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 investigate potential association of XRCC1-Arg399Gln polymorphism with hyroid-tassociated ophthalmopathy(TAO).Methods XRCC1-Arg399Gln polymorphism was identified by PCR-RFLP in 182 patients with TAO and 182 healthy subjects.Results The significant difference of the allelic frequency distribution was found between TAO and control group(P

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 explore the application of continuous subcutaneous insulin infusion (CSII) in elderly type 2 diabetic patients. Methods Elderly group(n = 415) and control group (n= 461) received the transient CSII intensive treatment. The different regiments and the incidence of hypoglycemia were observed between the two groups. Results The average duration reaching the target blood glucose and the insulin dosage at the target time were similar between the two groups (P>0.05). The insulin basal rate in the elderly patients was lower than that in control group. The incidence of hypoglycemia, especially at night, was significantly higher in the elderly patients.Conclusions CSII could control blood glucose effectively in elderly type 2 diabetic patients, but the basal insulin dosage should be decreased to reduce the risk of hypoglycemia.

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.

The relationship between visfatin.endothelin, and insulin resistance in the pathogenesis of type 2 diabetes mellitus was explored. Endothelin, visfatin, and other markers were compared. Plasma visfatin was reduced after therapy. Endothelin was positively correlated with fasting insulin, HOMA-IR, HOMA-p, and visfatin. Visfatin was positively correlated with endothelin, HbA1C , fasting insulin, and HOMA-IR. HOMA-IR was an independent related factor in influencing visfatin. The visfatin is related to endothelin and insulin resistance, which may contribute to the pathogenesis of insulin resistance and type 2 diabetes mellitus.

Objective:This study analyzes the clinicopathological characteristics, pathological diagnosis, treatment, and prognosis of ovarian small cell carcinoma (SCCO). Methods:The medical records of SCCO patients in the Cancer Hospital of Peking Union Medical College between 2005 and 2012 were reviewed. Results:The mean age of patients was 43. 75 years old (ranging from 17 to 57), two cases were postmenopausal, and one case was less than 30 years old. Twenty-one patients had FIGO stageⅠ, whereas three cases had stageⅢto Ⅳ. Three cases were classified as pulmonary type. Forty-three patients received cytoreductive surgery, and one underwent fertili ty-conserving surgery. All patients were postoperatively treated with platinum-based chemotherapy, whereas three cases received Paclitaxel plus Carboplatin. No patient received adjuvant radiotherapy. One patient died nine months after the initial diagnosis, and one died 12 months after the initial diagnosis. The other two cases remain alive with no evidence of recurrence after follow up at 7 and 30 months after diagnosis. Conclusion:SCCO is a rare ovarian tumor with high malignancy potential and thus has poor prognosis. The clinical manifestations of SCCO resemble those of epithelial ovarian cancer. Immunohistochemistry can be used for differential diagnosis. The standard SCCO treatments are cytoreductive surgery and adjuvant platinum-based chemotherapy. The optimal chemotherapy regimen requires further research.

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 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 study the regiments of continuous subcutaneous insulin infusion (CSII) in admitted type 2 diabetic patients, and to analyse the factors related to its effectiveness and insulin dosage. Methods A total of 1 276 type 2 diabetic patients were treated by CSII. The total efficacy of CSII was evaluted. The use of CSII was also analysed in the newly diagnosed patients, elderly patients, and patients with obese or infectious disease. Results The excellent control of blood glucose were achieved in (5.7±2.6)days in the dosage more early and quickly in the newly diagnosed group than that in the previously diagnosed group after the blood glucose levels achieved good control. The percentage of the patients reached the clinical relieve was also higher in the newly diagnosed group. The incidence of hypoglycemia was significantly higher in the elderly patients with lower basal insulin dosage at night. The bolus insulin dosage in the obese patients was higher than that in the non-obese patients. The patients with infectious disease usually have a higher basal insulin dosage than those without infectious disease. The days needed for achieving good control of blood glucose and the insulin dosage were related to infectious factors, the basal blood glucose and obesity. Conclusion The application of CSII among the patients is varied with different conditions. Blood glucose level, body mass index and infection factors are important to determine the initial insulin dosage.