Objective To observe the satisfaction of obtaining endometrial tissue in using endometrial sampling device and explore the influence for pathology diagnostic accordance rate,and to discuss the problem needs to focus in obtaining endometrial tissue with endometrial sampling device for endometrial cancer and precancerous lesion screening.Methods Totally 204 cases using endometrial sampling device with the subsequent diagnostic curettage,hysteroscopy,or hysterectomy were collected.A comparison of pathological diagnosis between two methods was made.The relationship among specimen quantity,proficiency,pathological types and diagnostic accordance rate were analyzed.Results The diagnostic accordance rate of endometrial cancer and precancerous lesion of two methods was 67％ (20/30).92.2％ (188/204) cases successfully got the endometrial glands,77.0％ (157/204) cases got ≥5 specimens of glands and 62.3％ (127/204) cases got ≥10 specimens of glands.When obtaining ≥5 but＜ 10 endometrial glands,the diagnostic accordance rate was 76.7％ (23/30); however,obtaining ≥10 endometrial glands,the diagnostic accordance rate was 92.9％ (118/127).The degree of specimen satisfaction of the first phase was lower than the second phase.Conclusions Obtaining ≥5 endometrial glands in using endometrial sampling device could satisfy the requirement of the basic pathological diagnosis.The proficiency of sampling and the pathological types could influence the degree of specimen satisfaction,and then influence the diagnostic accordance rate.

SUMMARY Pheochromocytomaisrareinpregn’ancy.Clinicalfeaturesofacaseofpheochromocytoma during pregnancy in the Peking University People’s Hospital was investigated and the literature reviewed to discuss the diagnosis and treatment of this disease.The patient manifested with hypertension and pro-teinuria,who was easily misdiagnosed with gestational hypertension disease.When she was transferred to our hospital,the symptoms such as,paroxysmal palpitation,dizziness,vomiting were noticed,and the possibility of pheochromocytoma was considered due to the accompanying abdominal mass.An emergent cesarean section was performed successfully due to preterm labor during the treatment of the disease.Af-ter the delivery the drug preparation continued.And the laparoscopic resection of pheochromocytoma pro-ceeded when the blood pressure was steady.The patient recovered fully after the surgery.The final diag-nosis of pheochromocytoma was confirmed with the pathology.Its diagnosis and treatment experiences could improve our understanding and treatment of secondary hypertension due to pheochromocytoma in pregnancy.

Objective To study the feasibility of endometrial sampling device as a sampling tool during the follow-up visit for endometrial cancer patients undergone conservative treatment.Methods Before the hysteroscopy examination,endometrial sampling device was used to take the endometrium specimens 43times in 19 patients who had been diagnosed as endometrial cancer or atypical hyperplasia,and were undergone conservative treatment during May 2012 to Mar.2013.All cases accepted vaginal ultrasound screening before every sampling by endometrial sampling device.The histological results were compared with those done by hysteroscopy.Results The average age of those patients was (30 ± 6) years old.The mean thickness of the endometrium during the treatment was (0.81 ± 0.65) cm.The qualified rate for the sampling was 95％ (41/43).Compared with the specimens undergone by hysteroscopy direct sampling,32samples got by the endometrial sampling device with thicker endometrium (0.93 ± 0.70) cm had the same histological results,while the other 9 patients with thinner endometrium (0.40 ± 0.14) cm were not (P =0.031).Conclusion The endometrial sampling device could be used during the follow-up visit for the conservative treatment patients with endometrial cancer or atypical hyperplasia,the vaginal ultrasound screening should be used together to figure out those with thinner endometrium.

Objective: To observe the changes of electroencephalogram (EEG) and its clinical significance in patients with acute cerebral infarction. Methods: From January 2017 to January 2019, 96 patients with acute cerebral infarction treated in Zhejiang Xiaoshan Hospital were randomly selected as observation group, and 96 healthy persons of the same age from the same period in our hospital were selected as control group.All the participants were given EEG examination.The values of alpha, beta, delta, theta and DTABR were compared between the two groups.The focal cerebral infarction and large area cerebral infarction in observation group were compared.The values of alpha, beta, delta, theta and DTABR of the dead patients were observed, and the factors affecting the prognosis of the patients with good prognosis and poor prognosis were observed.Logistic multivariate regression analysis was carried out with the prognosis of the patients as a strain to analyze the factors affecting the prognosis of the patients. Results: The values of delta, theta and DTABR of patients in the observation group were (43.26±10.51)Hz, (29.30±9.88)Hz, (1.14±0.40), respectively, which were higher than those in the control group[(22.49±5.37)Hz, (26.42±5.73)Hz, (0.92±0.37)](t=17.243, P=0.000; t=2.471, P=0.014, P=0.014; t=3.956, P=0.000). The alpha and theta of patients with focal cerebral infarction were (15.94±5.33)Hz and (30.76±10.02)Hz, respectively, which were higher than those of patients with large cerebral infarction[(11.37±4.06)Hz and (27.55±7.75)Hz](t=6.683, P=0.000; t=2.483, P=0.014). Delta and DTABR in patients with focal cerebral infarction were (37.42±5.33)Hz and (1.03±0.52)Hz, which were lower than those of patients with massive cerebral infarction[(52.36±5.21)Hz and (1.48±0.45)Hz](t=19.640, P=0.000; t=6.412, P=0.000). There was no significant difference in beta between the two groups (P>0.05). The patients with good prognosis had higher levels of alpha and beta on the affected side[(27.18 ±9.65)Hz and (14.83±5.06)Hz] than those with poor prognosis[(14.06 ±3.94)Hz and 9.03±4.33)Hz](t=8.034, P=0.000; t=5.841, P=0.000). The delta, theta, DTABR of affected side, affected side DTABR/contralateral DTABR were (31.42±9.83)Hz, (32.19 ±8.57)Hz, (0.916±0.371)Hz, (1.051±0.246), respectively, which were lower than those of patients with poor prognosis[(40.13±14.37)Hz, (37.44±10.11)Hz, (1.331±0.712)Hz, (1.376±0.352)](t=3.529, P=0.001; t=2.739, P=0.007; t=3.728, P=0.000; t=5.329, P=0.000). Logistic multivariate regression analysis was used to analyze the prognosis of patients with acute cerebral infarction.DTABR on the affected/healthy side was the factor influencing the prognosis of patients with acute cerebral infarction. Conclusion EEG in patients with acute cerebral infarction may increase the value of delta, theta and DTABR, and decrease the value of alpha and beta.DTABR in the affected side and the contralateral side is the prognostic factor.

Objective: To assess the value of non-invasive prenatal testing (NIPT) for the identification of fetal chromosomal aneuploidies. Methods: For 9470 pregnant women with a moderate-to-high risk by conventional serological screening or advanced maternal age, peripheral venous blood samples were collected and, following extraction of free fetal DNA, subjected to large-scale parallel sequencing on a Illumina Hiseq2000 platform. Those with a high risk by NIPT were validated by invasive prenatal diagnosis. Results: Out of the 9470 samples, 194 cases (2.0%) were positive by NIPT testing. These included 50 trisomy 21, 11 trisomy 18, 17 trisomy 13, 44 other autosomal aneuploidies, 55 sex chromosomal aneuploidies, and 17 chromosomal copy number variations. As validated by amniotic fluid or umbilical blood chromosomal karyotyping analysis, NIPT has a false positive rate of 2.0%, 18.2%, 41.2%, 97.7%, 81.8%, 94.1%, respectively. The test has a sensitivity of 100% and a specificity of 98.79%. Conclusion For common chromosomal aneuploidies such as trisomy 21 and trisomy 18, NIPT has a good sensitivity and specificity, therefore has good value for clinical application.

Objective:To investigate the molecular classification of endometrial carcinoma (EC) and atypical endometrial hyperplasia (AEH) treated with fertility-sparing therapy, and to analyze its relationship with clinicopathological factors and treatment efficacy.Methods:A total of 46 EC and AEH patients who received fertility-sparing therapy and molecular classification tested by next generation sequencing in Peking University People's Hospital from June 2020 to December 2021, were retrospectively collected. The relationships between molecular classification and clinicopathological factors and treatment outcomes were analyzed.Results:(1) Of the 46 patients, including 40 EC and 6 AEH patients, 32 cases (71%, 32/45) had complete response (CR) after treatment, with median CR time of 8 months, 6 cases (13%, 6/45) had partial response, and 8 cases (25%, 8/32) had recurrence. (2) The cases were distributed as no specific molecular profile (NSMP) 34 cases (74%, 34/46) subtype mainly, high microsatellite instability (MSI-H) 7 cases (15%, 7/46), POLE ultra-mutated 3 cases (7%, 3/46), and copy number high (CNH) 2 cases (4%, 2/46). Patients with CNH had the hightest serum cancer antigen 125 (CA 125) level [(34.3±35.2) kU/L]. MSI-H subtype had more family history of tumors (6/7), more with loss of mismatch repair (MMR) protein expression by immunohistochemical (7/7), and higher nuclear antigen associated with cell proliferation (Ki-67) expression level (3/3). (3) Patients in MSI-H subgroup had the lowest CR rate at 6 months (0/6; P=0.019), and survival analysis showed that they were less likely to achieve CR than those with NSMP subtype ( P=0.022). Subgroup analysis of patients with NSMP showed that age ≥30 years related with longer treatment time to CR ( P=0.010). In addition, CR was obtained after treatment in 2/3 POLE ultra-mutated cases and 2/2 CNH, respectively. Conclusions:Molecular classification relates with the treatment response in patients with EC and AEH treated with fertility-sparing therapy. Patients with MSI-H subtype have poor treatment efficacy, and patients with NSMP need to be further studied and predict treatment benefit. However, there are few cases in POLE ultra-mutated and CNH subtypes, which need further clinical research.

Objective: To investigate The Cancer Genome Atlas (TCGA) molecular classification of endometrial cancer (EC) and endometrial atypical hyperplasia (AH) treated with fertility-sparing therapy. Methods: A total of 46 EC and AH patients who received fertility-sparing therapy and TCGA molecular classification tested by next generation sequencing, in Peking University People’s Hospital from June 2020 to December 2021, were retrospectively collected. We analyzed the relationship between molecular classification and clinicopathological factors and treatment outcomes. Results: Of the 46 patients, including 40 EC and 6 AH patients, 70.5% (32 patients) had complete remission (CR) after treatment, with median CR time of 8 months. The cases were distributed as no specific molecular profile (NSMP; n=34, 73.9%) subtype mainly, microsatellite instability-high (MSI-H; n=7, 15.2%), POLE ultra‑mutated (n=3, 6.5%), and copy number high (CNH; n=2, 4.3%). Patients with MSI-H subtype had lower body mass index (24.0±5.5 kg/m2), more family history of tumor (6/7), more with loss of mismatch repair protein expression by immunohistochemical (7/7), and higher Ki67 expression level (3/3). Patients in MSI-H subgroup had the lowest CR rate at 6 months (0/6, p=0.019), and survival analysis showed that such patients were less likely to achieve CR than those with NSMP subtype (p=0.022). Subgroup analysis of patients with NSMP showed that, age ≥30 years and diabetes mellitus related with longer treatment time to CR (p=0.01 and p=0.059, respectively). In addition, CR was obtained in 2 (2/3) POLE ultra‑mutated cases and 1 (2/2) CNH case, respectively. Conclusion TCGA molecular classification relates with the treatment response in patients with EC and AH treated with fertility-sparing therapy. Patients with MSI-H subtype have poor treatment efficacy.

OBJECTIVETo assess the value of combined chromosomal karyotyping and BACs-on-Beads(BoBs) assay for the prenatal diagnosis of high risk gravida from Ningbo.

METHODSFor 2779 women, results of conventional karyotyping analysis and BoBs assay were compared.

RESULTSFor common aneuploidies involving chromosomes 13, 18, 21, X and Y, the two methods have yielded a concordance rate of 98.78%. Eight cases detected with microduplication by BoBs were missed by karyotyping analysis. On the other hand, 17 structural chromosomal abnormalities, 10 chimeras and 1 triploidy detected by karyotyping analysis were missed by BoBs.

CONCLUSIONThe BoBs technology has featured high throughput and rapidity, and can detect 9 microdeletion syndromes, which can improve the quality of prenatal diagnosis and provide an ideal complementary for conventional chromosomal karyotyping.

Adult ; Chromosome Aberrations ; Chromosome Deletion ; Chromosomes, Artificial, Bacterial ; genetics ; Female ; Humans ; Karyotyping ; methods ; Pregnancy ; Prenatal Diagnosis ; methods

Objective:To explore the effect of previous intestinal resection on anastomotic fistula within 30 days after surgery in Crohn′s disease.Methods:The clinical data from 92 Crohn′s disease patients who underwent intestinal resection and anastomosis at the Department of General Surgery in Shanghai Ninth People′s Hospital, Shanghai Jiaotong University School of Medicine from Jan 2016 to Sep 2019. Patients were divided into no previous intestinal resection group ( n=45) and previous intestinal resection group ( n=47). The relationship between previous intestinal resection and postoperative anastomotic leak in Crohn′s disease patients with intestinal resection and anastomosis was analyzed. Results:A total of 11 cases (12% leak rate) underwent postoperative anastomotic leak. There were 2 leaks in patients with no previous history of intestinal resection, while 9 leaks in patients with previous bowel resection (χ 2 =4.722, P=0.03). The OR of the postoperative anastomotic leak in Crohn′s disease patients with previous intestinal resection compared with no previous intestinal resection group was 5.092 (95% CI: 1.035-25.048). Patients with 1 previous resection (24 cases) had a leak rate of 13%, whereas patients with >1 previous resection episodes (23 cases) had a leak rate of 26%. The number of previous resection episodes correlated with an increasing risk for clinical anastomotic leak (correlation coefficien r=0.995). Conclusions:Previous intestinal resection is an independent risk factor for ensuing postoperative anastomotic leak in Crohn′s disease patients with intestinal resection and anastomosis.

Objective:To investigate the efficacy and pregnancy outcome of fertility-preserving treatment for patients with stage Ⅰa, grade 2 endometrial cancer (EC).Methods:Clinical data was retrospectively collected for EC or atypical endometrial hyperplasia (AEH) patients treated in Peking University People's Hospital, Foshan First People's Hospital of Guangdong Province and First Affiliated Hospital of Sun Yat-sen University, from 2010 to 2019. Inclusion criteria for fertility-preserving treatment included: (1) Age ≤45 years. (2) EC with histological differentiation of G 1, G 2 or endometrial AEH. (3) EC disease should be stage Ⅰa, confined to the endometrium without myometrial invasion, lymph node or extrauterine metastasis. Treatment regimen: patients were given oral progestin therapy and endometrial pathology was evaluated every three months. Patients were divided into three groups as G 2 EC group, G 1 EC group and AEH group based on the histological differentiation. Oncological and pregnancy outcomes were compared among them. Results:(1) Totally 57 eligible patients were included in this study, including 11 cases with G 2 EC, 22 cases with G 1 EC, and 24 cases with AEH. (2) Oncological outcome: among the three groups of G 2 EC, G 1 EC and AH, the complete remission rates (9/11, 91% and 96%, respectively) and recurrence rates (3/9, 30% and 22%, respectively) were not significantly different (all P>0.05). Median remission time was significantly longer in the G 2 EC group than those in the other two groups (8, 6 and 4 months; P=0.046). Among 9 G 2 EC patients who recurred after complete remission, three patients relapsed at 7, 18 and 53 months, respectively. All 3 patients chose fertility-sparing treatment again, and all achieved complete remission after retreatment. (3) Pregnancy outcome: among the three groups, the assisted reproduction technology rates (4/8, 5/18 and 36%, respectively) and pregnancy rates (6/8, 5/18 and 36%, respectively) had no significant difference ( P>0.05). However, time interval to pregnancy was shorter in G 2 EC patientsthan the other two groups (4, 9 and 22 months, respectively; P=0.006). Conclusions:Fertility-preserving treatment for patients with stageⅠa, G 2 endometrial cancer, may obtain a relatively high remission rate and an acceptable pregnancy rate. However, further exploration is needed due to the limited number of cases.