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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.

BackgroundAlthough 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 methodsThis 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.ResultsA 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

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.

Hexafluoropropylene oxide tetrameric acid (HFPO-TeA) is an alternative to perfluorooctanecarboxylic acid (PFOA) and is commonly used in the production of perfluoropolymers. In this study, the performances of ozone oxidation, electrochemical oxidation, and electrocatalytic ozone techniques in the degradation of HFPO-TeA were compared. The experimental results indicated that the electrocatalytic ozone technique was best. The effects of different current densities, ozone concentrations, electrolyte types, and initial pollutant concentrations on HFPO-TeA degradation were investigated. The results showed that the ratio of HFPO-TeA degradation reached 95.9% after electrolysis for 120 ​min for an initial HFPO-TeA concentration of 100 ​mg/L, a reaction volume of 120 ​mL, an applied current density of 10 ​mA/cm2, and an ozone concentration of 20 ​mg/L. The intermediate products detected were hexafluoropropylene oxide dimeric acid [C3F7OCF(CF3)COO−], pentafluoropropionic acid [C2F5COO−], and trifluoroacetic acid [CF3COO−]. The mechanisms involved in HFPO-TeA degradation include direct electron transfer, indirect oxidation mediated by hydroxyl radicals (·OH), and ozone oxidation.

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.