Objective:To develop and verify a nomogram to predict disease-free survival(DFS)and overall survival(OS)for patients undergoing cervical cancer surgery,which may provide reference for evaluating the prognosis of cervical cancer patients undergoing surgery.Methods:The clinical,pathological and follow-up data of patients who underwent radical operation for cervical cancer in Xijing Hospital,Air Force Medical University from March 2013 to October 2018 were analyzed retrospectively.Based on Cox regression analysis,Bayesian Informa-tion Criterion(BIC)backward stepwise selection method and R square screening variables,Net Reclassification Index(NRI)and Integrated Discrimination Improvement(IDI)were used to compare the predictive efficiency of the model,and a nomogram with better predictive efficiency was selected.The consistency index(C-index)and the receiver operating characteristic curve(ROC)were used to test the efficiency of the nomogram.Results:A total of 950 patients with cervical cancer were enrolled in this study.The risk factors for constructing the DFS nomogram were FIGO stage(2018),parametrium invasion,invasion depth,and maximum tumor diameter.The C-index for DFS in the training cohort and the verification cohort were 0.754 and 0.720,respectively.The area under ROC of the training cohort for 1-,3-and 5-years was 0.74(95%CI 0.65-0.82),0.77(95%CI 0.71-0.83)and 0.79(95%CI0.74-0.85),and the areas under ROC of verification cohort 1-,3-and 5-years were 0.72(95%CI 0.58-0.87),0.75(95%CI 0.64-0.86)and 0.72(95%CI 0.61-0.84),respectively.The risk factors for con-structing the OS nomogram were FIGO stage(2018),histological type,LVSI,parametrium invasion,surgical mar-gin,and invasion depth.The C-index for OS in the training cohort and the verification cohort were 0.737 and 0.759,respectively.The area under ROC of the 3-and 5-year training cohort were 0.76(95%CI 0.69-0.83)and 0.78(95%CI 0.72-0.84),and the areas under ROC of verification cohort 3-and 5-years were 0.76(95%CI 0.65-0.87)and 0.79(95%CI 0.69-0.88),respectively.Conclusions:This study is based on real-world big data to construct nomogram of DFS for 1,3,and 5 years and OS for 3,and 5 years for cervical cancer,which have ideal predictive effects and help clinical physicians correctly evaluate the prognosis of cervical cancer surgery patients.It provides strong reference basis for diagnosis,treatment,and prognosis evaluation.

Objective: This study aimed to identify the risk factors for genitourinary fistulas and delayed fistula recognition after radical hysterectomy for cervical cancer. Methods: This study was a retrospective analysis of data collected in the Major Surgical complications of Cervical Cancer in China (MSCCCC) database from 2004–2016. Data on sociodemographic characteristics, clinical characteristics, and hospital characteristics were extracted. Differences in the odds of genitourinary fistula development were investigated with multivariate logistic regression analyses, and differences in the time to recognition of genitourinary fistula were assessed by Kruskal–Wallis test. Results: In this study, 23,404 patients met the inclusion criteria. Surgery in a cancer center, a women’s and children’s hospital, a facility in a first-tier city, or southwest region, stage IIA, type C1 hysterectomy, laparoscopic surgery and ureteral injury were associated with a higher risk of ureterovaginal fistula (UVF) (p<0.050). Surgery in southwest region, bladder injury and laparoscopic surgery were associated with greater odds of vesicovaginal fistula (VVF) (p<0.050). Surgery at cancer centers and high-volume hospitals was associated with an increase in the median time to UVF recognition (p=0.016; p=0.005). International Federation of Gynecology and Obstetrics (FIGO) stage IIA1-IIB was associated with delayed recognition of VVF (p=0.040). Conclusion Intraoperative urinary tract injury and surgical approach were associated with differences in the development of UVFs and VVFs. Patients who underwent surgery in cancer centers and high-volume hospitals were more likely to experience delayed recognition of UVF. Patients with FIGO stage IIA1-IIB disease were more likely to experience delayed recognition of VVF.

Objective:To summarize our institutional experiences of screening and selecting potential recipients and living donors for uterine transplantation at a single center.Methods:A total of 102 patients were diagnosed as absolute uterine factor infertility (AUFI). Depending upon the outcomes of previous trials, 8 modules were selected for surveying. A registration form was distributed for subjects at outpatient clinics or through telephone consultations for clinical trials of uterus transplantation between November 2018 and October 2019. The relevant information was collected and entered into a dedicated system for data processing.Results:The number of eligible subjects was 84 and the number of recipients with potential donors 37. The average age of potential recipients was 26.0(18-47) years. Among potential recipients, 76(90.5%) had congenital AUFI and 8(9.5%) acquired AUFI. For potential donors with available organs, the average age was 47.5(32-64) years and the proportion of menopausal or peri-menopausal status 56.8%.Conclusions:Currently large demands and sufficient supports for conducting clinical trials of uterine transplantation are available in China. However, inherent deficiencies persist in organ donor population reserves and preoperative screening protocols, such as donor age and subjective/objective factors of participants. During clinical trials of uterine transplantation, preoperative screening should be performed for expanding the screening scope, extending the screening time and popularizing the screening knowledge to boost the success rate.

Objective:To compare the long-term oncological outcomes between laparoscopic and abdominal surgery in stage Ⅰa1 （lymph-vascular space invasion-positive, LVSI +）- Ⅰb1 cervical cancer patients with different tumor sizes. Methods:Based on the Big Database of Clinical Diagnosis and Treatment of Cervical Cancer in China (1538 project database), patients with stage Ⅰa1 （LVSI +）-Ⅰb1 cervical cancer who treated by laparoscopic or abdominal surgery were included. The 5-year overall survival (OS) and 5-year disease-free survival (DFS) between the two surgical approaches were compared under 1∶1 propensity score matching (PSM) in different tumor diameter stratification. Results:(1) A total of 4 891 patients with stage Ⅰa1 （LVSI +）-Ⅰb1 cervical cancer who underwent laparoscopy or laparotomy from January 1, 2009 to December 31, 2016 were included in the 1538 project database. Among them, 1 926 cases in the laparoscopic group and 2 965 cases in the abdominal group. There were no difference in 5-year OS and 5-year DFS between the two groups before matching. Cox multivariate analysis suggested that laparoscopic surgery was associated with lower 5-year DFS ( HR=1.367, 95% CI: 1.105-1.690, P=0.004). After 1∶1 PSM matching, 1 864 patients were included in each group, and there was no difference in 5-year OS between the two groups （94.1% vs 95.4%, P=0.151）. While, the inferior 5-year DFS was observed in the laparoscopic group (89.0% vs 92.3%, P=0.004). And the laparoscopic surgery was associated with lower 5-year DFS ( HR=1.420, 95% CI: 1.109-1.818, P=0.006). (2) In stratification analysis of different tumor sizes, and there were no difference in 5-year OS and 5-year DFS between the laparoscopic group and abdominal group in tumor size ≤1 cm, >1-2 cm and >2-3 cm stratification (all P>0.05). Cox multivariate analysis showed that laparoscopic surgery were not related to 5-year OS and 5-year DFS ( P>0.05). In the stratification of tumor size >3-4 cm, there was no difference in 5-year OS between the two groups ( P>0.05). The 5-year DFS in the laparoscopic group was worse than that in the abdominal group (75.7% vs 85.8%, P=0.025). Cox multivariate analysis suggested that laparoscopic surgery was associated with lower 5-year DFS ( HR=1.705, 95% CI: 1.088-2.674, P=0.020). Conclusions:For patients with stage Ⅰa1 （LVSI +）-Ⅰb1 cervical cancer, laparoscopic surgery is associated with lower 5-year DFS, and the adverse effect of laparoscopic surgery on oncology prognosis is mainly reflected in patients with tumor size >3-4 cm. For patients with tumor sizes ≤1 cm, >1-2 cm and >2-3 cm, there are no difference in oncological prognosis between the two surgical approaches.

Objective To evaluate the effects of the two methods of propaganda and education, conventional training method and that combined with hand contamination survey method, on the medical and nursing staffs' hand hygiene compliance. Methods From October 2017 to April 2018, all medical and nursing staffs in 6 Departments:General Surgery Ⅰ, General Surgery Ⅱ, Orthopedics Ⅰ, Orthopedics Ⅱ, Internal Medicine Ⅰ and Internal Medicine Ⅲin Cangnan Second People's Hospital receiving health education were divided into two groups; both groups received routine training, while in the observation group, on the basis of routine training, the hand hygiene pollution investigation training mode was added, In the combined training method, when the wrong hand hygiene mode occurred, the hand specimens were collected and the correct hand washing method was instructed on the spot, and then the following hand specimens were taken to investigate the contaminated condition. One month before the training, the real situations of hand hygiene compliance in the two groups were investigated. In the 1st month after the beginning of training, both groups were cultivated by conventional propaganda and training methods. From the second month to the sixth month, the observation group was additionally trained to investigate hand hygiene pollution situation on the basis of conventional propaganda and training methods. After 6 months, the compliance rates of hand hygiene in the two groups were observed. Results Before training, there was no significant differences in the compliance rate of hand hygiene in the observation group and the routine trainning group [37.14% (52/140) vs. 36.36% (48/132), P > 0.05]. The compliance rates of hand hygiene after 1, 2, 3 months of training in the observation group were 56.61% (77/136), 60.61% (80/132) and 61.20% (82/134), respectively, and those in the routine trainning group were 56.25% (72/128), 59.26% (80/135) and 58.70% (81/138), which were all significantly higher than those before the training (all P < 0.05), but there were no statistical significant differences between the two groups (all P > 0.05). From the 4th month to the 6th month after training, the compliance rates of hand hygiene in the observation group were significantly higher than those in the observation group [61.97% (88/142) vs. 49.23% (64/130), 62.50% (80/128) vs. 47.73% (63/132), 62.31% (81/130) vs. 46.03% (58/126)], the differences between the two groups being statistically significant (all P < 0.05). Conclusion The routine training combined with hand contamination investigation survey training for consecutive 3 months can nicely promote the improvement of hand hygiene compliance of medical and nursing staffs.

Objective: To explore the therapeutic feasibility of uterus transplantation for uterine infertility. Methods: Retrospective analysis was performed for the diagnosis, treatment and pregnancy course of the first domestic case of uterus transplantation and the relevant literature reviewed. The recipient was a 22-year-old woman with a congenital absence of uterus and vagina. Previously she underwent vaginal reconstruction and the donor was her mother. The specific procedures included donor/recipient screening, ethical argumentation, assisted reproductive technology of obtaining frozen embryos, Vinci robot-assisted uterine procurement, orthotopic replacement & fixation of retrieved uterus, revascularization; immunoregulation & monitoring of transplanted uterine recipient, assisted reproductive technology after transplantation and gestational management. Results: The durations of donor and recipient surgeries were 360 and 530 min respectively. No complications of recipient or donor occurred during the perioperative period. First menstruation occurred at 40 days post-transplantation and regularly thereafter. Pregnancy occurred after embryo transfer at 31 months post-transplantation. No rejection episodes occurred after transplantation or during gestation. Caesarean delivery occurred near gestational week 34. The boy weighed 2000 grams at birth and the mother remained well. Conclusions In conjunctions with literature review, uterine infertility may be treated by modified uterus transplantation. And a new path is paved for healthy pregnancy of women with uterine infertility.

We hereby reported the clinical manifestations and genetic diagnosis of a rare case of congenital adrenal hyperplasia (CAH) caused by cytochrome P450 oxidoreductase ( POR ) gene mutation. The case was an 11-year-old girl presented with craniofacial and skeletal malformation such as a depressed nasal bridge, radiohumeral synostosis and camptodactyly in feet. Moreover, she was diagnosed with ambiguous genitalia, and her mother had obvious masculine features during pregnancy. Laboratory tests showed that the levels of peripheral blood progesterone, 17-hydroxyprogesterone and adrenocorticotrophic hormone (ACTH) had increased significantly, which were consistent with the symptom of CAH. Genetic testing revealed a complex heterozygous mutation in POR gene of maternally inherited c.744C>G (p.Tyr248Ter) and paternal inherited c.1370G>A (p.Arg457His). Therefore, she was diagnosed with cytochrome P450 oxidoreductase deficiency (PORD), which is a rare type of CAH. The patient received oral glucocorticoid therapy and underwent knee arthroplasty.

Objective To investigate the changes of peripheral blood tacrolimus concentration and lymphocyte subsets in the uterus transplant recipient,and provide the evidence for monitoring the immune status after uterus transplantation.Methods The peripheral blood tacrolimus concentrations of the uterus transplant recipient during 1 year after transplantation were measured with the microparticle enzyme immunoassay (MEIA).Meanwhile,the whole blood cell counts and lymphocyte subsets were determined by the blood analyzer and flow cytometer,respectively.Results The blood tacrolimus concentrations of the uterus transplant recipient in the first month and second month after transplantation were (13.51 ± 3.92) ng/mL and (15.58 ± 1.19) ng/mL,respectively.The lymphocyte absolute counts were normal before transplantation.At the fifth day after transplantation,the counts of CD3 + T lymphocytes,CD4 + T lymphocytes,CD8 + T lymphocytes and NK cells and the ratio of CD4/CD8 were significantly decreased.One week after transplantation,the counts of CD4 + T lymphocytes were recovered to the normal range and maintained,but its recovery was slower than that of CD8 + T lymphocytes.The ratio of CD4/CD8 ranged from 0.4 to 0.8 during 10 days after transplantation,and increased and maintained between 0.8 and 1.1 after that.The counts of NK cells increased gradually from the 10th day after transplantation,but still did not recover to the level before transplantation even at the 20th day after transplantation.However,the counts and percentages of B lymphocytes did not decrease but increased at the fifth day after transplantation,and recovered to normal gradually from the 10th day after transplantation.There was no significant correlation between the CD3 + T lymphocyte count and blood tacrolimus concentration.Conclusion The dynamic changes of blood lymphocyte subsets and tacrolimus concentration exist in the uterus transplant recipient,which need to be further verified by a large amount of clinical data.

Objective To analysis the clinical high risk factors for fetal chromosomal abnormalities.Methods Amniocentesis,chromosomal karyotype analysis and other related methods were performed on 4829 pregnant women,who presented sole indication of prenatal diagnosis such as advanced age,high risk factors and fetal ultrasound abnormalities,for analyzing the correlations of those women to the incidence of fetal chromosomal abnormalities.Results The detection rates of abnormal karyotype were 5.0％ (57/1143),1.7％ (40/2367) and 4.3％ (57/1319) in the older women group (age＞35),abnormal maternal serological screening group and abnormal fetal ultrasound finding group,respectively.The detection rats of karyotype abnormality were 6.9％ (23/333) in women with fetal congenital heart diseases,8.5％ (20/234) in those with abnormal amniotic fluid,1.1％ (1/89) in those with fetal ventriculomegaly,1.1％ (10/898) in those with fetal intracardiac hyperechogenicity,5.9％ (2/34) in those with fetal choroid cyst and 5.6％ (1/18) in those with fetal renal pelvis broadening.Conclusion The pregnant women with age＞35,fetal sonographic structural anomalies or two or more soft marker abnormalities should be prenatally diagnosed and doing the genetic counseling combined with the family history.

This paper described the necessity to cultivate medical students′ethical quality during clinical pro-bation teaching in gynecology and obstetrics department. Then it analyzed the ethical problems faced in clinical pro-bation teaching due to traditional social values and cultural differences. As well, it put forward to improve the whole ethical quality and clinical ethics decision-making capacity of medical students through carrying out education and communication before probation, paying attention to ethical quality training, and penetrating ethical quality training throughout each part of teaching.