Optimization of Intraoperative Neural Monitoring of the Recurrent Laryngeal Nerve in Thyroid Surgery.

The application of intraoperative neural monitoring (IONM) has been widely accepted to improve surgical outcomes after thyroid surgery. The malfunction of an IONM system might interfere with surgical procedures. Thus, the development of anesthesia modalities aimed at ensuring functional neuromonitoring is essential. Two key issues should be taken into consideration for anesthetic management. Firstly, most patients undergo recurrent laryngeal nerve monitoring via surface electrodes embedded in an endotracheal tube. Thus, advanced video-assisted devices might optimize surface electrode positioning for improved neuromonitoring signaling accuracy. Secondly, neuromuscular blocking agents are routinely used during thyroid surgery. The ideal neuromuscular block should be deep enough for surgical relaxation at excision and recovered enough for an adequate signal f nerve stimulation. Proper neuromuscular block management could be achieved by titration doses of muscle relaxants and reversal agents.

Serum markers in the differential diagnosis of Waldenstrom macroglobulinemia and other IgM monoclonal gammopathies.

BACKGROUND: IgM monoclonal gammopathy can be present in a broad spectrum of diseases. We evaluated the value of serum markers in the differential diagnosis of Waldenstrom macroglobulinemia (WM) and other types of IgM monoclonal gammopathies. METHODS: We included patients who were first admitted to hospital and identified as having IgM monoclonal gammopathy by serum immunofixation electrophoresis (sIFE). We evaluated basic clinical features, sIFE, diagnosis, and serum markers. Furthermore, we applied the receiver operating characteristic (ROC) curve to analyze the differential diagnosis value of serum markers for WM. Finally, we used logistic regression and ROC curve to analyze the differential diagnosis value of multimarker combinations to identify WM. RESULTS: IgM monoclonal gammopathy was most frequently found in patients with Waldenstrom macroglobulinemia, followed by monoclonal gammopathy of undetermined significance (MGUS), B-cell non-Hodgkin Lymphoma (B-NHL), and multiple myeloma (MM). Serum markers showed significant differences among the four diseases. The diagnostic markers LDH, IgM, IgG, IgA, and serum light chain К had higher diagnostic efficiency. Among these markers, serum IgM provided the highest diagnostic efficiency. Additionally, the combined use of all five serum markers provided the most effective diagnosis. CONCLUSIONS: The five serum markers, LDH, IgM, IgG, IgA, and К, each yielded a specific efficacy in differential diagnosis of WM. The single marker with the highest diagnostic efficiency was the serum IgM level. However, a combination of multiple serum markers was better than the use of a single marker in diagnosing WM. The combined use of all five serum markers provided the most effective diagnosis, with an AUC of .952 and sensitivity and specificity of 87.8% and 86.9%, respectively.

The effect to IL-3Ralpha, downstream PI3k/Akt signaling of all-trans retinoic acid and arsenic trioxide in NB4 cells.

All-trans retinoic acid (ATRA) and arsenic trioxide (As2O3) are the classic drugs used for induction therapy of acute promyelocytic leukemia (APL). IL-3Ralpha (CD123) is a specific marker of acute myeloid leukemia stem cells (AML-LSCs). The over-expression of IL-3Ralpha in patients with AML is related to high white blood cells counts, high percentages of blast cells, and poor prognosis. Moreover, in some studies, IL-3Ralpha has been considered a new detection marker of minimal residual disease in the bone marrow from patients with APL. In contrast to ATRA, As2O3 reduces both mRNA and protein expression of IL-3Ralpha and inhibits the activity of PI3K/Akt after 24 h, 48 h, and 72 h of exposure. Furthermore, NB4 cells adhered to the human stroma cell line HS-5 cells were used as an in vitro model of APL cells in the bone marrow microenvironment. Our results demonstrate that adhesion to HS-5 cells up-regulated IL-3Ralpha protein expression and activated the downstream PI3K/Akt signaling pathway in NB4 cells. Compared with ATRA, As2O3 more potently inhibits proliferation of NB4 cells adhered to stroma cells.

Clinical analysis of ovarian epithelial carcinoma with coexisting pelvic endometriosis.

OBJECTIVES: To explore the differences between women with endometriosis associated ovarian cancer and typical epithelial ovarian cancer. STUDY DESIGN: The medical charts of total 226 patients with epithelial ovarian cancer treated at Peking Union Medical College Hospital between March 2011 and March 2012 were reviewed. Histology evaluation determined endometriosis associated ovarian cancer (n = 17) or non-endometriosis associated ovarian cancer (n = 209). RESULTS: Compared with non-endometriosis associated ovarian cancer, patients with endometriosis associated ovarian cancer were proved: (1) to be younger and more likely to be premenopausal at diagnosis of epithelial ovarian cancer (P = .03 and .005, respectively); (2) to have lower preoperative serum level of Ca125 (mean: 122.9 vs 1377.5 U/mL, P < .001) and more likely to display normal Ca125 level (P < .001); (3) to be identified at the earlier stage (stage I, P < .001); (4) to have completely different distribution of histological subtypes (significant overrepresentation of clear cell and endometrioid carcinoma). CONCLUSION: As such, patients with endometriosis associated ovarian cancer differ from non-endomertiosis associated ovarian cancer in many of their critical clinical and biologic characteristics.

Prognostic analysis of endometrioid epithelial ovarian cancer with or without endometriosis: a 12-year cohort study of Chinese patients.

OBJECTIVE: Clinicopathological characteristics and possible prognostic factors among women with endometrioid epithelial ovarian cancer (EEOC) with or without concurrent endometriosis were investigated. STUDY DESIGN: A search of medical charts at Peking Union Medical College Hospital from 2000 through 2012 identified patients with EEOC with or without endometriosis. RESULTS: Of 188 patients with EEOC, concurrent endometriosis was identified in 32 (17.0%). Patients with concurrent endometriosis were approximately 5 years younger, more likely to be premenopausal, more likely to have an early stage of EEOC, and less likely to have high-grade tumors compared to those without endometriosis. The univariate analysis showed that concurrent endometriosis was a significant prognostic factor for disease-free survival, but this association did not remain in the multivariate analysis. CONCLUSION: Women with EEOC and concurrent endometriosis showed distinct characteristics and had longer disease-free survival when compared to those without endometriosis.

[Pregnant rate and pregnancy-relating factors of patients with early endometrial carcinoma and severe atypical hyperplasia of endometrium after fertility-preserving treatment by progestin].

OBJECTIVE: To summarize the pregnant rate of patients with early endometrial carcinoma and severe atypical hyperplasia after fertility-preserving treatment and analyze their pregnancy-relating factors. METHODS: Endometrial curettage was used to evaluate the therapy response of endometrium after every 3 months of administration of high-dose progestin as fertility-sparing treatment for 51 patients with stage I endometrial carcinoma or severe endometrial atypical hyperplasia from Jun. 1996 to Jan. 2010. Individualized maintained treatment was given to patients after achieving complete remission of the endometrium. Pregnant results and pregnancy-relating factors were analyzed retrospectively. RESULTS: The median age of all the 51 patients was 29 years old. Forty-five (88%, 45/51) achieved complete response. Of the 34 cases who desired to conceive after complete response, 16 of them had 22 pregnancies, the pregnant rate was 47% (16/34); and 12 women obtained healthy live birth baby, the fertility rate was 35% (12/34). The pregnant rate of patients at age >35 or ≤ 35 was 0/2 and 50% (16/32) respectively (P > 0.05). The pregnant rate of patients with or without infertility was 40% (8/20) and 8/14, with endometrial cancer or severe atypical hyperplasia was 40% (10/25) and 6/9, respectively (all P > 0.05). The pregnant rate of patients who received in vitro fertilization-embryo transfer, ovulation promotion, or no treatment was 7/7, 6/16 and 3/11 respectively (P < 0.01). CONCLUSIONS: Fertility-preserving treatment for early endometrial cancer and severe atypical hyperplasia with high-dose progestin could achieve higher response rate. Assisted reproductive technologies could significantly increase the chance of conception.

[The association of insulin resistance, blood pressure variability and severity of acute coronary syndrome].

OBJECTIVE: To investigate the association of insulin resistance (IR), blood pressure variability (BPV) and the severity of acute coronary syndrome (ACS), and assess the effect of percutaneous coronary intervention (PCI) on recent prognosis. METHODS: A total of 260 patients diagnosed as ACS and hospitalized in our department of cardiology from December 2009 to December 2010 were enrolled in the study. There were 93 cases of unstable angina pectoris(UAP), 84 of non ST segment elevation myocardial infarction and 83 of unstable angina pectoris. The subjects were divided into two groups according to 24 hour systolic blood pressure coefficient of variability (24 h SBP-CV) levels: high-CV group (24 h SBP-CV > 11.5, n = 130) and low-CV group(24 h SBP-CV < 11.5, n = 130). The differences in HOMA-IR and the severity of coronary artery diseases between the two groups were compared. The association of major adverse cardiac events within 6 months after PCI treatment, and IR as well as BPV was analyzed. RESULTS: Compared with the low-CV group, ACS patients in the high-CV group had obviously higher HOMA-IR levels (5.7 ± 1.2 vs 4.0 ± 1.4, P < 0.01), more multivessel diseases (49.2% vs 33.3%, P < 0.05) and B2/C type coronary diseases (48.5% vs 27.7%, P < 0.01), and higher coronary Gensini scores (59.7 ± 17.5 vs 43.8 ± 18.6, P < 0.01). Multi-factors logistic regression analysis indicated that both 24 h BPV-CV and IR were independent predictors for MACE incidence within 6 months after undergone PCI (P < 0.05 or P < 0.01). CONCLUSIONS: IR and BPV were obviously associated with the severity of coronary artery diseases in ACS patients. IR and 24 h BPV-CV were valuable in predicting recent prognosis of ACS patients.

[Effects of pre-chemotherapy hemoglobin and platelet levels in patients with stage Ib2-IIb cervical cancer treated with neoadjuvant chemotherapy followed by radical hysterectomy].

OBJECTIVE: To investigate the role of pre-chemotherapy hemoglobin and platelet levels in the effect of chemotherapy and prognostic outcome in patients with International Federation of Gynecology and Obstetrics (FIGO) stage Ib2-IIb cervical cancer treated with neoadjuvant chemotherapy followed by radical hysterectomy. METHODS: From January 1999 to December 2010, 111 patients with FIGO stage Ib2-IIb who underwent chemosurgical treatment at the department of obstetrics and gynecology in Peking Union Medical College Hospital were reviewed. The median age of patients was 42 years (range: 21 - 68 years). The median level of prechemotherapy hemoglobin and platelet levels was 127 g/L and 266 × 10(9)/L, respectively. Chemotherapy response was evaluated according to the WHO criteria, including complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD). Patients who achieved CR or PR were defined as responder. Rates of clinical response were compared with the clinical-pathological variables using chi-square test. Multiple logistic regression was carried out to evaluate the relationship among the probability of achieving an optimal clinical response and the variables. The log-rank test was used to compare the homogeneity of progression-free survival and overall survival functions across strata defined by categories of prognostic variables. The Cox proportional hazard model was used to assess the significance of potential prognostic factors for progression-free survival and overall survival. RESULTS: All patients received one to three cycles of chemotherapy. After the neoadjuvant chemotherapy, 9 patients achieved CR, 77 patients PR, 23 patients SD, 2 patients PD. The overall response rate was 77.5% (86/111). By univariate analysis, the clinical response rate was associated with tumor grade (P = 0.026), deep cervical stromal invasion (P = 0.029) and positive lymph nodes (P = 0.048). By multiple logistic regression, deep cervical stromal invasion (P = 0.015) and positive lymph nodes (P = 0.031) were independent predictors of optimal clinical response. By log-rank test, 5-year overall survival rate and 5-year progression-free survival rate were associated with lymph nodes metastases status and lymphovascular invasion (P = 0.000), but not with hemoglobin and platelet levels (P > 0.05). By Cox regression model, lymph nodes metastases status and lymph-vascular space involvement (P < 0.01) were independently prognostic factors of 5-year overall survival rate and 5-year progression-free survival rate. CONCLUSION: Pretreatment hemoglobin and platelet levels were neither predictors of clinical response to chemotherapy nor prognostic factors.

[Management of invasive cervical cancer in pregnancy: clinical analysis of 13 cases].

OBJECTIVE: To analyze the clinical characteristics and assess the outcome of treatment for cervical cancer during pregnancy. METHODS: A cohort of 13 patients with cervical cancer diagnosed during pregnancy from January 2001 to September 2011 in Peking Union Medical College Hospital (PUMCH) was retrospectively studied. Clinical information, gestational age at diagnosis, treatment options and maternal and child outcomes were collected and analyzed. RESULTS: Thirteen patients out of 2030 cases of invasive cervical cancer were diagnosed during pregnancy with an incidence of 0.64% (13/2030). The Mean gestational age at diagnosis of 13 patients is 21(+6) weeks. Two cases were diagnosed during the first trimester, 8 cases at second trimester and 3 cases at third trimester respectively. Vaginal bleeding during the pregnancy was main clinical manifestation presented in 8 patients and all thirteen cases were diagnosed by biopsy with pathological types of squamous cell carcinoma in 10 cases. The International Federation of Gynecology and Obstetrics (FIGO) stage was I in eleven cases and stage II in two cases. Six patients of them received treatment promptly after diagnosis. The other 7 patients had delayed treatment with mean diagnosis-treatment interval time of 65 days due to fertility reasons, who ended pregnancy by cesarean section at mean gestational age of 34(+6) weeks, two of them received chemotherapy with cisplatin + fluorouracil (PF) or cisplatin respectively before the end of the pregnancy, while the one with PF chemotherapy experienced neonatal death. The rest 6 neonatal outcomes were good. As follow-up of 13 cases: 11 cases in stage I received surgical treatment, and two of which had recurrence respectively, 15 months and 7 months post surgery, and one case had died. One case of Stage II patients died and one had recurrence after 53 months after radiotherapy. The recurrence rate in 13 cases was 3/13 and the mortality rate was 2/13. CONCLUSIONS: Most cases of cervical cancer diagnosed during pregnancy were in early FIGO stage. For those patients diagnosed in late pregnancy with strong fertility demand, considering delayed treatment according to FIGO stage of the disease and fetus maturity is appropriate. Chemotherapy during pregnancy may cause neonatal complications.

Combination of Neutrophil-to-Lymphocyte Ratio and Red Cell Distribution Width With Serum Tumor Markers for the Differential Diagnosis of Breast Cancer and its Association With Pathological Features and Molecular Types.

OBJECTIVE: To explore the neutrophil-to-lymphocyte ratio (NLR), red cell distribution width (RDW) and serum tumor markers as differential diagnostic markers of breast cancer (BC) and breast fibroadenoma (FA) and their associations with histopathological indicators and molecular typing in BC patients. METHODS: We collected pathological and routine clinical test data [NLR, RDW, serum tumor markers (CEA, CA15-3, CA125, CA19-9)] of 653 patients with BC and 100 patients with FA. After identifying indicators with significant inter-group differences, we used ROC curves to determine clinically significant cutoff values. Binary logistic regression analyses and ROC curves were used to analyze combined models for the differential diagnosis of BC and FA. Ordinal multinomial logistic regression analysis was used to explore correlations between routine clinical test indicators and pathological BC features. RESULTS: The BC and FA groups had significantly different CEA, NLR, and CA19-9 levels (P < .05), with respective areas under the curve (AUC) of 0.799, 0.747, and 0.711 for differentiating BC from FA and respective optimal cutoff values of 1.35 ng/mL, 1.58, and 8.55 U/mL. Binary logistic regression and ROC curve analysis showed that CEA was superior to the other 2 factors for the differential diagnosis of BC and FA. whereas the combined use of all three indicators was diagnostically most effective (AUC = 0.886; 95% confidence interval: 0.838-0.933, P = .000; sensitivity and/or specificity: 76.5%/88.9%). Ordered multinomial logistic regression analysis showed that NLR, CEA, and CA15-3 correlated positively with BC TNM staging; RDW was negatively correlated with BC histological grade; RDW, CA15-3 and CA125 were obviously associated with BC molecular typing. CONCLUSION: The combination of CEA, NLR, and CA19-9 may be used to screen and diagnose BC. NLR, CEA and CA15-3 are related to the TNM staging of BC. RDW is related to BC histological grading. RDW, CA15-3 and CA125 are related to BC molecular typing.

[Clinicopathologic analysis of 130 cases of mucinous borderline ovarian tumors].

OBJECTIVE: To determine the clinicopathologic characteristics of mucinous borderline ovarian tumors (MBOT) and evaluate the risk factors for recurrence. METHODS: A retrospective study included age, the level of preoperative serum CA125, surgical procedures, surgical-staging and the risk factors for recurrence in 130 patients with MBOT who were treated from Jan. 1994 to Dec. 2008 in Peking Union Medical College Hospital was done. RESULTS: Preoperative serum CA125 and CA199 were elevated in 34% (33/96) and 50% (13/26) of patients respectively. Fifty-two radical surgeries included total hysterectomy and bilateral salpingo-ovarectomy (THBSO) and 78 fertility-sparing surgeries included 54 salpingo-oovarectomies (SO) and 24 cystectomy were done. Fifty-five cases underwent comprehensive surgical staging. Mean size of the tumors was (16 ± 10) cm and 90.0% (117/130) were limited to unilateral ovary. There were 59 (45.4%) cases, 62 (47.7%) cases, 2 (1.5%) cases and 7 (5.4%) cases in stage Ia, Ic, II, III, respectively. Forty-five (34.6%) concurrent with benign mucinous tumors, 14 (10.8%) ovarian intraepithelial carcinoma, 8 (6.2%) micro-invasive carcinoma and 4 (3.1%) pseudomyxoma peritonei were found. Median duration for follow-up was 56.3 months. Sixteen (12.3%) recurrences and 2 tumor related deaths were found. Median duration from surgery to recurrence was 25.6 months. Recurrent rate after THBSO (4%, 2/49) was significantly lower than that of SO (13%, 7/54) and cystectomy (17%, 4/24; P < 0.05). The recurrent rate of Ic or III was 18% (11/62) or 3/7, which were significantly higher than that of stage Ia (3%, 2/59; P < 0.05). Three of the 4 pseudomyxoma peritonei appeared of recurrence. While, the results showed that these were no effect on recurrent rate whether concurrent intraepithelial, microinvasive carcinoma or not comprehensive staging surgery. CONCLUSIONS: Majority of MBOT were diagnosed in early stage and have favorable prognosis. Patients who take conservative surgery had higher recurrence rate than those radical surgery, but it doesn't affect survival. Late stage and concurrent pseudomyxoma peritonei are risk factors for recurrence.

METTL3 mediates bone marrow mesenchymal stem cell adipogenesis to promote chemoresistance in acute myeloid leukaemia.

Adipogenesis of bone marrow mesenchymal stem cells (MSCs) promotes chemoresistance of acute myeloid leukaemia (AML) cells. MSCs from AML patients (AML-MSCs) display enhanced adipogenesis compared with bone marrow MSCs from healthy donors. However, the precise molecular mechanism by which adipogenesis of MSCs from AML marrow differs from normal counterparts remains obscure. We found that METTL3 significantly inhibits MSC adipogenesis. Here, we aimed to identify the molecular mechanism linking METTL3 and MSC adipogenesis. Analysis of m6 A epigenetic changes in MSCs determined via RIP-qPCR and MeRIP-qPCR indicated that METTL3 affects AKT protein expression in MSCs by mediating m6 A modification of AKT1-mRNA. Downregulated METTL3 expression in AML-MSCs induced an increase in AKT protein, resulting in enhanced MSC adipogenesis, thereby contributing to chemoresistance in AML cells. Therefore, targeting AKT regulation by mRNA modification in MSC adipogenesis might provide a novel therapeutic strategy to overcome AML chemoresistance.

[Mullerian adenosarcoma of the uterus: A clinicopathologic analysis of 9 cases].

OBJECTIVE: To investigate the clinicopathologic features, diagnosis, treatment and prognosis of uterine mullerian adenosarcoma. METHODS: The clinicopathological data of 9 cases of uterine mullerian adenosarcoma in PUMC hospital from January 2003 to February 2009 were retrospectively analyzed. RESULTS: There were 6 uterine endometrial adenosarcomas and 3 cervical adenosarcomas. The main clinical manifestations were abnormal vaginal bleeding and pelvic pain. Physical examination showed cervical/vaginal mass, enlarged uterus or pelvic mass. The adenosarcoma was characterized by benign or atypical-appearing neoplastic glands within a sarcomatous stroma. This stroma could appear as periglandular cuffs or intraglandular polypoid projections of increased cellular structure. The primary diagnostic rate was 66.7% and the most common clinical stage was stage I (7/9). All patients received surgical treatment and seven had postoperative chemotherapy, radiotherapy or hormone therapy. Conservation of unilateral ovary or bilateral ovaries was performed in 5 cases. Three patients underwent local excision, which resulted in the preservation of reproductive function. During the follow-up, 2 cases of uterine endometrial adenosarcoma recurred. One patient of clinical stage III containing sarcomatous overgrowth died from recurrence 13 months after surgery. The other one recurred 2 years after local excision of the tumor in the uterine cavity and she remained healthy since hysterectomy. CONCLUSION: Uterine mullerian adenosarcoma is a rare tumor without specific clinical symptoms and signs. The diagnosis depends on pathomorphologic examination. The tumors show low malignant potential and the vast majority are at early stage. Surgical excision is the main treatment strategy with a good prognosis in the early stage disease with complete removal of tumors. The prognosis is poor in advanced adenosarcoma with sarcomatous overgrowth. Due to the relatively high rate of recurrence, long-term follow-up is recommended.

[Prognostic factors and reproductive outcomes of borderline ovarian tumors: a review of 186 patients].

OBJECTIVE: To determine the clinicopathological characteristics of borderline ovarian tumors and to evaluate their prognostic factors and pregnancy rates/fertility outcomes after conservative surgery. METHODS: A total of 186 patients with borderline ovarian tumors receiving treatment at our hospital from 1990 to 2007 were retrospectively studied and followed-up post-operatively for at least six months. The effects of clinicopathological characteristics upon recurrence and mortality were analyzed by independent sample t test, Chi-square test, Kaplan-Meier and Cox proportional hazard model. RESULTS: The median follow-up time was 44 months. One hundred and nine patients underwent conservative surgery and 77 patients underwent radical surgery. Thirty-one relapses were reported. Only 3 died of disease. As demonstrated by multivariate analysis, surgical procedure, stage and pseudomyxoma peritonei were the independent prognostic factors for recurrence. CONCLUSION: The recurrence rate of conservative surgery is higher than that of radical surgery. However, conservative surgery is safe as it does not result in a higher mortality rate.

[Clinical Characteristics and Prognosis of 125 Hematopathy Patients with Abnormality of Chromosome 3].

OBJECTIVE: To investigate the clinical characteristics and prognosis of hematopathy patients with chromosome 3 abnormality. METHODS: The clinical data of the 125 hematopathy patients with chromosome 3 abnormality in our hospital from January 2011 to June 2018 were retrospectively analyzed. The conventional karyotype analysis was performed by R-banding. According to the main genetic abnormalities, the patients were divided into 3 group: group with 3q abnormality, 3p abnormality and +3/-3. RESULTS: Among 3 kinds of gene abnormality 3q abnormality was the most common one, followed by +3 and 3p abnormality. No significant differences were found in age, sex, WBC, Plt count and Hb level all in each group (P＞0.05). Among the 125 patients, 42 patients died without treatment or abandoned treatment, and 83 patients received more than 2 courses of treatment. The 2-year overall survival (OS) rate in the three groups was 30.25%, 43.0% and 58.7% respectively. The 2-year OS rate in the 3q abnormal group was significantly lower than that in the +3/-3 group (P=0.041). Among the 3q abnormality, the detection rate of the patients with 3q21/3q26 locus abnormality was the highest, and their 2-year OS rate (41.1%) was higher than that in other 3q locus abnormality (11.1%) (P=0.044). CONCLUSION: Hematopathy patients with chromosome 3 abnormality, especially 3q abnormality often show a poor prognosis, however, 3q abnormality involving 3q21/3q26 locus indicates a better prognosis relatively.

A Comparison of Laparoscopies and Laparotomies for Radical Hysterectomy in Stage IA1-IB1 Cervical Cancer Patients: A Single Team With 18 Years of Experience.

OBJECTIVE: To investigate the safety and efficacy of abdominal radical hysterectomy (ARH) and laparoscopic radical hysterectomy (LRH) in managing early-stage cervical cancer. METHODS: This retrospective study comprised patients with FIGO stage IA1 with lymphovascular space invasion (LVSI), IA2, and IB1 cervical cancer who underwent radical hysterectomy performed by a single gynecologic oncology team at Peking Union Medical College Hospital from 2000-2018. The clinicopathological characteristics, surgical outcomes, and survival outcomes were compared between the two groups. RESULTS: The ARH and LRH groups consisted of 84 and 172 patients, respectively. The 5-year progression-free survival (PFS) rates were 89.3 and 95.9% in the ARH and LRH groups (P = 0.122, adjusted HR = 0.449, 95% CI: 0.162-1.239), respectively, while the 5-year overall survival (OS) rates were 95.2 and 98.8%, respectively (P = 0.578, adjusted HR = 0.650, 95% CI: 0.143-2.961). The presence of more than two comorbidities led to poor OS (P = 0.011). For patients with a BMI greater than 24 kg/m2, LRH was associated with better PFS (P = 0.039). Compared with ARH, LRH was associated with a shorter operation time (248.8 vs. 176.9 min, P < 0.001), less blood loss (670.2 vs. 200.9 ml, P < 0.001), and lower postoperative ileus rates (2.4% vs. 0%, P = 0.042). No significant differences were observed in PFS and OS between 2006-2012, 2013-2015, and 2016-2018 in the LRH group (P = 0.126 and P = 0.583). CONCLUSION: Compared with ARH, LRH yields similar survival and improved surgical outcomes in patients with early-stage cervical cancer. LRH is not inferior to ARH for select cervical cancer patients treated by a single team with adequate laparoscopy experience.

[Ovarian growing teratoma syndrome clinical study of 22 cases].

OBJECTIVE: To describe the essential points for the correct diagnosis and best treatment for ovarian growing teratoma syndrome (GTS) developed after surgery and chemotherapy for ovarian immature teratoma. METHODS: Retrospective review of the clinical characteristics and long term follow up results of 22 cases of ovarian GTS to illustrate the unique biological behavior of the tumor and good prognosis of the disease. RESULTS: Pathological examination of the tumors revealed completely benign mature teratoma with G0 grading in 20 cases. The other 2 cases were found to be G0 mature teratoma with concurrent association of malignant somatic cell tumor: carcinoid and primitive neuroectodermal tumor (PNET) respectively. Among the 22 cases of ovarian GTS there are 6 cases with recurrent tumors developed repeatedly, so totally surgical treatments had been performed for 31 times. Time interval in between the development of the ovarian GTS and the initial surgery for their primary immature teratoma is equal to or exceeding one year in 94% (29/31) of the cases. Such a time factor is of high significance for the diagnosis of ovarian GTS. As the benign behavior of the ovarian GTS together with its poor response to chemotherapy have just been recognized in recent years, they were treated as malignant tumors as their original primary immature teratoma before the year of 1987. Postoperative chemotherapy of various kinds was applied. By the year of 1988 postoperative chemotherapy began to be abandoned and since then most of the patients (9/10) had not received postoperative chemotherapy. After long periods of follow up (3.6 -23.0 years) 20 of the 22 patients are found to be living and well. The rest 2 patients died of the concurrent association of malignant somatic cell tumors with carcinoid and PNET in 0.1 and 0.3 years respectively. CONCLUSIONS: Ovarian GTS is a tumor developed after surgical and chemotherapeutic treatment of malignant ovarian immature teratoma. Pathologic grading of the tumors showed retroconversion of the malignancy of the tumor from G3, G2 or G1 to G0 with good prognosis. The tumor usually remained to be quiescent for long periods of time. But there are also some potential of progressive growth, the tumor may grow to huge size and the recurrent tumor may develop repeatedly for several times more than 10 or 20 years later. Surgical removal should be the main treatment either for the primary or the recurrent tumors. Chemotherapy and radiotherapy are not effective and can do nothing but harm to patients. Only correct knowledge about the benign biological behavior of the ovarian GTS and reasonable therapeutic regimen can have the disease ends with good prognosis.

[Clinical analysis of thirteen cases of hypersensitivity reactions to carboplatin.].

OBJECTIVE: To characterize hypersensitivity reactions to chemotherapy with carboplatin in patients with gynecologic malignancies and serve use of carboplatin. METHODS: We retrospectively analyzed the clinical features, management, or outcome of carboplatin-related hypersensitivity reactions in 13 patients with gynecologic malignancies from 1983 to 2008. RESULTS: Twenty times hypersensitivity reactions happened in thirteen women with carboplatin hypersensitivity reactions. The earliest one was at the 5th cycle, the last one was at the 28th cycle; the average cycle was 11.6. The accumulative dosage of carboplatin was 1 900 - 11 400 mg. The average dose was 4840 mg, 2500 - 7200 mg were the main dose range. More than 5 cycles and (or) more than 2500 - 7200 mg of carboplatin administration significantly increased the incidence of hypersensitivity reactions in the twelve patients. Reactions were generally occurred at the first 5 - 10 minutes during intravenous infusion. The average time was 7.6 minutes. Symptoms included mild-to-moderate reactions and severe reactions. Thirteen patients experienced carboplatin hypersensitivity. Two out of 13 cases exhibited severe hypersensitivity reaction at the first time. The first hypersensitivity reactions was mild-to-moderate in 11 cases. When retreated with carboplatin, 4 exhibited no more reactions, 5 exhibited mild-to-moderate hypersensitiviry reactions, 2 exhibited severe reactions. Mild-to-moderate reactions were resolved by temporary interruption of carboplatin infusion, and (or) using steroid, while severe hypersensitivity reactions were resolved by more medicines. CONCLUSIONS: The hypersensitivity reactions in the patients receiving carboplatin are increased after multiple doses of the agent. The possible of retreat with the carboplatin for the mild-to-moderate reactions may be considered. Hypersensitivity reactions should be treated actively. The following chemotherapy should be planed individually. The primary chemotherapy protocol for the patients with severe hypersensitivity reactions should not be reconsidered.

[Treatment of malignant ovarian germ cell tumors with relapse or failed in primary therapy].

OBJECTIVE: To study the clinical characteristic, the optimal treatments and the prognosis for the recurrence and failure of primary treatment in malignant ovarian germ cell tumors (MOGCT). METHODS: The clinical data of 17 recurrent and failure of primary treatment in MOGCT cases treated in Pecking Union Medical College Hospital from January 1983 to May 2008 were analyzed retrospectively to evaluate failure of primary treatment and second treatment. RESULTS: Only the 4 cases of recurrent and failure of primary treatment of MOGCT were underwent comprehensive surgical staging. After primary surgery in 1 - 8 months, 16 cases received the non-standard chemotherapy were found the lesion again. The secondary debulking surgery was done for the 15 cases and also received the standard chemotherapy. Among of them, 8 cases were survival during follow up, 5 cases gave up the treatment and 4 patients were lost following up during the treatment. CONCLUSIONS: The standard primary treatment is the most important for the MOGCT. Even for the recurrence and failure of primary treatment of MOGCT, the satisfied cytoreductive surgery plus the standard chemotherapy also show the significant impact on the prognosis.

[Prevalence of human papillomavirus infection in women in Tibet Autonomous Region of China.].

OBJECTIVE: To determine the prevalence of cervical type-specific human papillomavirus (HPV) infection as well as risk factors associated in Tibet Autonomous Region of China. METHODS: A cluster sampling study was performed in Lasa, Rikaze and Naqu of Tibet. An epidemiological questionnaire was applied and 3036 cervical specimens were obtained for liquid-based cytology and HPV DNA detection. Statistical analysis included Wald Chi-square and stepwise logistic regression model. RESULTS: The overall HPV prevalence of involved 3036 women was 9.19% (279/3036), of which 7.05% (214/3036) of the women were infected by high-risk types (including 14 sorts of types) and 2.14% (65/3036) by low-risk types (including 6 sorts of types). There were no significant differences of HPV prevalence between age groups (P = 0.936), race (P = 0.718) and areas (P = 0.746), respectively. Twenty-one types of HPV were detected, of which HPV16 (1.52%) was the most common type, followed by HPV33 (1.42%), HPV58 (1.22%), HPV52 (1.15%), and HPV31 (1.05%). HPV type distribution was varied by age. Of the 279 HPV infected women, 14.3% (40/279) exhibited multiple HPV infections. Independent risk factors for HPV infection were smoking (P = 0.027), number of sex partners (P = 0.198) and early age of first intercourse (P = 0.237). CONCLUSION: The overall prevalence of HPV infection in Tibet Autonomous Region is lower than that in China or abroad, in which the most common genotype is HPV16 and the independent risk factors for HPV infection included early age of first intercourse, smoking, and number of sex partners.