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Objective@#To investigate the clinical characteristics, treatments, and prognostic factors among patients with gestational trophoblastic neoplasia (GTN) exhibiting brain metastases who underwent craniotomy. @*Methods@#Thirty-five patients with GTN who had brain metastases and subsequently underwent craniotomies between January 1990 and December 2018 at Peking Union Medical College Hospital were identified using the GTN database. Their clinical manifestations, treatments, outcomes, and prognostic factors were retrospectively analyzed. @*Results@#All 35 patients underwent decompressive craniotomy, hematoma removal, and metastatic tumor resection combined with multiagent chemotherapy. Eighty percent (28/35) achieved complete remission, 11.4% (4/35) achieved partial remission, and 8.6% (3/35) had progressive disease. Not counting 2 patients who were lost to follow-up, 81.8% of the patients (27/33) were alive after a median follow-up of 72 months. The 5-year overall survival rate was 80.4%. Univariate analysis revealed that a history of chemotherapy failure (p=0.020) and a >1-week interval between craniotomy and chemotherapy commencement (p=0.027) were adverse risk factors for survival. Multivariate analysis showed that previous chemotherapy failure remained an independent risk factor for poor survival (odds ratio=11.50; 95% confidence interval=1.55–85.15; p=0.017). @*Conclusion@#Decompressive craniotomy is a life-saving option if metastatic hemorrhage and intracranial hypertension produce a risk of cerebral hernia in patients with GTN who have brain metastases. Higher survival rates and improved prognoses can be achieved through perioperative multidisciplinary cooperation and timely standard postoperative chemotherapy.
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Objective@#To evaluate the oncological and reproductive outcomes in patients with seromucinous borderline ovarian tumors (SMBOT) treated with fertility-sparing surgery (FSS). @*Methods@#We retrospectively reviewed the medical records of patients with SMBOT who underwent surgery between 2000 and 2019. A centralized histological review was performed and recurrence rates were compared between different surgical procedures. @*Results@#A total of 105 patients fulfilled the inclusion criteria, of whom 65 underwent FSS and 40 were treated with radical surgery. Fourteen patients had recurrent disease after a median follow-up time of 59.6 months (range: 22.1–256.8 months). All but one relapsed with SMBOT. There was no significant difference in disease-free survival (DFS) between the 2 groups (p=0.141). Multivariate analysis showed that only bilateral involvement was associated with increased recurrence (p=0.008). In the subgroup of patients treated with conservative surgery, there was no significant difference in DFS with regard to surgical procedures (ovarian cystectomy vs. salpingo-oophorectomy, p=0.487). Of the 12 patients in the FSS group who developed recurrence, 11 underwent a second round of FSS and all remained alive with no evidence of disease at the end of follow-up. Of 20 patients desiring pregnancy, 16 patients were successful and resulted in 17 term deliveries. @*Conclusion@#FSS is feasible for young patients who wish to preserve their fertility. Patients initially treated with ovarian cystectomy may be managed by close surveillance if post-operative imaging are negative. Repeat FSS remains a valuable alternative for young patients with recurrent SMBOT after thorough communication.
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Objective To analyze the mortality risk and evaluate the curative effects of surgery and non-surgery on NSCLC with diameter > 7.0 cm. Methods We collected the data of NSCLC patients with diameter > 7.0 cm from 2010 to 2015 from the SEER database. The 1, 2, 3-year survival rates were analyzed by life table method. Overall survival curve was estimated by Kaplan-Meier method. Univariate and multivariate Cox regression models were used to analyze the independent prognostic factors. Results The 1, 2, 3-year survival rates were 51.8%, 33.0% and 25.0%, respectively. In univariate and multivariate analyses, tumor size, N stage and treatment were the independent prognostic factors (P < 0.001). Conclusion Surgery is benefited for the prognosis of stage N0-N1 NSCLC patients with diameter > 7.0 cm. And for stage N2 NSCLC patients with diameter 7.0-9.0 cm, surgical treatment has advantages in improving the prognosis. Surgical and non-surgical patients with tumor diameter ≥9.0 cm or lymph node N3 stage have no statistically significant differences in prognosis. In addition, palliative treatment does not improve the prognosis of patients.
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Objective:To evaluate the oncologic outcomes of different laparoscopic radical hysterectomy.Methods:From January 2011 to December 2014, the laparoscopic operation cases of cervical cancer at stage Ⅰb1, Ⅰb2, Ⅱa1 and Ⅱa2, including the histologic subtypes of squamous-cell carcinoma, adenocarcinoma and adenosquamous carcinoma, were collected in five clinical centers. The data were divided into two groups according to the surgical procedures, that is, modified laparoscopic-vaginal radical hysterectomy (mLVRH) and total laparoscopic radical hysterectomy (TLRH). The overall survival rate (OS), disease-free survival rate (DFS) at 5 years were retrospectively analyzed in this study.Results:There were 674 cases in total, including 377 cases of mLVRH, 297 cases of TLRH. (1) The OS at 5 years: the mLVRH was 96.1% and the TLRH was 92.0%, and the mLVRH was higher than that of TLRH （ P=0.010）. Stratify analysis， including stage of disease （Ⅰb1 and Ⅱa1）， histologic subtypes （squamous-cell carcinoma, adenocarcinoma）， lymph node metastasis， revealed that, ① Stage of disease: in stage Ⅰb1, the OS at five years of mLVRH was higher than that in TLRH group （98.6% vs 93.6%, P=0.012）. In stage Ⅱa1, there was significant difference between the two groups, the OS at five years of mLVRH and TLRH were 93.6% and 77.6% （ P=0.007）. ② Histologic subtypes: for the OS at five years of squamous-cell carcinoma, mLVRH and TLRH were 96.1% and 92.3%, and there was significant difference （ P=0.046）； for adenocarcinoma, the OS at five years were 91.0% and 88.6%， and there was no difference between two groups （ P=0.230）. ③ Lymph node metastasis： the mLVRH and TLRH with lymph node metastasis, the OS at five years were 98.6% and 96.4%; the mLVRH and TLRH without lymph node metastasis, the OS at five years were 89.3% and 80.8%. There were no significant differences between the two groups,respectively ( P=0.156， P=0.093）. (2) The DFS at 5 years: there was no significant difference between mLVRH and TLRH (94.1% vs 90.9%, P=0.220). Stratify analysis for stage of disease, the mLVRH group was higher than that in the TLRH group in stage Ⅰb1 (97.0% vs 92.8%, P=0.039). However, for stage Ⅱa1, there was no significant difference between mLVRH and TLRH group （88.2% vs 75.8%, P=0.074）. Conclusions:The results of this retrospective study indicated that different laparoscopy surgical procedures had diverse oncologic outcomes. The OS at 5 years of the mLVRH is superior to the TLRH. The DFS at 5 years in Ⅰb1 stage, the mLVRH is higher than the TLRH. Therefore, the modified laparoscopy is still an alternative surgery for early cervical cancer patients when following the principle of no-tumor-exposure.
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Objective:To investigate the therapeutic effect of programmed cell death receptor 1 (PD-1) inhibitor in drug-resistant recurrent gestational trophoblastic neoplasia (GTN).Methods:Clinicopathological features, previous treatments, PD-1 inhibitor treatment and prognosis of 8 patients with drug-resistant recurrent GTN treated with PD-1 inhibitor pembrolizumab， in Peking Union Medical College Hospital of Chinese Academy of Medical Sciences from August 2018 to June 2019 were collected and retrospectively analyzed.Results:(1) Clinicopathological features: the average age of onset of 8 GTN patients was 32.9 years old (31-39 years old); pathological types: choriocarcinoma in 7 cases, epithelioid trophoblastic tumor in 1 case. International Federation of Gynecology and Obstetrics (FIGO) stages: stage Ⅲ in 5 cases, stage Ⅳ in 3 cases; FIGO score: 4 patients with 7-12 points (high-risk group) and 4 patients with ≥13 points (ultra high-risk group). All the 8 patients had lung metastasis, 2 patients with brain metastasis, 1 patient with kidney and 1 patient with intestinal metastasis. (2) Previous treatments: ① Chemotherapy: 8 patients with GTN received an average of 21.1 courses (5-30 courses) of chemotherapy; the main route was systemic intravenous chemotherapy. One patient received intrathecal methotrexate chemotherapy due to brain metastasis. ② Surgery: 7 of 8 patients with GTN received surgical treatment, including 5 cases of pelvic surgury, 6 cases of pulmonary lobectomy and 1 case of right hemicolectomy. ③ Radiotherapy: 2 of 8 patients with GTN received radiotherapy, among which 1 patient received radiotherapy for lung for 8 times due to lung metastasis, and the other one received radiotherapy for lung, right sacroiliac joint and skull for a total of 22 times. (3) PD-1 inhibitor treatment: 8 patients with GTN received PD-1 inhibitor treatment with a mean course of 9 (2-12 courses). Six patients appeared Ⅰ-Ⅱ grade of immune related adverse events (AE), and no severe AE occurred. (4) Prognosis: after 2-3 courses of PD-1 inhibitor treatment, serum β-hCG level came to normalization in 4 patients. They were followed up for 2-7 months without any recurrence after 0-9 courses of consolidation treatment. One patient received 12 courses of PD-1 inhibitor treatment. The serum β-hCG level normalized after the 6th courses but increased 1 months later, and then received bevacizumab treatment due to the progression of the disease. The remaining 3 patients received other chemotherapy regiments due to disease progression during PD-1 inhibitor treatment.Conclusions:PD-1 could be used as a remedial treatment for drug-resistant recurrent GTN, with a high effective rate and relatively mild AE. However, more cases need to be accumulated clinically and efficacy should be comprehensively evaluated in combination with pathology and immunohistochemical examination.
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Objective To investigate the short-term clinical efficacy of arthroscopic reconstruction of posterior cruciate ligament (PCL) via double posteromedial portals.Methods A retrospective case series study was performed on the clinical data of 29 patients with PCL injury from January 2013 to January 2018 admitted to Xuancheng People's Hospital of Anhui province.There were 15 males and 14 females,with an average age of 49.6 years (range,27-61 years).There were 13 patients with left knee injury and 16 patients with right knee injury.The combined injuries included five patients with medial meniscus tear,seven patients with lateral meniscus tear,one patient with medial collateral ligament injury,and two patients with lateral medial collateral ligament injury.The average duration from injury to surgery was 14.1 days (range,5-97 days).All patients received arthroscopic PCL reconstruction surgery using double posteromedial portals.The operation time and intraoperative blood loss were recorded.The posterior drawer test,reverse Lachman test,posterior translation,and Lysholm knee score scale were used to evaluate knee function preoperatively and 6 months after operation.The complications were recorded.Results All patients were followed up for 6-22 months (mean,12 months).The operation time was (63.3 ±9.5) minutes,and the intraoperative blood loss was (48.9 ± 22.8)ml.The posterior drawer tests and reverse Lachman tests of all patients turned to be negative 6 months after surgery.Preoperatively,the posterior translation and Lysholm score were (11.2 ± 3.3)mm and (42.7 ± 12.2)points,respectively.At 6 months postoperatively,the posterior translation and Lysholm score were (2.2 ± 0.5) mm and (86.3 ± 9.0) points,respectively (P ＜ 0.05).No complication such as infection and neurovascular injury occured.Conclusion The technique of arthroscopic PCL reconstruction surgery using double posteromedial portals has the advantages of good knee joint stability,less tibial posterior translation,and fast function recovery with satisfactory short-term efficacy.
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BACKGROUND: Hepatocyte transplantation has achieved some success in animal experiments for the treatment of metabolic diseases and acute liver failure. However, the clinical efficacy of hepatocyte transplantation is unsatisfactory. The difference between the experimental results and the clinical efficacy may be related to the hepatocyte transplantation approach. OBJECTIVE: To evaluate the therapeutic effects of hepatocyte transplantation by the intubation via the intubation of the splenic artery and intrasplenic injection in rats with acute hepatic failure, providing more optimal transplantation approaches and methods. METHODS: Hepatocytes were isolated and cultured by the modified Seglen's method (two-step). Acute hepatic failure was induced by D-gal in Sprague-Dawley rats (provided by the Experimental Animal Center of Chongqing Medical University in China). After 24 hours, an intubation tube was inserted into the splenic artery in 65 rats with acute hepatic failure, which was successful in 60 rats. Then these 60 rat models were randomly divided into three groups (n=20 per group). Intrasplenic injection group received about 2×107 hepatocytes through intrasplenic injection and 0.4 mL of Hank's solution through the splenic artery. Splenic artery group received 0.4 mL of Hank's solution through intrasplenic injection and 2×107 hepatocytes through the splenic artery. Model group received 0.4 mL of Hank's solution through intrasplenic injection and 0.4 mL of Hank's solution through the splenic artery. Survival rate and liver function of the rats was observed within 14 days after transplantation. The distribution of CFDA-SE-labeled hepatocytes transplanted via the splenic artery was observed under fluorescence microscope at 7 days after transplantation, and meanwhile, the distribution and proliferation of transplanted hepatocytes in the spleen were observed using hematoxylin-eosin staining. Synthesis of albumin in the spleen was observed by immunofluorescence staining. RESULTS AND CONCLUSION: (1) 80％-90％ hepatocytes survived after isolation. (2) At 14 days after transplantation, the survival rates of rats in the three groups were significantly different: intrasplenic injection group> splenic artery group> model group. (3) The liver function of rats was significantly improved in the intrasplenic injection group and the splenic artery group, especially in the former group. (4) CFDA-SE-labeled hepatocytes (green fluorescence) were scattered in the rat spleen and liver at 7 days after transplantation via the splenic artery. (5) At 14 days after transplantation, immunofluorescent staining of albumin demonstrated some positive cells in the rat spleen in the intrasplenic injection group and splenic artery group. (6) At 7 days after transplantation, transplanted hepatocytes were concentrated and colonized in the red pulp of the spleen. In conclusion, hepatocyte transplantation through catheterization of the splenic artery via carotid route can improve the survival of rats with acute hepatic failure and ameliorate the hepatic function, but intrasplenic injection is significantly superior to the injection via the splenic artery.
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BACKGROUND: Hepatocyte transplantation has achieved some success in animal experiments for the treatment of metabolic diseases and acute liver failure. However, the clinical efficacy of hepatocyte transplantation is unsatisfactory. The difference between the experimental results and the clinical efficacy may be related to the hepatocyte transplantation approach. OBJECTIVE: To evaluate the therapeutic effects of hepatocyte transplantation by the intubation via the intubation of the splenic artery and intrasplenic injection in rats with acute hepatic failure, providing more optimal transplantation approaches and methods. METHODS: Hepatocytes were isolated and cultured by the modified Seglen's method (two-step). Acute hepatic failure was induced by D-gal in Sprague-Dawley rats (provided by the Experimental Animal Center of Chongqing Medical University in China). After 24 hours, an intubation tube was inserted into the splenic artery in 65 rats with acute hepatic failure, which was successful in 60 rats. Then these 60 rat models were randomly divided into three groups (n=20 per group). Intrasplenic injection group received about 2×107 hepatocytes through intrasplenic injection and 0.4 mL of Hank's solution through the splenic artery. Splenic artery group received 0.4 mL of Hank's solution through intrasplenic injection and 2×107 hepatocytes through the splenic artery. Model group received 0.4 mL of Hank's solution through intrasplenic injection and 0.4 mL of Hank's solution through the splenic artery. Survival rate and liver function of the rats was observed within 14 days after transplantation. The distribution of CFDA-SE-labeled hepatocytes transplanted via the splenic artery was observed under fluorescence microscope at 7 days after transplantation, and meanwhile, the distribution and proliferation of transplanted hepatocytes in the spleen were observed using hematoxylin-eosin staining. Synthesis of albumin in the spleen was observed by immunofluorescence staining. RESULTS AND CONCLUSION: (1) 80％-90％ hepatocytes survived after isolation. (2) At 14 days after transplantation, the survival rates of rats in the three groups were significantly different: intrasplenic injection group> splenic artery group> model group. (3) The liver function of rats was significantly improved in the intrasplenic injection group and the splenic artery group, especially in the former group. (4) CFDA-SE-labeled hepatocytes (green fluorescence) were scattered in the rat spleen and liver at 7 days after transplantation via the splenic artery. (5) At 14 days after transplantation, immunofluorescent staining of albumin demonstrated some positive cells in the rat spleen in the intrasplenic injection group and splenic artery group. (6) At 7 days after transplantation, transplanted hepatocytes were concentrated and colonized in the red pulp of the spleen. In conclusion, hepatocyte transplantation through catheterization of the splenic artery via carotid route can improve the survival of rats with acute hepatic failure and ameliorate the hepatic function, but intrasplenic injection is significantly superior to the injection via the splenic artery.
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Objective Using a questionnaire to evaluate different regimens of chemotherapy on ovarian function and quality of life of patients with gestational trophoblastic neoplasia (GTN).Methods At least 6 months after completion of chemotherapy,200 patients with GTN treated in Peking Union Medical College Hospital from January 2010 to June 2017 were randomly selected to fill up the questionnaire.The questionnaire items were included the patient's menstrual cycles,sexual life,gestational issues and common health.The patients were divided into 3 groups by chemotherapy regimens:actinomycin D (Act-D) group,floxuridine + Act-D + vincristine (FAV) or floxuridine + Act-D + etoposide + vincristine (FAEV) group (FAV-FAEV group),and etoposide + methotrexate + Act-D (EMA)/vincristine + cyclophosphamide (CO) or EMA/ etoposide + cisplatin (EP) group (EMA/CO-EMA/EP group).Chi-square test was used with a significance level of P-value less than 0.05.Results One hundred and seventy-three (86.5％,173/200) of the patients completed the questionnaire.Forty three point two percent (43.2％,19/44) in the EMA/CO-EMA/EP group had a normal menstrual cycle,which were significantly lower than those of Act-D group (84.6％,22/26) and FAV-FAEV group (71.2％,37/52;all P＜O.05).Amenorrhea rate was also significantly higher in EMA/CO-EMA/EP group (25.0％,11/44) than in Act-D group(0) and FAV-FAEV group (17.3％,9/52;all P＜0.05).The sexual life parameters were comparable among 3 groups.Ten out of thirty-two patients conceived after chemotherapy,2 had miscarriages and 8 had full-term delivery of healthy babies.The common health and labor capacity were significantly decreased after chemotherapy (all P＜0.05).Conclusions EMA/CO or EMA/EP regimen have a worse impact on ovarian function than Act-D and FAV or FAEV regimen.Gynecologic oncologist should be concerned about the ovarian function and quality of life of GTN patients.
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Objective To summarize and analyze the clinical outcomes of gestational trophoblastic neoplasia (GTN) patients receiving primary treatment at Peking Union Medical College Hospital from 1985 to 2015,and investigate the changes in treatment efficacy between the first and the second 15 years.Methods Clinical data of GTN patient receiving primary chemotherapy at Peking Union Medical College Hospital from January 1985 to December 2015 were retrospectively analyzed.It further compared the therapeutic results and chemotherapy cycles given to GTN patients,according to International Federation of Gynecology and Obstetrics (FIGO,2000) prognostic score system,who were classified to different stages and low-or high-risk groups.Results In total,1 711 GTN patients were included in this study.Comparing the 1985-2000 group and the 2001-2015 group,the results showed that:(1) while the overall complete remission (CR) rate was 93.7％ (1 603/1 711),the CR rate of 2001-2015 group was significantly higher than that of 1985-2000 group [98.4％ (1 155/1 174) vs 83.4％ (448/537),x2=139.353,P＜0.01].This difference was significant between stage Ⅲ and Ⅳ patients,but nonexistent between stage Ⅰ and Ⅱ patients,including low-and high-risk groups.(2) The relapse rate of patients who had been in CR was 2.7％ (43/1 603),with no significant differences between the groups of 1985-2001 and 2001-2015 [3.6％ (16/448) vs 2.3％ (27/1 155),x2=6.867,P=0.142].(3) The overall mortality rate was 2.6％ (44/1 711),which significantly decreased in 2001-2015 group compared to 1985-2000 group [1.6％ (19/1 174) vs 4.7％ (25/537),x2=13.830,P＜0.01].This difference appeared only in high-risk patients with stage Ⅲ disease (x2=9.505,P＜0.01).(4) Fluorouracil was gradually replaced by floxridine in chemotherapy regimens.The total cycles of chemotherapy regimens given to low-risk patients with stage Ⅲ disease significantly decreased in 2001-2015 group,but no statistical difference was shown with patients at other stages.Moreover,the cycles of consolidation treatment were significantly reduced in patients with stage Ⅲ patients.Conclusions GTN patients could obtain satisfactory curative results after appropriate and standard treatment.Peking Union Medical College Hospital has achieved better curative effect in the latest 15 years than before.
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Objective To compare the curative effect of fixation of adolescent tibial intercondylar emi-nence fracture among suture anchor,hollow screw and wire. Methods Forty-six adolescent cases of the tibial intercondylar eminence fracture treated with surgical treatment were selected from January 2010 to June 2016 and divided into three groups refer to intra-operative fixation suture anchor group(Group A),hollow screw group (Group B)and wire group(Group C).Duration of treatment,total operation time,hospital stay and surgery times were recorded. All patient condition was assessed with the Lysholm,Tegner,IKDC and VAS score. Results All patients received an average of 13(11~14)months follow-up visit. No blood-vessel,nerve and osteoepiphysis injured,infection and fracture displacement occurred.Before receiving treatment,difference in Lysholm,Tegner, IKDC and VAS score of group A,B and C showed no statistical difference.When it comes to hospitalization condi-tion,data were as follows.Group A/B/C:operation time(80.67 ± 16.68/114.00 ± 20.28/111.88 ± 20.07)min, hospital stay(8.40 ± 1.12/ 15.47 ± 1.25/ 15.19 ± 1.17)d,surgery times(1/2/2)times. Moreover,compared with those before operation and after operation in both of groups,the Lysholm,Tegner,IKDC and VAS score were improved(P < 0.05). Besides,the Lysholm,Tegner,IKDC and VAS score of group A,B and C did not have statistically significant difference yet after post treatment(P>0.05).Conclusions The curative effect of fixation of adolescent tibial intercondylar eminence fracture among suture anchor,hollow screw and wire was similar. By contrast,the fixation of fracture by use of suture anchor can decrease operation time and hospital stay to some extent. It had advantage of need not to have a second operation to remove the internal fixation and can be used in preference.
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Objective To analyze the homology, biofilm-forming ability, and risk factors of prevalent A, B, C clones(carrying blaOXA-23 and blaOXA-51 genes mostly) of carbapenem-resistant Acinetobacter baumannii (CRAB) relative to carbapenemsusceptible Acinetobacter baumannii (CSAB). Methods A total of 87 prevalent A, B, C clones of CRAB and CSAB strains were collected from the First Affiliated Hospital of Chongqing Medical University. Multilocus sequence typing (MLST) was used for homologyanalysis of clone A, B, C strains. Biofilm-forming ability of CRAB and CSAB was measured quantitatively via crystal violet staining. Results Clone A was measured to be homologous type of ST238, while clones B and C were ST238 type. In general, CRAB prevalent clones showed weaker biofilm-forming ability than CSAB strains (0.470±0.301 versus 0.913±0.626, P＜0.05). CRAB clones A, B, and C varied in ability of biofilm formation. Clone A had comparative biofilm-forming ability to clone C (P=0.432). Both clone A and C were weaker than clone B in biofilm-forming ability (both P＜0.001). Biofilm-forming ability was not associated with blaOXA-23 or blaOXA-51 genes in CRAB strains (both P＞0.05). Conclusions Prevalent CRAB clone A, B, C are derived from the same origin. We are the first to report the prevalence of ST238 and the homologous types in a hospital. Biofilm-forming ability is negatively correlated with carbapenem resistance of Acinetobacter baumannii, which suggests that clone prevalence is mainly related to antibiotic resistance acquisition and antibiotic selective pressure. Biofilm-forming ability varies with the prevalent CRAB clone. The wide spread of clone B is of concern.
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Objective To investigate gender differences in the curative effects of allograft and autologous hamstring tendon in anterior cruciate ligament reconstruction. Methods One hundred and forty-eight patients with the anterior cruciate ligament injury received surgical treatment were enrolled from January 2011 to January 2015 and divided into two groups,including group M(Men)and group W(Women). Patients in each group were also divided in the allograft group (Group A) and the autologous hamstring tendon group (Group B). The patient condition was separately assessed with the Lysholm,Tegner,VAS score and the value of KT-1000 before and after surgery. Results All patients received an average of 16(13-18)-month follow-up visit. No severe complication , such as blood-vessel and nerve injury ,infection and rupture of graft ,occurred in patients after operations. Compared with those before operation,the Lysholm,Tegner,VAS score and the value of KT-1000 after operation in four groups were significantly improved (P 0.05). Conclusions The curative effect of ACL reconstruction between allograft ligament and autologous hamstring tendon has no significant difference in gender. The selection of graft should be considered in more aspects.
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Objective To discuss the effects of prophylactic chemotherapy on the outcomes and prognosis of invasive mole patients.Methods One hundred and fifteen invasive mole (IM) patients older than 40 years were registered in Peking Union Medical Collage Hospital.Eleven of them were treated with prophylactic chemotherapy before diagnosed as IM prophylactic chemotherapy group,while the other 104 cases received therapeutic chemotherapy after diagnosed as IM (non-prophylactic chemotherapy group).The general clinical data (including age,clinical stage,risk factor score),treatment,outcomes and relapse of patients were retrospectively compared between two groups.Results (1) The age of prophylactic chemotherapy group and non-prophylactic chemotherapy group were (47±5) versus (46±4) years old.Ratio of clinical stage Ⅰ-Ⅱ were 3/11 versus 29.8％ (31/104),clinical stage Ⅲ-Ⅳ were 8/11 versus 70.2％ (73/104).Ratio of risk factor score 0-6 were 11/11 versus 84.6％ (88/104),risk factor score ＞6 were 0 versus 15.4％(16/104).There were no significant statistical differences between two groups in age,clinical stage or risk factor score (all P＞0.05).(2) Treatment:the total chemotherapy courses between prophylactic chemotherapy group and non-prophylactic chemotherapy group (median 7 versus 5) were significantly different (Z=3.071,P=0.002).There were no significant statistical differences between two groups in the chemotherapy courses until negative conversion of β-hCG,consolidation chemotherapy courses,total therapeutic chemotherapy courses or ratio of hysterectomy (all P＞0.05).(3) Outcomes and relapse:between the prophylactic chemotherapy group and the non-prophylactic chemotherapy group,the complete remission rate were 11/11 versus 98.1％(102/104),the relapse rate were 0 versus 1.0％(1/102).There were no significant difference between the two groups in outcomes or relapse rate (P＞0.05).Conclusions Prophylactic chemotherapy does not substantially benefit the IM patients older than 40 years.Prophylactic chemotherapy may not significantly improve patients' prognosis,in which increased sample size is required in further study.
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Objective To compare and analyze the curative effects of mediopatellar plica syndrome under different therapies. Methods 147 patients with mediopatellar plica syndrome were enrolled in the study from January 2011 to January 2015 and divided into three groups refer to treatment: Group A, B and C. Each group was also divided in the youth group and the mid-age group. Different treatments were used in the three groups. Group A: drug therapy and physicotherapeutics; Group B: intraarticular injection regularly; Group C: arthroscopic surgical treatment. All patient conditions were assessed with Lysholm score. Results All patients received an average of 11 (9 ~ 13) months follow-up. No blood-vessel and nerve injured and infection occurred. Before receiving treatment, difference in Lysholm score of the three groups showed no statistical difference (F = 0.08, P = 0.926); after treatment, difference revealed significant difference (F = 15.48, P = 0.001). Compared with those before operation and after operation among the three groups, the Lysholm score was improved (tA = 3.43, tB = 6.74, tC = 7.99, P = 0.001). In the rangeability of Lysholm score, the Group C > B > A (F = 66.43, tAB = 5.97, tAC = 11.52, tBC = 5.55, P = 0.001);The general youth group > the general mid-age (t = 7.91, P = 0.001). Conclusion The best therapeutic method for mediopatellar plica syndrome is the arthroscopy. As for mid-age patients, it is necessary to inform them of possibility that prognosis is not well in preoperative planning.
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OBJECTIVE:To establish a method for the contents determination of psoralen,isopsoralen,psoralenoside and isop-soralenoside in Danzhi qing’e tablet. METHODS:HPLC performed on the column of Eclipse XDB-C18 with mobile phase of metha-nol-water(51∶49,V/V)(isocratic elution,for psoralen and isopsoralen)and acetonitrile-0.1% formic acid(12∶88,V/V)(isocratic elution,for psoralenoside and isopsoralenoside)at a flow rate of 1.0 ml/min,the detection wavelength was 246 nm,column tem-perature was 30℃,and injection volume was 10 μl. RESULTS:The linear range was 3.138-200.8 μg/ml for psoralen(r=0.999 9), 3.175-203.2μg/ml for isopsoralen(r=0.999 9),3.181-101.8μg/ml for psoralenoside(r=0.999 9)and 3.169-101.4μg/ml for isopso-ralenoside (r=0.999 9);RSDs of precision,stability and reproducibility tests were lower than 2%;limits of quantitation were 0.627 5 ng,0.635 0 ng,3.181 0 ng and 3.169 0 ng,the limits of detection were 0.251 0 ng,0.254 0 ng,1.273 0 ng and 1.268 0 ng;recoveries were 95.68%-102.80%(RSD=2.4%,n=6),95.91%-102.10%(RSD=2.3%,n=6),98.64%-99.13%(RSD=0.23%,n=6) and 100.20%-101.70%(RSD=0.69%,n=6),respectively. CONCLUSIONS:The method is simple and accurate, and can be used for the simultaneous determination of psoralen,isopsoralen,psoralenoside and isopsoralenoside in Danzhi qing’e tablet.
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Objective To evaluate the value of laparoscopic surgery in the diagnosis of suspected gestational trophoblastic neoplasia (GTN) cases with uterine mass.Methods The clinical characteristics of patients underwent laparoscopic surgery for a suspected diagnosis of GTN with uterine mass in Peking Union Medical College Hospital from November 2009 to November 2014 were retrospectively reviewed and analyzed.GTN and other pregnant-related disease were definitely diagnosed by pathological findings.The prognoses of the GTN cases were also investigated.Results Sixty-two patients with a suspected diagnosis of GTN with uterine mass were studied.Among them,17 cases were definitely diagnosed as GTN,including 8 choriocarcinoma,5 invasive mole and 4 placental site trophoblastic tumor(PSTT).The other 45 cases were diagnosed as benign pregnancy-related diseases,including 29 cornual pregnancy,6 cesarean scar pregnancy,5 placenta accreta,4 intramural uterine pregnancy and 1 exaggerated placental site.There were no significantly differences between the two groups in average age,preoperative value or tendency of β-hCG,and location or size of lesions (P＞0.05).More GTN patients showed a history of hydatidiform mole [5/17 vs 4％ (2/45),P＞0.05],and more patients with benign pregnancy-related disease showed a history of cesarean section [38％ (17/45) vs 1/17,P＞0.05].No serious perioperative complication was found in these patients received laparoscopic surgery.All GTN patients achieved complete remission by chemotherapy later.Except for 1 case loss,no recurrence was found in 11 low-risk stage Ⅰ cases with an average follow-up period of 11-66 months,1 high-risk stage Ⅰ case with a follow-up period of 61 months and 4 cases PSTT with a follow-up period of 13-66 months.Conclusions There were some atypical GTN cases with uterine mass,which were difficult to be differentiated from benign pregnancy-related diseases according to the clinical characteristics.Laparoscopic surgery with a pathologic diagnosis could be an essential way with efficiency and safety.
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Objective To analyze the treatment and prognosis of patients with gestational trophoblastic neoplasia with urinary system and adrenal glands metastasis.Methods The treatment and prognoses of 32 patients with gestational trophoblastic neoplasia with urinary system and adrenal glands metastasis from Dec.1990 to Dec.2010 at Peking Union Medical College Hospital,Chinese Academy of Medical Sciences were respectively reviewed.Results Treatment methods:all 32 patients received 9 courses(in average) of a multi-drug chemotherapy in our hospital (range 1-24 coures).Among them,3 patients with bladder metastasis received intravesical chemotherapy of fluorouracil.9 patients received surgical treatments in other hospital and 15 patients received surgical treatments while undergoing chemotherapy in our hospital.Treatment results:after the treatments,of the 32 patients,21 (66％) patients achieved complete remission,3(9％) exhibited partial remission and 8 (25％) progressed.Seven patients with renal metastasis achieved complete remission.Two patients with adrenal glands metastasis achieved complete remission.Nine patients with urinary bladder metastasis achieved complete remission.Seven patients with ureters metastasis achieved complete remission.Two (10％) of 21 patients with complete remission relapsed.Conclusions Multidrug and muhiroute chemotherapy is the main strategy for patients with gestational trophoblastic neoplasia with urinary system and adrenal glands metastasis.The prognoses of patients with renal or adrenal glands metastasis are much worse than those in patients with bladder and ureters metastasis because of concomitant multiogran metastasis.Adequate attention should be given to patients with renal or adrenal glands metastasis.Individual treatment,assisted by surgery when necessary,may be carried out for these patients to achieve a better outcome.
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Objective To examine the complement component 1 Q subcomponent-binding protein (C1QBP) gene expression in human resistance choriocarcinoma cell lines and its parental cell line JeG-3,and to investigate whether silence C 1QBP by small interference RNA could reverse the resistance of human resistance choriocarcinoma cell lines to its relevant chemotherapy drugs.Methods Expression of C1QBP mRNA and protein in cells were detected by real-time fluorogenic quantitative PCR and western blot,respectively.The difference of C 1QBP expression was compared between human resistance choriocarcinoma cell lines and its parental cell line JeG-3.Sub-cellular location was proved by confocal immunofluorescence microscopy.A lentiviral vector containing short hairpin RNA (shRNA) targeting C 1QBP was constructed and cotransfected with the packaging plasmid mixture into 293T cells by lipofectamine 2000.The human resistance choriocarcinoma cell lines were infected with the packaged lentivirus.Real-time fluorogenic quantitative PCR and western blot were used to validate whether the C 1QBP gene expression was silenced.The cell counting kit 8(CCK8)was used to determine the drug sensitivity.Results (1)The C1QBP mRNA expression levels among four human resistance choriocarcinoma cell lines[JeG-3/floxuridiuum (FUDR),JeG-3/methotrexate (MTX),JeG-3/etoposide (VP),JeG-3/dactinomycin (KSM)] were 2.520±0.680,1.770±0.230,1.940±0.090 and 1.740±0.350 folds compared to that in JeG-3 cells.The C1QBP protein was higher expression level in human resistance choriocarcinoma cell lines than that in JeG-3.The immunofluorescence methods and confocal analysis showed that C1QBP localized predominantly in the mitochondrial matrix.(2)The C1QBP mRNA expression in JeG-3/FUDR cells after infected with lentiviral vector were decreased by 93.1％ (P＜0.01).The protein expression of C 1QBP in JeG-3/FUDR cells after infected with lentiviral vector were almost completely suppressed.The resistance indexes of four human resistance choriocarcinoma cell lines(JeG-3/FUDR,JeG-3/MTX,JeG-3/VP,JeG-3/KSM) were respectively 86.3％,93.9％,92.8％ and 89.9％,which were decreased remarkably by knockdown the C 1QBP expression (P＜0.05).Conclusions C1QBP is overexpressed in human resistance choriocarcinoma cell lines compared with parental cell line JeG-3.Inhibition of C 1QBP by lentivirus-mediated small interference RNA could effectively reverses the resistance of human resistance choriocarcinoma cell lines to its relevant chemotherapy drugs.
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ObjectiveTo investigate the relationship between metastasis-associated gene 1 ( MTA1 )expression and invasive and metastatic ability of cervical cancer cell. MethodsThree kinds of plasmids pcDNA3( control group), pcDNA3-MTA1 ( MTA1 group) and pSilencer3. 1-MTA1-siRNA ( MTA1-siRNAgroup) were transfected into human cervical cancer cell line CaSki cells. Reverse transcription (RT)-PCR and western blot were used to detected MTA1 mRNA and protein expressions. The effects of MTA1 expression on CaSki cell growth and proliferation, cell migration, adhesion and invasion, and cell cycles were tested by methyl thiazolyl tetrazolium (MTT), clone formation experiment, wound-healing assay, transwell assay, adhesion assay and flow cytometry, respectively. In animal experiment, three groups of cells were inoculated to BALB/c nude mouse subcutaneously to observe tumor formation ability. ResultsCompared with control group, MTA1 mRNA and protein were significantly overexpressed in MTA1 group, while MTA1-siRNA group showed lower MTA1 expression. Compared with control group, MTA1 group showed significantly accelerated cell growth; while MTA1-siRNA group showed decreased cell growth since the second day (P＜0. 05). Clone formation number in control, MTA1 and MTA1-siRNA group were 133 ±6, 169 ± 10 and 57 ±5,respectively. MTA1 group showed accelerated cell formation, while MTA1-siRNA group showed the reverse effect compared with that in control group(P ＜ 0. 05 ). At 24, 48 and 72 hours after wounding, the healing ability of MTA1-siRNA group significantly lagged behind that in the control group, while MTA1 group showed accelerated cell healing ability. The adhesion rate of control, MTA1 and MTA1-siRNA group were (69. 3 ± 3. 6) ％, ( 80. 4 ± 5. 6 ) ％ and ( 39. 2 ± 7.4 ) ％ separately at 90 minutes after cell seeding. In contrast with control group, MTA1 group promoted the adhesion of CaSki cell to matrigel matrix, while MTA1-siRNA group inhibited the adhesion process (P ＜0. 05 ). In the migration assay, the number of cells migrated to the bottom side of the membrane in control,MTA1 and MTA1-siRNA group were 153 ± 17,247 ± 38 and 82 ± 10, respectively. The number of cells in the invasion assay were 231 ± 19,354 ± 36 and 76 ± 7, respectively. Compared with the control group, MTA1 group significantly increased the migration and invasion ability, while MTA 1-siRNA group showed lower cell migration and invasion ability (P ＜ 0. 05 ). In cell cycle experiment, no significant differences of cell proportions including G1, S and G2 stage were found among three groups (P ＞ 0.05).In animal experiment, compared with control group,MTA1 group showed accelersted tumor formation and growth,whilethe MTA1-siRNA group showed the reverse effect ( P ＜ 0. 05 ). ConclusionsMTA1 may play its roles to promote cervical cancer cell invasion, migration, adhesion, as well as cell growth and colony formation, while RNA interference against MTA1 may decrease the malignant phenotypes. This study shows that it will be an effective beginning to explore metastasis mechanisms and cancer gene therapy strategy targeting MTA1 in cervical cancer.