Objective : To examine the association between dietary patterns during pregnancy and gestational diabetes mellitus (GDM), so as to provide the evidence for guiding the establishment of healthy and balanced dietary patterns and reducing the prevalence of GDM. Methods: Pregnant women who underwent oral glucose tolerance tests in Hangzhou Obstetrics and Gynecological Hospital from 2020 to 2021 were enrolled, and their demographic information were collected using questionnaires. Pregnant women's diets during the past three months were collected using Food Frequency Questionnaires (FFQs), and dietary patterns were extracted using principal component analysis. In addition, the association between dietary patterns and risk of GDM was examined using a multivariable logistic regression model. Results: A total of 1 689 pregnant women were included, with a median age of 28.53 (interquartile range, 2.47) years and a median gestational age of 26.00 (interquartile range, 2.00) weeks. Five dietary patterns were identified according to pregnant women's types of diets, including meat-based diets, dessert-fruit-refined grain diets, plant-based diets, eggs-milk-nut diets and whole-grain diets, with a cumulative contribution rate of 58.76%. The prevalence of GDM was 24.57% (415 cases) among the study subjects. Multivariable logistic regression analysis showed that pregnant women with scores in the highest quartile (Q4) of the meat-based diets had an increased risk of GDM (OR=1.372, 95%CI: 1.043-2.055) relative to those with scores in the lowest quartile (Q1), and pregnant women with Q4 scores of the dessert-fruit-refined grain diets had an increased risk of GDM (OR=1.743, 95%CI: 1.397-2.432) relative to those with Q1 scores, while pregnant women with Q4 scores of the plant-based diets had a reduced risk of GDM (OR=0.382, 95%CI: 0.346-0.613) relative to those with Q1 scores. Conclusion A plant-based dietary pattern may reduce the risk of GDM, while meat-based and dessert-fruit-refined grain dietary patterns may increase the risk of GDM.

Objective To explore the effects and postoperative prognostic factors in cervical cancer patients received neoadjuvant chemotherapy combined with surgery and post-operative adjuvant therapy. Methods A total of 177 patients with cervical cancer at International Federation of Gynecology and Obstetrics (FIGO) stageⅠb2, Ⅱa2 who underwent neoadjuvant chemotherapy (NACT) followed by surgery with and without adjuvant therapy in Cancer Hospital, Chinese Academy of Medical Sciences were included. Univariate and multivariate analyses of 5-year overall survival (OS) rate and 5-year disease-free survival (DFS) rate were performed. Results Of 177 patients, 133 (75.1%) had stageⅠb2 and 44 (24.9%) hadⅡa2 cancers. After NACT,overall response rate was 63.3% (112/177) including 12 cases of complete response (CR), 100 of partial response (PR) and no progressive disease (PD) case. At a median follow-up of 59.2 months, the 5-year DFS rate was 73.6% and the 5-year OS rate was 86.8%. Univariate analysis revealed that lymph node metastasis, deep stromal invasion and tumor size after NACT significantly affected 5-year DFS rate (P<0.05). Lymph node metastasis, deep stromal invasion and tumor size after NACT significantly affected 5-year OS rate (P<0.05). The multivariate analysis showed that, stromal invasion (outer 1/3 or outer 1/2) was independent risk factor of 5-year DFS rate (P<0.05), and 5-year OS rate was significantly affected by tumor size >3 cm after NACT (P<0.05). Conclusions The effect of NACT in Ⅰb2, Ⅱa2 squamous carcinoma of the uterined cervix is confirmed. The independent risk factor for 5-year DFS rate in patients received NACT and hysterectomy is deep stromal invasion of the cervix. The presence of tumor size>3 cm after NACT adversely affect 5-year OS rate.

Objective: To explore the effects and postoperative prognostic factors in cervical cancer patients received neoadjuvant chemotherapy combined with surgery and post-operative adjuvant therapy. Methods: A total of 177 patients with cervical cancer at International Federation of Gynecology and Obstetrics (FIGO) stage Ⅰ b2, Ⅱ a2 who underwent neoadjuvant chemotherapy (NACT) followed by surgery with and without adjuvant therapy in Cancer Hospital, Chinese Academy of Medical Sciences were included. Univariate and multivariate analyses of 5-year overall survival (OS) rate and 5-year disease-free survival (DFS) rate were performed. Results: Of 177 patients, 133 (75.1%) had stage Ⅰb2 and 44 (24.9%) had Ⅱa2 cancers. After NACT, overall response rate was 63.3% (112/177) including 12 cases of complete response (CR), 100 of partial response (PR) and no progressive disease (PD) case. At a median follow-up of 59.2 months, the 5-year DFS rate was 73.6% and the 5-year OS rate was 86.8%. Univariate analysis revealed that lymph node metastasis, deep stromal invasion and tumor size after NACT significantly affected 5-year DFS rate (P<0.05). Lymph node metastasis, deep stromal invasion and tumor size after NACT significantly affected 5-year OS rate (P<0.05). The multivariate analysis showed that, stromal invasion (outer 1/3 or outer 1/2) was independent risk factor of 5-year DFS rate (P<0.05), and 5-year OS rate was significantly affected by tumor size >3 cm after NACT (P<0.05). Conclusions The effect of NACT in Ⅰ b2, Ⅱ a2 squamous carcinoma of the uterined cervix is confirmed. The independent risk factor for 5-year DFS rate in patients received NACT and hysterectomy is deep stromal invasion of the cervix. The presence of tumor size >3 cm after NACT adversely affect 5-year OS rate.

Objective: The correlation between dosimetric parameters of transposed ovary and different clinical ovarian functional status was assessed in young patients with cervical cancer who needed adjuvant radiotherapy after radical resection of the Ⅰ_B1-Ⅱ_A2 phase of preserved and transposed ovaries. Methods: The function of transposed ovary and relevant clinical symptoms in 86 patients before and 2 years after treatment between 2015 and 2017 were retrospectively analyzed, and the correlation between the dosimetric parameters and functional status of transposed ovaries during radiotherapy was evaluated. Different in vitro measures were adopted to protect the transposed ovaries during postoperative radiotherapy including 68 cases of IMRT or VMAT and 18 cases of two-dimensional and other central radiotherapy. Results: The nearest distance between ovary and PTV was negatively correlated with the ovarian dose ≥V_{5 Gy} (P=0.025). V₈ Gy and D_mean were positively correlated with FSH after treatment (P=0.011, 0.020). The larger the volume of V_{8 Gy} and the large D_mean, the higher the FSH, the worse the ovarian function. In two-dimensional technology, the ovarian dose ≥V_{5 Gy} was significantly lower than that in three-dimensional technique. The average age of those with normal ovarian function after treatment was 33.4 years, whereas the average age of women with ovarian failure was 39.6 years (P=0.007). The number of preserved ovaries and whether synchronous chemotherapy was delivered were similar in patients with different ovarian status, which were correlated with the levels of FSH and E2 (Estradiol) before treatment, that is, the higher the level of FSH before treatment, the lower the E2 of ovarian FSH after treatment, and the higher the level of FSH after treatment, the lower the level of ovarian E2. Patients who retained their ovaries before treatment but suffered from ovarian failure received neoadjuvant chemotherapy with a slightly higher age. Conclusions Age, V_{8 Gy} and D_mean of the transposed ovary, the shortest distance between transposed ovary and PTV, whether neoadjuvant chemotherapy was delivered before surgery and radiotherapy technique affect the protection of the function of transposed ovary.

Objective To investigate the prevalence of high-risk HPV subtypes in different pathological types of cervical cancer, and analyze the attribution of carcinogenic HPV subtypes in different pathological types. Methods A total of 1 541 patients with cervical cancer were treated between February 2009 and October 2016 in Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. The median age at diagnosis was 49 years (ranged 20-82 years old). The numbers of patients with cervical cancer from North China, Northeast China, East China, Central China and other regions (including Northwest, Southwest and South China) were 961, 244, 175, 87 and 74 cases, respectively. Pathological types: 1 337 cases of squamous cell carcinoma (SCC), 87 usual adenocarcinoma (ADC), 23 adenosquamous carcinoma (ASC), 20 mucinous carcinoma (MC), 19 clear cell carcinoma (CCC), 12 endometrioid carcinoma (EC), 25 neuroendocrine carcinoma (NEC), 9 serous carcinoma (SC), 5 villous adenocarcinoma (VADC) and 4 minimal deviation adenocarcinoma (MDAC). The prevalence of high-risk HPV in different regions, age groups at diagnosis and pathological types in cervical cancer were analyzed. The attribution of 13 high-risk HPV subtypes in different pathological types of cervical cancer based on proportional attribution method, and the attribution of high-risk HPV subtypes prevented by 9-valent HPV vaccine in SCC and ADC were calculated. Results (1) The prevalence of high-risk HPV in 1 541 patients with cervical cancer was 86.6% (1 335/1 541). The multiple high-risk HPV infection rate in patients with SCC ≥60 years old (23.0%, 37/161) was significantly higher than those in patients aged 45-59 years old and≤44 years old [11.4% (85/747) vs 11.7% (50/429), P<0.01], and the high-risk HPV infection rates of patients with cervical cancer in North China, Northeast China, East China, Central China and other regions were respectively 86.8% (834/961), 87.7% (214/244), 83.4% (146/175), 83.9% (73/87) and 91.9% (68/74). SCC (86.8%, 1 337/1 541) and ADC (5.6%, 87/1 541) were the most common pathological types in cervical cancer. The high-risk HPV prevalence of SCC, ADC, ASC, MC, NEC and VADC were 90.1% (1 205/1 337), 74.7% (65/87), 87.0% (20/23), 65.0% (13/20), 72.0% (18/25) and 5/5 respectively. The high-risk HPV infection rates of SC, EC, CCC and MDAC were 4/9, 3/12, 2/19 and 0/4 respectively. (2) According to proportional attribution, HPV 16 (69.5%), HPV 18 (5.6%), HPV 58 (2.2%), HPV 31 (1.9%), HPV 52 (1.4%) and HPV 33 (1.3%) were the six common high-risk HPV subtypes in SCC. While, HPV 18 (44.1%), HPV 16 (20.5%), HPV 52 (2.3%), HPV 58 (1.2%) and HPV 51 (1.2%) were the main carcinogenic subtypes in ADC. The main carcinogenic high-risk HPV subtypes of ASC, NEC and MC were HPV 18 and HPV 16. The total attribution of HPV 16, 18, 31, 33, 45, 52 and 58 prevented by 9-valent HPV vaccine in SCC and ADC were 82.6% and 68.1% respectively; the attribution of HPV 45 in SCC and ADC were only 0.8% and 0. Conclusions SCC and ADC are the main pathological types in cervical cancer. SCC, ADC, ASC, MC, NEC and VADC are closely related to high-risk HPV infection. HPV 16 is the main carcinogenic genotypes of SCC. HPV 18 maybe play an important role in the pathogenesis of ADC.

Objective To analyze the prognosis and appropriate treatment modalities of the patients with recurrence of early stage (Ⅰb-Ⅱa) cervical squamous cancer primarily treated with radical hysterectomy. Methods This retrospective study included patients with International Federation of Gynecology and Obstetrics (FIGO) stage Ⅰb and Ⅱa recurrent cervical squamous cancer who underwent radical hysterectomy primarily from January 2007 to July 2015. Kaplan-Meier method and Cox regression analysis were performed to analyze related prognostic factors of overall survival and progression-free survival, which included age, postoperative therapy, the site of recurrence, therapy-free interval (TFI) and treatment modality. The patients who were treated with palliative chemotherapy after recurrence were selected as a subgroup. The responses of palliative chemotherapy were evaluated and analyzed among different factors, included TFI, the site of recurrence and chemotherapy regime. Results Of the 2 071 patients, 116 relapsedⅠb-Ⅱa cervical squamous cancer were included in the study with the average age of (45.6±7.2) years old. 3-year progression-free survival rate and 3-year overall survival rate after recurrence were 30.2% and 42.2%, respectively. Univariate analysis implied that postoperative radiotherapy, recurrence site, TFI and treatment modality were associated with progression-free survival (P<0.05), while postoperative radiotherapy, TFI and treatment modality with overall survival (P<0.05). Multivariate analysis showed that TFI and treatment modality were independent prognostic factors for progression-free survival (P<0.05), while postoperative radiotherapy at initial treatment, TFI and treatment modality were independent prognostic variables for overall survival (P<0.05). In the analysis of treatment modality, 3-year progression-free survival rate and 3-year overall survival rate of 47 patients who were treated with definitive local therapy were significantly higher than that of 69 patients who were treated with palliative chemotherapy (P<0.01). In the subgroup analysis of palliative chemotherapy, 15 patients achieved complete response (21.7%) and 16 displayed partial response (23.2%). The overall response rate (ORR) was 44.9%. TFI (P<0.01) and chemotherapy regime (P<0.05) were significant factors associated with ORR. The ORR of TFI≥12 months was significantly higher than that of TFI <12 months. Besides, the ORR of paclitaxel plus platinum chemotherapy was prominently higher than that of other regimens, while there was no significant difference between the ORR of paclitaxel plus cisplatin and other platinum (P=0.408). Conclusions For recurrent stageⅠb-Ⅱa cervical squamous carcinoma treated with radical hysterectomy, use of definitive local therapy for suitable patients is advised to achieve better prognosis. In terms of palliative chemotherapy, longer TFI may mean better ORR and the combination of paclitaxel plus platinum is preferred.

Objective To investigate the relationship between the channel design of tandem-andovoid (T&O) applicator and the doses to organs at risk (OARs) and target volume in three-dimensional brachytherapy for advanced cervical carcinoma.Methods The data on 15 patients with advanced cervical carcinoma treated with three-dimensional brachytherapy in our hospital from 2015 to 2016 were collected,and 30 randomly selected high-dose-rate titanium T&O plans were retrospectively studied.CT-guided,conformal brachytherapy plans were generated.To simulate T&O applicator,the tandem applicator was virtually compared with the T&O plans with the target volume and OARs remaining unchanged.The DVH parameters of the rectum,bladder,and sigmoid were compared using the paired t test.Results For T&O plans and tandem applicator plans,the mean D2cc of the rectum was 387.8±96.8 cGy and 340.8±88.1 cGy,respectively;the mean D2cc of the bladder was 443.2± 87.5 cGy and 719.4± 243.0 cGy,respectively;the mean D2cc of the sigmoid was 330.3±88.8 cGy and 383.1±105.6 cGy,respectively.In the T&O plans,the doses to the rectum,bladder,and sigmoid were within the limits (rectum:D2cc ≤ 500 cGy;bladder:D2cc ≤ 550 cGy;sigmoid:D2c ≤ 500 cGy),while D2cc of the bladder and sigmoid was higher or partially higher than the limits.T&O plans showed a significant reduction in bladder D2cc and sigmoid D2cc compared with the tandem applicator plans (all P＜0.05).Conclusions Compared with tandem applicator plans,plans using T&O applicator provide significant sparing of bladder and sigmoid tissues in three-dimensional brachytherapy for cervical carcinoma,but the toxicities require further investigation.

Objective To assess the clinical value of HPV genotyping in follow-up after treatment for cervical high grade squamous intraepithelial lesion (HSIL). Methods Two hundred and thirty eight patients with HSIL receiving conization in Cancer Hospital, Chinese Academy of Medical Sciences from Dec, 2006 to Jan, 2009 were accrued in our study. All the patients were prospectively observed after conization every 6 months for 3 times or till histologically confirmed recurrence. The items in every visit included pelvic examination, cervical cytology and HPV genotyping. Twenty-one HPV genotypes were detected by PCR-hybridization method. The last follow-up was July 31, 2010, and the median follow-up time was 28.3 months (range 6.5-43.0 months). Kaplan-Meire method as used for analyzed the median recurrent time, and the relationships between HPV status and recurrent disease were calculated by and log-rank test and Cox-regression model. Results Among the 238 patients, 110 cases (46.2%, 110/238) had positive result of HPV DNA testing at any visit. The most common HPV types detected in follow-up were HPV16 (45.6%), HPV58 (26.5%), and HPV52 (16.9%). There was no correlation between recurrent disease and any individual high risk HPV infections (P>0.05). Seventeen recurrent cases (7.1%) were identified in 238 patients within a median recurrent time of 14.9 months (range 6.0-32.1 months). In univariate analyses, HPV positive at any visit, persistent infection, multiple infection, type specific persistent infection and positive HPV at 18 months after conization were indicators for residual/recurrent disease (P<0.05). In multivariate analysis, only multiple HPV infection (HR=8.6, 95%CI:1.8-41.7, P=0.008) and type specific persistent HPV infection (HR=5.1, 95%CI: 1.0-24.8, P=0.042) had an elevated risk of recurrent disease. Conclusions HSIL with multiple HPV infection and type specific persistent HPV infection in follow-up are at high risk of recurrent disease. Patients with HPV turning into negative within 18 months after treatment have a low risk of recurrence.

Objective To evaluate the outcomes and the prognostic factors for advanced squamous cervical cancer after concurrent chemoradiotherapy (CCRT).Methods Totally 172 patients with International Federation of Gynecology and Obstetrics stage Ⅱ b-Ⅳ who were treated in Cancer Hospital,Chinese Academy of Medical Sciences between January 2007 and December 2008 were retrospectively analyzed.Patients were received external radiotherapy,high-dose rate brachytherapy and cisplatin-based chemotherapy concurrently.Results The median follow-up period was 54.5 months.The 2-year and 5-year overall survival (OS) were separately 81.5％ and 68.8％.The 2-year and 5-year progress-free survival (PFS) were separately 69.2％ and 63.1％.Using univariate analysis followed with multivariate analysis,the results showed that these clinicopathological factors including stage (Ⅲ and above versus Ⅱ b; P =0.021,HR =1.95 ; P =0.020,HR =1.86),maximum diameter of local tumor size (＞4 versus ≤4 cm; P =0.009,HR =2.55 ; P =0.033,HR =1.94),squamous cell carcinoma antigen (SCC) level before treatment (＞3 versus ≤3 μg/L; P =0.010,HR =2.47; P =0.013,HR =2.09) and retroperitoneal lymph node status on imaging (para-aortic lymph node positive versus negative,P =0.009,HR =3.00,P=0.010,HR =2.74; pelvic lymph node positive only versus negative,P =0.044,HR =1.98,P =0.033,HR =1.92) had the significant effect on OS and PFS.Patients with no above adverse prognostic factor were assigned to Group A (n =18),those with one factor were assigned to Group B (n =43),and those with no less than two factors were assigned to Group C (n =1 11).Among three groups,the 2-year OS were separately 94.1％,97.7％ and 73.1％,the 5-year OS were separately 81.4％,90.1％ and 58.6％,the 2-year PFS were separately 88.2％,90.4％ and 57.9％,the 5-year PFS were 82.4％,87.9％ and 50.0％.The results showed that group C was significant difference from Group A or B in OS and PFS (all P ＜ 0.05),while Group A had no significant difference from Group B in OS and PFS (P ＞ 0.05).Conclusions Stage Ⅲ or above,maximum diameter of local tumor size ＞ 4 cm,SCC level ＞ 3 μg/L before treatment and positive retroperitoneal lymph nodes on imaging are four independent adverse factors for prognosis of squamous cervical cancer of advanced stage after CCRT.The treatment of patients with no less than two adverse factors should be considered to be improved.

Objective To investigate the relationship between dose-volume histogram (DVH) parameters and the late side effects (LSE) of the rectum in external-beam radiotherapy combined with computed tomography (CT)-based brachytherapy for locally advanced cervical cancer.Methods From 2008 to 2011,18 patients with stage ⅡB-ⅢB cervical cancer received external-beam radiotherapy and CTbased brachytherapy.The DVH parameters of high-risk clinical target volume (HR CTV) D90,point A dose,and D1 cm3 and D2 cm3 of the rectum and bladder were calculated by Oncentra HDR treatment planning system.Survival outcomes were followed up and rectal LSE were evaluated by RTOG/EORTC grades.Results The point A dose and HR CTV D90 were (93.0 ± 5.5) Gy and (73.6 ± 11.9) Gy,respectively.The median follow-up was 26 months.No recurrence was found during follow-up.Eight patients had mild and moderate rectal LSE,and their rectum D2 cm3 and D1 cm3 were significantly higher than those of patients without mild and moderate rectal LSE (D2 cm3:(87.4 ± 3.8) Gy vs.(75.8 ± 7.4) Gy,P =0.004 ; D1 cm3:(96.4±6.6) Gy vs.(80.5± 7.1) Gy,P=0.001).Conclusions HR CTV D90 in CT-based brachytherapy for locally advanced cervical cancer might be lower than that in the MRI-based plan.Rectum D2 cm3 is recommended to be less than 75 Gy.