Objective To explore the clinical efficacy of endoscopic transgastric or transpapillary drainage in treatment of pancreatic pseudocyst. Methods 100 patients with pancreatic pseudocyst from March 2014 to March 2015, 80 cases were underwent endoscopic ultrasound-guided transgastric and the other 20 cases were underwent transpapillary drainage. The treatment effect and complications were recorded. Results The success rate was 95.00 %, and cysts completely disappeared in 84.00 % of the patients. Among all the patients there are 10 cases occurred intraoperative bleeding, 3 cases occurred stent clogging or migration and 7 cases occurred infection, the overall incidence of complications was 20.00 %. Conclusion Endoscopic transgastric or transpapillary drainage in treatment of pancreatic pseudocysts has better clinical curative effect, and can also reduce the occurrence of complications, which is worth popularizing clinically.

Objective To explore the clinical significance of human papillomavirus L1 capsid protein detection in cervical exfoliated cells in high-risk HPV positive women. Methods From November 2012 to June 2013,386 high-risk HPV positive (detected by hybrid capture Ⅱ) cases were enrolled as eligible women from Huzhou Maternity&Child Care Hospital and Women′s Hospital,School of Medicine, Zhejiang University. All eligible women underwent liquid-based cytology (ThinPrep) followed by colposcopy. Biopsies were taken if indicated. Cervical exfoliated cells were collected for HPV L1 capsid protein detection by immunocytochemistry. Expression of HPV L1 capsid protein in groups with different histological diagnosis were compared, and the role of HPV L1 capsid protein detection in cervical exfoliated cells in cervical lesions screening was accessed. Results Total 386 enrolled eligible women were finally diagnosed histologically as follwed:162 normal cervix, 94 low-grade squamous intraepithelial lesion (LSIL), 128 high-grade squamous intraepithelial lesion (HSIL) and 2 squamous cervical cancer (SCC). The positive expression rate of HPV L1 in HSIL+(HSIL or worse) group was significantly lower than that in LSIL-(LSIL or better) group (19.2% vs 66.4%,P=0.000). While identifying HSIL+ in HPV positive cases and compared with cytology, HPV L1 detection resulted in significant higher sensitivity (80.77%vs 50.77%,P=0.000) and negative predictive value (NPV;87.18% vs 76.47%,P=0.004), significant lower specificity (66.41% vs 81.25%,P=0.000),and comparable positive predictive value (PPV;54.97% vs 57.89%, P=0.619). To identify HSIL+in HPV-positive/cytology-negative women, the sensitivity, specificity, PPV, and NPV of HPV L1 detection were 87.50%, 61.54%, 41.18%, and 94.12%respectively, while 80.00%, 86.36%, 80.00%and 86.36%respectively in HPV-positive/atypical squamous cell of undetermined significance(ASCUS)women. Conclusions HPV L1 capsid detection in cervical exfoliated cells have a role in cervical lesions screening in high-risk HPV positive women, and may be a promising triage for high-risk HPV-positive/cytology-negative or ASCUS women.

Bub1 is essential for assembling of the functional spindle assembly checkpoint (SAC) to guarantee the correct separation of sister chromatids. Abnormal expression of Bub1 can elevate defects in SAC function, chromosome instability, and the incidence of aneuploidy. Several recent studies indicate that aberrantly expressed Bub1 may promote the tumorigenesis via regulating cell proliferation, invasion, migration and cancer stem cell activation. Further understanding of the mechanism of Bub1 in malignancy may provide new targeted therapy strategies.

Chemotherapy resistance is one of the biggest challenges in treatment of ovarian cancer. Mounting evidence shows that the exosomes shedding from tumor cells are considered to be involved in chemotherapy resistance of ovarian cancer by enhanced exosomal export of drugs, transferring RNAs or proteins and interfering with the bioactivity of therapeutic anti-tumor antibodies. In this review, we display the correlation between exosomes and chemotherapy resistance of ovarian cancer, the mechanism of exosomes involved in chemotherapy resistance of ovarian cancer, and discuss the potential clinical values of exosomes in chemotherapy resistance of ovarian cancer.
Antineoplastic Agents ; therapeutic use ; Carcinoma, Ovarian Epithelial ; drug therapy ; physiopathology ; Drug Resistance, Neoplasm ; Exosomes ; metabolism ; Female ; Humans ; Ovarian Neoplasms ; drug therapy ; physiopathology

Objective To investigate the manifestations and clinical application of magnetic resonance imaging (MRI) in the diagnosis of pelvic tumors during pregnancy.Methods Clinical data and MRI manifestations of 161 patients attending Women's Hospital,School of Medicine,Zhejiang University with pelvic tumors during pregnancy between March 2013 and July 2016 were retrospectively analyzed.MRI manifestations and clinical treatments of different tumors in pregnancy were summarized.All data were analyzed by descriptive statistics.Results (1) The gestational ages at initial diagnosis of the 161 patients ranged between 8-39 weeks and the average gestational age was (29±-4) weeks.Of all patients,147 (91.3％) had benign tumor,while the other 14(8.7％) were diagnosed as malignanices.The sensitivity,specificity and accuracy of MRI in the diagnosis of malignancy during pregnancy were 92.8％ (13/14),97.3％ (143/147) and 96.7％ (156/161).Uterine neoplasm,ovarian tumor,intestinal tumor and pelvic peripheral nerve schwannoma respectively accounted for 67.1％ (108/161),29.8％ (48/161),1.9％ (3/161) and 1.2％ (2/161) of all cases.(2) Among the 108 gravidas with uterine neoplasm,104 cases of leiomyoma continued to term pregnancy,among which 71 underwent myomectomy after vaginal delivery and 33 had myomectomy during cesarean section;the other four cases of cervical cancer terminated their pregnancy.(3) Among the 48 gravidas with ovarian tumor,38 were diagnosed as having benign tumor by MRI and continued to term pregnancy;five were diagnosed with tumor pedicle torsion and treated with emergency operation because of acute abdominal disease;two patients who were both in their second trimester (16 and 20 gestational weeks) were diagnosed with ovarian cancer complicated with peritoneal metastasis by MRI and decided to terminate pregnancy;another two patients with uncertain preoperative diagnosis of ovarian cancer were followed up closely to term and the tumor was removed during cesarean section;one patient with ovarian malignant tumor,which was diagnosed by MRI at the 32nd gestational week,received cesarean section and cytoreductive surgery.(4) In the three gravidas with intestinal tumor,one was complicated with sigmoid colon cancer and underwent cesarean section,radical resection of sigmoid colon tumor,colostomy and enterodialysis at 28+3 weeks of gestation;one with appendiceal mucinous adenocarcinoma was monitored closely until full-term pregnancy and received right hemicolectomy during cesarean section;the third case with malignant stromal tumor of the small intestine underwent cesarean section at 30+5 weeks of gestation as well as the completer resection of tumor.(5) One gravida with pelvic peripheral nerve schwannomas was diagnosed with pelvic schwannoma and underwent cesarean section and tumor extirpation at term.The other one underwent tumor extirpation prior to delivery due to the larger size of tumor and had a vaginal delivery at term.Conclusions MRI can provide more precise information for prenatal diagnosis of pelvic tumors during pregnancy.

Objective To evaluate the effect of delivery without perineum protection on maternal and neonatal outcomes .Methods The current study was conducted between July 1st, 2012 and February 1st, 2013. A total of 701 maternal women were included in the study , and 208 maternal women went on unprotected perineum delivery method and 493 went into routine episiotomy .Maternal and neonatal outcomes at the first day , the first week and the third month after delivery were compared and analyzed between the two groups .Results The aspects of intrapartum hemorrhage , suture material within delivery and the average hospitalization days in unprotected perineum group were significantly lower than those in the routine episiotomy group ( t= -14.58,-97.07,-21.88, respectively;P<0.01).The rate of episiotomy was 24.04%(50/208) in the unprotected perineum group and 61.26% (302/493) in the routine episiotomy group, and the difference was statistically significant (χ2 =81.06,P<0.01).In the unprotected perineum group ,65, 44, 93 and 6 patients had perineal integrity, incision, laceration and incision with laceration , which in the routine episiotomy group were 78,269, 113 and 33, respectively, and the difference was significant (χ2 =81.09,P<0.01).The perineal pain at the first day,the first week and the third month after delivery were significantly different between two groups (χ2 =82.95,32.51,5.58, respectively;P<0.01).The incidence of postpartum urinary retention (χ2 =10.07,P<0.01), healing complications (χ2 =18.79,P<0.01) at first week and painful sex (χ2 =18.83,P<0.01) in the unprotected perineum group were significantly lower than those in the routine episiotomy group .There were no significant differences between the two groups with the aspects of time of the first ( t=-1.72,P>0.05) and the second stage of birth (t=1.55,P>0.05), neonatal birth weight (t =0.91,P >0.05), Apgar scores (χ2 =0.10,P>0.05) and NICU admission (χ2 =0.60,P>0.05).Conclusions The unprotected perineum delivery could decrease short-term and long-term complications , and it can be a new idea of restrictive episiotomy.

Chemotherapy is a main treatment option for malignant tumors,but it may cause various adverse effects,including dysfunction of female endocrine system and fertility.Chemotherapy-induced ovarian damage has been concerned with ovarian preservation but also the prevention and treatment of ovarian dysfunction.In this article,the mechanisms of ovarian injury caused by chemotherapy,including apoptosis of the follicle and supporting cells,follicle"burn out",ovarian stromal and microvascular damage;and influencing factors,including age at diagnosis,initial low pre-treatment anti-Müllerian hormone levels,toxicity,dose and regimen of chemotherapy drugs are reviewed based on the latest research results and clinical practice.The article also discusses measures and frontier therapies for the prevention and treatment of ovarian injury,including the application of gonadotropin releasing hormone agonists or antagonists,tyrosine kinase inhibitors,antioxidants,sphingosine-1-phosphate,ceramide-1-phosphate,mammalian target of rapamycin inhibitors,granulocyte-colony stimulating factor,stem cell therapy and artificial ovaries.

Objectives:To investigate the clinicopathological and prognostic significance of International Endocervical Adenocarcinoma Criteria and Classification (IECC) in classifying endocervical adenocarcinomas among Chinese women.Methods:A total of 286 endocervical adenocarcinomas diagnosed from January 2013 to December 2019 at the Women′s Hospital, Zhejiang University School of Medicine were identified and included. The cases were reviewed and reclassified based on IECC. The histological types were correlated with p16 immunostaining, human papilloma virus (HPV) mRNA status, the clinicopathological parameters including the International Federation of Gynecologic Oncology (FIGO) stage, and clinical follow-up data.Results:The patients aged from 19 to 77 (median 47) years. There were 223 patients at FIGO stage Ⅰ, 22 at stage Ⅱ, 38 at stage Ⅲ and 3 at stage Ⅳ. The IECC types included 213 (74.5%) HPV-related adenocarcinomas (HPVA), 60 (21%) non-HPV-related adenocarcinomas (NHPVA), and 13 (4.5%) adenocarcinomas, no other specified (NOS). The major histological subtypes in HPVA and NHPVA were common type ( n=156, 54.5%) and gastric type (GAC, n=46, 15.9%), respectively. The p16 positive rates in HPVA, NHPVA and adenocarcinoma, NOS were 92% (173/188), 26.6% (17/64) and 61.5% (8/13), respectively, and those of HPV mRNA hybridization in situ were 89.4% (144/161), 0/18 and 7/13, respectively. Compared to HPVA, NHPVA was more frequently associated with older age, FIGO stage Ⅱ-Ⅳ, neural involvement, lymphovascular invasion and aberrant p53 expression ( P<0.05). Univariate survival analysis showed that age (>47 years), NHPVA, GAC, FIGO stage Ⅱ-Ⅳ, neural involvement, lymphovascular invasion and aberrant p53 expression were indicators for a poorer overall survival and tumor recurrence ( P<0.05). Mucinous HPVA showed worse clinical outcomes compared to usual-type HPVA ( P<0.01). Multivariate survival analysis demonstrated that FIGO stage Ⅱ-Ⅳ, NHPVA and aberrant p53 expression were independent indicators for poor overall survival while FIGO stage Ⅱ-Ⅳ and GAC were independently associated with tumor recurrence ( P<0.05). Conclusions:The two broad IECC categories, HPVA and NHPVA, not only provide morphological links to the etiology (HPV infection), but also have significant clinicopathological and prognostic relevance.

Objective:To identify the factors associated with long-term survival and guide the decision for primary surgery in patients with advanced high-grade serous ovarian cancer(HGSOC).Methods:In this case-control study, clinical parameters, including surgical and non-surgical associated factors, were collected and compared between the patients with short-term (<2 years) and long-term (>5 years) survival who all underwent primary debulking surgery (PDS) followed by carboplatin and paclitaxel chemotherapy from January 2004 to December 2016. Univariate analysis was examined by chi-square test and multivariate analysis was performed by logistic regression analysis.Results:There were 95 cases long-term survival (LTS group) and 77 cases short-term survival (STS group) in 698 newly diagnosed HGSOC patients with International Federation of Gynecology and Obstetrics (FIGO) stage Ⅲc and Ⅳ who met include and exclude criteria. (1) Univariate analysis showed that the proportion of complete cytoreduction with no visible residual disease (R0) at PDS and platinum sensitivity in LTS group were significantly higher than those in STS group ( P<0.01). The surgical complexity score (SCS), the preoperative serum CA 125 level and the ascites volume in the LTS group were significantly lower than those of the STS group (all P<0.05). In the LTS group, the preoperative incidence of lesions in retrograde peritoneum of the bladder, serosal and mesangial membrane of the small intestine, upper abdominal peritoneum and liver parenchyma were significantly lower than those in the STS group (all P<0.05). Multivariate logistic regression analysis showed that platinum sensitivity ( OR=0.016, 95% CI: 0.004-0.063, P<0.01), ascites volume >500 ml ( OR=3.193, 95% CI: 1.285-7.930, P=0.012), and SCS ≥8 ( OR=17.433, 95% CI: 2.281-133.25, P=0.003) were independent factors affecting long-term survival ( P>0.05). (2) Totally 37 of 95 in long-term survival and 16 of 77 in short-term survival achieved R0 cytoreduction at PDS. Univariate analysis showed that preoperative serum CA 125 level, preoperative lesion score, preoperative lesion (DS) score, ascites volume, platinum sensitivity,and SCS were significantly correlated with the R0 PDS (all P<0.05). Multivariate analysis showed that ascites volume >500 ml ( OR=5.199, 95% CI: 2.015-13.409, P=0.001), DS >2 ( OR=15.264, 95% CI: 5.843-39.874, P<0.01) and SCS ≥4 ( OR=4.176, 95% CI: 1.618-10.777, P=0.003) were independent factors associated with R0 cytoreduction. In patients with DS ≤2 or SCS <4, but not those with DS >2 or SCS ≥4, R0 cytoreduction was significantly associated with long-term survival. Conclusion:The intrinsic biology of tumor is the factor influencing long-term survival of advanced HGSOC patients, and those who present with wide intraperitoneal metastases and need to remove multiple organs may not benefit from R0 cytoreduction.

Objective:To evaluate the association between the efficacy and safety of metformin and the influence of variants in SLC47A1 rs2289669 G>A polymorphism in the treatment of systemic lupus erythematosus (SLE).Methods:A multicenter, randomized, double-blind, placebo-controlled trial was conducted. Patients were consented at enrollment for blood donation for genotyping, and their peripheral blood were used to detect the distribution frequency of SLC47A1 mutations. The major or mild/moderate flares defined by modified safety lupus erythematosus national assessment (SELENA)-systemic lupus erythematosus disease activity index (SLEDAI) Flare Index (SFI) and adverse events were recorded at 12 months of follow-up. The correlation between efficacy/safety and genotype was analyzed. Student's t test and χ2 test was used to assess the continuous variables and categorical variables. Results:Between May 24, 2016, and Dec 13, 2017, a total of 31 patients in the metformin group and 35 in the placebo group were detected. There were no statistical significant differences in the clinical manifestations, SELENA-SLEDAI scores, and therapy of the participants at baseline. There was no significant difference in the frequency of AA genotype, GA genotype, and GG genotype of SLC47A1 rs2289669 distribution between the metformin group and the placebo group. In the metformin group, patients who flared had a lower frequency of A alleles than those non-flared [25%(4/16) vs 61%(28/46), χ2=6.116, P=0.019 8]; the flare rate was significantly lower in patients with AA genotype than in GG genotype [0%(0/8) vs 57%(4/7), χ2=6.234, P=0.012 5]. The infection rate was lower in the metformin group than that in the placebo group [38%(12/31) vs 69%(24/35), χ2=5.913, P=0.015 0], but there was no significant difference among different genotypes in the metformin group. Compared to GG geno-type, AA genotype showed a trend of decrease in infection rate[38%(3/8) vs 72%(5/7), χ2=1.727, P=0.188 8]. Conclusion:Metformin has a favorable safety profile and may reduce the frequency of flares in SLE patients with low-grade lupus disease activity. The metformin therapeutic efficacy in SLE is relevant to the SLC47A1 gene polymorphism. Patients of the AA genotype may benefit most from metformin than those of the GG and GA genotypes.