1.Application of genome tagging technology in elucidating the function of sperm-specific protein 411 (Ssp411).
Xue-Hai ZHOU ; Min-Min HUA ; Jia-Nan TANG ; Bang-Guo WU ; Xue-Mei WANG ; Chang-Gen SHI ; Yang YANG ; Jun WU ; Bin WU ; Bao-Li ZHANG ; Yi-Si SUN ; Tian-Cheng ZHANG ; Hui-Juan SHI
Asian Journal of Andrology 2025;27(1):120-128
The genome tagging project (GTP) plays a pivotal role in addressing a critical gap in the understanding of protein functions. Within this framework, we successfully generated a human influenza hemagglutinin-tagged sperm-specific protein 411 (HA-tagged Ssp411) mouse model. This model is instrumental in probing the expression and function of Ssp411. Our research revealed that Ssp411 is expressed in the round spermatids, elongating spermatids, elongated spermatids, and epididymal spermatozoa. The comprehensive examination of the distribution of Ssp411 in these germ cells offers new perspectives on its involvement in spermiogenesis. Nevertheless, rigorous further inquiry is imperative to elucidate the precise mechanistic underpinnings of these functions. Ssp411 is not detectable in metaphase II (MII) oocytes, zygotes, or 2-cell stage embryos, highlighting its intricate role in early embryonic development. These findings not only advance our understanding of the role of Ssp411 in reproductive physiology but also significantly contribute to the overarching goals of the GTP, fostering groundbreaking advancements in the fields of spermiogenesis and reproductive biology.
Animals
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Female
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Humans
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Male
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Mice
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Spermatids/metabolism*
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Spermatogenesis/physiology*
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Spermatozoa/metabolism*
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Thioredoxins/genetics*
2.Study on knowledge, attitudes and practices of pulse oximetry among pediatric healthcare providers in China and their influencing factors
Fengxia XUE ; Yuejie ZHENG ; Adong SHEN ; Hanmin LIU ; Xing CHEN ; Lili ZHONG ; Guangmin NONG ; Xin SUN ; Gen LU ; Shenggang DING ; Yuanxun FANG ; Jiahua PAN ; Zhiying HAN ; Yun SUN ; Qiang CHEN ; Yi JIANG ; Xiaoping ZHU ; Suping TANG ; Xiufang WANG ; Changshan LIU ; Shaomin REN ; Zhimin CHEN ; Deyu ZHAO ; Yong YIN ; Rongfang ZHANG ; Ming LI ; Yunxiao SHANG ; Yaping MU ; Shuhua AN ; Yangzom YESHE ; Peiru XU ; Yan XING ; Baoping XU ; Jing ZHAO ; Shi CHEN ; Wei XIANG ; Lihong LI ; Enmei LIU ; Yuxin SONG ; Yonghong YANG ; Kunling SHEN
Chinese Journal of Applied Clinical Pediatrics 2022;37(23):1807-1812
Objective:To investigate the knowledge, attitudes, and practices (KAP) of pulse oximetry among pediatric healthcare providers in China and analyze the factor influencing the KAP.Methods:A self-developed questionnaire was used for an online research on the KAP of 11 849 pediatric healthcare providers from 31 provinces, autonomous regions, and municipalities of China from March 11 to 14, 2022.The factors influencing the KAP of pulse oximetry among pediatric healthcare providers were examined by Logistic regression. Results:The scores of KAP, of pulse oximetry were 5.57±0.96, 11.24±1.25 and 11.19±4.54, respectively.The corresponding scoring rates were 69.61%, 74.95%, and 55.99%, respectively. Logistic regression results showed that the gender and working years of pediatric healthcare providers, the region they were located, and whether their medical institution was equipped with pulse oximeters were the main factors affecting the knowledge score (all P<0.05). Main factors influencing the attitude score of pediatric healthcare providers included their knowledge score, gender, educational background, working years, region, medical institution level, and whether the medical institution was equipped with pulse oximeters (all P<0.05). For the practice score, the main influencing factors were the knowledge score, gender, age, and whether the medi-cal institution was equipped with pulse oximeters (all P<0.05). Conclusions:Chinese pediatric healthcare providers need to further improve their knowledge about and attitudes towards pulse oximetry.Pulse oximeters are evidently under-used.It is urgent to formulate policies or guidelines, strengthen education and training, improve knowledge and attitudes, equip more institutions with pulse oximeters, and popularize their application in medical institutions.
3.Effects of porcine acellular dermal matrix combined with human epidermal stem cells on wound healing of full-thickness skin defect in nude mice.
Xiao Hong ZHAO ; Yu Cheng GUO ; Hong Hao CHEN ; Xue LI ; Ying WANG ; Wen Qiang NI ; Meng Qiu XING ; Rui ZHANG ; Shi Cang YU ; Yin Gen PAN ; Ri Xing ZHAN ; Gao Xing LUO
Chinese Journal of Burns 2022;38(1):45-56
Objective: To explore the effects of porcine acellular dermal matrix (ADM) combined with human epidermal stem cells (ESCs) on wound healing of full-thickness skin defect in nude mice. Methods: The morphology of porcine ADM was analyzed by photograph of digital camera, the cell residues in porcine ADM were observed by hematoxylin-eosin (HE) staining, the surface structure of porcine ADM was observed by scanning electron microscope, the secondary structure of porcine ADM was analyzed by infrared spectrometer, the porcine ADM particle size was analyzed by dynamic light scattering particle size analyzer, and the porcine ADM potential was analyzed by nano-particle size potentiometer. The morphology of porcine ADM was observed by inverted fluorescence microscope when it was placed in culture medium for 30 min, 1 d, and 5 d (n=2). The porcine ADM was divided into 5 min group, 10 min group, 20 min group, 30 min group, 60 min group, and 120 min group according to the random number table (the same grouping method below) in static state at normal temperature for the corresponding time to calculate the water absorption by weighing method (n=3). Swiss white mouse embryonic fibroblasts (Fbs) were divided into blank control group (culture medium only), and 50.0 g/L ADM extract group, 37.5 g/L ADM extract group, 25.0 g/L ADM extract group, 12.5 g/L ADM extract group, and 6.5 g/L ADM extract group which were added with the corresponding final concentrations of ADM extract respectively. At post culture hour (PCH) 24, 48, and 72, the cell survival rate was detected by cell counting kit 8 and the cytotoxicity was graded (n=5). The erythrocytes of a 6-week-old male Sprague-Dawley male rat were divided into normal saline group, ultra-pure water group, and 5 mg/mL ADM extract group, 10 mg/mL ADM extract group, and 15 mg/mL ADM extract group which were treated with the corresponding final concentrations of porcine ADM extract respectively. After reaction for 3 h, the absorbance value of hemoglobin was detected by microplate reader to represent the blood compatibility of porcine ADM (n=3). ESCs were isolated and cultured from the discarded prepuce of a 6-year-old healthy boy who was treated in the Department of Urology of the First Affiliated Hospital of Army Medical University (the Third Military Medical University) in July 2020, and then identified by flow cytometry. The porcine ADM particles of composite ESC (hereinafter referred to as ESC/ADM) were constructed by mixed culture. After 3 days of culture, the composite effect of ESC/ADM was observed by HE staining and laser scanning confocal microscope. Thirty-six 7-8-week-old male non-thymic nude mice were divided into phosphate buffer solution (PBS) alone group, ADM alone group, ESC alone group, and ESC/ADM group, with 9 mice in each group, and the wound model of full-thickness skin defect was established. Immediately after injury, the wounds were treated with the corresponding reagents at one time. On post injury day (PID) 1, 7, 11, and 15, the wound healing was observed and the wound healing rate was counted (n=3). On PID 7, the epithelialization of wounds was observed by HE staining and the length of un-epithelialized wound was measured (with this and the following sample numbers of 4). On PID 11, the dermal area and collagen deposition of wounds were observed by Masson staining and the dermal area of wound section was calculated, the number of cells expressing CD49f, a specific marker of ESC, was calculated with immunofluorescence staining, the mRNA expression of glyceraldehyde-3-phosphate dehydrogenase (GAPDH) in ESC after wound transplantation was detected by real-time fluorescence quantitative reverse transcription polymerase chain reaction. Data were statistically analyzed with independent sample t test, one-way analysis of variance, analysis of variance for repeated measurement, and least significant difference t test. Results: The porcine ADM was white particles and composed of reticular structure, with no cells inside, disordered structure, and rough surface. The absorption peak of porcine ADM appeared at the wave numbers of 1 659, 1 549, and 1 239 cm-1, respectively. The main particle size distribution of porcine ADM in solution was 500 to 700 nm, with negative charge on the surface. The morphology of porcine ADM in static state at 30 min and on 1 and 5 d was relatively stable. The water absorption of porcine ADM remained relatively high level in static state from 30 min to 120 min. The cytotoxicity of mouse embryonic Fbs in 6.5 g/L ADM extract group, 12.5 g/L ADM extract group, and 25.0 g/L ADM extract group was grade 1 at PCH 24, and the cytotoxicity of the other groups was 0 grade at each time point. After reaction for 3 h, the absorbance value of hemoglobin of erythrocytes in ultra-pure water group was significantly higher than the values in normal saline group and 15 mg/mL ADM extract group (with t values of 8.14 and 7.96, respectively, P<0.01). After 3 days of culture, the cells of the fourth passage showed pebble-like morphology, with low expression of CD71 and high expression of CD49f, which were identified as ESCs. There was ESC attachment and growth on porcine ADM particles. On PID 1, the wound sizes of nude mice were almost the same in PBS alone group, ADM alone group, ESC alone group, and ESC/ADM group. On PID 7, 11, and 15, the wound contraction of nude mice in each group was observed, especially in ADM alone group, ESC alone group, and ESC/ADM group. On PID 7, the wound healing rates of nude mice in ESC alone group and ESC/ADM group were significantly higher than the rate in PBS alone group (with t values of 2.83 and 4.72 respectively, P<0.05 or P<0.01). On PID 11, the wound healing rate of nude mice in ESC/ADM group was significantly higher than that in PBS alone group (t=4.86, P<0.01). On PID 15, the wound healing rates of nude mice in ADM alone group, ESC alone group, and ESC/ADM group were significantly higher than the rate in PBS alone group (with t values of 2.71, 2.90, and 3.23 respectively, P<0.05). On PID 7, the length of un-epithelialized wound of nude mice in ADM alone group, ESC alone group, and ESC/ADM group was (816±85), (635±66), and (163±32) μm, respectively, which were significantly shorter than (1 199±43) μm in PBS alone group (with t values of 5.69, 10.19, and 27.54 respectively, P<0.01). On PID 11, the dermal areas of wound section of nude mice in ADM alone group, ESC alone group, and ESC/ADM group were significantly larger than the area in PBS alone group (with t values of 27.14, 5.29, and 15.90 respectively, P<0.01); the collagen production of nude mice in ADM alone group and ESC/ADM group was more obvious than that in PBS alone group, and the collagen production of nude mice in ESC alone group and PBS alone group was similar. On PID 11, in the wounds of nude mice in ESC alone group and ESC/ADM group, the cells with positive expression of CD49f were respectively 135±7 and 185±15, and the mRNA expressions of GAPDH were positive; while there were no expressions of CD49f nor mRNA of GAPDH in the wounds of nude mice in PBS alone group and ADM alone group. Conclusions: ESC/ADM particles can promote the wound healing of full-thickness skin defects in nude mice, which may be related to the improved survival rate of ESCs after transplantation and the promotion of dermal structure rearrangement and angiogenesis by ADM.
Acellular Dermis
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Animals
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Fibroblasts
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Humans
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Male
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Mice
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Mice, Nude
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Rats
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Rats, Sprague-Dawley
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Stem Cells
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Swine
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Wound Healing
4. Genome sizes of four important medicinal species in Kadsura by flow cytometry
Jing XU ; Xue-ping WEI ; Jiu-shi LIU ; Yao-dong QI ; Ben-gang ZHANG ; Hai-tao LIU ; Pei-gen XIAO ; Xue-ping WEI ; Jiu-shi LIU ; Yao-dong QI ; Ben-gang ZHANG ; Hai-tao LIU ; Pei-gen XIAO
Chinese Herbal Medicines 2021;13(3):416-420
Objective: Dianjixueteng is a geoherb in Yunnan Province, the source plant of which is Kadsura interior. However, the formation of this geoherb is not clear in genetic mechanism, in which genome size is the first step that should be known on the genomic level. In this study we aimed to estimate the genome sizes of source plants of K. interior and three related herbs K. heteroclita, K. longipedunculata, and K. coccinea by flow cytometry (FCM) and make a comparison. Methods: The genome sizes of K. interior, K. heteroclita, K. longipedunculata and K. coccinea, i.e., the source plants of Dianjixueteng and its relative medicinal materials, were estimated by FCM. The nuclei of K. interior were isolated using modified LB01 buffer, for the rest species, by the Galbraith's buffer. Results: The genome sizes of K. interior, K. heteroclita, K. longipedunculata, and K. coccinea were 7.36, 7.12, 7.01, and 5.15 pg/1C, respectively. Genome size of K. interior had no significant variation with those of K. heteroclita and K. longipedunculata (P = 0.296), which was significantly larger than that of K. coccinea. Conclusion: Genome size can not distinguish K. interior from K. heteroclita and K. longipedunculata, but could distinguish them from K. coccinea, which lays the foundation for future studies on genetic mechanism of the geoherb formation.
5.Progress of Functional Imaging in Brain Structure and Functional Changes in People with Amphetamine Addiction
Feng-Lin XUE ; Shi-Jun HONG ; Xiao-Feng ZENG ; Jing YANG ; Gen-Meng YANG ; Yi-Qing ZHOU ; Li-Hua LI
Journal of Kunming Medical University 2018;39(8):129-133
Amphetamines abuse is defined as a chronic recurrent encephalopathy, and it is a global public health problem which seriously threatens the health of human and the social stability. Long-term abuse and addiction of amphetamines leads to structural and functional changes of specific encephalic regions. Further researches on these encephalic regions, the network of brain and biological information may be helpful to understanding drug abuse mechanism and possible therapeutic measures. Recently, a series of functional imaging techniques, including magnetic resonance imaging (MRI), functional magnetic resonance imaging (f MRI), magnetic resonance spectroscopy (MRS), diffusion tensor imaging (DTI), and positron emission tomography (PET), were used to detect different brain structural changes of the volume and density of encephalic regions, functional changes of cerebral blood flow and brain cognition. The results showed functional imaging techniques play significant roles to detect different structural and functional changes of the brain. Based on these results, the researchers aim to clarify the mechanisms of drug abuse. That is the main focus of this review.
6.Effects of gastrodin against SH-SY5Y cell autophagy induced by methamphetamine and underlying mechanisms
Gen-Meng YANG ; Juan LI ; Shi-Jun HONG ; Feng-Lin XUE ; Yong-Wang HE ; Yi-Qing ZHOU ; Xiao-Feng ZENG ; Li-Hua LI
Chinese Pharmacological Bulletin 2018;34(4):577-583
Aim To investigate the effects of gastrodin on SH-SY5Y cell autophagy induced by methamphet-amine (METH) and the underlying mechanisms. Methods SY5Y cells were treated by METH with the concentration of 0.5,1.0,1.5,2.0,2.5,3.0 mmol·L-1for 24 h. The morphological changes were ob-served by microscopy,the expression of LC3-Ⅱ,Bec-lin-1,Akt,p-Akt,mTOR and p-mTOR were detected by Western blot. Gastrodin was added to the medium 1 h before METH treatment. Results The SY 5 Y cells were morphologically featured by shrinkage and den-drite disruption after exposed to METH(0~3 mmol· L-1),and autophagic vacuoles occurred in cytoplasm. The expression of LC3-Ⅱ increased over METH dose. Confocal results showed that LC3-Ⅱsignificantly in-creased in METH group as compared with control, while decreased in METH+ Gastrodin group. The ex-pression levels of LC3-Ⅱand Beclin-1 significantly in-creased (P<0.01) in METH group, p-mTOR and p-Akt decreased, and mTOR and Akt showed no signifi-cant difference as compared with control. However, the gastrodin could decrease the expression of LC3-Ⅱand Beclin-1 and increase the expression of mTOR,p-mTOR,Akt and p-Akt as compared with METH-trea-ted groups. Conclusions METH can induce SY5Y cells autophagy. The protective effect of gastrodin a-gainst METH-induced autophag may be related to gast-rodin regulation mTOR and Akt signaling pathway.
7.Value of combined determination of neutrophil CD64 and procalcitonin in early diagnosis of neonatal bacterial infection.
Dao-Jian QIN ; Zong-Sheng TANG ; Shu-Li CHEN ; Xue-Mei XU ; Shuang-Gen MAO ; Shi-Fa ZHANG
Chinese Journal of Contemporary Pediatrics 2017;19(8):872-876
OBJECTIVETo investigate the value of combined determination of neutrophil CD64 and procalcitonin (PCT) in the early diagnosis of neonatal bacterial infection.
METHODSAccording to discharge diagnosis, 37 neonates with bacterial infection were divided into sepsis (n=15) and ordinary infection (non-sepsis) groups (n=22). Twenty-one neonates without infection who were hospitalized during the same period of time were enrolled as the control group. Venous blood samples were collected immediately after admission. Flow cytometry was used to measure the serum level of neutrophil CD64. Chemiluminescence and immune transmission turbidimetry were used to measure the serum levels of PCT and CRP respectively.
RESULTSThe sepsis group had higher serum levels of neutrophil CD64, PCT, and CRP than the control group (P<0.01), the ordinary infection group had a higher serum level of neutrophil CD64 than the control group (P<0.01), and the sepsis group had higher serum levels of PCT and CRP than the ordinary infection group (P<0.01). The areas under the ROC curve (AUC) of neutrophil CD64, PCT, and CRP in diagnosing bacterial infection were 0.818, 0.818, and 0.704 respectively, and the AUC of combined neutrophil CD64 and PCT was 0.926. A combination of neutrophil CD64 and PCT had a sensitivity of 97.29% and an accuracy of 89.65% in the early diagnosis of neonatal bacterial infection.The sensitivity and accuracy were higher than those of a combination of CRP and neutrophil CD64 or PCT as well as neutrophil CD64, PCT, or CRP alone for the early diagnosis of neonatal bacterial infection.
CONCLUSIONSThe combined determination of neutrophil CD64 and PCT can improve the sensitivity and accuracy in the diagnosis of neonatal bacterial infection, which helps with early identification of bacterial infection.
Bacterial Infections ; blood ; diagnosis ; C-Reactive Protein ; analysis ; Calcitonin ; blood ; Early Diagnosis ; Female ; Humans ; Infant, Newborn ; Male ; Neutrophils ; chemistry ; ROC Curve ; Receptors, IgG ; blood
8.Experimental research on parameters of red blood cells in additive solution leukocytes reduced preserved in navy ship force
chuan Da SHI ; Yan LI ; Xue YAO ; Lei SHI ; Wei LIU ; zhen Zhen HAO ; Ying HAN ; xia Min LIU ; gen Dong WANG ; qing Chang ZHENG
Military Medical Sciences 2017;41(9):742-744
Objective To study the changes in red blood cells(RBCs),hemoglobin(Hb),hematocrit(HCT),mean corpuscular volume(MCV),RBC distribution width variation coefficient(RDW-CV)and RBC distribution width standard deviation(RDW-SD)of leukocyte-poor red blood cells preserved in navy ship force on a long voyage.Methods According to the Requirement of Health Examination for Blood Donors(GB 18467 -2011),red blood cells in additive solution leukocytes reduced were randomly collected from ten healthy voluntary blood donors one day before sailing.Each blood sample was preserved.The relevant parameters were detected as data before sailing.Each blood sample was divided into two parts,one in test group and the other in control group.Samples were taken from the two groups of leukocyte-poor red blood cells for the sampling detection after 21 days of sailing respectively.Results ①After sailing, the concentrations of RBCs and Hb declined in both groups,and the difference of RBC concentrations was not significant(P=0.319),but that of the concentrations of Hb was significant(P=0.002).②After sailing, the concentrations of HCT and MCV increased, but the change of HCT was significant(P=0.015),while that of MCV was insignificant(P=0.051).③After sailing,the concentrations of RDW-SD and RDW-CV were higher,but the change of RDW-SD was significant(P<0.001),while that of RDW-CV was not(P=0.528).Conclusion When leukocyte-poor red blood cells are preserved in navy ship force,the concentrations of RBC and Hb decrease,while the concentrations of HCT,MCV,RDW-SD and RDW-CV increase with the prolongation of preservation.A long voyage has some impact on the parameters of red blood cells in additive solution leukocytes reduced,as is the case with the conventional blood storage refrigerator(4 ±2)℃.
9.Biochemical indices of red blood cells in additive solution leukocytes reduced preserved in navy ship force during a long voyage
chuan Da SHI ; Xue YAO ; Lei SHI ; Yan LI ; Wei LIU ; jie Wei SUN ; Ying HAN ; xia Min LIU ; gen Dong WANG ; qing Chang ZHENG
Military Medical Sciences 2017;41(9):745-748,751
Objective To explore the influence on and changes in the biochemical indices of red blood cells(RBCs)in additive solution leukocytes reduced preserved in navy ship force on a long voyage.Methods According to the Requirement of Health Examination for Blood Donors(GB 18467 -2011),RBCs in additive solution leukocytes reduced were prepared from 10 healthy voluntary blood donators one day before sailing.Each blood sample was divided into two parts,one in test group and another in control group.All the groups had samples taken for the biochemical index detection after 1,3,5,7,14 and 21 days of sailing respectively.Results ①The change in total protein(P=0.235)and albumin (P=0.119)concentration was not obvious,and the difference between the two groups was not significant.②The change in total creatinine(P=0.001)and uric acid(P=0.001)concentration was obvious, but the difference between the two groups was not significant.③The change in total cholesterol(P=0.354)concentration was not obvious,but the change in triglycerides(P=0.005)concentration was significant.The difference between the two groups was not significant.④The concentration of lactate dehydrogenase, hydroxybutyrate dehydrogenase and creatine kinase increased with the time of preservation(P<0.001).The difference between the two groups was not significant.⑤The interaction between grouping effect and time effect had no significant influence on the concentration of osmolarity(OSM)(P=0.968)and glucose(Glu) (P=0.406).Between the two groups,the difference of concentrations of OSM(P=0.569)and Glu(P=0.115)was not significant.Conclusion Under the 4 class sea conditions, a long voyage has some impact on the storage of RBCs in additive solution leukocytes reduced,as in the conventional blood storage refrigerator(4 ±2)℃.The results of this study have important clinical implications for our further study of marine blood support.
10.Proportion of Uterine Malignant Tumors in Patients with Laparoscopic Myomectomy: A National Multicenter Study in China
Yang HUA ; Li XIAO-CHUAN ; Yao CHEN ; Lang JING-HE ; Jin HANG-MEI ; Xi MING-RONG ; Wang GANG ; Wang LU-WEN ; Hao MIN ; Ding YAN ; Chen JIE ; Zhang JIAN-QING ; Han LU ; Guo CHENG-XIU ; Xue XIANG ; Li YAN ; Zheng JIAN-HUA ; Cui MAN-HUA ; Li HUAI-FANG ; Tao GUANG-SHI ; Chen LONG ; Wang SU-MIN ; Lu AN-WEI ; Huang ZE-HUA ; Liu QING ; Zhuang YA-LI ; Huang XIANG-HUA ; Zhu GEN-HAI ; Huang OU-PING ; Hu LI-NA ; Li MU-JUN ; Zhou HONG-LIN ; Song JING-HUI ; Zhu LAN
Chinese Medical Journal 2017;130(22):2661-2665
Background:The Food and Drug Administration recently announced that the use of morcellation may cause fibroids or pelvic dissemination and metastasis of uterine sarcoma;therefore,the use of morcellation is limited in the USA.A large sample study is necessary to assess the proportion of uterine malignant tumors found in patients with laparoscopic myomectomy.Methods:A national multicenter study was performed in China.From 2002 to 2014,33,723 cases were retrospectively selected.We calculated the prevalence and recorded the clinical characteristics of the patients with malignancy after morcellation application.A total of 62 cases were finally pathologically confirmed as malignant postoperatively.Additionally,the medical records of the 62 patients were analyzed in details.Results:The proportion of postoperative malignancy after morcellation application was 0.18% (62/33,723) for patients who underwent laparoscopic myomectomy.Nearly 62.9% (39/62) of patients had demonstrated blood flow signals in the uterine fibroids before surgery.And,23 (37.1%) patients showed rapid growth at the final preoperative ultrasound.With respect to the pathological types,38 (61.3%) patients had detectable endometrial stromal sarcoma,13 (21.0%) had detectable uterine leiomyosarcoma,only 3 (3.2%) had detectable carcinosarcoma,and 5 (8.1%) patients with leiomyoma had an undetermined malignant potential.Conclusions:The proportion of malignancy is low after using morcellation in patients who undergo laparoscopic myomectomy.Patients with fast-growing uterine fibroids and abnormal ultrasonic tumor blood flow should be considered for malignant potential,and morcellation should be avoided.

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