow-up group., Conclusions: The follow-up effect of the cloud follow-up group was not inferior to that of the manual follow-up group. The cloud follow-up was more effective for prevention and control requirements in the post-epidemic era. Cloud follow-up can save medical resources, improve cost-effectiveness, provide sufficient health education resources for patients, and improve their satisfaction., (© 2024. The Author(s).)

Competing Interests: Declaration of interests We declare no competing interests.

Background: Patients with gynecologic cancers experience side effects of chemotherapy cardiotoxicity. We aimed to quantify cardiac magnetic resonance (CMR) markers of myocardial fibrosis in patients with gynecologic cancer and low cardiovascular risk who undergo chemotherapy., Methods: This study is part of a registered clinical research. CMR T1 mapping was performed in patients with gynecologic cancer and low cardiovascular risk undergoing chemotherapy. The results were compared with those of age-matched healthy control subjects., Results: 68 patients (median age = 50 years) and 30 control subjects were included. The median number of chemotherapy cycles of patients was 9.0 (interquartile range [IQR] 3.3-17.0). Extracellular volume fraction (ECV) (27.2% ± 2.7% vs. 24.5% ± 1.7%, P < 0.001) and global longitudinal strain (-16.2% ± 2.8% vs. -17.4% ± 2.0%, P = 0.040) were higher in patients compared with controls. Patients with higher chemotherapy cycles (>6 cycles) (n=41) had significantly lower intracellular mass indexed (ICMi) compared with both patients with lower chemotherapy cycles (≤6 cycles) (n=27) (median 27.44 g/m 2 [IQR 24.03-31.15 g/m 2 ] vs. median 34.30 g/m 2 [IQR 29.93-39.79 g/m 2 ]; P = 0.002) and the control group (median 27.44 g/m 2 [IQR 24.03-31.15 g/m 2 ] vs. median 32.79 g/m 2 [IQR 27.74-35.76 g/m 2 ]; P = 0.002). Patients with two or more chemotherapy regimens had significantly lower ICMi compared with both patients with one chemotherapy regimen (27.45 ± 5.16 g/m 2 vs. 33.32 ± 6.42 g/m 2 ; P < 0.001) and the control group (27.45 ± 5.16 g/m 2 vs. 33.02 ± 5.52 g/m 2 ; P < 0.001). The number of chemotherapy cycles was associated with an increase in the ECV (Standard regression coefficient [β] = 0.383, P = 0.014) and a decrease in the ICMi (β = -0.349, P = 0.009)., Conclusion: Patients with gynecologic cancer and low cardiovascular risk who undergo chemotherapy have diffuse extracellular volume expansion, which is obvious with the increase of chemotherapy cycles. Myocyte loss may be part of the mechanism in patients with a higher chemotherapy load., Clinical Trial Registration: http://www.chictr.org.cn, identifier ChiCTR-DDD-17013450., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Ye, Wang, Yang, Li, Luo, Lin, Li, Song, Ma, Huang, Zhong, Yang, Zhang, Gong, Xu, Xie, Yin and Guo.)

Background: Connexin 43 (Cx43) has been closely linked to the occurrence and progression of breast cancer. Distant metastasis of breast cancer is aided by the epithelial-mesenchymal transition of circulating tumor cells (CTCs). However, the impact of Cx43 expression on CTCs and the extent of its role in the disease remain unclear., Methods: We determined CTCs in 156 patients, who had breast cancer with a disease course of two or more years. We also measured the expression of Cx43 in the CTCs. The CTCs were detected in the blood of 139 of these patients. These 139 patients were divided into two groups: the Cx43 group and the non-Cx43 group based on their Cx43 expression., Results: Overall, Cx43 expression was found in 83 of the 139 patients (59.7%, 83/139 cases). The two groups significantly differed in terms of the number of mixed biphenotypic type CTCs and the total number of CTCs ( P  < 0.05). There were significant correlations between Cx43 expression and Ki67 expression, tumor size, lymph node metastasis, and TNM stage ( P  < 0.05 for all). The data suggested that patients with Cx43 expression had a higher risk of distant metastasis and had later-stage disease. The difference in Cx43 expression between patients with and without epidermal growth factor receptor 2 (Her2) overexpression was statistically significant ( P  < 0.05). The difference in disease-free survival (DFS) between the two groups was statistically significant ( P  = 0.03), and the Cx43 group had a shorter duration of DFS. Univariate Cox regression analysis revealed that Cx43 expression, Her2 expression, and tumor size were significantly correlated with DFS ( P  = 0.03, 0.0023, and 0.01, respectively)., Conclusion: Cx43 expression in the CTCs of patients with breast cancer is a cancer-promoting factor., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Livestock manure is a major carrier that stores and transmits antibiotic resistance genes (ARGs). The aim of this study was to identify the crucial environmental factors that result in the change in relative abundance of ARGs and MGEs to explore effective methods to reduce the occurrence of ARGs. The abundance of ten ARGs and five MGEs were measured using real-time quantitative PCR with 0, 3, 7, 10, 14, 21, 28, 45, 60, and 75 d in CM and PM aerobic composting. The succession law of the bacterial community was analyzed using 16S rRNA high-throughput sequencing. Furthermore, the abundance of ARGs and MGEs was correlated with the properties (temperature, moisture content, pH, and DOC) of composting piles to identify the crucial factors affecting the variation in ARGs and MGEs. The results showed that the abundance of ARGs and MGEs in PM was higher than that in CM. Composting significantly reduced the relative abundance of nine ARGs and five MGEs. The removal ratios of three ARGs ( tetM, tetT , and aacA ) and four MGEs ( ISEcp1, IS1216, IS613 , and tnp614 ) in CM reached 99%. The removal ratios of nine ARGs[ tetB(P), tetL, tetM, tetO, tetT, aacA, aadD,aphA3 , and sat4 ] and four MGEs ( ISEcp1, IS26, IS1216 , and tnp614 ) reached 99% in PM. However, the abundance of the genes tetG, intI1 , and IS6100 increased. Firmicutes and Actinobacteri a were dominant in CM and PM during composting. Actinobacteria and Proteobacteria may have been the major host bacteria of tetG and intI1 . The redundancy analysis showed that moisture and pH were the crucial factors that could influence the differences in the abundance of ARGs and MGEs. The composition and abundance of ARGs were driven by physicochemical properties, bacterial community, and MGEs. Composting could significantly reduce the abundance of ARGs in CM and PM, thus reducing the risk of ARGs being distributed via livestock manure application. However, some ARGs and MGEs remained in high abundance. Therefore, it is necessary to further optimize the composting process, improve the harmless treatment effect of livestock manure, and promote the safe agricultural use of organic fertilizers.

Objective: Myocardial edema is an early manifestation of chemotherapy-related myocardial injury. In this study, we used cardiac magnetic resonance (CMR) T2 mapping to assess myocardial edema and its changes during chemotherapy for gynecologic malignancies., Methods: We enrolled 73 patients receiving chemotherapy for gynecologic malignancies, whose the latest cycle was within one month before the beginning of this study, and 41 healthy volunteers. All participants underwent CMR imaging. Of the 73 patients, 35 completed CMR follow-up after a median interval of 6 (3.3 to 9.6) months. The CMR sequences included cardiac cine, T2 mapping, and late gadolinium enhancement., Results: Myocardial T2 was elevated in patients who were treated with chemotherapy compared with healthy volunteers [41ms (40ms to 43ms) vs. 41ms (39ms to 41ms), P = 0.030]. During follow-up, myocardial T2 rose further [40ms (39ms to 42ms) vs. 42.70 ± 2.92ms, P < 0.001]. Multivariate analysis showed that the number of chemotherapy cycles was associated with myocardial T2 elevation (β = 0.204, P = 0.029). After adjustment for other confounders, myocardial T2 elevation was independently associated with a decrease in left ventricular mass (β = -0.186; P = 0.024)., Conclusion: In patients with gynecologic malignancies, myocardial edema developed with chemotherapy cycles increase, and was associated with left ventricular mass decrease. T2 mapping allows the assessment of myocardial edema and monitoring of its change during chemotherapy., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Yang, Li, Wang, Ye, Li, Lin, Li, Fu, Ma, Liu, Yin, Yang and Guo.)

Objectives: Cancer chemotherapy potentially increases the risk of myocardial ischemia. This study assessed myocardial microvascular function by cardiac magnetic resonance (CMR) first-pass perfusion in patients treated with chemotherapy for gynecologic malignancies., Methods: A total of 81 patients treated with chemotherapy for gynecologic malignancies and 39 healthy volunteers were prospectively enrolled and underwent CMR imaging. Among the patients, 32 completed CMR follow-up, with a median interval of 6 months. The CMR sequences comprised cardiac cine, rest first-pass perfusion, and late gadolinium enhancement., Results: There were no significant differences in the baseline characteristics between the patients and normal controls (all p > 0.05). Compared with the normal controls, the patients had a lower myocardial perfusion index (PI) (13.62 ± 2.01% vs. 12% (11 to 14%), p = 0.001) but demonstrated no significant variation with an increase in the number of chemotherapy cycles at follow-up (11.79 ± 2.36% vs. 11.19 ± 2.19%, p = 0.234). In multivariate analysis with adjustments for clinical confounders, a decrease in the PI was independently associated with chemotherapy treatment (β = - 0.362, p = 0.002) but had no correlation with the number of chemotherapy cycles (r = - 0.177, p = 0.053)., Conclusion: Myocardial microvascular dysfunction was associated with chemotherapy treatment in patients with gynecologic malignancies, and can be assessed and monitored by rest CMR first-pass perfusion., Key Points: • Chemotherapy was associated with but did not aggravate myocardial microvascular dysfunction in patients with gynecologic malignancies. • Rest CMR first-pass perfusion is an ideal modality for assessing and monitoring alterations in myocardial microcirculation during chemotherapy treatment., (© 2022. The Author(s), under exclusive licence to European Society of Radiology.)

Mucinous minimal deviation adenocarcinoma (MDA) is a rare highly differentiated mucinous adenocarcinoma of the uterine cervix, which always remains a diagnostic dilemma. Lobular endocervical glandular hyperplasia (LEGH), a rare benign lesion of the uterine cervix, is identified as precursor of mucinous MDA. The insulin-like growth factor-II mRNA-binding protein 3 (IMP3) is expressed in a number of cancers and is associated with progression of the tumors. The purpose of this study was to evaluate the expression of the IMP3, carcinoembryonic antigen (CEA), and cyclin-dependent kinase inhibitor p16(INK4a) in mucinous MDA and LEGH, and to estimate the possible role of these biomarkers in the diagnosis of mucinous MDA. Twelve samples of MDA, eight samples of lobular endocervical glandular hyperplasia (LEGH), and 20 normal control cases were included in this study. Typical lesions and less well-differentiated lesions coexisted in 11/12 mucinous MDA samples. Positive cytoplasmic expression for IMP3 and CEA was found in less well-differentiated lesions of all 11 mucinous MDA samples, primarily with strong to intermediate staining intensity. The typical well-differentiated lesions of all 12 MDA cases and 8 cases of LEGH showed negativity for both IMP3 and CEA. No exact p16(INK4a) positivity was observed in 12 mucinous MDA and 8 LEGH. The significant expression of IMP3 and CEA in less well-differentiated foci of mucinous MDA may be helpful in the diagnosis of mucinous MDA to some extent, particularly in small specimens from cervical biopsy. More cases and in-depth researches are needed to elucidate the potential different mechanisms between typical and less well-differentiated lesions of mucinous MDA., (Copyright © 2011 Elsevier GmbH. All rights reserved.)

Ovarian sclerosing stromal tumor (OSST) is an extremely rare neoplasm that primarily affects young women. Signet-ring stromal tumor is another rare non-functioning benign ovarian stromal neoplasm. We report a case of a right OSST with prominent characteristics of signet-ring stromal tumor in a 4-year-old girl with symptoms of premature thelarche. We describe the clinical, histopathological, and immunohistochemical findings and review the literature. To our knowledge, the 4-year-old patient presented here is the youngest case of OSST reported in premenarchal children. The presence of non-mucin/non-lipid obvious signet-ring-like cells in this case suggests a possible relationship between OSST and signet-ring stromal tumor of the ovary., ((c) 2009. Published by Elsevier GmbH. All rights reserved.)

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.

Objective: To observe whether human papillomavirus 16 (HPV16) E6-specific small interfering RNAs (siRNAs) can be employed to inhibit the growth of cervical cancer cell line, and to investigate the associated mechanism., Methods: RNAi was performed using synthetic small interfering RNAs transferred into CaSki cell line by lipofectamine. The cell growth curves, live cell ratio and inhibition ratio of cells were measured by using cell counting. At various time points of post-transfection, the distributions of cell cycle, the expression levels of HPV16 E6, p53, p21 mRNA and proteins were detected by using flow cytometry (FCM) and real-time quantitative reverse transcription-polymerase chain reaction (real-time RT-PCR)., Results: The growth inhibition of E6 siRNA to CaSki cells was demonstrated after cells treated with E6 siRNA. No substantial G1 arrest was observed by FCM analysis. For 24 hours after cell transfection, the level of E6 mRNA was decreased by 20. 11 folds compared with control (P < 0.05). However, p53 and p21 mRNA levels appeared unaffected. 48 hours after cell transfection, the expression level of E6 protein was efficiently decreased, but the P53 and P21 protein levels increased in comparison., Conclusions: The inhibitory effect of HPV16 E6 siRNA to CaSki cell maybe due to specially and efficiently silence E6 mRNA expression, decrease the degradation of wild type P53 protein, and then recover the function activity of P53 protein.

Objective: To observe the effect of HPV16E7 specific expression vector on cell proliferation in cervical carcinoma SiHa cells., Methods: The HPV16E7 siRNA expression vector and empty expression vector were transfected into SiHa cells by liposome. The effects on E7 mRNA and E7 protein expression, cell cycle phase and cell growth rate were examined respectively by real-time RT-PCR, FCM and MTT assay., Results: The HPV16E7 siRNA expression vector significantly inhibited the expression levels of E7 mRNA and E7 protein, the inhibition rates being 92.15% and 84.30% respectively. It also inhibited the transition from G, phase to S phase and the growth of SiHa cell line., Conclusion: HPV16E7 specific siRNA expression vector could specifically and efficiently inhibit the expression of E7 gene and hence it could regulate cell cycle and inhibit cell proliferation in cervical carcinoma SiHa cells. siRNA expression vector

Objective: To test of the effect of vector-based RNA interference (RNAi) technique on inhibiting HPV16E7 gene in CaSki cells of cervical cancer., Methods: The HPV16E7-specific siRNA expression vectors P1, P2 and P3 were constructed and transfected into CaSki cells by liposome. The expression of HPV16E7 mRNA and protein were detected by real-time RT-PCR and Western blot., Results: The expression of HPV16E7 mRNA and protein decreased with the transfection of P1, P2 and P3. Vector P1 had the strongest inhibition effect, with an inhibition rates of 92.86% and 81.0% for the expression of HPV16E7 mRNA and protein respectively three weeks after transfection., Conclusion: The expression of E7 gene in CaSki cells can be inhibited by HPV16E7-specific siRNA expression vector.

Objective: To investigate the synergistic effects on cell apoptosis and growing restriction of SKOV3 cells by the combination of compound herbal medicinal prescription (CHMP) with cisplatin (DDP)., Methods: Cisplatin and two CHMP for tonic quality(CHMP1) and activating blood circulation (CHMP2), which was medicated serum, were prepared and used to treat the human ovarian carcinoma cell line SKOV3. By serum pharmacologic method, the growth and apoptosis of SKOV3 cell were observed at different time points(24,48,72, 96 h) with different concentrations of medicated serum. Coefficient of drug interaction (CDI) between CHMP, and CHMP2 was studied by MTT method. The effects of control group(A group),CHMP1 group(B group),CHMP2 group (C group), DDP group(D group), CHMP1 + DDP group(E group), CHMP2 + DDP group(Fgroup)to SKOV3 cell were studied by flow cytometry; and the cell apoptosis was observed by agarose electrophoresis; the expressions of TNFR1, caspase-8 on each group were analyzed by Western blot method., Results: Synergistic effects were found between herbal medicinal mixtures and DDP, Restraining rate of SKOV3 and CHMP serum concentration was not in a dose-dependent manner as DDP was. CDI between CHMPI and CHMPS was found to be significant difference (CDI of CHMP1, CHMP2 and DDPwas 0.66, 0.58 respectively). It showed that the combined treatment was able to get better effect than single drug treatment. The performed agarose electrophoresis revealed the extracted DNA to show a typical ladder patterns for cell apoptosis. The analysis results of western blot showed the increased expressions of TNFR1 and caspase-8 after combined using of medicine, which were accord to the rates of apoptosis., Conclusions: CHMP drug granules show the synergistic effects with DDP, and the suppressing functions in the course of cell proliferation, and the inducing effect on apoptosis of human ovarian carcinoma cell line SKOV3 in vitro. And this mechanism is showed to be sponsored by the activation of TNFR1 and Caspase-8.

Objective: To investigate the inhibitory effects of RNAi(RNA interference)expression vector on the expression of human papilomavirus E6 gene., Methods: siRNA expression vectors were constructed to be aimed directly at HPV16 E6 gene. The recombinants were transfected into cervical cancer cell line, caski, with liposomes. Expression of E6 was detected with fluorescence quantitative PCR (FQ-PCR) and flow cytometry., Results: Three kinds of expression vectors could reduce the expression of E6 mRNA and protein all in caski-B cell. The expression of E6 mRNA reduced to 21.7% of control group, and the protein inhibition ratio reached 98.1%., Conclusion: The RNAi expression vector can effectively inhibit the expression of HPVE6 gene.