Epithelioid hemangioendothelioma (EHE) is a rare malignant vascular tumor. Its malignancy is between benign hemangioma and highly malignant angiosarcoma. It originates from vascular endothelial cells or pre-endothelial cells. It is characterized by the proliferation of vascular endothelial cells with a skin-like or histiocyte-like appearance. The incidence of EHE is less than 1% in all vascular tumors, and it can occur in multiple parts of the body, most often in the liver, followed by simultaneous involvement of the liver and lung, the lung alone, and the bone alone. At present, there is no report of epithelioid hemangioendothelioma diagnosed by bone marrow cell morphological examination in China. In this case, abnormal cells were found through bone marrow cell morphological examination, which guided the direction of further diagnosis and treatment. And finally the patient was diagnosed as epithelioid hemangioendothelioma. The bone marrow cell morphological examination can provided an important basis for clinical diagnosis and treatment. Epithelioid hemangioendothelioma needs to be differentiated from a variety of benign and malignant angiogenic tumors, especially other types of epithelioid angiogenic tumors. At present, it has been found that the disease has characters of cytogenetic and molecular biological abnormalities. Combined with histopathological morphology and immunohistochemical examination, we can make the diagnosis and differential diagnosis.

Objective:To investigate the clinical value of single embryo transfer for the patients with gonadotropin-releasing hormone (GnRH) antagonist protocol.Methods:The clinical data of the patients underwent in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) in Reproductive Medicine Center, the 901th Hospital of the Joint Logistics Support Force of PLA from January 2017 to March 2021 were retrospectively analyzed in this cohort study. According to the days of embryo development and No. of embryos, patients were divided into day 3 (D3) single top-quality cleavage-stage embryo transfer group (single top-quality embryo group), D3 double top-quality cleavage-stage embryo transfer group (double top-quality embryos group), and single blastocyst transfer group. In fresh cycles, there were 301 patients in single top-quality embryo group, 253 patients in double top-quality embryos group and 127 patients in single blastocyst group in frozen-thawed embryo transfer (FET) cycles,there were 84 patients in single top-quality embryo group, 136 patients in double top-quality embryos group and 396 patients in single blastocyst group in first FET cycles after all embryos frozen,there were 69 patients in single top-quality group and 161 patients in single blastocyst group. The rates of clinical pregnancy, implantation, multiple pregnancy, early abortion and ongoing pregnancy in the fresh and FET cycles were compared among single top-quality embryo group, double top-quality embryos group and single blastocyst group. Also, the rates of clinical pregnancy, implantation, multiple pregnancy, early abortion and ongoing pregnancy of single top-quality embryo transfer and single blastocyst transfer were compared between the fresh cycle and the first FET cycle. One-way ANOVA and chi-square test were used in this study. Results:There were no significant difference in duration of infertility, body mass index (BMI), the levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, anti-Müllerian hormone (AMH), gonadotropin (Gn) and the numbers of oocytes retrieved among all the groups (all P>0.05). There were no significant differences in the rates of clinical pregnancy, implantation, multiple pregnancy, early abortion and ongoing pregnancy between single top-quality embryo group and single blastocyst group (all P>0.05) in fresh cycle, while the clinical pregnancy rate [46.18% (139/301)], the ongoing pregnancy rate [40.86% (123/301)] and the multiple pregnancy rate [0% (0/139)] in single top-quality embryo group were significantly lower than those in double top-quality embryos group [58.89% (149/253), P<0.001; 52.17% (132/253), P<0.001; 30.20% (45/149), P<0.001], with the similar implantation rate between the two groups ( P>0.016 7). The rates of clinical pregnancy, implantation and ongoing pregnancy were comparable between single top-quality embryo group and double top-quality embryos group in FET cycle ( P>0.016 7), while which were all significantly lower than those in single blastocyst group [62.88% (249/396), P<0.001; 63.89% (253/396), P<0.001; 55.30% (219/396), P<0.001]. The multiple pregnancy rate of double top-quality embryos group [20.37% (11/54)] was significantly higher than that of single top-quality embryo group [0% (0/27), P=0.013] in FET cycle. The ongoing pregnancy rate of the single top-quality embryo transfer in first FET cycle [27.54% (19/69)] was significantly lower than that in fresh cycle [40.86% (123/301), P=0.040], while the clinical pregnancy rate [63.35% (102/161)] and the implantation rate [63.98% (103/161)] of single blastocyst transfer in first FET cycle were significantly higher than those in fresh cycle [50.39% (64/127), P=0.027; 51.97% (66/127), P=0.040]. Conclusion:The clinical outcomes of D3 single top-quality cleavage-stage embryo transfer were similar to D5 single blastocyst transfer in fresh cycle, while the clinical outcomes of single blastocyst transfer in FET cycle were better compared with fresh cycle for the patients with GnRH antagonist protocol. Single embryo transfer can significantly reduce the multiple pregnancy rate of IVF/ICSI .

Objective:To investigate the clinical value of single embryo transfer for the patients with gonadotropin-releasing hormone (GnRH) antagonist protocol.Methods:The clinical data of the patients underwent in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) in Reproductive Medicine Center, the 901th Hospital of the Joint Logistics Support Force of PLA from January 2017 to March 2021 were retrospectively analyzed in this cohort study. According to the days of embryo development and No. of embryos, patients were divided into day 3 (D3) single top-quality cleavage-stage embryo transfer group (single top-quality embryo group), D3 double top-quality cleavage-stage embryo transfer group (double top-quality embryos group), and single blastocyst transfer group. In fresh cycles, there were 301 patients in single top-quality embryo group, 253 patients in double top-quality embryos group and 127 patients in single blastocyst group in frozen-thawed embryo transfer (FET) cycles,there were 84 patients in single top-quality embryo group, 136 patients in double top-quality embryos group and 396 patients in single blastocyst group in first FET cycles after all embryos frozen,there were 69 patients in single top-quality group and 161 patients in single blastocyst group. The rates of clinical pregnancy, implantation, multiple pregnancy, early abortion and ongoing pregnancy in the fresh and FET cycles were compared among single top-quality embryo group, double top-quality embryos group and single blastocyst group. Also, the rates of clinical pregnancy, implantation, multiple pregnancy, early abortion and ongoing pregnancy of single top-quality embryo transfer and single blastocyst transfer were compared between the fresh cycle and the first FET cycle. One-way ANOVA and chi-square test were used in this study. Results:There were no significant difference in duration of infertility, body mass index (BMI), the levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, anti-Müllerian hormone (AMH), gonadotropin (Gn) and the numbers of oocytes retrieved among all the groups (all P>0.05). There were no significant differences in the rates of clinical pregnancy, implantation, multiple pregnancy, early abortion and ongoing pregnancy between single top-quality embryo group and single blastocyst group (all P>0.05) in fresh cycle, while the clinical pregnancy rate [46.18% (139/301)], the ongoing pregnancy rate [40.86% (123/301)] and the multiple pregnancy rate [0% (0/139)] in single top-quality embryo group were significantly lower than those in double top-quality embryos group [58.89% (149/253), P<0.001; 52.17% (132/253), P<0.001; 30.20% (45/149), P<0.001], with the similar implantation rate between the two groups ( P>0.016 7). The rates of clinical pregnancy, implantation and ongoing pregnancy were comparable between single top-quality embryo group and double top-quality embryos group in FET cycle ( P>0.016 7), while which were all significantly lower than those in single blastocyst group [62.88% (249/396), P<0.001; 63.89% (253/396), P<0.001; 55.30% (219/396), P<0.001]. The multiple pregnancy rate of double top-quality embryos group [20.37% (11/54)] was significantly higher than that of single top-quality embryo group [0% (0/27), P=0.013] in FET cycle. The ongoing pregnancy rate of the single top-quality embryo transfer in first FET cycle [27.54% (19/69)] was significantly lower than that in fresh cycle [40.86% (123/301), P=0.040], while the clinical pregnancy rate [63.35% (102/161)] and the implantation rate [63.98% (103/161)] of single blastocyst transfer in first FET cycle were significantly higher than those in fresh cycle [50.39% (64/127), P=0.027; 51.97% (66/127), P=0.040]. Conclusion:The clinical outcomes of D3 single top-quality cleavage-stage embryo transfer were similar to D5 single blastocyst transfer in fresh cycle, while the clinical outcomes of single blastocyst transfer in FET cycle were better compared with fresh cycle for the patients with GnRH antagonist protocol. Single embryo transfer can significantly reduce the multiple pregnancy rate of IVF/ICSI .

Objective:To investigate the effects of blastulation and transferred blastocyst derived from the 4-5-cell grade I to III (4/I-5/III) embryos on day 3 on clinical outcomes of in vitro fertilization and embryo transfer (IVF-ET). Methods:A total of 884 IVF cycles with blastocyst culture in the 901st Hospital of the Joint Logistics Support Force of PLA from January 2016 to February 2019 were retrospectively analyzed. The blastocyst formation status was compared among the 4/I-5/III embryos. Blastocyst derived from 4/I-5/III embryos in transfer cycle was served as group A ( n=164), blastocyst derived from good-quality cleavage stage embryos (7/I-10/II) in transfer cycle was served as group B ( n=247) according to quality of cleavage stage embryos on day 3. The clinical outcomes were compared between the two groups. The effects of different blastomere number and grade on clinical pregnancy rate and spontaneous abortion rate were evaluated among the 4/I-5/III embryos. Results:Good-quality blastulation rate for 4/I, 4/II, 4/III, 5/I, 5/II and 5/III were 5.6%, 1.8%, 0.6%, 8.3%, 8.4% and 1.6%, respectively. The differences reached statistical significances ( P<0.05). There were no significant differences in number of oocytes retrieved, number of mature oocytes, fertilization rate, cleavage rate, number of transferred embryos, percentage of good-quality blastocyst transfer cycles, clinical pregnancy rate, spontaneous abortion rate, implantation rate and ongoing pregnancy rate between group A and group B ( P>0.05), group A had higher number of embryo transfer cycles ( P=0.034) and lower good-quality embryo rate on day 3 ( P<0.001). There were no significant differences in clinical pregnancy rate and spontaneous abortion rate between transferred blastocyst derived from the 4-cell and 5-cell embryo (51.6% vs. 50.0%；15.2% vs. 26.8%, respectively). There were no significant differences in clinical pregnancy rate and spontaneous abortion rate between transferred blastocyst derived from grade I+II and grade III (4/I-5/III) (53.6% vs. 41.2%； 22.4% vs. 21.4%, respectively). Conclusion:Blastocyst derived from 4/I-5/III embryos and good cleavage stage embryos both are similar clinical outcomes in blastocyst transfer cycles, there are no effects of blastomere number and grade on clinical pregnancy rate and abortion rate in blastocyst transfer cycles, but blastulation rate derived from 5-cell embryo was significantly higher than that of 4-cell embryo.

Objective:To investigate the effects of blastulation and transferred blastocyst derived from the 4-5-cell grade I to III (4/I-5/III) embryos on day 3 on clinical outcomes of in vitro fertilization and embryo transfer (IVF-ET). Methods:A total of 884 IVF cycles with blastocyst culture in the 901st Hospital of the Joint Logistics Support Force of PLA from January 2016 to February 2019 were retrospectively analyzed. The blastocyst formation status was compared among the 4/I-5/III embryos. Blastocyst derived from 4/I-5/III embryos in transfer cycle was served as group A ( n=164), blastocyst derived from good-quality cleavage stage embryos (7/I-10/II) in transfer cycle was served as group B ( n=247) according to quality of cleavage stage embryos on day 3. The clinical outcomes were compared between the two groups. The effects of different blastomere number and grade on clinical pregnancy rate and spontaneous abortion rate were evaluated among the 4/I-5/III embryos. Results:Good-quality blastulation rate for 4/I, 4/II, 4/III, 5/I, 5/II and 5/III were 5.6%, 1.8%, 0.6%, 8.3%, 8.4% and 1.6%, respectively. The differences reached statistical significances ( P<0.05). There were no significant differences in number of oocytes retrieved, number of mature oocytes, fertilization rate, cleavage rate, number of transferred embryos, percentage of good-quality blastocyst transfer cycles, clinical pregnancy rate, spontaneous abortion rate, implantation rate and ongoing pregnancy rate between group A and group B ( P>0.05), group A had higher number of embryo transfer cycles ( P=0.034) and lower good-quality embryo rate on day 3 ( P<0.001). There were no significant differences in clinical pregnancy rate and spontaneous abortion rate between transferred blastocyst derived from the 4-cell and 5-cell embryo (51.6% vs. 50.0%；15.2% vs. 26.8%, respectively). There were no significant differences in clinical pregnancy rate and spontaneous abortion rate between transferred blastocyst derived from grade I+II and grade III (4/I-5/III) (53.6% vs. 41.2%； 22.4% vs. 21.4%, respectively). Conclusion:Blastocyst derived from 4/I-5/III embryos and good cleavage stage embryos both are similar clinical outcomes in blastocyst transfer cycles, there are no effects of blastomere number and grade on clinical pregnancy rate and abortion rate in blastocyst transfer cycles, but blastulation rate derived from 5-cell embryo was significantly higher than that of 4-cell embryo.

Objective: To investigate the effects of heme oxygenase-1 (HO-1) knockdown on proliferation, invasion and migration of lung adenocarcinoma A549 cells and explore the mechanism. Methods: The expression levels of HO-1 mRNA in human bronchial epithelial cells (HBECs) and human lung cancer cell lines (A549, H1299, H358 and H1993) were detected by real-time quantitative polymerase chain reaction (RT-qPCR), and immunohistochemistry (IHC) was used to detect the expression level of HO-1 in human lung adenocarcinoma specimens. The HO-1 short hairpin RNA (shRNA) was transfected into A549 cells by RNA interference technique. HO-1 stably deleted A549 cells were selected (HO-1 shRNA group) and verified by RT-qPCR and western blot. HO-1 shRNA A549 cells and control shRNA A549 cells were treated with the inducer of autophagy Torin1 or its inhibitor Bafilomycin A1 (Baf A1), respectively. The expressions of autophagic markers LC3B and p62 were determined by western blot. The proliferation, invasion and migration abilities of each group of A549 cells were assessed by cell counting, Transwell and wound healing assays, respectively. Results: The expressions of HO-1 mRNA in lung cancer cell lines (A549, H1299, H358 and H1993) were significantly higher than that of HBECs, and HO-1 upregulated in human lung adenocarcinoma. The expression of p62 protein and the ratio of LC3B-Ⅱ/ LC3B-Ⅰ in no treatment group, Torin1 treatment group and Baf A1 treatment group were significantly higher than those of the corresponding control group (P<0.05). After 11 days of culture, the number of cells in HO-1 shRNA group were 41.8%, 30.4% and 14.0% of the corresponding control group, respectively. The number of lower chamber cells in HO-1 shRNA group were (35.7±2.1), (27.0±1.0) and (38.0±1.0)/field, respectively, which were lower than (66.0±9.2), (39.3±1.2) and (43.0±2.6)/field of the corresponding control group, respectively (P<0.05). The migration distances of HO-1 shRNA group were (7.47±0.91) mm, (4.23±0.82) mm and (5.42±0.24) mm, which were lower than (10.07±1.26) mm, (7.14±0.07) mm and (12.04±0.80) mm of the corresponding control groups, respectively (P<0.05). Conclusion Knockdown of HO-1 inhibits the proliferation, invasion and migration of A549 cells by impeding autophagy.