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.

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.

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

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.

Objective To evaluate the diagnostic performance of digital breast tomosynthesis (DBT) breast X-ray photography image texture characteristics based deep learning classification model on differentiating malignant masses. Methods Retrospectively collected 132 cases with simplex breast lesions (89 benign lesions and 43 malignant lesions) which were confirmed by pathology and DBT during January 2016 to December 2016 in Nanfang Hospital. DBT was performed before biopsy and surgery. Image of cranio-caudal view (CC) and medio-lateral oblique (MLO) were captured. The lesion area was segmented to acquire ROI by ITK-SNAP software. Then the processed images were input into MATLAB R2015b to establish a feature model for extracting texture features. The characteristics with high correlation was analyzed from Fisher score and one sample t test. We built up support vector machine (SVM) classification model based on extracted texture and added neural network model (CNN) for deep learning classification model. We randomly assigned collected cases into training group and validation group. The diagnosis of benign and malignant lesions were served as the reference. The efficiency was evaluated by ROC classification model. Result We extracted 82 texture characteristics from 132 images of leisure (132 images of CC and 132 images of MLO) by establishing deep learning classification model of breast lesions. We randomly chose and combined characteristics from 15 texture characteristics with statistical significance, then differentiated benign and malignant by SVM classification model. After 50 iterations on each combination of characteristics, the average diagnostic efficacy was compared to obtained the one with higher efficacy. Nine of CC and 8 of MLO was selected. The result showed that the sensitivity, specificity, accuracy and area under curve (AUC) of the model to differentiate simplex breast lesions for CC were 0.68, 0.77, 0.74 and 0.74, for MLO were 0.71, 0.71, 0.71 and 0.76. Conclusions MLO has better diagnostic performance for the diagnosis than CC. The deep learning classification model on breast lesions which was built upon DBT image texture characteristics on MLO could differentiate malignant masses effectively.

Objective To clarify the status of tobacco exposure and identify risk factors of smoking among smear-positive pulmonary tuberculosis patients in Shenzhen,in order to provide a scientific basis for the formulation of tuberculosis-tobacco control strategy in Shenzhen.Methods From January to December 2016,a special survey was carried out in 8 districts in Shenzhen.A unified questionnaire was used to make face to face interviews for 958 smear-positive pulmonary tuberculosis patients registered in 2016.Descriptive statistics was conducted to analyze the status of tobacco exposure.Single factor analysis and multiple logistic regression were used to identify the important risk factors of smoking.Results Among smear-positive pulmonary tuberculosis patients in Shenzhen,the rates of general smoking,current smoking,regular smoking were 40.9％,34.2％ and 30％,respectively.All smoking rates were higher among male than female participants (x2=255.226,197.463 and 162.707,respectively,and the P values were all＜0.001);164cases of heavy smokers accounted for 50.0％ of current smokers.Among 392 smokers,64 had quitted smoking,and the rate of smoking cessation was 16.3％.Among 566 nonsmokers,the rate of passive smoking from cohabiting smokers was 17.8％ (101/566),and it was higher in female than male participants (23.1％ vs.12.3％,x2=11.219,P=0.001).In single factor analysis,gender,work or living environment,age,education level,marital status,and body mass index were closely related to smoking (x2=255.226,28.375,40.922,29.585,9.117,and 7.052,respectively,and the P values were all＜0.05).In multiple logistic regression,the major risk factors for smoking included in the model were gender (x2=120.797,P＜0.001),age (x2=5.728,P=0.017),education level (x2=17.159,P＜0.001),mode of case-finding (x2=3.670,P=0.055),work or living environment (x2=6.039,P=0.049),and marital status (x2=5.091,P=0.078).Conclusion The smoking status of smear-positive pulmonary tuberculosis patients was serious in Shenzhen.Tuberculosis patients were the key smokers.We should provide accurate intervention and health guidance for patients,such as,macro policy guidance,instillation of knowledge,mental health intervention,and smoke-free environment.

Objective:To retrospectively analyze the clinical characteristics of patients with coronavirus disease 2019 (COVID-19) accompanied with diarrhea.Methods:From January 11 to February 6 in 2020, the clinical data of 663 patients diagnosed with COVID-19 admitted to Renmin Hospital of Wuhan University were collected and divided into diarrhea group and non-diarrhea group according to whether they had diarrhea or not. The differences in baseline characteristics, basic disease history, clinical manifestations, chest computed tomography (CT), laboratory findings, disease severity and mortality between the two groups were compared. Chi-square test and Fisher exact test were used for statistical analysis.Results:Among 663 COVID-19 patients, 70 (10.6%) patients accompanied with diarrhea. The proportion of fatigue and increased lactate dehydrogenase (LDH) levels of diarrhea group were higher than those of non-diarrhea group (58.6%, 41/70 vs. 28.2%, 167/593; and 64.2%, 43/67 vs. 50.4%, 277/550), and the differences were statistically significant ( χ2=26.891 and 4.566, both P<0.05). There was no statistically significant difference in the proportion of pneumonia in chest CT between diarrhea group and non-diarrhea group (100.0%, 62/62 vs. 99.4%, 529/532) ( P>0.05). There were no statistically significant differences in the proportions of mild and normal type, severe type and critical type between diarrhea group and non-diarrhea group (35.7%, 25/70 vs. 38.6%, 229/593; 50.0%, 35/70 vs. 47.2%, 280/593; and 14.3%, 10/70 vs. 14.2%, 84/593, respectively) (all P>0.05). There were no statistically significant differences in the mortality of mild and normal type, severe type and critical type between diarrhea group and non-diarrhea group (0 vs. 0.5%, 3/593; 0 vs. 0 and 1.4%, 1/70 vs. 3.5%, 21/593) (all P>0.05). Conclusions:Patients with COVID-19 accompanied with diarrhea are more likely to have fatigue and increased LDH level. Diarrhea is not significantly correlated with the disease severity of patients with COVID-19.

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.

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.