Objective:To evaluate the short-term efficacy of dual biologics combination therapy in the treatment of refractory Crohn′s disease (CD) .Methods:The clinical features, diagnosis and treatment of 5 cases of refractory CD treated with biologics dual-target therapy in the Seventh Medical Center of Chinese PLA General Hospital between January 26, 2020 and August 15, 2021 were retrospectively analyzed. The relevant literatures were reviewed and summarized by searching the articles on biologics dual-target therapy published in MEDLINE, EMBASE and Cochrane Library until August 2021.Results:Five patients with refractory CD were all male, aged 40.8 (23.0, 56.0) years, with disease course of 10.4 (6.0, 17.0) years, including 2 patients treated with infliximab (IFX) in combination with ustekinumab (UST) . Two patients treated with IFX in combination with vedolizumab (VDZ) and 1 patient treated with UST in combination with VDZ. Laboratory and colonoscopy examinations were performed 14 weeks after combination therapy in the VDZ containing group and 16 weeks after combination therapy in the VDZ free group. Results of examinations after treatment indicated that 1 case presented clinical remission, 3 cases presented clinical response and 3 cases presented endoscopic response. Combination therapy group with UST had better efficacy. None of the 5 patients had special adverse drug reactions during follow-up for six months after combined treatment. A total of 17 relevant reports were retrieved.Conclusion:Biologic dual-target therapy may be a short-term effective and safe treatment for refractory CD.

Objective:To evaluate the short-term efficacy of dual biologics combination therapy in the treatment of refractory Crohn′s disease (CD) .Methods:The clinical features, diagnosis and treatment of 5 cases of refractory CD treated with biologics dual-target therapy in the Seventh Medical Center of Chinese PLA General Hospital between January 26, 2020 and August 15, 2021 were retrospectively analyzed. The relevant literatures were reviewed and summarized by searching the articles on biologics dual-target therapy published in MEDLINE, EMBASE and Cochrane Library until August 2021.Results:Five patients with refractory CD were all male, aged 40.8 (23.0, 56.0) years, with disease course of 10.4 (6.0, 17.0) years, including 2 patients treated with infliximab (IFX) in combination with ustekinumab (UST) . Two patients treated with IFX in combination with vedolizumab (VDZ) and 1 patient treated with UST in combination with VDZ. Laboratory and colonoscopy examinations were performed 14 weeks after combination therapy in the VDZ containing group and 16 weeks after combination therapy in the VDZ free group. Results of examinations after treatment indicated that 1 case presented clinical remission, 3 cases presented clinical response and 3 cases presented endoscopic response. Combination therapy group with UST had better efficacy. None of the 5 patients had special adverse drug reactions during follow-up for six months after combined treatment. A total of 17 relevant reports were retrieved.Conclusion:Biologic dual-target therapy may be a short-term effective and safe treatment for refractory CD.

Objective To investigate the efficacy and side effect of paclitaxel liposome for neoadjuvant chemotherapy (NACT) in locally advanced cervical cancer. Methods This study were included 265 cervical cancer patients staging Ⅰb2 and Ⅱa2 who underwent paclitaxel-platinum NACT followed by radical surgery from June 2008 to December 2016 in the Cancer Hospital , Peking Union Medical College, Chinese Academy of Medical Sciences. All patients were classified into two groups with 106 patients in paclitaxel liposome group and 159 patients in traditional paclitaxel group. The difference in clinicopathologic characteristics, efficacy and side effect were analyzed retrospectively between the two groups.Results (1)Clinicopathologic characteristics: there were no significant difference in clinicopathologic characteristics between the two groups, including age, body mass index, clinical stage, pathological histology, cycles of NACT, combined platinum regimen, lymph-vascular space invasion, lymph node metastasis, deep stromal invasion, and postoperative adjuvant therapy (all P＞0.05). (2) Efficacy: after NACT, the overall response occurred in 90 (15 complete response plus 75 partial response) of 106 cases in the paclitaxel liposome group versus 131 (21 complete response plus 110 partial response) of 159 cases in the traditional paclitaxel group without statistical significance (84.9% vs 82.4%; χ2=0.291, P=0.590). A total of 248 patients received surgery after NACT and were evaluable in survival. The 5-year recurrence-free survival (RFS) rate and 5-year overall survival (OS) rate of these patients was 85.1% and 88.2%. The 5-year RFS rate in the paclitaxel liposome group was 85.9% compared with 85.2% in the traditional paclitaxel group, while the corresponding 5-year OS rate was 88.5% and 88.7%, respectively. There was no statistically significant difference in efficacy between the two groups (P=0.968, P=0.797). (3) Side effect: the incidence of allergic reaction between the paclitaxel liposome group and the traditional paclitaxel group was 0 versus 1.9% (3/159) without statistical significance (P=0.277). But the incidence of neurotoxicity in the paclitaxel liposome group significantly decreased compared with the traditional paclitaxel group (6.6% vs 15.7%, P＜0.05), as well as the incidence of alopecia (67.9% vs 79.2%, P＜0.05) and myalgia (17.9% vs 28.9%, P＜0.05). However, significant differences were not found in terms of hematological toxicity, gastrointestinal reaction, and hepatic function damage (P＞0.05). Conclusion In paclitaxel-platinum NACT of local advanced cervical cancer, paclitaxel liposome can achieve similar efficacy compared with traditional paclitaxel, but paclitaxel liposome is helpful in decreasing the toxicity of neurotoxicity, alopecia and myalgia.

Objective: To investigate the efficacy and side effect of paclitaxel liposome for neoadjuvant chemotherapy (NACT) in locally advanced cervical cancer. Methods: This study were included 265 cervical cancer patients staging Ⅰb2 and Ⅱa2 who underwent paclitaxel-platinum NACT followed by radical surgery from June 2008 to December 2016 in the Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences. All patients were classified into two groups with 106 patients in paclitaxel liposome group and 159 patients in traditional paclitaxel group. The difference in clinicopathologic characteristics, efficacy and side effect were analyzed retrospectively between the two groups. Results: (1) Clinicopathologic characteristics: there were no significant difference in clinicopathologic characteristics between the two groups, including age, body mass index, clinical stage, pathological histology, cycles of NACT, combined platinum regimen, lymph-vascular space invasion, lymph node metastasis, deep stromal invasion, and postoperative adjuvant therapy (all P>0.05). (2) Efficacy: after NACT, the overall response occurred in 90 (15 complete response plus 75 partial response) of 106 cases in the paclitaxel liposome group versus 131 (21 complete response plus 110 partial response) of 159 cases in the traditional paclitaxel group without statistical significance (84.9% vs 82.4%; χ²=0.291, P=0.590). A total of 248 patients received surgery after NACT and were evaluable in survival. The 5-year recurrence-free survival (RFS) rate and 5-year overall survival (OS) rate of these patients was 85.1% and 88.2%. The 5-year RFS rate in the paclitaxel liposome group was 85.9% compared with 85.2% in the traditional paclitaxel group, while the corresponding 5-year OS rate was 88.5% and 88.7%, respectively. There was no statistically significant difference in efficacy between the two groups (P=0.968, P=0.797). (3) Side effect: the incidence of allergic reaction between the paclitaxel liposome group and the traditional paclitaxel group was 0 versus 1.9% (3/159) without statistical significance (P=0.277). But the incidence of neurotoxicity in the paclitaxel liposome group significantly decreased compared with the traditional paclitaxel group (6.6% vs 15.7%, P<0.05), as well as the incidence of alopecia (67.9% vs 79.2%, P<0.05) and myalgia (17.9% vs 28.9%, P<0.05). However, significant differences were not found in terms of hematological toxicity, gastrointestinal reaction, and hepatic function damage (P>0.05). Conclusion In paclitaxel-platinum NACT of local advanced cervical cancer, paclitaxel liposome can achieve similar efficacy compared with traditional paclitaxel, but paclitaxel liposome is helpful in decreasing the toxicity of neurotoxicity, alopecia and myalgia.

Objective: To investigate the clinicopathological features and risk factors in patients with mucinous borderline ovarian tumors (MBOT). Methods: From 1999 to 2006, 66 MBOT patients in our hospital with more than ten-year follow-up were enrolled retrospectively. They were re-classified according to the literature. The clinicopathological features of different subgroups, including age, preoperative serum tumor markers, surgical methods, pathological features, surgical pathology staging, as well as the risk factors of recurrence and survival were analyzed. Results: Median age was 39 years in 66 patients. Before the surgery, 33.3% (20/60) patients had elevated CA125 and 51.7% (30/58) had elevated CA199. The accurate rate for fast frozen pathology of resected specimen was 73.4%. 21 patients underwent conservative surgery and 45 patients underwent extensive surgery. 57 patients underwent comprehensive operation and 43 cases (75.4%) resulted in stage Ⅰ. 48 of the 66 patients (72.7%) had intestinal-type tumors (IMBT) and 18 patients (27.3%) had endocervical-like tumors (EMBT). The median follow-up was 150 months. Eight recurrences (12.1%) were identified. The mean time between surgery to the initial recurrence was 26.4 months (13 to 50 months). Recurrence rate of IMBT was higher than that of EMBT (14.6% versus 5.6%) with no significance (P>0.05). All patients with pseudomyxoma had disease recurrence. Recurrence rate of stage Ⅲ patients was significantly higher than that of stage Ⅰ patients (33.3% versus 9.3%, P<0.05). During the follow-up period, tumor-related death occurred in 2 cases with a 10-year survival rate of 95.4%. Kaplan-Meier method and Log Rank analysis showed that clinical staging and peritonealmyxoma were adverse prognostic factors (P<0.05). Although the recurrence rate of patients undergoing conservative surgery was higher than that of patients with extensive surgery (23.8% versus 6.7%, P=0.047), the overall survival was almost the same between these two groups (P>0.05). Conclusions MBOT patients have relatively good prognosis. IMBT are more common than EMBT subtypes, but recurrence rate and patient survival were almost the same between these two groups. Patients with pseudomyxoma was more likely to have disease recurrence. Patients who underwent conservative surgery resulted in higher recurrence rate but did not affect the overall survival of patient. Pseudomyxoma and clinical staging were adverse prognostic factors in MBOT patients.

Objective To investigate the survival and recurrence data after treatment in neuroendocrine carcinoma of the uterine cervix(NECUC)with stageⅠb-Ⅱa, and to analyse its prognostic factors. Methods Thirty-two cases of primary NECUC in early-stage disease treated from Jan. 2005 to Dec. 2013 at Cancer Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences were reviewed, and their data of clinicopathologic characteristics were collected and analysed. The median age was 37 years (range, 23-57 years). The distribution by International Federation of Gynecology and Obstetrics (FIGO) clinical stage:19 cases stageⅠb1, 10 cases stageⅠb2, 1 case stageⅡa1, 2 cases stageⅡa2. Pathologic types: 22 cases of small cell carcinoma, 1 case of atypical carcinoid, 9 cases of mixed carcinoma. The diameter of cervical tumor:12 cases≥4 cm, 20 cases<4 cm. All patients underwent radical hysterectomy and pelvic ± para-aortic lymphadenectomy, and 15 cases of them were preserved unilateral or bilateral ovaries. Pathologic examination showed that 25 cases with cervical deep stromal invasion thickness ≥1/2, 21 cases with lymph-vascular space invasion (LVSI), and 18 cases with pelvic and (or) para-aortic lymph nodes involvement. Ten cases were performed neoadjuvant chemotherapy (range,1-3 cycles), all patients received postoperative chemotherapy (range,3-6 cycles), and 15 patients were treated with radiotherapy after surgery. The follow-up data were updated on Jul. 2014. The median follow-up time was 18 months (range, 7-71 months). A retrospective analysis was conducted to analyse the survival and recurrence data,and to explore the prognostic factors of NECUC. Results Thirteen patients died during the follow-up period. The cumulative progression-free survival (PFS) of 2 and 5 years were respectively 54.2%and 38.1%, and the estimated median PFS was 29 months. The cumulative overall survival (OS) of 2 and 5 years were respectively 56.1%and 44.9%, and the estimated median OS was 31 months. Fourteen cases had recurrence, and the median recurrence time was 9 months (range, 3-30 months). Recurrent or metastatic sites:2 cases in pelvis, 4 cases in liver, 3 cases in lung, 3 cases in adrenal glands, 3 cases in bones, 2 cases in brain, 1 case in pancreas, 1 case in lymph nodes of para-aorta and neck, and 3 cases had metastasis in two or more organs. Thirteen cases with recurrence died of disease, and another one is alive with disease. The univariate analysis showed that lesion size of the cervix and FIGO stage were significant prognostic factors (P<0.01), while age, tumor components, deep invasion in cervical stromal, LVSI, pelvic and (or) para-aortic lymph nodes involvement, neoadjuvant chemotherapy, adjuvant radiotherapy and preserving ovaries were not significantly associated with prognosis(all P>0.05). Conclusion The prognosis of NECUC in early-stage is poor and the lesion size of the cervix and FIGO stage are prognostic factors.

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 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.

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.