Objective To investigate the effect of sumical resection in the management of gestafional trophoblastic neoplasia(GTN)patients with pulmonary metastases.Methods A retrospective review of the medical records of 62 GTN patients who underwent pulmonary resection was carried out.The cases were divided into recurrent group(group A,,l=10),drug-resistant group(group B,n=28),and the group with satisfactory response to chemotherapy but residual pulmonary lesion(s)(group C,n=25).One patient underwent lobectomy twice,and she was allocated simultaneously to groups A and B.The patients'median age,antecedent pregnancy,International Federation of Gynecology and Obstetrics(NGO)risk score,number of preoperative chemotherapy courses,preoperative β-human chorionic gonadotrophin (β-hCG)titer,lesion size,number of lobes affected,positive rate of histology,follow-ups and prognosis were compared between the three groups.Results The proportion of hish-risk patients in the three groups wag 90%,82%and 44%,respectively.The complete remission rates of the three groups were 90%,79%and 100%,with relapse mtes of 2/8,15%and zero,respectively.Positive histology of the resected specimen wasmore frequently recognized in recurrent and drug-resistant groups(A 60%,B 36%,C 12%).In the drug-resistant group there were more preoperative chemotherapy 8essiorls(A 3,B 7,C 5)and more patients with abnormal preoperative B-hCG titer(A 50%,B 61%,C 12%).Conclusions Surgical resection is effective in the treatment of pulmonary metastases of GTN.Surgery is indicated when clinical evidence suggests that pulmonary metastatic disease causes relapse or drug—resistance and the lesions are relatively localized.Surgical resection is not recommended for patients with satisfactory response to chemotherapy but residual pulmonary lesions.

Objective To investigate the clinical characteristics, management and prognosis of gestational trophoblastic disease in women aged 50 years or more. Methods Thirty-eight cases of gestational trophoblastic disease in women aged 50 years or more, who were treated in Peking Union Medical College Hospital between 1992 and 2002, were reviewed retrospectively. Results The median age was 52 years (range from 50 to 58 years ). The lesions included 5 hydatidiform moles (13%), 19 invasive moles (50%), 12 choriocarcinomas (32%) and 2 placenta site trophoblastic tumors (5%). All of 38 cases presented with abnormal vaginal bleeding. Twenty-three cases of hydatidiform moles were diagnosed at their first visit to the hospital, and 15 of them received prophylactic chemotherapy, of whom 10 progressed to invasive mole, 3 developed lung metastasis. All of the other 8 cases without prophylactic chemotherapy progressed to malignant changes with metastasis of lung. The use of prophylactic chemotherapy reduced the incidence of subsequent metastasis. All of 38 cases received chemotherapy. Thirty-two cases underwent hysterectomy, complete remission was achieved in 91% of patients; complete remission was achieved in 2 of 6 patients without hysterectomy. Conclusions The diagnosis of pregnancy and pregnancy-related disease should be considered in the elderly women presenting with abnormal vaginal bleeding. Once gestational trophoblastic disease in women aged 50 years or more is diagnosed, chemotherapy should be given as soon as possible. Hysterectomy is frequently required to improve the prognosis of gestational trophoblastic disease in the elderly women.

Objective To analyze and compare the clinical characteristics and the treatment outcome of the patients with chemo-resistant and relapsed gestational trophoblastic neoplasia (GTN).Methods The clinical records of the patients with refractory GTN treated at the Peking Union Medical College Hospital (PUMCH) from Jan 2005 to Dec 2007 were retrospectively reviewed.According to the reasons for referral, all cases were classified as chemo-resistant GTN group who had never a normal serum human chorionic gonadotropin-beta subunit (β-hCG) level during their previous treatment, relapsed GTN group who had elevated serum β-hCG levels in the absence of the pregnancy after finished treatment 3 months or more, and undetermined GTN group who had elevated serum β-hCG levels in the absence of the pregnancy less than 3 months after completed treatment.The clinical features and treatment outcomes were compared between undetermined GTN group and chemo-resistant GTN group and also between undetermined GTN group and relapsed GTN group, respectively.Results Of 81 patients with refractory GTN, 32 cases were defined as undetermined GTN, 38 cases as chemo-resistant GTN and 11 cases as relapsed GTN.The median number of previous chemotherapy regimens, the rate of serologic complete remission ( SCR), the patients who needed to change regimens due to resistance, and the patients who needed to change regimens in the undetermined GTN group and the chemo-resistant GTN group were 2.3 versus 3.1 ( P = 0.010),100% (32/32) versus 66% (25/38, P ＜ 0.01 ), 22% (7/32) versus 58% (22/38, P = 0.002) and 28% (9/32) versus 63% (24/38, P = 0.003 ), respectively.No significant difference were observed between undetermined GTN group and relapsed GTN group in clinical features, previous and current treatment or treatment outcome ( all P ＞0.05 ).Conclusions In order to evaluate accurately the treatment outcome of refractory GTN, it seems more appropriate for the patients who had reached the normal value of serum β-hCG when completed treatment to be defined as patients with relapsed GTN, while whose serum β-hCG levels elevated in the absence of the pregnancy after the completion of treatment, irrespectively of duration of stopping treatment.Comparing with the patients with chemo-resistant GTN, the outcome of patients with relapsed GTN is better.

Objective To investigate the effects of 20% lipid emulsion on plasma ropivacaine concentration and myocardial ropivacaine content in rats. Methods Sixty male pathogen-free SD rats weighing 220-270 g were randomly divided into 2 groups (n = 30 each): group A normal saline and group B lipid emulsion.The animals were anesthetized with intraperitoneal 4% pentobarbital 40 mg/kg. The femoral vein was cannulated for drug and fluid administration. ECG (lead Ⅱ) was continuously monitored. 1% ropivacainc 5 mg/kg was injected iv. A bolus of 20% lipid emulsion 5 ml/kg was then injected iv in group B, while in group A equal volume of normal saline was administered instead of 20% lipid emulsion. The animals were sacrificed at 5, 10,20, 40, 60 and 120 min after ropivacaine infusion (5 animals at each time point). Blood samples and myocardial specimens were taken for determination of plasma and myocardial ropivacaine levels by HPLC. Results Plasma ropivacaine concentration at 20 min after ropivacaine administration was significantly higher in group B than in group A. The myocardial ropivacaine concents at 5, 10 min after ropivacaine administration were significantly lower in group B than in group A. Conclusion 20% lipid emulsion infusion can bind ropivacaine and decreasee myocardial ropivacaine content thus reducing the cardiac toxicity of ropivacaine.

Objective To measure the quality of life (QoL) of gestational trophoblastic neoplasia ( GTN ) survivors after chemotherapy by using a self-invented scale, and to explore the factors associated with QoL Methods The design of questionnaire was based on a series of internationally valid QoL scales,which was tested by epidemiology and showed good reliability and validity. A total of 100 survivors of GTN patients from Peking Union Medical College Hospital participated in this survey from December 2008 to May 2009. Results Patients with disease-free more than three months after chemotherapy enjoys a good QoL,while only 16% (16/100) of survivors feel general overall QoL, but no one feels bad Qol. As refer to sexual function, more than half of these patients (70%, 70/100) satisfied with their sexual life, while there were still 47% (47/100) and 45% (45/100) of the patients complaining of decreased sexual desire and dryness of vagina. 66% (66/100) of the GTN survivors expressed depression, and 50% (50/100) of patients complained anxiety, which were potential factors influencing QoL of GTN survivors. Relevant analysis explored the possible predictors of QoL for GTN patients, including physical function ( r = 0. 609,P ＜0. 01 ), sexual function ( r = 0. 473, P ＜ 0. 01 ), and social psychology ( r = 0. 294, P ＜ 0. 01 ).Conclusions GTN survivors have an overall good QoL after chemotherapy, the possible predictors of QoL for GTN patients include physical function, sexual function and social psychology. The sexual dysfunctions mostly present with short of sexual desire and dryness of vagina. Fear of recurrence may be a potential factor influencing QoL a long term after remission.

Objective To study the clinical features,differential diagnosis and treatment of caesarean scar pregnancy (CSP) with sonographic mass.Methods A retrospective analysis was performed on 39 patients of CSP with sonographic mass undergoing treatment in Peking Union Medical College Hospital from 2005 to 2012.14 cases with misdiagnosis of gestational trophoblastic neoplasm,among 4 cases were administered by chemotherapy with methotrexate (MTX),cisplatin,fluorouracil (5-FU) and dactinomycin.According to treatment methods,39 cases were divided into five groups: 3 cases in methotrexate,16 cases in dilation and curettage,15 cases in excision of CSP lesion via laparoscopy,6 cases in excision of CSP lesion via laparotomy,and 4 cases in transabdominal hysterectomy (TAH).Results (1)Clinical characteristics: the mean age was (33 ± 5) years old.Five patients had undergone two prior caesarean sections.The median interval from the last caesarean delivery to CSP was 4 years.Thirty-five cases presented vaginal bleeding or abnormal serum β-hCG level from 5 cases with medical abortion,9 cases with artificial abortion and 21 cases with dilation and curettage.The sonography showed cystic-solid or solid mass with mixed echoes in the lower segment of anterior uterine wall,surrounded by peritrophoblastic vasculature.(2) Treatment outcome: diagnosis of gestational trophoblastic neoplasm was suspected or made in 20 patients,four of whom were even treated by chemotherapy.MTX therapy was given to 3 patients,2 of whom were cured.Dilation and curettages were given to 16 patients,11 of whom were cured.8 patients underwent curettage with sonographic guidance after uterine artery embolism,and 8 patients with laparoscopic or hysteroscopic guidance.All of 15 patients underwent excision of CSP lesion via laparoscopy were cured.4 patients were treated by TAH.(3) Time of in hospital and operation:in laparoscopy group,the average hospitalization days were (3.5 ± 1.6) days,the average operation duration was (54 ± 16)minutes.In laparotomy group,the average hospitalization days were (9.7 ± 5.8) days,and the average surgical duration was (87 ± 15) minutes.It reached significant difference (P ＜ 0.05).Conclusions CSP with sonographic mass was the consequence of continued growth of residual pregnancy mass after incomplete abortion or curettage of CSP with gestation sac.The similar sonographic image might lead to misdiagnosis.Individual therapy was recommended.Excision of CSP lesion via laparoscopy might be the primary option for its advantages in differential diagnosis,caesarean scar defect repair and successful ratio.

Retrospective analysis was conducted for the results of first-aid competitions so as to understand the present status of how emergency doctors of Hubei Province grasp the skills and consciousnesses of cervical immobilization.From 6 out of 19 teams,38 participating doctors from grade 3A hospitals provided patient cervical immobilization while 2 teams offered no cervical protection.It is necessary to intensify the skills and consciousnesses of cervical immobilization in clinical practice.

Objective To analyze prophylactic chemotherapy outcome and clinical characteristics in patients of high-risk hydatidiform mole. Methods Twenty-three patients who were diagnosed as high-risk hydatidiform mole and undergone prophylactic chemotherapy in our hospital were retrospectively analyzed.After prophylactic chemotherapy, 11 patients didn't develop to gestational trophoblastic neoplasia (GTN),while the other 12 patients developed to GTN and needed a regimen change to combination chemotherapy.The clinical characteristics of these patients and outcome of prophylactic chemotherapy were compared between two groups. Results There was no significant difference between the two groups on patients' age,weeks of delayed menses, enlarged uterine size excessive for gestational age, and incidence of theca-lutein cysts of ovaries. However,the median levels of pre-evacuation serum β-hCG in two groups were 469 144 U/L and 768 044 U/L respectively, and median days needed for β-hCG declining to normal(≤2U/L) at the first time were 71 and 120 days respectively, which were both significantly different between two groups.Analyzed with receiver operating charactristic(ROC), the level of serum β-hCG could be a predictor for prognosis. Choosing 750 000 U/L as the cut-off value, we could expect the serum β-hCG to have a specificity of 91% and a sensitivity of 58% to predict whether prophylactic chemotherapy will be successful.Conclusions For those patients who have to receive prophylactic chemotherapy because of risk factors and unavailable hCG assessments for follow-up, it's better to use double-agent or combination chemotherapy if the level of serum β-hCG reached 750 000 U/L so as to reduce therapy duration and prevent relevant chemoresistance.

0.05)between the recurrent rate[2.2%(10/463)]of the CR patients with lung metastasis and the progression rate of the 152 patients.Conclusions After normalization of ?-hCG titer,patients whose lung tumors remained unchanged even after several additional courses of chemotherapy should be considered as CR patients.Follow-ups should be strictly carried out on these patients,especially at around 6 months after the completion of treatment,and particularly for high-risk and drug-resistant choriocarcinoma patients.

Objective To distinguish choriocarcinoma from gestational or non-gestational choriocarcinoma and also identify the causative pregnancy of gestational choriocarcinoma by the genetic origin through molecular genetic analysis. Methods Twelve patients with choriocarcinoma, who had experienced surgery prior to chemotherapy were enrolled in this study. All 12 cases were diagnosed pathologically as choriocarcinoma. Peripheral venous blood samples and formalin-fixed paraffin-embedded blocks of choriocarcinoma tissue microdissected from haematoxylin and eosin-stained sections of tissue by microdissection method were available from the patient and (or) her husband. DNA was then prepared from the couples' blood samples and choriocarcinoma tissue by using standard techniques. PCR amplification and fluorescent microsatellite genotyping were performed by using DNA from the couples and captured choriocarcinoma tissues. The genetic contributions to the choriocarcinoma tissue were determined by comparing the fragments of genes from the choriocarcinoma tissue to those from blood samples of the couples. Results The primary lesion was ovary in 7 cases, but only 4 of them had the maternal contribution, indicating a non-gestational origin; the other three were gestational choriocarcinoma. The primary lesion was uterus in 5 cases, which were all gestational choriocarcinoma confirmed by genetic analyses. The causative pregnancies of the 8 cases with gestational choriocarcinoma were identified as androgenetic complete hydatidiform mole (AnCHM) in six cases and normal pregnancies in two cases, respectively. Conclusion Microsatellite polymorphism analysis is a molecular approach for distinguishing the non-gestational choriocarcinoma from the gestational one, and also be used to identify the causative pregnancy of gestational choriocarcinoma.