Qiling Li

Introduction: Accurate detection of malignant cells in ovarian cancer ascites is essential for diagnosis and surgical staging. However, conventional cytological examination is hampered by low sensitivity and interpretive subjectivity. We evaluated a dual-modality strategy combining a near-infrared fluorescent zwitterionic folic acid (ZW-FA) probe targeting folate receptor α with serum biomarkers. Methods: Ascites and peritoneal lavage specimens were processed into cell blocks. A ZW-FA fluorescence cutoff was exploratorily derived using receiver operating characteristic curve analysis. Diagnostic performance of ZW-FA staining (quantified using ImageJ), hematoxylin-eosin (H&E) staining, serum cancer antigen 125 (CA125), human epididymis protein 4, and the risk of ovarian malignancy algorithm was assessed individually and in combination. Postoperative histopathological diagnosis served as the reference standard. Results: Among 80 participants, the optimal ZW-FA cutoff was 48.40 (area under the curve = 0.881). Automated fluorescence quantification achieved 100.00% technical reproducibility, providing an objective and consistent readout. ZW-FA correctly classified 2 of 5 (40.00%) specimens that were non-diagnostic by H&E because of insufficient cellularity. In the complete-case comparative analysis of 65 participants, ZW-FA showed higher diagnostic accuracy than H&E staining (86.15% vs. 81.54%). The combination of ZW-FA staining and serum CA125 achieved a sensitivity of 100.00%, a specificity of 81.25%, and an accuracy of 95.38%, exceeding the accuracy of all H&E-based dual-modality strategies (≤ 90.77%). Conclusion: The ZW-FA/CA125 dual-modality strategy may improve the diagnostic assessment of ovarian cancer ascites and peritoneal lavage specimens, particularly in paucicellular samples. Further validation in larger, independent multicenter cohorts is warranted.

Background: Both hyperthermic intraperitoneal chemotherapy (HIPEC) and conventional intraperitoneal chemotherapy (IP) have shown survival benefits in ovarian cancer (OC), but direct comparisons between the two perfusion modalities are lacking. This study aimed to compare effectiveness and safety between HIPEC and conventional IP in OC. Methods: This retrospective real-world study analyzed 606 patients with stages II-IV OC who received HIPEC or IP following cytoreductive surgery between 2013 and 2024. The primary endpoint was progression-free survival. Overall survival and adverse events were secondary endpoints. The study used inverse probability of treatment propensity-score weighting. We also conducted sensitivity analyses to evaluate result robustness and subgroup analyses to explore potential effect modification. Results: After a median follow-up of 26 months, disease progression occurred in 40.6% of patients in the HIPEC group and 55.0% in the IP group (hazard ratio [HR] 0.79; P = .103). Mortality rates were 13.2% and 22.5%, respectively (HR 0.83; P = .434), showing no significant differences in progression and survival between the two groups. Exploratory subgroup analyses suggested a trend toward improved progression-free outcomes with HIPEC, particularly among patients with BRCA wild-type or BRCA1-mutated tumors and early postoperative perfusion. Hypoalbuminemia was the most common event in both groups (HIPEC 27.2%; IP 15.6%). HIPEC group had more abdominal distension and wound dehiscence, whereas IP patients experienced nausea and rash more frequently. Conclusions: HIPEC did not significantly improve survival over conventional IP in the overall population, but showed greater benefit in specific subgroups, underscoring the importance of individualized intraperitoneal chemotherapy strategies in OC.

Background Robotic-assisted laparoscopic single-site hysterectomy is popular among patients and surgeons due to good cosmetic outcomes and fast recovery. However, questions remain such as loss of triangulation and instrument collision. Our aim is to test the feasibility and safety of a purpose-designed single-site robotic surgical platform mainly in hysterectomies. Methods We retrospectively collected patients who had undergone hysterectomy by SHURUI (SR-ENS-600) robotic surgical system in the First Affiliated Hospital of Xi’an Jiaotong University. Initial cases as control were also collected including da Vinci single-site (IS4000) and multi-port (IS3000 and IS4000) hysterectomies performed by the same surgical team. The main outcome was surgical feasibility rate (valid surgeries/total cases × 100%). Short-term post-operative outcomes and complications were recorded and compared between three groups. Results From Dec, 2nd, 2023 to Mar, 1st, 2024, 19 cases of hysterectomies were enrolled, including 6 myomas, 2 adenomyosis, 9 cervical high-grade squamous intraepithelial lesion/stage Ia1 cancers, and 2 stage Ia endometrial cancers. Seventeen cases of da Vinci single-site surgeries and 20 cases of multi-ports surgeries were also included for comparation. Intra-operative bleeding volume was significantly lower in SHURUI group compared with da Vinci single-site and multi-ports groups (40.5 mL vs 47.4 mL vs 58.5 mL, P = 0.046 and 0.028). Post-operative time to flatus was also shorter in SHURUI group compared with da Vinci single-site and multi-port surgeries (22.9 h vs. 33.5 h vs. 28.6 h, P = 0.054 and 0.001). Follow-up for SHURUI group lasted for 3 months with no complications. Conclusions SHURUI robotic surgery was feasible and safe in hysterectomies. It also had comparable outcomes with da Vinci robotic platform and approaches. Graphical abstract

Objective To provide a better pathological method for clinical diagnosis of endometrial lesions. Design Comparing the accuracy of hematoxylin-eosin (H-E) with Papanicolaou stain for endometrial cytology. Setting The First Affiliated Hospital of Xi’an Jiaotong University. Population or Sample 180 patients. Methods Endometrial slides were stained by H-E and Papanicolaou methods, respectively. The cytology between them were compared, with histology as standard control, as well as the cost performance. Main Outcome Measures The dyeing degree of satisfaction, sensitivity, specificity, Cohen’s kappa coefficient, false positive rate, false negative rate, positive likelihood ratio, negative likelihood ratio, Youden index, positive predictive values, and negative predictive values. The price and service time of dye, dyeing efficiency, and dyeing time. Results The sensitivity of H-E stain was higher than that of Papanicolaou stain. The specificity of H-E stain was same to that of Papanicolaou stain. Cohen’s kappa coefficient indicatied a high consistency between them. The morphological characterization of Papanicolaou stain were superior to those of H-E stain. The cost performance of H-E stain was lower. Conclusions In terms of overall evaluations and economic benefits, H-E stain is better than Papanicolaou stain. If a small sample volume of endometrial cells, Papanicolaou stain is recommended. Funding The Clinical Research Award of the First Affiliated Hospital of Xi’an Jiaotong University, China, the Major Basic Research Project of Natural Science of Shaanxi Provincial Science and Technology Department, the Key Research and Development Project of Shaanxi Provincial Science and Technology Department. Keywords: H-E stain, Papanicolaou stain, Endometrium, Cytology

Objective: To assess the sealing effect of a Magnetic-Sealing Uterine Manipulator (MUM) in isolated uterus. Design: Non - intervention study. Setting: This study was conducted at the First Affiliated Hospital of Xi’an Jiaotong University from November 2019 to April 2021. Population: Patients with early-stage cervical cancer who underwent radical laparotomy hysterectomy. Methods: The MUM closure test (group 2) and the control test (right-angle forceps closure tests, group 1 and 3) were carried out in an isolated uterus. Main outcome measure: DNA ploidy analysis system was used to analyze the exfoliated cells. Statistical analysis was performed using Wilcoxon signed rank test to assess the sealing effect of MUM. Results: We identified 36 patients. None regional node metastasis was found in all cases and only one of their tumors was larger than 4.0 cm. The mean numbers of exfoliated tumor cells in groups 1, 2, and 3 were 1, 1, and 2, respectively. There was no significant difference in the number of exfoliated cells between group 1 and group 3 (p=0.476). We merged the results of group 1 and 3. Furthermore, there was significant difference between right-angle forceps closure tests and MUM closure test (p=0.022). Conclusion: The sealing effect for MUM was better than the right-angle forceps. The MUM can effectively seal the cervical cancer cells in the cup cover and avoid the dissemination of tumor cells.

Background: Acetyl-CoA acetyltransferase 2 (ACAT2) is a lipid metabolism enzyme and rarely was researched in epithelial ovarian cancer (EOC). Methods: ACAT2 expressions were confirmed in two pairs of cell lines (A2780 and A2780/DDP, OVCAR8 and OVCAR8/DDP) from Gene Expression Omnibus database by bioinformatics analysis, and in A2780 and A2780/DDP cell lines by quantitative real-time polymerase chain reaction and western blotting. Tissue samples were stained by immunohistochemistry and scored for ACAT2 expression. The relationships between ACAT2 expression and clinicopathological characteristics were analyzed by χ² test. The prognosis of ACAT2 was analyzed by the log-rank tests and Cox regression models. Results: ACAT2 was remarkably upregulated in the above drug-resistant cell lines by mRNA (all P < 0.05) and protein expression (P = 0.026) than those in sensitive ones. Patients were classified as ACAT2-high (n = 51) and ACAT2-low (n = 26) according to immunohistochemical score. ACAT2 expression had a significantly inverse correlation with FIGO stage (P = 0.030) and chemo-response (P = 0.041). A marginal statistical significance existed in ACAT2 expression and ascites volume (P = 0.092). Univariate analysis suggested that high-expressed ACAT2 was associated with decreased platinum-free interval (PFI) (8.57 vs. 14.13 months, P = 0.044), progression-free survival (PFS) (14.12 vs. 19.79 months, P = 0.039) and overall survival (OS) (36.89 vs. 52.40 months, P = 0.044). Multivariate analysis demonstrated that ACAT2 expression (hazard ratio = 2.18, 95% confidence interval: 1.15–4.11, P = 0.017) affected OS independently, rather than PFI and PFS. Conclusion: The expression of ACAT2 in A2780/DDP and OVCAR8/DDP was higher than the corresponding A2780 and OVCAR8. High-expressed ACAT2 was associated with advanced FIGO stage, chemo-resistance, and decreased PFI, PFS and OS. It was an independent prognostic factor of OS in EOC.

Objective: To propose a computerized system utilizing multiscene analysis based on a support vector machine (SVM) and convolutional neural network (CNN) to assess cardiotocography (CTG) intelligently.Methods: We retrospectively collected 2542 CTG records of singleton pregnancies delivered at the maternity ward of the First Affiliated Hospital of Xi'an Jiaotong University from October 10, 2020, to August 7, 2021. CTG records were divided into five categories (baseline, variability, acceleration, deceleration, and normality). Apart from the category of normality, the other four different categories of abnormal data correspond to four scenes. Each scene was divided into training and testing sets at 9:1 or 7:3. We used three computer algorithms (dynamic threshold, SVM, and CNN) to learn and optimize the system. Accuracy, sensitivity, and specificity were performed to evaluate performance.Results: The global accuracy, sensitivity, and specificity of the system were 93.88%, 93.06%, and 94.33%, respectively. In acceleration and deceleration scenes, when the convolution kernel was 3, the test data set reached the highest performance.Conclusion: The multiscene research model using SVM and CNN is a potential effective tool to assist obstetricians in classifying CTG intelligently.

Objective: To confirm the differences in the risk factors for epithelial ovarian cancer-associated venous thromboembolism (EOC-VTE) among patients on different continents. Methods: We reviewed all EOC-VTE cases from two tertiary hospitals for ten years. Multivariate logistic regression analysis was used to identify significant risk factors for VTE. Then we searched the literature on EOC-VTE risk assessments. The risk factors presented in the acquired literature and our data were evaluated by meta-analysis. Two subgroups, according to the continents mentioned in the studies, were set as Asia and Europe & America, respectively for analyzation. Results: A total of 122 patients with EOC-VTE were included. We found six significant risk factors for VTE among cases of EOC by multivariate logistic regression analysis. Among the 2064 initial articles, only 30 met the inclusion criteria. Including our data, there were cumulative 1432 cases and 9874 controls. The meta-analysis selected 13 out of 23 possible risk factors. Risk factors were not identical between subgroups. Except for five same elements, the Asia subgroup had six other significant risk factors for EOC-VTE that were preoperative D-Dimer > 0.3mg/L (OR: 5.030, 95% CI: 2.003-12.635), surgery time ≥ 180min (OR: 3.459, 95% CI: 2.198-5.441), WHO performance status score > 1 (OR: 2.847, 95% CI: 1.840-4.405), hypertension (OR: 1.945, 95% CI: 1.238-3.058), age ≥ 60 years (OR: 1.821, 95% CI: 1.374-2.413) and preoperative blood platelet > 300 × 109/L (OR: 1.532, 95% CI: 1.025-2.289). Accordingly, another two significant risk factors were found in Europe & America subgroup, which were the initial FIGO stage (Ⅲ/Ⅳ) (OR: 2.837, 95% CI: 2.147-3.748) and postmenopausal status (OR: 1.926, 95% CI: 1.025-3.622). Six EOC-VTE risk factors in our data were covered by the 11 risk factors of Asian subgroup analyzes. Conclusions: Patients in Asia and Europe & America have different risk factors for EOC-VTE.

Background: A meta-analysis followed by PRISMA 2020 statement was performed aiming to present a whole prolactin and sex hormone profile in hemodialysis women. Methods: Literatures were searched in PubMed, Cochrane library, Embase, and Web of science before March 11, 2023. Trial sequential analysis (TSA) was performed to test the conclusiveness of this meta-analysis. Egger’s test and trim-and-fill analysis was used to test publication bias. We took standardized mean difference (SMD) as pool effect of hormones values including prolactin (PRL), follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E₂) and progesterone (P). This study was registered in PROSPERO and the number was CRD42023394503. Results: Twenty-two articles from 13 countries were analyzed. Combining the results of TSA and meta-analysis, we found that compared with healthy control, hemodialysis women had higher PRL, follicular FSH and LH values and lower P levels (PRL: I² = 87%, SMD 1.24, 95% CI: 0.79–1.69, p < 0.00001; FSH: I² = 0%, SMD 0.34, 95% CI: 0.13–0.55, p = 0.002; LH: I² = 39%, SMD 0.64, 95% CI: 0.34–0.93, p < 0.00001; P: I² = 30%, SMD − 1.62, 95% CI: -2.04 to -1.20, p < 0.00001). What’s more, compared with women after renal transplantation, hemodialysis women had higher PRL levels (I² = 0%, SMD 0.51, 95% CI: 0.25–0.78, p = 0.0001). There was not enough evidence to draw a conclusion on the comparison of hormones between regular and irregular menses hemodialysis women. Egger’s test and trim-and-fill analysis didn’t show significant publication bias. Conclusions: Hemodialysis women had higher serum PRL, follicular phase FSH, LH and lower serum P values compared with healthy control. PRL values of hemodialysis women were also higher than that of women after renal transplantation.