Objective To investigate the transition of uropathogens and drug resistance in patients with type 2 diabetes(T2DM)complicated with urinary tract infection(UTI)in recent 10 years.Methods A total of 392 cases of T2DM with UTI were included in the study.The patients were divided into 2 groups according to time of hospitalization:group A(January 1998 to December 2002)and group B(January 2003 to December 2007).Clinical information,distilbution of uropathogens and antibiotic resistance between the two groups were analyzed.Results The most common pathogens isolated were Escherichia coli(50/152,32.89%),followed by Candida albicans(21/152,13.82%)and Enterococcus faecium(15/152,9.87%).Of the various pathogenic organisms isolated in group B,there were 16 new species not seen in group A.Escherichia coli was found to have higher resistant rates to ciprofloxacin and ceftriaxone in group B than in group A(80.8%vs.42.8%,26.9%vs.0,respectively).Enterococcus faecium was found to be more susceptibility to tetracycline in group B than in group A(0 vs.100.O%).Conclusion Species of uropathogens in T2DM patients ale increased,and the isolates are of high drug resistance,which should be noted in clinic.

Objective To analyze the clinical and histopathologic characteristics and prognostic factors for primary carcinoma of the vagina managed with radiotherapy at a single institution . Methods Eighty-three patients with primary vaginal carcinoma were treated with definitive radiation therapy between 1980 and 2007 were retrospectively analyzed. Radiotherapy was delivered with external beam radiation alone in 11 patients, intracavitary after-loading radiation alone in 7 patients, and external beam combined with After-loading radiation in 65 patients. The median radiation dose was 75 Gy. Fifty-one patients received more than 75 Gy. Thirty-one patients received combined chemotherapy. Of them, 16 received intravenous neoadjuvant or adjuvant chemotherapy, 8 received intra-arterial chemotherapy and 7 received concomitant chemotherapy. Patients were staged acoording to FIGO staging system. Nineteen patients had stage Ⅰ ;31 had stage Ⅱ, 25 had stage Ⅲ and 8 had stage Ⅳ diseases. Fifty-three patients had squamous cell carcinoma, 22 had adenocarcinoma, 2 had adenosquamous cell carcinoma,3 had papillary serous carcinoma,2 had clear-cell carcinoma and 1 had undifferentiated carcinoma. Thirty-nine patients had grade 1 and 44 had grade 2 and/or grade 3 diseases. Results The follow-up rate was 89%. Thirty-five and 31 patients had minimum followed-up time of 3 and 5 years respectively. The 3-and 5-year overall survival rates were 51% and 42% respectively. Univariate analysis showed that FIGO stage ( x2 = 11.30,P= 0. 010), histopathology type (x2=5.76,P=0.016),pathologic grade (x2=5.76,P=0.016), tumor size (x2=4.81,P=0. 020), tumor site ( x2=23.50,P =0. 000), external beam combined with intracavitary irradiation ( x2 =29. 76,P =0. 000) correlated with overall survival rate. Cox multivariate analysis showed only FIGO stage ( x2 = 5.93, P = 0. 015 ) and tumor size ( x2 = 8.48, P= 0. 004 ) were independent prognostic factors affecting overall survival. Serious complications were developed in 12% ( 10/83 ) of the patients. One patient suffered from vesicovaginal fistula and 3 from rectovaginal fistula. Twenty-eight patients had local or distant relapses, and the 3-year overall survival rate was 14% after salvage therapy. Conclusions Radiotherapy is effective for early stage primary vaginal carcinoma. FIGO stage and tumor size were independent prognostic factors affecting overall survival. The role of chemotherapy for advanced disease needs further study.

Objective To evaluate the risk of hyperuricemia in patients younger than 45 with coronary artery disease.Methods Six hundred and seventy-seven patients with coronary artery disease under 45 years old at disease onset were recruited retrospectively.The subjects were divided into hyperuricemia group (n=164) and normal uric acid group (n=513).Patients with coronary artery disease with hyperuricemia were analyzed for clinical characteristics.The risk of hyperuricemia was analyzed on the severity of coronary lesions.T-test,x2 test and Logistic regression analysis were used for statistical analysis.Results Comparing with patients with normal uric acid,patients in the hyperuricemia group were male predominant and more prevalent with hypertension [197(38.5％) and 93(56.7％) ; x2=16.85,P＜0.01],hypedipidemia [274(53.4％) and 130 (80.7％); x2=37.58,P＜0.01],and cardiac dysfunction [24 (4.7％) and 17 (10.4％); x2=7.18,P=0.01].Hyperuricemia increased the risk of coronary artery disease complicated with cardiac dysfunction [ORlcorrection=2.66,95％CI (1.28,5.53)],and it also increased the risk of coronary artery disease concurrent with cardiac arrhythmia [OR2correction=1.28,95％CI (1.00,1.65)] revealed by multivariate regression analysis.Conclusion In young patients under 45 years old with coronary artery disease,hyperuricemia is the independent risk factor for coronary artery disease complicated with cardiac dysfunction and arrhythmia.

Objective To investigate the impact of squamous cell carcinoma antigen(SCCAg)in patients with recurrent squamous cell carcinoma of the uterine cervix.Methods Totally 72 patients with recurrent squamous cell carcinoma of the uterine cervix treated at the Cancer Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,between 1999 and 2005 were retrospectively analyzed to investigate the impact of SCCAg on diagnosis and prognosis by univariate and multivariate analysis.Results This study included 30 patients with recurrent disease after primary radical surgery and 42 patients with recurrent cervical cancer after radio-chemotherapy.Sixty one patients(85%)had serum SCCAg elevated (≥1.5 pg/L),and 20 of these(28%)had an increase of SCCAg before clinical manifestation of relapse.The median leading time was 3 months(range:1-13 months).Forty five patients had no symptoms with only SCCAg elevation,and 15 patients experienced leg edema and(or)sciatic pain,7 patients suffered from irregular bleeding and 5 patients had symptoms resulting from distant metastasis.Thirty three patients were diagnosed by histology biopsy and (or) cytology,39 patients were diagnosed with SCCAg elevation and clinical and radiological examinations,29 of these patients were diagnosed only by SCCAg elevation and CT or MRI.Fourteen patients recurred limited to the cervix or to the cervix and adjacent tissues(central recurrence),31 cases recurred at pelvis,and 20 patients with distant metastasis and 7 patients suffered from Pelvic recurrence and distant metastasis.Twenty three cases received salvage therapy including surgery for patients recurring after definitive radiotherapy and radiotherapy and or conform radiotherapy for patients after primary radical surgery,46 patients were given palliative chemotherapy and or radiotherapy,and 3 patients refused any treatment.The median and mean survival time were 11 months and 23 months respectively(2-62 months).The 3-year,5-year overall survival rate were 25%and 19%respectively.Univariate analysis showed SCCAg elevation before primary treatment,grade,recurrent site,treatment method,SCCAg≥10pg/L,SCCAg elevation during treatment,and SCCAg not within normal after treatment were correlated with 3-year survival rate.Twenty patients had an increase of SCCAg before clinical manifestation of relapse compared with other patients who did not,and the 3-year survival rate was not significantly different (22% vs 27%). Multivariate analysis revealed that only grade and treatment methods were independent risk factors. Conclusion The impact of the SCCAg in recurrent squamous cell carcinoma of the uterine cervix needs further study.

Objective To investigate the clinical manifestations,radiographic presentations,histopathological features,treatment and clinical follow-up of IgG4 related disease (IgG4-RD).Methods Forty-nine cases in our hospital were enrolled from 2009 to 2012 and were followed up.Results Of the 49 patients with IgG4-RD,the male to female ratio was 2.1∶1,the mean age was (53±15) years,and the serum IgG4 ranged between 0.39 to 20.8 g/L.The most commonly affected organ was pancreas.Two or more organs were involved in 15 patients.Histopathological findings included tissue infiltration by lymphocytes,IgG+ plasma cells and IgG4+ plasma cells and diffuse fibrosis among 45 patients.The IgG4+ plasma cells were over 10/high power fields (HPF).Responses to glucocorticoid in combination with immunosuppressants were good except 3 patients suffered relapses.Conclusion IgG4-RD is an autoimmune disease affecting multiple organs,and the increased IgG4 positive plasma cells is characteristic.This disease can be effectively alleviated with prompt use of glucocorticoid.

Objective To probe into the advantages and disadvantages of intravenous chemotherapy and intraperitoneal chemotherapy for advanced epithelial ovarian cancer.Methods All of the 226 patients with advanced epithelial ovarian cancer were treated by maximum cytoreductive surgery or non-effective cytoreductive surgery and received 6-8 courses of postoperative regular chemotherapy(chemotherapy regimens,TP:taxol and cis-platinum or carboplatinum;PC:cis-platinum and cyclophosphamide;PAC:cis platinum and adriamycin and cyclophosphamide)during Jan 1998-Jan 2006.We systematically compared the characteristics of patients in intraperitoneal chemotherapy(IPC)group and intravenous chemotherapy(IVC)group.We measured the incidence rate of the response,side-effects,the recurrence time of intraperitoneal tumor and survival time of the two groups respectively.ResultsFor the first phase after operation(three courses of treatment),the response rate of two groups were 75.8％and 52.8％respectively.For the response rate of IPC was higher than that of IVC(P＜0.01).The second phase after operation(all courses finished),the response rate of two groups were 93.9％and 87.7％,respectively(P＞0.05).After maximum cytoreductive surgery,the recurrence rate of IPC and IVC were 47.0％and 59.4％,respectively(P＞0.05).After non-effective cytoreductive surgery of IPC and IVC groups,the recurrence rates were 84.8％and 86.2％,respectively(P＞0.05).The recurrence time of intraperitoneal tumor of IPC and IVC groups were 24 and 18 months,respectively(P=0.001).The overall survival time ofgroups IPC and IVC were 32 and 30 months(P=0.188).There were some differences in the side-effect between IPC and IVC.The rates of chemotherapeutic phlebitis of IPC and IVC were 34.0％and 10.8％ respectively(P＜0.01).The rates of serious gastrointestinal reaction of IPC and IVC were 33.8％and 25.8％,respectively(P=0.236).There was no significant difference in bone marrow depression,intestinal adhesion and intestinal obstruction.ConclusionsIPC can extend the disease progression free survival than IVC,without increasing overall survival period.IPC can also reduce the side-effect of chemotherapeutic phlebitis.However,IPC is used limitedly,and can not substitute for IVC.Combination of IPC with IVC may enhance their effectiveness and reduce the side-effects.

Objective To analyze the clinicopathologic characteristics,treatment and prognostic factors in malignant transformation of mature cystic teratoma(MCT)of ovary.Methods The clinical data of 44 patients with MCT from January 1961 to June 2009 were reviewed.Results The median age of the 44 patients was 48 years(range,16-84 years).Mean tumor size was(16 ±6)cm.Thirty-two cases were diagnosed squamous cell carcinoma(73％,32/44),and 5 of them with the elevated level of serumal squamous cell antigen(SCC-Ag).Three of 37 cases(8％,3/37)were identified with malignant transformation in image examinations.Rapid frozen section examination and multiple-location biopsy were performed in 8 cases,and 5 of them were detected with malignant diseases.Twenty-two patients with disease confined within the unilateral ovary(10 with intact capsule,and 12 with ruptured capsule).Diseases extended extra ovaries in the others 22 patients.The median cumulative overall survivals were 126 and 10 months,respectively.The difference between the two groups was significant(P ＜ 0.01).Twenty-seven patients had no residual tumor after primary surgery.The median cumulative overall survivals between the patients with and without residual tumor were 10 and 84 months respectively,and there were significant difference between two groups(P ＜ 0.01).Seven selected patients with malignant disease confined within unilateral ovary underwent fertility-sparing surgery,and 2 cases of them had successful pregnancies and delivery,while other 4 cases with ruptured capsule recurred.Conclusions The most common pathology type of malignant transformation in mature cystic teratoma of the ovary is squamous cell carcinoma.Comprehensive pre-operation image examination and tumor marker level detection might be of great help in diagnosis.Tumor extension extraovary and residual tumor after surgery are the most significant poor prognostic factors.Early stage patient with ruptured capsule should be very discreet to choose fertility-sparing surgery.

Objective To evaluate the clinical significance of rearrangements during transfection of papillary thyroid cancer (RET/PTC) 1,3 in fine needle aspiration (FNA) specimen from regional thyroid nodules by FQ-PCR.Methods Two hundred and eighty-five FNA samples were collected from patients with thyroid nodules during January 2012 to January 2013.RET/PTC1,3 rearrangements were detected with FQ-PCR.Results The frequencies of the RET/PTC1 and RET/PTC3 rearrangements in 285 FNA samples were 17.2％ (49/285) and 1.4％ (4/285),respectively.During 21.7 months of follow-up,19 (40.4％,19/47) RET/PTC1 positive patients were confirmed to have papillary thyroid carcinoma(PTC) after operation.In the patients with RET/PTC1 rearrangement PTC was found in Thy5 and Thy4 groups.In Thy 2 group,22.6％ cases with RET/PTC1 rearrangements developed PTC as compared with 3.2％ cases without it(x2 =6.667,P＜0.01).In addition,8.5％ (4/47) RET/PTC1 rearrangements emerged in benign lesions.Conclusions It is convenient and reliable to detect RET/PTC1,3 rearrangements by FQ-PCR using FNA samples.RET/PTC1 rearrangement frequently occurs in PTC,however it would be detected in benign lesions occasionally.

Objective To analyze the disease-free survival (DFS) and prognostic factors for stage Ⅰ_b cervical squamous cell carcinoma treated by radical hysterectomy. Methods From January 1999 to December 2005, a total of 206 patients with uterus cervical squamous cell carcinoma were retrospectively analyzed. All the patients were treated by type 3 hysterectomy and pelvic and/or para-aortic lymphadenectomy at Cancer Hospital, Chinese Academy of Medical Sciences. The diseases were stage Ⅰ_(B1) and Ⅰ_(B2)= in 103 patients each. Seventy-nine (76.7%) patients had preoperative radiotherapy and 111 (53. 9%) had postoperative adjuvant treatment (PosAT). Prognostic factors were analyzed using univariate model and multivariate Cox model. Results The follow-up rate was 92. 7%. 106 patients had following-up time of five years. The overall 5-year survival rate and the disease-free survival rate of stage Ⅰ_b,Ⅰ_(B1) and Ⅰ_(B2) were 96. 3% and 86. 8%, 100% and 94. 6%, 92. 2% and 77.9%, respectively. Univariate predictors of DFS included tumor size (FIGO stage, 77.9% : 94. 6% ; Χ~2 = 5. 58, P = 0. 018), lympho-vascular space involvement (LVSI, 74.6% : 89. 8% ; Χ~2 = 10. 44, P =0. 001), vaginal involvement (purely fornix involvement was not included disease, 50% : 87. 9% ; Χ~2 = 7.01,P = 0. 008), parametrial involvement (PI, Χ~2 = 17.69 ,P = 0. 000), and metastatic lymph nodes (LNM) > 2 (Χ~2 = 21.47, P = 0. 000) in stage Ⅰ_b disease, while LVSI (Χ~2 =6. 35,P =0. 012), PI (Χ~2 =90.00,P =0. 000) and LNM >2(Χ~2 =26. 27,P = 0. 000) in stage Ⅰ_(B1) disease, LVSI (Χ~2=10. 12,P =0. 001), cervical canal involvement (Χ~2 =4. 60,P = 0.032), vaginal involvement (Χ~2 =5.87,P=0.015), PI (Χ~2 =4.78,P=0.029) and LNM >2(Χ~2= 6. 72, P = 0. 010) in stage Ⅰ_(B2) disease. In multivariate analysis, FIGO stage (Χ~2 = 4. 73 ,P =0. 030), LVSI (Χ~2 = 9. 81, P = 0. 002), and LNM > 2 (Χ~2 = 6. 30, P = 0. 012) were significantly associated with DFS in stage Ⅰ_b, while LVSI (Χ~2 = 6. 38, P = O. 012) and LNM > 2 (Χ~2 = 3.92, P = 0. 048) were significantly associated with DFS in stage Ⅰ_(B2)-Conclusions LVSI is an important prognostic factor for stage Ⅰ_(B1) cervical cancer. PosAT reduces the recurrences in stage Ⅰ_(B2) desease. When PosAT is needed, preoperative radiotherapy can not improve DFS. PosAT should not be commonly used for stage Ⅰ_(B1) disease with only deep muscularis invasion.

Objective To investigate the survival and recurrence data after treatment in neuroendocrine carcinoma of the uterine cervix(NECUC)with stageⅠb-Ⅱa, and to analyse its prognostic factors. Methods Thirty-two cases of primary NECUC in early-stage disease treated from Jan. 2005 to Dec. 2013 at Cancer Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences were reviewed, and their data of clinicopathologic characteristics were collected and analysed. The median age was 37 years (range, 23-57 years). The distribution by International Federation of Gynecology and Obstetrics (FIGO) clinical stage:19 cases stageⅠb1, 10 cases stageⅠb2, 1 case stageⅡa1, 2 cases stageⅡa2. Pathologic types: 22 cases of small cell carcinoma, 1 case of atypical carcinoid, 9 cases of mixed carcinoma. The diameter of cervical tumor:12 cases≥4 cm, 20 cases<4 cm. All patients underwent radical hysterectomy and pelvic ± para-aortic lymphadenectomy, and 15 cases of them were preserved unilateral or bilateral ovaries. Pathologic examination showed that 25 cases with cervical deep stromal invasion thickness ≥1/2, 21 cases with lymph-vascular space invasion (LVSI), and 18 cases with pelvic and (or) para-aortic lymph nodes involvement. Ten cases were performed neoadjuvant chemotherapy (range,1-3 cycles), all patients received postoperative chemotherapy (range,3-6 cycles), and 15 patients were treated with radiotherapy after surgery. The follow-up data were updated on Jul. 2014. The median follow-up time was 18 months (range, 7-71 months). A retrospective analysis was conducted to analyse the survival and recurrence data,and to explore the prognostic factors of NECUC. Results Thirteen patients died during the follow-up period. The cumulative progression-free survival (PFS) of 2 and 5 years were respectively 54.2%and 38.1%, and the estimated median PFS was 29 months. The cumulative overall survival (OS) of 2 and 5 years were respectively 56.1%and 44.9%, and the estimated median OS was 31 months. Fourteen cases had recurrence, and the median recurrence time was 9 months (range, 3-30 months). Recurrent or metastatic sites:2 cases in pelvis, 4 cases in liver, 3 cases in lung, 3 cases in adrenal glands, 3 cases in bones, 2 cases in brain, 1 case in pancreas, 1 case in lymph nodes of para-aorta and neck, and 3 cases had metastasis in two or more organs. Thirteen cases with recurrence died of disease, and another one is alive with disease. The univariate analysis showed that lesion size of the cervix and FIGO stage were significant prognostic factors (P<0.01), while age, tumor components, deep invasion in cervical stromal, LVSI, pelvic and (or) para-aortic lymph nodes involvement, neoadjuvant chemotherapy, adjuvant radiotherapy and preserving ovaries were not significantly associated with prognosis(all P>0.05). Conclusion The prognosis of NECUC in early-stage is poor and the lesion size of the cervix and FIGO stage are prognostic factors.