Construction and operation of the multi-level medical security system of the West China Women and Children Alliance / 中华医院管理杂志

Medical mutual aid is an important component of multi-level medical security system. West China Second University Hospital of Sichuan University led the establishment of the pediatric specialty alliance " West China Women and Children Alliance". Based on customized and inclusive mutual insurance product " Family Doctor Mutual Aid Plan", the alliance implemented key links such as mutual aid product forms, patient risk protection, institutional financing and hematopoiesis, and distribution of benefits to all parties, explored innovative mutual aid funding, payment, and incentive mechanisms, forming a closed-loop pediatric tiered diagnosis and treatment service system with the Mutual Aid Plan as the core. This system operated continuously under the " Four-in-One" framework, stimulating the integration of medical insurance and service supply systems while enhancing the synergistic effect between mutual insurance and social security. It has formed a distinctive health-centered multi-level medical security system within the alliance, and could provide reference for the construction and exploration of hierarchical diagnosis and treatment system.

Effect of estrogen-related receptor α-mediated lipophagy on proliferation and migration abilities of nasopharyngeal cancer cells / 肿瘤研究与临床

Objective:To investigate the effect of estrogen-related receptor α (ESRRA)-mediated lipophagy on the proliferation and migration abilities of nasopharyngeal carcinoma cells.Methods:A total of 16 clinical samples diagnosed by pathology in the Affiliated Hospital of Nantong University from 2021 to 2023 were selected, including 8 normal nasopharyngeal mucosa tissues and 8 nasopharyngeal carcinoma tissues. Immortalized normal nasopharyngeal epithelial cell line NP69 and nasopharyngeal carcinoma cell lines C666-1, CNE2, TW03-EBV and TW03 were selected. The cell lines C666-1 and CNE2 were divided into the siR-NC group (transfected with small interfering RNA negative control sequence) and siR-ESRRA group (transfected with small interfering RNA against ESRRA gene). The relative expression levels of ESRRA were detected by Western blotting and immunohistochemical assay. EdU assay was used to detect the proliferation ability of C666-1 and CNE2 cells, and Transwell assay was used to detect the migration ability. Real-time fluorescence quantitative polymerase chain reaction (qRT-PCR) was used to detect the relative expression levels of ESRRA and perilipin 3 (PLIN3) mRNA. The formation of lipophagy in C666-1 and CNE2 cells was observed by transmission electron microscopy. The co-localization of LC3, PLIN3 and LAMP2 with lipid droplets labeling with Bodipy was detected by immunofluorescence assay. Dual-luciferase reporter gene assay was used to verify the targeting relationship between ESRRA and PLIN3.Results:The relative expression level of ESRRA in nasopharyngeal carcinoma tissues was higher than that in normal nasopharyngeal mucosa tissues(1.15±0.75 vs. 0.32±0.21, t = 3.02, P = 0.009). The relative expression level of ESRRA in nasopharyngeal carcinoma cell lines C666-1 (1.539±0.044), CNE2 (1.420±0.030), TW03-EBV (2.867±0.044), and TW03 (1.323±0.022) were higher than that in normal nasopharyngeal epithelial cell line NP69 (0.094±0.002), and the difference was statistically significant ( F = 34.08, P < 0.001).The results of EdU assay showed that the proportions of EdU labeled positive cells in CNE2 cells of siR-NC group and siR-ESRRA group were (70.44±4.06)% and (51.51±0.92)% ( t = 7.88, P = 0.001), and the proportions in C666-1 cells were (62.25±3.89)% and (54.91±0.27)% ( t = 3.26, P = 0.031). The results of Transwell assay showed that the number of migrating cells in CNE2 and C666-1 cells was less than that in siR-NC group [CNE2 cells: (181±7) cells vs. (261±21) cells; C666-1 cells: (201±16) cells vs. (256±7) cells], and the differences were statistically significant ( t = 6.30, P = 0.003; t = 5.43, P = 0.006). According to qRT-PCR results, the relative expression level of PLIN3 mRNA in the siR-ESRRA group was higher than that in the siR-NC group (CNE2 cells: 1.58±0.16 vs. 0.83±0.17, t = 5.59, P = 0.005; C666-1 cells: 1.37±0.12 vs. 1.06±0.06, t = 3.86, P = 0.018). The dual-luciferase reporter gene assay results indicated a targeted binding interaction between PLIN3 and ESRRA. Transmission electron microscopy observation showed that the lipid droplets in nasopharyngeal carcinoma cells increased and the binding to autophagosomes decreased after knockdown of ESRRA. The results of immunofluorescence assay demonstrated that, in contrast to the siR-NC group, there was a decrease in the co-localization of LC3 and LAMP2 and an increase in the co-localization of lipid droplets with PLIN3. Conclusions:ESRRA is highly expressed in nasopharyngeal carcinoma tissues and cells. As a transcription repressor, ESRRA may work to prevent PLIN3 from being transcribed, decrease lipid droplet stability, mediate lipophagy, and promote proliferation and migration of nasopharyngeal carcinoma cells.

Epitope spreading in autoimmune bullous diseases / 中华皮肤科杂志

Epitope spreading often occurs in patients with autoimmune bullous diseases (ABDs), resulting in exposure of more antigenic epitopes, aggravation or transformation of pre-existing diseases, or concurrence of other diseases. With the increase in the immunological evidence for epitope spreading, more and more scholars have realized that epitope spreading plays an important role in the development of ABDs. This review introduces the phenomenon of epitope spreading in ABDs from 4 aspects, including the concurrence of or transformation between different types of pemphigoid, different types of pemphigus, pemphigus and pemphigoid, as well as between ABDs and other skin diseases.

Nonbullous pemphigoid / 中华皮肤科杂志

Nonbullous pemphigoid (NBP) , which is related to bullous pemphigoid, has various clinical manifestations, and is frequently accompanied by itching. Typical clinical manifestations of bullous pemphigoid (BP) , such as tense blisters or bullae, are absent in NBP cases. It is easy to misdiagnose. Histopathological findings are not specific, and its diagnosis should be confirmed by direct immunofluo-rescence, indirect immunofluorescence or salt-split indirect immunofluorescence. NBP may develop into BP in some cases, and the prognosis of NBP is better than that of BP. However, delayed diagnosis usually leads to a relatively high dosage of drugs for disease control, and a high rate of adverse reactions.

Effect of Asiaticoside on Expression of Th17/Treg Cells in DBA/1 Mice with Collagen-Induced Arthritis / 中国实验方剂学杂志

ObjectiveTo observe the effect of asiaticoside （AC） on the expression of T helper 17 （Th17） cells and regulatory T （Treg） cells in DBA/1 mice with collagen-induced arthritis （CIA）. MethodMale SPF DBA/1 mice were randomized into six groups according to body weight： control group， CIA group， methotrexate group （MTX group， ip， 0.5 mg·kg-1）， and AC low-， medium-， and high-dose groups （ig， 5， 15， 45 mg·kg-1， respectively）. Modeling was performed in rats other than the control group. To be specific， they were immunized with bovine type Ⅱ collagen and complete Freund's adjuvant on the first day and with bovine type Ⅱ collagen and incomplete Freund's adjuvant on the 21st day. Administration began on the day of the second immunization， once a day for 28 days. On the 49th day， related tissues were collected. Then， hematoxylin-eosin （HE） staining was performed to observe the pathological changes of the joints. Immunohistochemical method was used to detect the expression of interleukin-17 （IL-17） and forkhead box protein-3 （FoxP3）， the markers of Th17 and Treg cells， respectively， immunofluorescence double staining the expression of IL-17 and FoxP3 in CD4+T cells of mouse joint tissue， and flow cytometry the proportions of Th17 and Treg cells in mouse lymph nodes. ResultCompared with the control group， CIA group demonstrated joint disorder， damage of articular cartilage and bone， severe bone erosion （P<0.01）， increase in stained CD4 and IL-17 and the integral absorbance （IA） （P<0.01）， decrease in stained FoxP3 and the IA （P<0.01）， rise of Th17/Treg ratio （P<0.01）， elevation of Th17 expression in mouse lymph nodes （P<0.01）， and reduction in Treg expression （P<0.01）. Compared with CIA group， MTX group and three AC groups showed normal joints， alleviated bone erosion and damage， intact and smooth joint surface， and decrease in stained IL-17 and IA （P<0.05， P<0.01）， and MTX group and AC medium-dose and high-dose groups registered decrease in stained CD4 and IA （P<0.01） and reduction in Th17/Treg ratio （P<0.05， P<0.01）. Moreover， AC medium-dose and high-dose groups showed rise in stained FoxP3 and IA （P<0.05， P<0.01）. In the lymph nodes of mice， decrease in expression of Th17 cells （P<0.05， P<0.01） and the increase in expression of Treg cells （P<0.05， P<0.01） were observed in all the three AC group. ConclusionAC can regulate Th17/Treg balance by inhibiting the expression of Th17 cells and promoting the expression of Treg cells in CIA mice.

Clinical Characteristics and Gene Mutations in 186 Cases of Kindler Syndrome / 中国医学科学院学报

Objective To investigate the clinical characteristics and genetic mutations in Kindler syndrome(KS)and provide a theoretical basis for the diagnosis and treatment of KS. Methods The clinical data of one case of KS from Peking Union Medical College Hospital and 185 cases reported in literature were collected. The gene mutation types,patient clinical data,and tumor characteristics were statistically analyzed. Results A total of 186 cases were enrolled,including 110 males and 76 females,with the mean age of(28±16)years. The data of gene mutation and specific clinical manifestations were available in 151 and 94 patients,respectively. The main clinical manifestations of KS included poikiloderma,occurrence of blister in childhood,and photosensitivity,and the secondary clinical manifestations included oral inflammation,palmoplantar keratoderma,webbing/pseudoainhum,dysphagia,urethral stricture and so on.Oral inflammation(r=0.234,P=0.023),palmoplantar keratoderma(r=0.325,P=0.001),webbing/pseudoainhum(r=0.247,P=0.016),dysphagia(r=0.333,P=0.001),urethral stricture(r=0.280,P=0.006)were significantly correlated with age,showing significantly higher incidence in the patients over 32 years old.Urethral stricture(χ2=11.292,P=0.001)and anal stenosis(χ2=4.014,P=0.045)were significantly correlated with sex,with higher incidence in males.Eighty different mutations were found in 151 patients,and the most common gene mutation was c.676C>T.Forty-one tumors occurred in 27 patients,among which squamous cell carcinoma accounted for 92.7%. The gene mutation site had no significant correlation with squamous cell carcinoma or patient country. Conclusions The c.676C>T in FERMT1 gene is the most common mutation in KS.The patients are prone to squamous cell carcinoma and mainly attacked at the exposure sites(hand and mouth).

Correlation between autoimmune bullous diseases and psoriasis / 中华皮肤科杂志

There are overlaps in the pathogenesis of autoimmune bullous diseases (AIBDs) and psoriasis. In recent years, there have been many reports on correlations between psoriasis and AIBDs. Bullous pemphigoid is the most common AIBD associated with psoriasis, followed by pemphigus vulgaris, pemphigus erythematosus and linear IgA bullous dermatosis. AIBDs occur after the onset of psoriasis in most cases, but simultaneously with or before the onset of psoriasis in some patients. This review summarizes correlations between AIBDs and psoriasis, as well as possible mechanisms.

Fetal inflammatory response syndrome and neonatal clinical outcomes / 中国小儿急救医学

Fetal inflammatory response syndrome(FIRS) is a state of systemic inflammatory response in the fetus, induced by infectious and non-infectious pathways, with increased levels of cytokines represented by interleukin-6.Chorioamnionitis and funisitis are common placental pathological changes of FIRS.FIRS can not only lead to premature birth, but also is closely related to multiple organ damage such as brain injury, lung injury, early-onset sepsis, necrotizing enterocolitis, and cardiovascular system diseases during the neonatal period.Therefore, reducing the damage caused by FIRS to neonates is a common clinical problem that obstetricians and pediatricians will face together.

Effect of Fangji Huangqitang on DBA/1 Mice Collagen Induced Arthritis and Synovial Angiogenesis / 中国实验方剂学杂志

Objective:To observe the effect of Fangji Huangqitang （FJHQT） on collagen induced arthritis （CIA） and synovial angiogenesis in DBA/1 mice. Method:DBA/1 mice were randomly divided into normal group， CIA group and FJHQT group. DBA/1 mice in CIA group and FJHQT group were immunized with bovine type Ⅱ collagen and complete Freund's adjuvant on the first day， and DBA/1 mice were immunized with bovine type Ⅱ collagen and incomplete Freund's adjuvant on the 21^st day to establish CIA model. On the day of the second immunization， the drug was given by gavage once a day for 28 days. On the 22^nd day， the arthritis score and other symptoms of CIA mice were observed. On the 49^th day， Hematoxylin eosin （HE） staining was carried out to observe the angiogenesis in the synovium of CIA mice， the expression of vascular endothelial cell marker platelet endothelial cell adhesion molecule-1 （CD31） and vascular endothelial growth factor （VEGF） in the synovium of CIA mice were detected. Immunofluorescence double staining was used to detect the mature and immature vessels in the synovium of CIA mice. And the microvascular growth of the rat thoracic aortic ring was induced by VEGF （20 μg·L^-1）. The effects of FJHQT （0.25， 0.5， 1 g·L^-1） at different concentrations were observed under microscope. Result:Compared with the normal group， the inflammation， joints， red and swelling of the inflammatory joints of the CIA group were significantly increased （<italic>P</italic><0.01）. The scores of clinical arthritis， the incidence rate， synovial inflammation and angiogenesis were significantly increased （<italic>P</italic><0.01）. The density of blood vessels， the positive expression of CD31 and VEGF， the number of immature vessels in synovial membrane were significantly increased （<italic>P</italic><0.01）. And compared with the CIA group， the inflammation， joint swelling， and malformation of the FJHQT group were significantly improved， the clinical arthritis score， incidence rate， synovial inflammation and angiogenesis were significantly reduced （<italic>P</italic><0.01）. The vascular density， the positive expression of CD31 and VEGF， and the number of immature blood vessels in synovial membrane were significantly increased （<italic>P</italic><0.01）. Compared with blank group， VEGF could significantly induce the growth of microvasculature in rat thoracic aortic ring （<italic>P</italic><0.01）. Compared with VEGF group， FJHQT（0.25， 0.5， 1 g·L^-1） could significantly inhibit the formation of microvasculature in rat thoracic aortic ring （<italic>P</italic><0.01）. Conclusion:FJHQT can effectively alleviate the clinical symptoms and condition of CIA mice， reduce the clinical arthritis score and incidence rate，and inhibit the synovial angiogenesis of CIA mice joints and VEGF induced microvascular formation in rat thoracic aortic rings.

Exploration and practice of the two-way referral path of medical alliances based on telemedicine / 中华医院管理杂志

" Two-way referral, and synergy between the tertiary hospitals and primary institutions" is the core measure for promoting hierarchical diagnosis and treatment in the region. The authors introduced the exploration and practice of constructing a two-way referral path in the medical alliance based on telemedicine in West China Second University Hospital of Sichuan University. As of May 2021, the hospital had established a two-way referral path with 52 member hospitals of the medical alliance. By clarifying the functionality and positioning of these institutions, optimizing work processes and IT support, building the mechanism of referral and liaison, and that of appraisal as support, these efforts had achieved progresses in such fields as innovative medical service modes, lean management of referral processes, and promotion of hierarchical diagnosis and treatment system building.

Exploration and practice of the closed-loop health management system of the West China Women and Children Alliance / 中华医院管理杂志

As one of the main forms of the medical alliance, the specialty alliance functions as a service carrier for hierarchical medical service and resources integration in the region. The authors introduced the exploration and practice of the West China Women′s and Children′s Alliance, the first pediatric specialty alliance in Sichuan, established by the West China Second Hospital of Sichuan University. Based on family doctor contracted services, the West China Women′s and Children′s Alliance took such measures as differentiated functional positioning, assessment of certified physicians, continuous online quality control, construction of referral platforms, and innovative payment mechanisms. Such efforts effectively integrated the three stages of pre-hospital " preventive care" , in-hospital " disease diagnosis and treatment" , and post-hospital " follow-up management" , exploring the homogenization of medical services within the alliance, and forming a pediatric closed-loop health management system, hence improving the primary medical services.

GeneXpert MTB/RIF evaluated in diagnosis of pulmonary tuberculosis / 上海预防医学

Objective To evaluate GeneXpert MTB/RIF in diagnosis of pulmonary tuberculosis by comparing the lab results of diagnosed patients. Methods A total of 97 diagnosed pulmonary tuberculosis patients were enrolled from July 2017 to June 2018.Sputum smear microscopy (Ziehl-Neelsen stain), sputum culture (MGIT liquid culture) and Xpert MTB/RIF were conducted in all patients.Drug susceptibility test and strain identification by PNB were done for culture positive sputum samples.Consistency rate was calculated. Results In terms of M.tuberculosis detection, sensitivity and specificity of GeneXpert were 93.44% and 55.55%, respectively, compared with bacteriological examination (consistency rate 79.38%).Consistency rate of GeneXpert and PNB is 94.55%.In terms of RIF resistance test, sensitivity and specificity of GeneXpert were 66.67% and 98.08%, respectively, compared with phenotypic drug-susceptibility testing (consistency rate 96.36%). Conclusion GeneXpert MTB/RIF can be utilized in combination with smear microscopy and liquid culture to diagnose more etiologically positive patients, and can spot RIF resistance patients early.But strain identification and drug susceptibility test are still needed for individualized therapy and optimal treatment outcome.

GeneXpert MTB/RIF evaluated in diagnosis of pulmonary tuberculosis / 上海预防医学

Objective To evaluate GeneXpert MTB/RIF in diagnosis of pulmonary tuberculosis by comparing the lab results of diagnosed patients. Methods A total of 97 diagnosed pulmonary tuberculosis patients were enrolled from July 2017 to June 2018.Sputum smear microscopy (Ziehl-Neelsen stain), sputum culture (MGIT liquid culture) and Xpert MTB/RIF were conducted in all patients.Drug susceptibility test and strain identification by PNB were done for culture positive sputum samples.Consistency rate was calculated. Results In terms of M.tuberculosis detection, sensitivity and specificity of GeneXpert were 93.44% and 55.55%, respectively, compared with bacteriological examination (consistency rate 79.38%).Consistency rate of GeneXpert and PNB is 94.55%.In terms of RIF resistance test, sensitivity and specificity of GeneXpert were 66.67% and 98.08%, respectively, compared with phenotypic drug-susceptibility testing (consistency rate 96.36%). Conclusion GeneXpert MTB/RIF can be utilized in combination with smear microscopy and liquid culture to diagnose more etiologically positive patients, and can spot RIF resistance patients early.But strain identification and drug susceptibility test are still needed for individualized therapy and optimal treatment outcome.

Serum nesfatin-1 changes in osteonecrosis of the femoral head / 中国组织工程研究

BACKGROUND: Nesfatin-1, a novel feeding regulator, has been found to be closely linked to orthopedic diseases in recent years. The correlation between Nesfatin-1 and osteonecrosis of the femoral head (ONFH) remains unclear. OBJECTIVE: To determine the changes in plasma Nesfatin-1 level in patients with ONFH and to study its correlation with the development of ONFH. METHODS: From May to December 2016, we enrolled 86 patients with ONFH who were hospitalized in the Hip Preserving Ward, No. 3 Orthopedic Department, the First Affiliated Hospital of Guangzhou University of Chinese Medicine (including 13 ARCO stage II, 26 ARCO stage III, and 47 ARCO stage IV) and 86 healthy controls. In the ONFH group, there were 26 cases of steroid-induced ONFH, 40 cases of alcoholic ONFH, 12 cases of traumatic ONFH, and 8 cases of idiopathic ONFH. The levels of Nesfatin-1 in peripheral venous blood were measured by enzyme-linked immunosorbent assay (ELISA). Comparison was performed between different ARCO stages, different etiologies as well as before and after collapse. The study protocol was approved by the Ethics Committee of the First Affiliated Hospital of Guangzhou University of Chinese Medicine (No. 20140307), and each patient had signed an informed consent form prior to inclusion in the study. RESULTS AND CONCLUSION: Plasma Nesfatin-1 level was significantly higher in ONFH patients than healthy controls (P=0.000). There were insignificant differences among different etiologies (P=0.956), but significant differences among different ARCO stages (P=0.011) as well as before and after collapse (P=0.003). There was a positive correlation between plasma Nesfatin-1 level and ARCO stages. Receiver operator characteristic curve analysis showed that Nesfatin-1 level had sensitivity (52.05%) and specificity (92.31%) in the diagnosis of ONFH. These findings indicate that Nesfatin-1 is closely related to the development of ONFH. It can reflect the degree of necrosis, which can provide reference for clinical diagnosis and treatment of ONFH.

Phosphorylation residue T175 in RsbR protein is required for efficient induction of sigma B factor and survival of Listeria monocytogenes under acidic stress / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

Listeria monocytogenes is an important zoonotic foodborne pathogen that can tolerate a number of environmental stresses. RsbR, an upstream regulator of the sigma B (SigB) factor, is thought to sense environmental challenges and trigger the SigB pathway. In Bacillus subtilis, two phosphorylation sites in RsbR are involved in activating the SigB pathway and a feedback mechanism, respectively. In this study, the role of RsbR in L. monocytogenes under mild and severe stresses was investigated. Strains with genetic deletion (ΔrsbR), complementation (C-ΔrsbR), and phosphorylation site mutations in the rsbR (RsbR-T175A, RsbR-T209A, and RsbR-T175A-T209A) were constructed to evaluate the roles of these RsbR sequences in listerial growth and survival. SigB was examined at the transcriptional and translational levels. Deletion of rsbR reduced listerial growxth and survival in response to acidic stress. Substitution of the phosphorylation residue RsbR-T175A disabled RsbR complementation, while RsbR-T209A significantly upregulated SigB expression and listerial survival. Our results provide clear evidence that two phosphorylation sites of RsbR are functional in L. monocytogenes under acidic conditions, similar to the situation in B. subtilis.

Nucleocapsid protein from porcine epidemic diarrhea virus isolates can antagonize interferon-λ production by blocking the nuclear factor-κB nuclear translocation / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

Porcine epidemic diarrhea virus (PEDV) is a highly infectious pathogen that can cause severe diseases in pigs and result in enormous economic losses in the worldwide swine industry. Previous studies revealed that PEDV exhibits an obvious capacity for modulating interferon (IFN) signaling or expression. The newly discovered type III IFN, which plays a crucial role in antiviral immunity, has strong antiviral activity against PEDV proliferation in IPEC-J2 cells. In this study, we aimed to investigate the effect of PEDV nucleocapsid (N) protein on type III IFN-λ. We found that the N proteins of ten PEDV strains isolated between 2013 and 2017 from different local farms shared high nucleotide identities, while the N protein of the CV777 vaccine strain formed a monophyletic branch in the phylogenetic tree. The N protein of the epidemic strain could antagonize type III IFN, but not type I or type II IFN expression induced by polyinosinic-polycytidylic acid (poly(I:C)) in IPEC-J2 cells. Subsequently, we demonstrated that the inhibition of poly(I:C)-induced IFN-λ3 production by PEDV N protein was dependent on the blocking of nuclear factor-κB (NF-κB) nuclear translocation. These findings might help increase understanding of the pathogenesis of PEDV and its mechanisms for evading the host immune response.

Risk factors and prognosticsignificance of positive peritoneal cytology in endometrial cancer / 基础医学与临床

Objective To determine the prognostic significance of positive peritoneal cytology (PPC) among patients with endometrial cancer and to find out potential risk factors for PPC in endometrial cancer.Methods Data were extracted from Peking Union Medical College Hospital between Jan 1 2005 and Dec 31 2010.Only those patients who had undergone a staging procedure were included.A total of 486 patients were identified.Statistical analyses were performed using Fisher`s exact test, Kaplan-Meier log rank, and Cox proportional hazards models.ResultsRate of PPC was 4.8% in endometrial cancer.Non-endometrioid endometrial cancer(P=0.000), stage Ⅲ/Ⅳ(P=0.000), deep myometrial invasion(P=0.001), and cervical stromal involvement(P=0.018) appeared to be risk factors for PPC in endometrial cancer.Univariate analysis revealed statistically difference in 5-year PFS (70.9% vs 90.0%) and 5-year OS (72.2% vs 96.0%).Progression-free survival and overall survival showedstatistically difference(P=0.005,P=0.000)between PPC and NPC endometrial cancer.On multivariate analysis, PPC remained no statistically difference in progression-free survival or overall survival(RR=3.812,95% CI 0.897-16.200,P=0.070;RR=3.426,95% CI 0.800-14.673,P=0.097).Conclusions PPC is not an independent risk factor in patients with endometrial cancer.Aggressive histology, FIGO stage, deep myometrial invasion and cervical stromal involvement are presumed to be associated with PPC in endometrial cancer.

Prognosis after fertility-sparing management with oralprogestin for women with complex endometrial hyperplasia and endometrial cancer / 基础医学与临床

Objective To investigate the oncologic and reproductive outcomes after progestin treatment of complex endometrial hyperplasia(CEH) and grade 1 endometrial carcinoma(EC).Methods In a retrospective study, data were obtained for patients with CEH or grade 1 EC at presumed stage IA(without myometrial invasion) who wished to preserve fertility and were treated at the Peking Union Medical College Hospital, China, between January 1, 2000 and December 31, 2011.Patients had received oral medroxyprogesterone acetate(250-500 mg/d) or megestrol acetate(160-480 mg/d) for at least 6 months.Results Among 55 included patients, median age was 32 years(range 21-41 years).41(75%) achieved complete response after a median period of 6(3-24) months.Complete response was less frequent among obese than nonobese patients(4/12 [33%] vs 37/43 [86%];P=0.001).Disease recurrence was recorded in 10(24%) patients with complete response;the 5-year recurrence-freesurvival rate was 71%.Among the 33 patients who retained a desire to conceive, 17(52%) became pregnant.Conclusions Fertility-sparing management with oral progestin is effective and safe.Obesity is associated with a lower probability of long-term success.

Management of endometrioid carcinomapatients with preoperative diagnosis of endometrial hyperplasia / 基础医学与临床

Objective To investigate the clinical characteristics and treatments of endometrioid carcinoma patients with preoperative diagnosis of endometrial hyperplasia.Methods From 2005 to 2010, 404 patients were diagnosed with endometrioid carcinoma after hysterectomy.Among these patients,44 of them were diagnosed atypical endometrial hyperplasia(AEH) preoperatively.Retrospectively analysis the characteristics of these patients with SPSS13.0.Results Among the 44 cases, all of them were grade G1 disease, and 39 of them received comprehensive staging surgery.14(32%)young cases preserved bilateral ovaries.9 cases(20%) were given adjuvant radiology.No recurrence was detected during the median follow up of 52 months.Compared to the premenstrual group, although no statistical difference was detected, more patients with risk factors of deep myometrium invasion(4/22 vs 1/22) and lymph-vascular space invasion(LVSI, 3/22 vs 0/22) in the postmenstrual group.Compared to the patients who diagnosed with endometrioid cancer(EC) preoperatively, there are more patients with grade G1(P=0.000), fewer patients received adjuvant chemotherapy(P=0.003) and fewer recurrence(P=0.019) in AEH group.Conclusions The endomtrioid cancer patients who diagnosed with atypical hyperplasia preoperatively have better prognosis.Hysterectomy with bilateral ovaries preserved is acceptable in young patients.Post menopause patients have more risk factors of deep myometrium invasion and LVSI.

High-risk factors and prognostic analysis ofpelvic nodal metastasis in patients with endometrial carcinoma / 基础医学与临床

Objective To investigate the high-risk factors of retroperitoneal lymph nodes metastasis (LNM) and the effect of lymph nodes metastasis on prognosis in patients with endometrial carcinoma (EC).Methods Retrospec-tive research was carried out from January 2005 to December 2010 to identify 289 endometrial carcinoma patients treated with retroperitoneal lymphadenectomy at Peking Union Medical College Hospital.The high-risk factors of retroperitoneal LNM and prognostic factors of this disease were studied.Results 1) The median age at diagnosis was 55 years old.Patients of stage Ⅰ, Ⅱ, Ⅲ and Ⅳ were 224 (77.5%), 13 (4.5%), 45 (15.6%) and 7 (2.4%), respectively.Two hundred and eighty-nine patients received pelvic lymphadenectomy, of that 30 (10.4%) patients were found the pelvic LNM.Ninety-six patients received periaortic lymphadenectomy, of that 11 (11.5%) patients were found the periaortic LNM.Twenty-one (7.3%) patients developed recurrent disease and 11 (3.8 %) dead.The median follow-up was 37 months and the median disease-free survival (DFS) was 34 months.2) In univariate analysis, the incidence of LNM significantly increased in patients with CA125 ≥ 35 U/mL preoperatively, non-endometrioid adenocarcinoma, low grade, deep myometrium invasion, diameter of tumor ≥ 2 cm, cervical stroma involvement, positive peritoneal cytology and vagina or parametrial involvement (P<0.05).In multivariate analysis, CA125 ≥ 35 U/mL preoperatively, low grade, deep myometrium invasion were the independent high-risk factors of LNM (P<0.05).3)The Kaplan-Meier analysis showed a significant difference between positive peritoneal cytology, vagina or parametrial involvement, appendix involvement, LNM and DFS (P<0.05).We also found a significant difference in the impact of non-endometrioid adenocarcinoma, low grade, deep myometrium invasion, positive peritoneal cytology, appendix involvement and LNM on overall survival (OS) (P<0.05).Cox regression analysis revealed retroperitoneal LNM is the independent prognostic factor of 5-year DFS (patients without LNM 92.1% vs patients with LNM 65.3%, P=0.002, 95% CI 0.078-0.552).We also found the trend that the 5-year OS was higher in patients without LNM than them with LNM, even though there was no significant difference(patients without LNM 96.1% vs patients with LNM 70.0%, P=0.086, 95% CI 0.039-1.238).Conclusions 1) there is a predictive value of low grade and deep myometrium invasion for EC patients with LNM.2)Patients with LNM have poorer prognosis than them without LNM.Therefore, patients with LNM should receive adjuvant therapy to reduce the risk of recurrence.