Objective To evaluate the prognosis and fertility outcomes of patients with early stage of cervical cancer treated by vaginal radical trachelectomy ( VRT ) in combination with laparoscopic pelvic lymphadenectomy.Methods The surgical data , disease recurrences and fertility outcomes were analyzed retrospectively for 51 patients who received VRT in Peking Union Medical College Hospital from Dec.2003 to Nov.2013.Results Forty-eight patients succeeded in preserving fertility.The median age was 29 years.International Federation of Gynecology and Obstetrics ( FIGO ) stage: 5 cases Ⅰa1 with lymph vascular space invasion (LVSI),4 cases Ⅰa2 and 39 cases in stage Ⅰb1.Tumor size: 20 cases with no visible lesion, 20 cases with tumor size ≤2 cm, 8 cases with tumor size >2 cm.Histological type:42 cases with squamous carcinoma , 6 cases with adenocarcinoma or adeno-squamous carcinoma.The mean excised cervical length and parametrial width was ( 2.6 ±0.6 ) cm and ( 1.9 ±0.5 ) cm, respectively.Six recurrences ( 12%) were observed after following up for a mean duration of ( 35 ±21 ) months.The recurrent rate in patients with tumor size >2 cm was 3/8, which was significantly higher than that of the
patients with tumor size ≤2 cm (8%, 3/40;P<0.01).Of the 35 patients who desired to conceive after the surgery, 13 women had 17 pregnancies and the pregnant rate was 37% (13/35).Nine women obtained 10 healthy live birth babies.The fertility rate was 26%( 9/35 ).Conclusions VRT in combination with laparoscopic pelvic lymphadenectomy could preserve the fertility of patients with early stage of cervical cancer with acceptable oncologic and fertility outcomes.Tumor size ≤2 cm should be emphasized as the indication of VRT in considering of the higher recurrent rate in patients with tumor size >2 cm.

Objective To compare the effect between intra-arterial and intra-venous neoadjuvant chemotherapy(NACT)in stage Ⅰb2-Ⅱ b cervical carcinoma.Methods A retrospective analysis Was done on 52 cases of intra-venous NACT and 95 eases of intm-arterial NACT for stage Ⅰ b2-Ⅱ b cervical carcinoma treatad in Peking Union Medical College Hospital from 1999.ResulIs The response rate of intraveHous NACT and intra-arterial NACT was 88%(46/52)and 79%(75/95).and the operative rate after NACT Was 81%(42/52)and 72%(68/95)respectively(P>0.05).There were no significant differences in surgery time,blood loss and pest-operative morbidity between these two groups.Pathological parametrial positive rate after NACT in arterial group(6%)Was significantly lower than that of venous group (50%,P>0.05).The venous group had very similar recurrence rates(13%vs 17%)and death rates (9%VS 12%)when compared with the arterial group(P>0.05).Conclusions The intra-arterial and intra-venous NACT for stage Ⅰ b2-Ⅱb cervical carcinoma show similar response rate.operative rate and surgical difficulties.Arterial NACT shows a better effect on parametrial infiltration.

Objective To determine the clinicopathologic characteristics of mucinous borderline ovarian tumors (MBOT) and evaluate the risk factors for recurrence. Methods A retrospective study included age, the level of Preoperative serum CA125, surgical procedures, surgical-staging and the risk factors for recurrence in 130 patients with MBOT who were treated from Jan. 1994 to Dec. 2008 in Peking Union Medical College Hospital was done. Results Preoperative serum CA125 and CA199 were elevated in 34% (33/96) and 50% (13/26) of patients respectively. Fifty-two radical surgeries included total hysterectomy and bilateral saipingo-oovarectomy (THBSO) and 78 fertility-sparing surgeries included 54salpingo-oovarectomies (SO) and 24 cystectomy were done. Fifty-five cases underwent comprehensive surgical staging. Mean size of the tumors was (16 ± 10)cm and 90. 0% (117/130) were limited to unilateral ovary. There were 59 (45.4%) cases, 62 (47.7%o) cases, 2 (1.5%) cases and 7 (5.4%) cases in stage Ⅰa, Ⅰc, Ⅱ , Ⅲ , respectively. Forty-five(34.6%)concurrent with benign mucinous tumors, 14(10.8%)ovarian intraepithelial carcinoma, 8 (6.2%) micro-invasive carcinoma and 4 (3.1%) pseudomyxoma peritonei were found. Median duration for follow-up was 56.3 months. Sixteen (12.3%) recurrences and 2 tumor related deaths were found. Median duration from surgery to recurrence was 25.6 months. Recurrent rate after THBSO(4%, 2/49)was significantly lower than that of SO(13%, 7/54) and cystectomy (17%,4/24; P ＜ 0.05). The recurrent rate of Ⅰc or Ⅲ was 18% (11/62) or 3/7, which were significantly higher than that of stage Ⅰa (3% ,2/59; P ＜0.05). Three of the 4 pseudomyxoma peritonei appeared recurrence.While,the results showed that these were no effect on recurrent rate whether concurrent intraepithelial,microinvasive carcinoma or not comprehensive staging surgery. Conclusions Majority of MBOT were diagnosed in early stage and have favorable prognosis. Patients who take conservative surgery had higher recurrence rate than those radical surgery, but it doesn't affect survival. Late stage and concurrent pseudomyxoma peritonei are risk factors for recurrence.

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

This study aims to investigate the effect of transmembrane protein angiotensin converting enzyme 2 (ACE2) on the prognosis of breast cancer and its potential mechanism.Public databases were used to analyze ACE2 expression and its relationship with clinicopathological features and prognosis of breast cancer patients, combined with in vitro experiments to analyze the mechanism of action and immune relevance of ACE2 in breast cancer.Results showed that the expression of ACE2 in breast cancer tissues was significantly lower than that in normal breast tissues, and that its expression was negatively correlated with age, M stage and N1mi stage of breast cancer patients (P < 0.05).Patients with Luminal type breast cancer with high ACE2 expression had poor prognosis, while in the triple-negative breast cancer (TNBC) subtype, ACE2 showed different prognostic significance.In addition, ACE2 is closely associated with the metabolic and immune microenvironment of tumor tissue.In vitro experiments have shown that ACE2 is lowly expressed in MDA-MB-231 cells and may inhibit cell progress by downregulating matrix metalloproteinase 2（MMP2）.The results suggest that the low expression of ACE2 in breast cancer is closely associated with patient prognosis as well as metabolic and immune microenvironment, and that ACE2 may inhibit TNBC cell progress through the MMP2 pathway.

Objective:To evaluate the treatment persistence and long-time safety of infliximab (IFX) in the real-world in Chinese patients with Crohn′s disease (CD).Methods:From January 2009 to December 2021, at Sir Run Run Shaw Hospital, School of medicine, Zhejiang University, the clinical data of 1 309 patients with CD and treated with IFX were retrospectively analyzed, which included baseline data (gender, age at diagnosis, follow-up time, etc.), usage of IFX (the duration of treatment and situation of discontinuation) and adverse effects of IFX. Kaplan-Meier method was used to calculate the rate of consistent use of IFX and Cox regression was performed to analyze the influencing factors of treatment persistence. The chi-square test was used to analyze the associations between different factors and safety outcomes.Results:Among 1 309 patients, 936 (71.5%) were male, age at diagnosis was 28.7 years (28.1 years, 29.3 years). The follow-up time was 3.9 years (3.7 years, 4.0 years). The longest time of IFX treatment was 9.4 years. During the follow-up period, a total of 421 (32.2%) patients discontinued use of IFX and the sustained use of IFX at year 1, 3, 5 and 10 were 84.0%, 65.8%, 56.7% and 30.9% respectively. The results of Cox regression analysis revealed that patients with perianal lesions had an increased rate of sustained use of IFX ( HR(95% confidence interval) 0.75 (0.61, 0.92), P=0.006), while patients with adverse reactions had a decreased rate of sustained use of IFX ( HR(95% confidence interval) 1.23(1.01, 1.50), P=0.038). A total of 445 patients experienced adverse events, with an incidence rate of 34.0% (445/1 309). The acute infusion reaction was the most common side with an incidence rate of 13.7% (179/1 309), of which the rate of severe acute infusion reaction was 2.8% (5/1 309). The rate of infection was 10.5% (138/1 309), among which the rate of severe infection was 2.6% (34/1 309), and the rate of special pathogens infection was 5.5% (72/1 309). The rate of tuberculosis infection was 1.0% (13/1 309), and the most common affected site was the lungs (10 cases). The incidence of skin lesions (non-allergic, non-infectious and non-tumor skin) was 6.9% (90/1 309). The incidence of tumor was 1.1% (14/1 309). Patients who discontinued IFX due to adverse reactions accounted for 20.7% (92/445) of the patients with adverse reactions, among them patients who discontinued IFX due to acute infusion reaction, infections, neoplasms, delayed infusion reaction, skin lesions, abnormal liver function, hematological disorder, acute pancreatitis, joint pain and seizure accounted for 47.8% (44/92), 18.5% (17/92), 8.7% (8/92), 6.5% (6/92), 5.4% (5/92), 5.4% (5/92), 3.3% (3/92), 2.2% (2/92), 1.1% (1/92) and 1.1% (1/92), respectively. Among 14 patients with tumor, 11 were malignant tumors, 1 case of chronic leukemia was related with IFX. Multi-round of IFX treatment increased the risk of acute infusion reaction and severe acute infusion reaction, combination of immunosuppressants decreased the risk of liver injury, and IFX treatment for more than 1 year increased the risk of skin lesions ( χ2=6.16, 11.30, 18.20 and 9.47; P=0.013, =0.001, <0.001, =0.002). Conclusions:The rate of constant use of IFX is relatively high in Chinese Crohn′s disease patients. The long-term safety is good. Clinicians should pay more attention on the safety of patients receiving multiple rounds and long courses of IFX treatment.

OBJECTIVE： To study the tonifying spl een effect of Codonopsis pilosula polysaccharides （CPP） on spleen-deficiency model mice. METHODS ：Totally 60 ICR male mice were randomized into blank group ，model group ，CPP high-dose，medium-dose and low-dose groups [ 1.6，0.8，0.4 g/（kg·d）]，Sijunzi tang （SJZT）group [ 30 g/（kg·d），by crude drug] ， with 10 mice in each group. Except for blank group ，other groups were given Sennae Folium solution intragastrically （0.4 g/d）to establish spleen-deficiency model. After modeling ，administration groups were given relevant drug intragastrically ，and blank group and model group were given 20 mL/kg normal saline intragastrically ，once a day ，for consecutive 6 weeks. After last administration，body weight of mice in each group was measured and their general behavioral characteristics were observed. The red blood cell count in whole blood were recorded ，and the contents of D-xylose，gastrin（GAS），motilin（MTL），somatostatin （SS），vasoactive intestinal peptide （VIP），amylase（AMS），immunoglobulin（IgG and IgM ）and lipopolysaccharide （LPS）in serum were determined ；mRNA and protein expressions of Claudin and Occludin in colon tissues of mice were also detected. RESULTS：Compared with blank group ，body weight of mice in model group was significantly decreased （P＜0.05），and the spleen deficiency symptoms such as sparse back hair and no luster appeared ；the red blood cell count in whole blood ，serum contents of D-xylose，SS，VIP，AMS，IgG and IgM ，mRNA and protein expressions of Claudin and Occludin were significantly decreased（P＜0.05 or P＜0.01）；serum contents of GAS ，MTL and LPS were significantly increased （P＜0.01）. Compared with model group ，the body weight of mice were increased significantly in CPP high-dose group （P＜0.05），and spleen-deficiency symptom was improved significantly. Except for the serum contents of D-xylose and IgM ，the protein expressions of Claudin and Occludin in colon tissue had no statistical significance in CPP low-dose group （P＞0.05），above indexes of other groups w ere improved significantly （P＜0.05 or P＜0.01）. CONCLUSION ：CPP can i mprove spleen-defic iency model mice induced by Sennae Folium，the mechanism of which may be associated with regulating gastrointestinal hormone secretion ， enhancing immunity and protecting intestinal mucosal barrier.

ObjectiveThe transcriptome characteristics of different tissues of Codonopsis pilosula were analyzed to illustrate the genetic basis of the accumulation of active ingredients in the root of C. pilosula， and to provide theoretical basis for its high-quality production and cultivation. MethodDifferent tissues of C. pilosula at flowering stage were selected as experimental materials， and the contents of tangshenoside Ⅰ， lobetyolin and atractylenolide Ⅲ were detected by high performance liquid chromatography（HPLC）. RNA-Seq was used to perform transcriptome sequencing of different tissues， and the differentially expressed genes were screened and analyzed by Gene Ontology（GO） and Kyoto Gene and Encyclopedia of Genes and Genomes（KEGG） enrichment analysis， in order to explore the characteristics of active compound distribution and the transcriptional profiles. ResultThe contents of polysaccharides and tangshenoside Ⅰ in the root of C. pilosula were significantly higher than those in other tissues. The transcriptional profiles of the root were significantly different from those of stem， leaf and flower. Cluster analysis， GO and KEGG enrichment analysis of differential gene expression showed that the differential expression genes were mainly enriched in flavonoid and phenylpropanoid biosynthesis， sucrose-starch metabolism， plant hormone signal transduction， plant-pathogen interaction， mitogen-activated protein kinase（MAPK） cascade signal transduction， Adenosine triphosphate（ATP）-binding cassette（ABC） transporter and other pathways. The expression of genes related to biosynthesis of phenylpropanoid compounds were significantly up-regulated in the roots and flowers， and ABC transporter proteins were mostly highly expressed in the flowers. The expression of key enzyme genes for polysaccharide synthesis， such as sucrose：sucrose 1-fructosyltransferase（1-SST） and fructan 1-exohydrolase（1-Feh）， were significantly up-regulated in the roots， and a large number of stress-responsive genes closely related to the accumulation of secondary metabolites were significantly up-regulated in the roots. ConclusionThe active compound content and transcriptional profiles in C. pilosula roots were significantly different from those in stem， leaf， flower and other tissues， showing tissue specificity. Meanwhile， the genes related to stress response and biosynthesis of active compound， such as fructan and phenylpropanoid compounds， were up-regulated in roots of C. pilosula.

Objective:To evaluate the surgery combined chemotherapy and radiation in locally advanced neuroendocrine carcinoma of the cervix (NECC) .Methods:This is a single-center retrospective cohort study. Locally advanced NECC patients admitted to Peking Union Medical College Hospital, Chinese Acadmy of Medical Sciences from January 2011 to April 2022 were enrolled. They were divided into concurrent chemoradiotherapy group, and surgery combined with chemotherapy and radiation group. The Kaplan-Meier method was used to analyze the progression free survival (PFS), overall survival (OS), recurrence rate, and mortality rate.Results:(1) Forty-six cases were included, 22 in concurrent chemoradiotherapy group, 24 in surgery combined chemotherapy and radiation group. With 16 patients (35%, 16/46) received neoadjuvant chemotherapy (NACT), the NACT effective rate was 15/16. (2) The median follow-up time was 27.5 months (range: 10-106 months), with 26 (57%, 26/46) experienced recurrences. There were 4 (9%, 4/46) pelvic recurrences and 25 (54%, 25/46) distant recurrences, and 3 (7%, 3/46) both pelvic and distant recurrences. Compared with concurrent chemoradiotherapy group, surgery combined chemotherapy and radiation group had lower pelvic recurrence rate [14% (3/22) vs 4% (1/24); χ2=1.296, P=0.255] but without statistic difference. Both groups had similar distant recurrence rate [55% (12/22) vs 54% (13/24); χ2=0.001, P=0.979] and overall recurrence rate [59% (13/22) vs 54% (13/24); χ2=0.113, P=0.736]. (3) During the follow-up period, 22 cases (48%, 22/46) died, with 11 cases (50%, 11/22) in concurrent chemoradiotherapy group and 11 cases (46%, 11/24) in surgery combined chemotherapy and radiation group, without significant difference ( χ2=0.080, P=0.777). The postoperative 3-year and 5-year OS rates were 62.3% and 36.9%. Compared with concurrent chemoradiotherapy group, the patients in surgery combined chemotherapy and radiation group showed an extended trend in PFS (17.0 vs 32.0 months) and OS (37.0 vs 50.0 months) but without statistic differences ( P=0.287, P=0.125). Both groups had similar 3-year OS rate (54.2% vs 69.9%; P=0.138) and 5-year OS rate (36.1% vs 38.8%; P=0.217). Conclusions:Our study supports the multi-modality treatment strategy (including surgery, chemotherapy and radiation) as an important component in the treatment of locally advanced NECC. The combination of surgery, chemotherapy and radiation seems to have advantages in the treatment of locally advanced NECC, but needs to be confirmed by further multicenter studies.