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.

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.

There are many factors that may affect the microenvironment of acute and chronic wounds.This article reviews the relationship between temperature factor in the external microenvironment of wound surface and wound healing.The temperature changes in different types and stages of wounds are closely related to the wound healing status.Therefore,wound temperature monitoring provides timely,reliable,and non-invasive method in the evaluation of wound status.As low temperature affects the physiological state of wound,relieving the low temperature state and maintaining normal temperature of the microenvironment of wound can promote wound healing.Further research is needed on the wound repair related effector cell proliferation and the mechanism of regulatory function to determine the optimal constant temperature and heat treatment duration needed for wound healing.

Objective To determine the prognostic significance of positive peritoneal cytology (PPC) among patients with endometrial cancer and to find out potential risk factors for PPC in endometrial cancer.Methods Data were extracted from Peking Union Medical College Hospital between Jan 1 2005 and Dec 31 2010.Only those patients who had undergone a staging procedure were included.A total of 486 patients were identified.Statistical analyses were performed using Fisher`s exact test, Kaplan-Meier log rank, and Cox proportional hazards models.ResultsRate of PPC was 4.8% in endometrial cancer.Non-endometrioid endometrial cancer(P=0.000), stage Ⅲ/Ⅳ(P=0.000), deep myometrial invasion(P=0.001), and cervical stromal involvement(P=0.018) appeared to be risk factors for PPC in endometrial cancer.Univariate analysis revealed statistically difference in 5-year PFS (70.9% vs 90.0%) and 5-year OS (72.2% vs 96.0%).Progression-free survival and overall survival showedstatistically difference(P=0.005,P=0.000)between PPC and NPC endometrial cancer.On multivariate analysis, PPC remained no statistically difference in progression-free survival or overall survival(RR=3.812,95% CI 0.897-16.200,P=0.070;RR=3.426,95% CI 0.800-14.673,P=0.097).Conclusions PPC is not an independent risk factor in patients with endometrial cancer.Aggressive histology, FIGO stage, deep myometrial invasion and cervical stromal involvement are presumed to be associated with PPC in endometrial cancer.

Objective The aim of this study is to evaluate the safety and prognosis of ovarian preservation in young women with early-stage endometrial cancer.Methods Women≤45 years of age with stageⅠendometrial cancer recorded from Jan 2005 to Dec 2011 in Peking Union Medical College Hospital were examined.They were further divided into two groups: ovarian preservation group and oophorectomy group.Clinical and pathological recording of these patients were compared.Results A total of 72 women, including 25 patients (34.7%) who had ovarian preservation, were identified.The ovarian preservation group was younger (P=0.007) and had a lower prevalence of lymphadenectomy (P<0.001).While there were no significant difference in stage, tumor grade, the invasion depth of myometrium and adjuvant treatment between two groups (all P>0.05).Of seventy-two cases, five patients relapsed and all survived after a median follow-up time of 89 months (rang: 7-131 months).The Kaplan-Meier curve and the log rank test showed no difference in recurrence-free survival (P=0.194).In Cox model analysis, ovarian preservation had no effect on recurrence-free survival(HR=3.08, 95% CI 0.54-18.44).Conclusions Ovarian preservation in young women with early-stage endometrial cancer is safe and has no negative effect on recurrence-free survival or overall survival.

Objective To investigate the oncologic and reproductive outcomes after progestin treatment of complex endometrial hyperplasia(CEH) and grade 1 endometrial carcinoma(EC).Methods In a retrospective study, data were obtained for patients with CEH or grade 1 EC at presumed stage IA(without myometrial invasion) who wished to preserve fertility and were treated at the Peking Union Medical College Hospital, China, between January 1, 2000 and December 31, 2011.Patients had received oral medroxyprogesterone acetate(250-500 mg/d) or megestrol acetate(160-480 mg/d) for at least 6 months.Results Among 55 included patients, median age was 32 years(range 21-41 years).41(75%) achieved complete response after a median period of 6(3-24) months.Complete response was less frequent among obese than nonobese patients(4/12 [33%] vs 37/43 [86%];P=0.001).Disease recurrence was recorded in 10(24%) patients with complete response;the 5-year recurrence-freesurvival rate was 71%.Among the 33 patients who retained a desire to conceive, 17(52%) became pregnant.Conclusions Fertility-sparing management with oral progestin is effective and safe.Obesity is associated with a lower probability of long-term success.

Objective To investigate the clinical characteristics and treatments of endometrioid carcinoma patients with preoperative diagnosis of endometrial hyperplasia.Methods From 2005 to 2010, 404 patients were diagnosed with endometrioid carcinoma after hysterectomy.Among these patients,44 of them were diagnosed atypical endometrial hyperplasia(AEH) preoperatively.Retrospectively analysis the characteristics of these patients with SPSS13.0.Results Among the 44 cases, all of them were grade G1 disease, and 39 of them received comprehensive staging surgery.14(32%)young cases preserved bilateral ovaries.9 cases(20%) were given adjuvant radiology.No recurrence was detected during the median follow up of 52 months.Compared to the premenstrual group, although no statistical difference was detected, more patients with risk factors of deep myometrium invasion(4/22 vs 1/22) and lymph-vascular space invasion(LVSI, 3/22 vs 0/22) in the postmenstrual group.Compared to the patients who diagnosed with endometrioid cancer(EC) preoperatively, there are more patients with grade G1(P=0.000), fewer patients received adjuvant chemotherapy(P=0.003) and fewer recurrence(P=0.019) in AEH group.Conclusions The endomtrioid cancer patients who diagnosed with atypical hyperplasia preoperatively have better prognosis.Hysterectomy with bilateral ovaries preserved is acceptable in young patients.Post menopause patients have more risk factors of deep myometrium invasion and LVSI.

Objective To investigate the high-risk factors of retroperitoneal lymph nodes metastasis (LNM) and the effect of lymph nodes metastasis on prognosis in patients with endometrial carcinoma (EC).Methods Retrospec-tive research was carried out from January 2005 to December 2010 to identify 289 endometrial carcinoma patients treated with retroperitoneal lymphadenectomy at Peking Union Medical College Hospital.The high-risk factors of retroperitoneal LNM and prognostic factors of this disease were studied.Results 1) The median age at diagnosis was 55 years old.Patients of stage Ⅰ, Ⅱ, Ⅲ and Ⅳ were 224 (77.5%), 13 (4.5%), 45 (15.6%) and 7 (2.4%), respectively.Two hundred and eighty-nine patients received pelvic lymphadenectomy, of that 30 (10.4%) patients were found the pelvic LNM.Ninety-six patients received periaortic lymphadenectomy, of that 11 (11.5%) patients were found the periaortic LNM.Twenty-one (7.3%) patients developed recurrent disease and 11 (3.8 %) dead.The median follow-up was 37 months and the median disease-free survival (DFS) was 34 months.2) In univariate analysis, the incidence of LNM significantly increased in patients with CA125 ≥ 35 U/mL preoperatively, non-endometrioid adenocarcinoma, low grade, deep myometrium invasion, diameter of tumor ≥ 2 cm, cervical stroma involvement, positive peritoneal cytology and vagina or parametrial involvement (P<0.05).In multivariate analysis, CA125 ≥ 35 U/mL preoperatively, low grade, deep myometrium invasion were the independent high-risk factors of LNM (P<0.05).3)The Kaplan-Meier analysis showed a significant difference between positive peritoneal cytology, vagina or parametrial involvement, appendix involvement, LNM and DFS (P<0.05).We also found a significant difference in the impact of non-endometrioid adenocarcinoma, low grade, deep myometrium invasion, positive peritoneal cytology, appendix involvement and LNM on overall survival (OS) (P<0.05).Cox regression analysis revealed retroperitoneal LNM is the independent prognostic factor of 5-year DFS (patients without LNM 92.1% vs patients with LNM 65.3%, P=0.002, 95% CI 0.078-0.552).We also found the trend that the 5-year OS was higher in patients without LNM than them with LNM, even though there was no significant difference(patients without LNM 96.1% vs patients with LNM 70.0%, P=0.086, 95% CI 0.039-1.238).Conclusions 1) there is a predictive value of low grade and deep myometrium invasion for EC patients with LNM.2)Patients with LNM have poorer prognosis than them without LNM.Therefore, patients with LNM should receive adjuvant therapy to reduce the risk of recurrence.

Objective To study the clinical features,treatment and prognosis of struma ovarii.Methods From January 1990 to January 2012,a total of 68 patients were diagnosed struma ovarii at the Department of Obstetrics and Gynecology,Peking Union Medical College Hospital.Clinical data of these patients were studied retrospectively.Results (1) Characteristics of patients:the median age of patients was 42 years old (17-81 years).Of those patients,64 cases (94％) were diagnosed begin struma ovarii and 4(6％) were malignant struma ovarii.(2) Clinical feature:32(47％,32/68) patients were identified with pelvic mass by ultrasonic test,28 cases(41％) had clinical abdominal pain,8(12％) touched a mass from abdominal wall.Preoperative CA125 were tested in 54 patients,but only 8 cases(15％) had moderate elevation.All patients receive ultrasound examination,and 51 cases (75％) were mulitcystic lesions with many septi,3(4％) solid lesions and 14(21％) solid-cystic tumors.The mean diameter of tumors was(8 ± 3) cm.Ascites was present in 4 (6％,4/68)patients.Sixty-seven patients had unilateral lesions,and 1 patient had bilateral lesions.No patient had hyperthyroidism presentation.Nineteen cases underwent thyroid function test after operation,and the results were normal.(3) Treatment:all patients underwent surgical treatment.Among patients with begin struma ovarii,25 cases underwent cystectomy,15 cases unilateral,2 bilateral salpingo-oophorectomy,22 cases hysterectomy + unilateral or bilateral salpingo-oophorectomy.Four malignant struma ovarii,1 patient underwent fertility-sparing staging surgery,2 patients unilateral salpingo-oophorectomy,1 case hysterectomy + bilateral salpingo-oophorectomy.Two patients received chemotherapy after surgery.(4) Prognosis:all patients were followed up in Peking Union Medical College Hospital.The median follow-up time of benign struma ovarii was 5.4 years (6 months-21 years) and there were no recurrence.The median follow-up time of malignant struma ovarii was 11.5 years (9-20 years).Three cases had long-term recurrence at 2,7 and 16 years respectively after surgery.They were received surgical treatment after recurrence and all were alive.Two cases were given by thyroidectomy and 131I treatment.Conclusions Struma ovarii is a rare ovarian monodermal teratoma.Tumorectomy or salpingo-oophorectomy is the appropriate therapeutic treatment for benign struma ovarii.The incidence of malignant struma ovarii is low,and there are no standard treatments.Because of higher long-term recurrence rate,these patients need close follow-up.

Objective To evaluate the current status and outcomes of pelvic exenteration (PE) for recurrent cervical cancer.Methods The following electronic databases has been searched on recurrent cervical cancer management and treatment:Chinese Biological Medicine Disk (CBM),PubMed and Cochrane library.All retrieved studies had to fulfill the following inclusion criteria:cohort studies of recurrent cervical cancer,containing information of detailed patient and operation characteristics as well as the survival rate.Only publications in the English literature were included.All eligible literatures between Jan.1990 and Aug.2013 were assessed for quality.Relevant basic characteristics,complications,survival rate and prognostic factors were reviewed.Results There were eight trials involving 607 patients with cervical cancer received PE,including 515 cases with recurrent disease and 92 cases with primary disease.Four hundred and ninety patients had received total pelvic exenteration (TPE) operation,103 underwent anterior pelvic exenteration(APE) and 14 received posterior pelvic exenteration(PPE).The 5-year overall survival rate for recurrent cervical cancer fluctuate from 26.7％ to 56.0％.Complication rates were from 34.3％ to 83.3％ and the mortality rate was 1.2％ (7/607).Among the relevant factors affecting survival time,resection margin status seemed to be the most important.Conclusion Based on this systematic review,PE does help improve the survival of recurrent cervical cancer patients on the basis of strict selection of candidates.