2016 Vol. 7, No. 4

Display Method:
Ovarian Aging Column
Abstract:
  Objective  To explore the impact of menstrual status on musculoskeletal pain in healthy women.  Methods  A total of 697 generally healthy women aged 35 to 64 years were recruited from a community in Beijing. Data were collected by face-to-face interview with a questionnaire including social and demographic features, menstrual status, frequency of musculoskeletal pain (rarely, occasionally, or frequently) during the last two weeks at neck, lower back, knee, and other parts of the body. Frequent pain was considered severe and its potential relevant factors were analyzed.  Results  In all the subjects, 33.4% complained of frequent lower back pain, 31.0% frequent knee pain, 29.7% frequent neck pain, and 25.6% pain at other parts. The prevalence of musculoskeletal pain was higher in postmenopausal women than in premenopausal women(P < 0.01); early postmenopausal women had most frequent musculoskeletal pain, while the frequency declined in late postmenopausal period. The prevalence of neck pain and lower back pain increased during the menopausal transition period and was not associated with age. The prevalence of knee pain increased with body mass index(BMI) and age (OR=1.085, 1.050). Overweight and obesity were risk factors for knee pain in women. Logistic regression analysis showed that the odds ratio of knee pain increased in obese women(BMI ≥ 28 kg/m2) compared with women with normal BMI(< 24 kg/m2)(OR=2.256).  Conclusions  Menopause may be an important factor for musculoskeletal pain in women, the association of musculoskeletal pain with age and BMI also should be considered.
Original Contributions
Abstract:
  Objective  To explore the effect of lower uterine segment involvement (LUSI) in predicting the prognosis of stage Ⅰ endometrial carcinoma patients treated with postoperative radiotherapy.  Methods  The data of a total of 265 patients with stage Ⅰ endometrial carcinoma treated with hysterectomy and adjuvant radiotherapy between January 1999 and December 2012 were retrospectively analyzed. The median age of the cohort was 53 years. The most common pathological type was endometrioid adenocarcinoma (226/265, 85.3%). The patients were divided into two groups according to the presence of LUSI:LUSI group and non-LUSI group. The prognostic factors and treatment outcomes were compared between the two groups, subgroup analysis was conducted in the high-risk and high-intermediate-risk patients in the two groups. Primary outcomes were overall survival (OS), progression-free survival (PFS), loco-regional recurrence (LR), distant metastasis (DM), and treatment failure (TF). The survival rates were calculated using the Kaplan-Meier method. The survival rates between different groups were compared using the Log-rank test. Prognostic factors for survival were analyzed using a Cox proportional hazards regression model.  Results  The 5-year OS and PFS for all the patients were 92.8% and 89.7%, respectively; the 5-year LR, DM, and TF were 4.5%, 6.4%, and 7.8%, respectively. Univariate analysis revealed that LUSI was a significant predictor of OS and PFS (P=0.015, 0.035). Cox proportional hazard model demonstrated a significantly decreased OS and PFS in the LUSI group compared with the non-LUSI group(P=0.041, RR=0.346, 95% CI:0.125-0.959; P=0.041, RR=0.411, 95% CI:0.175-0.963). Subgroup univariate analysis showed that for high-risk and high-intermediate-risk patients, LUSI was a significant predictor of TF (P=0.034).  Conclusions  LUSI may be a significant predictor of reduced OS and PFS in patients with stage Ⅰ endometrial carcinoma treated with adjuvant radiotherapy. In addition, LUSI may be associated with treatment failure in high-risk and high-intermediate-risk patients.
Abstract:
  Objective  To investigate the application of laparoscopy and/or hysteroscopy in differential diagnosis and treatment of suspected gestational trophoblastic neoplasia (GTN), and its potential impact on outcome.  Methods  From January 2005 to December 2013, 160 patients with a suspected diagnosis of GTN were admitted to Peking Union Medical College Hospital and underwent laparoscopy and/or hysteroscopy for it. The clinical data, diagnosis, and outcome of these patients were retrospectively analyzed.  Results  Among the 160 eligible patients, 26 were confirmed with GTN, including choriocarcinoma in 15 cases, invasive mole in 6 cases, and placental site trophoblastic tumor (PSTT) in 5 cases. The diagnosis of GTN was ruled out in the other 134 cases, including intrauterine gestational residues in 106 (51 cases of incomplete abortion, 52 cases of residues of cornual pregnancy, 2 cases of placental remnants, 1 case of residual hydatidiform mole), cesarean scar pregnancyin 23, cornual pregnancy in 3, intramural pregnancy in 2. There was no significant difference in most of the clinical data between GTN patients and non-GTN patients except for the type of last pregnancy (P < 0.001). All of the GTN and the non-GTN patients achieved complete remission or cure by subsequent chemotherapy or surgical therapy except one patient lost to follow-up during the course of the treatment.  Conclusions  Laparoscopy and/or hysteroscopy could be an effective strategy to facilitate diagnosis when it is difficult to differentiate GTN from non-GTN diseases by clinical data. Furthermore, that technique would not affect the outcome for GTN patients, while for non-GTN patients they could offer effective treatment.
Abstract:
  Objective  To investigate the prevalence of hospital-acquired infection (HAI) in a hospital and its change over time, so as to better prevent and control HAI.  Methods  A cross-sectional survey on prevalence of HAI was carried out among all hospitalized patients in Peking Union Medical College Hospital on December 12, 2012, December 4, 2013, May 21, 2014, May 20, 2015, and May 11, 2016, respectively. The data related to HAI in these five years were analyzed.  Results  The prevalence rate of HAI in the five years from 2012 to 2016 was 6.67%, 6.33%, 5.66%, 5.16%, and 4.65%, respectively, appearing to be reducing over time. The intensive care unit(ICU) had the highest infection prevalence. The top infection site was lower respiratory tract, accounting for 40.88% of all the HAI; followed by urinary tract(10.81%) and surgical site(9.97%). Gram-negative bacteria were the main pathogens of HAI, accounting for 63.16%. Multidrug-resistant organisms (MDROs) accounted for 32.85% of the total detected bacteria.  Conclusions  The prevalence of HAI appears to be decreasing year by year, suggesting the effect of hospital infection management and control. ICU and lower respiratory tract infection are still the focus of HAI control. HAI control is currently faced with the threat of MDROs. Contact isolation for patients with MDROs infection is equally important as rational use of antimicrobial drugs.
Abstract:
  Objective  To analyze the clinical features and genetic mechanism of a Chinese glycogen storage disease type Ia (GSD Ia) patient.  Methods  Clinical features of the patient including medical history, physical examination and laboratory results were collected in detail. DNA was extracted from peripheral blood of the patient and his parents. Mutation analysis was performed for the five exons of glucose-6-phosphatase catalytic subunit (G6PC) gene using DNA sequencing, prediction of protein function was conducted for novel mutation.  Results  The patient was a 27-year-old male Chinese GSD with typical symptoms of hypoglycemia, hyperlactaci-demia, hyperuricemia and hyperlipidemia, and the diagnosis of GSD Ia was confirmed by liver biopsy. Missense mutations of c.248G > A (p.R83H) in the second exon and c.674T > C (p.L225P) in the fifth exon were detected in G6PC gene in this patient, which were separately carried in his mother and father, respectively. The pathogenicity of novel mutation c.674T > C(p.L225P) was supported by Polyphen2 and SIFT software analysis, which showed that the mutation might damage the function of glucose-6-phosphatase protein.  Conclusions  The compound heterozygous mutation in G6PC gene causes GSD Ia in this patient. Our findings of the novel pathogenic mutation of G6PC gene expands the spectrum of G6PC gene mutations in Chinese.
Abstract:
  Objective  To analyze the clinical characteristics, treatment, and outcomes of children with primary vaginal malignancies.  Methods  We conducted a retrospective analysis on clinical and pathological data of all children with pathologically confirmed primary vaginal malignancies treated at Peking Union Medical College Hospital between January 1980 and March 2015. The clinical characteristics, therapeutic methods, treatment effect, and outcomes of the children were summarized.  Results  Twenty-five patients (median age, 11 months; range, 8 months to 12 years) were identified, including 16 (64%) endodermal sinus tumor (EST), 7 (28%) embryonal rhabdomyosarcoma (ERMS), and 2 (8%) clear-cell adenocarcinoma (CCA). Bleeding or blood-tinged discharge was the most common clinical presentation (76%), followed by a protruding mass (24%). All patients were performed conservative surgery. Only one patient received radiotherapy. Childhood genital malignancies were generally sensitive to chemotherapy.According to the histological type and high risk factors, different chemotherapy regimens were administrated after surgery, such as PEB (cisplatin, etoposide, bleomycin), PVB (cisplatin, vincristine, bleomycin), IVA (ifosfamide, vincristine, actinomycin), or VAC (vincristine, actinomycin, cyclophosphamide). The patients were followed up for a median of 44 months (range, 6 months to 18 years). Twenty-two patients (88%) remained alive. Three patients (12%) died of disease progression (1 ERMS, and 2 CCA). Recurrence and death occurred mostly in the first two years after treatment.  Conclusions  Vaginal primary malignancies are extremely rare in children, among which EST is the most common type, followed by ERMS and CCA. EST and ERMS at the vagina are sensitive to chemotherapy, therefore the main therapeutic method is combined chemotherapy, and the prognosis is good. CCA is not sensitive to chemotherapy, thus the main therapeutic methods are surgery and radiotherapy, and the prognosis is poor. Early recognition of symptoms and early treatment is the key to improve survival.
Abstract:
  Objective  To analyze the clinical characteristics of patients with Gleason score 10 prostate cancer on core biopsy and without distant metastases when first diagnosed, and to evaluate the effectiveness of external radiotherapy combined with hormone therapy in these patients.  Methods  From January 2003 to March 2014, 9 patients were identified as Gleason score 10 prostate cancer without distant metastases when first diagnosed at Peking Union Medical College Hospital. All the patients were treated by whole pelvic external radiotherapy and long-term hormone therapy. The whole pelvic radiation dose was 50.0 Gy, the boost dose for the whole prostate, bilateral seminal vesicles, and regional positive lymph nodes ranged from 76.2 to 78.0 Gy. The hormone therapy used maximal androgen blockade, i.e. oral anti-androgen drugs plus monthly injection of luteinizing hormone-releasing hormone analogs. We assessed the clinical characteristics of the patients and the treatment outcomes of the combination therapy. Survival curves were calculated using the Kaplan-Meier method.  Results  The median follow-up was 4.8 years (26-75 months). The median pre-treatment serum prostate specific antigen (PSA) level was 11.2 μg/L. The pre-treatment PSA levels were lower than 20 μg/L in 6 patients, and higher than 70 μg/L in 3 patients. The median percentage of positive biopsy cores was 90.9%. In TNM staging, 3, 4, and 2 cases were classified as T2c, T3a, and T3b, respectively; 6 and 3 cases were classified as N0 and N1, respectively; and all the 9 cases were classified as M0. Six patients developed biochemical failure, 5 of which progressed into distant metastasis. Four patients died during the follow-up period, 3 of which died of prostate cancer. The 5-year biochemical failure-free survival (BFFS), distant metastasis-free survival (DMFS), cancer-specific survival (CSS), and overall survival (OS) were 28.6%, 57.1%, 66.7%, and 57.1%, respectively. Five patients experienced grade 1-2 acute gastrointestinal (GI) toxicity and 6 patients developed grade 1-2 acute genitourinary (GU) toxicity due to radiotherapy. No late GI or GU toxicity was reported. No bone fracture, cardiovascular event, or other severe hormone therapy-related complications was detected.  Conclusions  Gleason score 10 prostate cancer without distant metastases when first diagnosed may be often combined with high risk factors such as high percentage of positive biopsy cores, and advanced tumor stage. Timely and active comprehensive treatments including external radiotherapy and hormone therapy are usually necessary because these patients generally have unfavorable prognosis.
Abstract:
  Objective  To evaluate the effect of surgical resection of isolated metastases in patients with advanced renal cell carcinoma after targeted therapy.  Methods  Data were retrospectively collected from 126 patients with metastatic renal cell carcinoma who received targeted therapy in Peking Union Medical College Hospital between December 2007 to December 2013, of whom 16 underwent surgery for distant isolated metastases. All the patients had a confirmed pathological diagnosis of renal cell carcinoma. The targeted therapy involved taking oral drugs including Sorafenib, Sutent, or Everolimus continuously until the isolated metastases were evaluated as stable and resectable. Safety and long-term effect of surgical resection were evaluated.  Results  The 16 patients included 11 males and 5 females with a median age of 51 (37-72) years. Fourteen cases were renal clear cell carcinomas and 2 were renal papillary cell carcinomas; lung metastasis was found in 5 cases, bone metastasis in 2 cases, adrenal metastasis in 5 cases, brain metastasis in 2 cases, liver metastasis in 1 case, and abdominal wall metastasis in 1 case. In the perioperative period, all the patients recovered well without serious complications. Tumor-related symptoms were relieved after the surgery and the general situation was improved. The 1-, 3-, and 5-year survival of the 16 patients were 75.0%, 43.8%, and 31.3%, respectively. There was no surgery-related mortality.  Conclusion  Patients with renal cell carcinoma treated with targeted therapy who develop distant isolated metastases may benefit from surgical resection of the metastases, achieving reasonable long-term survival.
Abstract:
  Objective  To investigate the characteristics of fertility-sparing surgery for non-invasive low-grade serous carcinoma (LGSC) of the ovary.  Methods  All the histologically diagnosed patients of non-invasive LGSC who admitted to Peking Union Medical College Hospital and received fertility-sparing surgeries between January 2015 and June 2015 were reviewed and their clinicopathological characteristics, surgical procedures, and follow-up results were retrospectively analyzed.  Results  Totally five cases of non-invasive LGSC receiving fertility-sparing surgeries were reviewed. Their median age was 29 years (range, 24-34 years). One case received laparotomy and four received laparoscopies; four cases received ovarian cystectomy and one received emergency unilateral adnexectomy for the affected and necrotic ovary because of acute torsion. One case was diagnosed at International Federation of Gynecology and Obstetrics (FIGO) stage IB, and the other four were at stage IA. All the five cases received no further therapy after the surgery. The median follow-up period was 7 months (range, 6-12 months). No case relapsed so far. One case conceived naturally and both the mother and the fetus were in good condition.  Conclusions  For non-invasive LGSC patients, there are many unresolved issues in aspects of spare of fertility, conception after fertility-sparing surgeries, recurrence, and follow-up. Although the possibility to spare the ovary is supported by this study for young non-invasive LGSC patients, long-term prognosis (including fertility and survival) needs to be observed in further follow-up.
2016, 7(4): 245-245.
HTML (39) PDF(11)
Abstract:
2016, 7(4): 252-252.
HTML (14) PDF(3)
Abstract:
2016, 7(4): 263-263.
HTML (35) PDF(5)
Abstract:
Abstract:
Abstract:
2016, 7(4): 290-294. doi: 10.3969/j.issn.1674-9081.2016.04.010
HTML (39) PDF(4)
Abstract:
2016, 7(4): 295-299. doi: 10.3969/j.issn.1674-9081.2016.04.011
HTML (199) PDF(5)
Abstract:
2016, 7(4): 300-302. doi: 10.3969/j.issn.1674-9081.2016.04.012
HTML (140) PDF(19)
Abstract:
2016, 7(4): 303-305. doi: 10.3969/j.issn.1674-9081.2016.04.013
HTML (39) PDF(8)
Abstract:
2016, 7(4): 306-310. doi: 10.3969/j.issn.1674-9081.2016.04.014
HTML (50) PDF(12)
Abstract:
2016, 7(4): 311-315. doi: 10.3969/j.issn.1674-9081.2016.04.015
HTML (51) PDF(41)
Abstract:
2016, 7(4): 316-318. doi: 10.3969/j.issn.1674-9081.2016.04.016
HTML (46) PDF(1)
Abstract:
2016, 7(4): 319-320. doi: 10.3969/j.issn.1674-9081.2016.04.017
HTML (35) PDF(9)
Abstract: