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.

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 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 More evidence has shown FDG PET/CT parameters might be associated with survival of patients with locally advanced cervical cancer (LACC) treated with concurrent chemo-radiotherapy (CCRT). Objectives To perform this meta-analysis to investigate the prognostic value of pretreatment FDG PET/CT parameters. Search strategy PubMed and Embase. Selection criteria Studies that met the following criteria were enrolled: patients treated with CCRT for LACC; FDG PET/CT scans performed before or during treatment; and relationship between the parameters of FDG PET/CT and the prognosis of patients were investigated. Data collection and analysis Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were used to estimate overall survival (OS) or event-free survival (EFS). Main results Higher primary tumor TLG (HR = 1.843, 95% CI = 1.100–3.086, P = 0.02) and MTV (HR = 2.06, 95% CI, 1.21–3.51, P = 0.007) were significantly associated with shorter EFS. Patients with high SUVmax have a shouter OS than those with low SUVmax (HR = 2.582, 95% CI 1.936–3.443, P <0.001). Primary tumor SUVmax (HR = 1.938, 95% CI, 1.203–3.054, P = 0.004) and nodal SUVmax (HR = 3.478, 95% CI = 2.006-6.029, P <0.001) were significantly correlated with EFS with relatively high heterogeneity (I2 = 84%, I2 = 69.4%, respectively). Nodal SUVmax (HR = 2.095, 95% CI = 2.027–2.166, P <0.001) were significantly correlated with OS with relatively high heterogeneity (I2 = 54.1%, P = 0.140). Other parameters had no detected association with survival. Conclusions Pretreatment FDG PET/CT parameters serve as a prognostic predictor.

Objective: To investigate the feasibility and diagnostic accuracy of endometrial biopsy using Li Brush sampler in IUD users. Design: Clinical research Setting: A public teaching hospital in China. Population: IUD users with irregular uterine bleeding and IUD non-users who arranged for dilatation and curettage at the First Affiliated Hospital of Xi’an Jiaotong University, China from January 2018 to January 2020. Methods: This study was conducted in two parts. Part Ⅰ was to assess the impact of Li Brush on the position of IUDs. Transvaginal ultrasound was used to locate IUDs before and after sampling. Part Ⅱ was to explore the diagnostic accuracy of Li Brush in detecting endometrial lesions. Both IUD users and non-users were recruited, and the sampling satisfaction and accuracy of Li Brush were evaluated. Main outcome Measures: The positions of IUDs before and after sampling, cytopathological and histopathological diagnosis, sampling satisfaction rate. Results: Seventeen cases in part Ⅰ confirmed no significant difference in the position of IUDs before and after sampling (p=0.20). 112 IUD users and 139 IUD non-users were recruited in part Ⅱ. The Li Brush achieved 94.64% and 92.09% sampling satisfaction in the IUD group and control group, respectively, and the overall diagnostic accuracy was 88.04% and 93.33% in the two groups. Conclusions: Li Brush used for endometrial biopsy did not affect the position of IUDs and had high sampling satisfaction and accuracy for endometrial diagnoses.