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To compare oncological outcomes of laparoscopic radical hysterectomy (LRH) and abdominal radical hysterectomy (ARH) for low-risk cervical cancer. We retrospectively compared the 3-year overall survival (OS) and 3-year disease-free survival (DFS) of 1269 low-risk cervical cancer patients with FIGO 2009 stage IA2, IB1 and IIA1 with a tumour size

Objective: To compare the oncological results and surgical outcomes of abdominal Q-M type B and type C2 radical hysterectomy (RH) for patients with FIGO 2018 stage IB1 cervical cancer.Methods: We retrospectively compared the oncological results and surgical outcomes of 1158 cervical cancer patients treated with Q-M type B (n=775) or type C2 (n=383) RH between January 2004 and December 2018 at 47 hospitals in mainland China.Results: The type B group and type C2 group showed similar 5-year DFS and OS rates (OS: 98.5% vs 98.0%, P=0.461; DFS: 94.3% vs 93.3%, p=0.461) in the total study population. Multivariable analysis revealed that Q-M type B RH was not associated with a worse 5-year OS rate (hazard ratio [HR]=1.493; 95% CI=0.522-4.269, P=0.455 95% CI: 0.522-4.269;p=0.455) or DFS rate (HR=1.169;95%CI: 0.650-2.101;p=0.603). Compared with type C2, type C resulted in a significantly shorter operating time (215 min vs. 188 min, P＜0.001). The defecation time and atherization time were less in the type B group than in the type C2 RH group (3.04 d vs. 2.81 d, PConclusion: Among cervical cancer patients with FIGO 2018 stage IB1 disease, the oncological outcomes of Q-M type B RH and Q-M type C2 RH were similar, and Q-M type B RH was associated with a shorter operation time, less intraoperative blood loss and fewer intraoperative complications. This suggests that Q-M type B RH might be an rational option for FIGO 2018 stage IB1 cervical cancer.

Objective The primary objective was to describe the incidence and risk factors of urologic complications during radical hysterectomy for cervical cancer. The secondary objective was to investigate the impact of urologic complications on long-term survival. Methods Patients who underwent radical hysterectomy for cervical cancer from 2004 to 2016 were identified in the MSCCCC (Major Surgical Complications of Cervical Cancer in China) database. Data on demographic characteristics, clinical characteristics, hospital characteristics and urologic complications were collected. Multivariable logistic regression was used to assess the risk factors of urologic complications and Cox proportional hazards models were performed to identify prognostic factors. Results A total of 21,026 patients undergoing radical hysterectomy for cervical cancer were identified. The incidence of any urologic complications was 1.54%: 83 (0.39%) ureteral injuries, 17 (0.08%) bladder injuries, 1 (0.005%) ureteral injury combined with bladder injury, and 223 (1.05%) genitourinary fistulas. In a multivariable analysis, surgery at a women and children's hospital (OR = 2.26, 95% CI 1.47–3.48), surgery at a facility in a first-tier city (OR = 2.08, 95% CI 1.24–3.48), and laparoscopic surgery (OR = 4.68, 95% CI 3.44–6.36) were associated with a higher risk of urologic complications. Cox proportional hazards models revealed that the occurrence of urologic complications was a significant predictor of 2-year overall survival (OR = 1.78, 95% CI = 1.09–2.92), but was not a predictor of 5-year overall survival (OR = 1.27, 95% CI = 0.83–1.94). Conclusion The incidence of urologic complications during radical hysterectomy is low. The risk of urologic complications may be higher for patients who are treated at a women and children's hospital, are treated in first-tier city hospitals, and receive laparoscopic surgery. Urologic complications have an impact on short-term survival, but not on long-term survival.

Purpose To explore the oncological and obstetric results after radical trachelectomy in early-stage cervical cancer. Methods Retrospective analysis of the oncological and obstetric results to 23 patients with early cervical cancer (stage IA2-IB3; International Federation of Gynecology and Obstetrics 2018) accepting radical trachelectomy in The Maternal and Child Health Care Hospital of Guiyang from Oct 2004 to Sep 2018. Results Among those patients with tumor size＞4cm (up to 5cm) three patients who wished to preserve fertility accepted radical trachelectomy after neoadjuvant chemotherapy. 23 patients had cervical tumors of the histological type squamous cell carcinoma (SCC). All of the patients retained reproductive function. The mean time of the follow-up was 112.87±55.75months(36-199months). The median tumor size was 2.00±1.35cm (invisible by eyes-5.00cm). No occurred recurrence in any of the cases. Pregnancy outcomes are described as follows: 17 cases attempted to pregnancy, in which 8 cases (47.06%) conceived 12 times. First-trimester abortion and voluntary abandonment of pregnancy occurred in 4 cases (33.33%) respectively, one among patients who choose to abandon pregnancy being induced at 24 weeks of gestation. Second-trimester abortion occurred in3 cases (25.0%), and the reason for abortion was chorioamnionitis. Premature delivery at 32 weeks occurred once (8.33%). Conclusion Radical trachelectomy is a safe and effective treatment for young women with early-stage cervical cancer. Neoadjuvant chemotherapy and Radical trachelectomy provides the possibility of preserving pregnant ability for patients with cervical tumor＞4cm. However, it is worth further exploration.

Purpose: To examine the association between surgical volume and surgical and oncological outcomes of women with stage IB1 cervical cancer who underwent laparoscopic radical hysterectomy (LRH).Methods: We retrospectively analyzed the oncological outcomes of 1,137 patients with stage IB1 cervical cancer receiving LRH from 2004 to 2016. The surgical volume for each surgeon was defined as low [fewer than 50 surgeries, n = 392(34.5%)], mid [51-100 surgeries, n = 315(27.7%)], and high [100 surgeries or more, n = 430(37.8%)]. Surgical volume-specific survival was examined with Kaplan–Meier analysis, multivariable analysis, and propensity score matching.Results: The operative times of the high-volume group (227.35 ± 7.796 min) were significantly shorter than that of the low- (272.77 ± 4.887 min, p < 0.001) and mid-volume (255.86 ± 4.981 min, p < 0.001) groups. Blood loss in the high-volume group (169.42 ± 8.714 ml) was significantly less than that in the low-volume group (219.24 ± 11.299 ml, p = 0.003). The 5-year disease-free survival (DFS) and overall survival (OS) in the low-volume, mid-volume, and high-volume groups were similar (DFS: 91.9, 86.7, and 89.2%, p = 0.102; OS: 96.4, 93.5, and 94.2%, p = 0.192). Multivariable analysis revealed surgical volume was not an independent risk factor for OS or DFS. The rate of intraoperative and postoperative complications was similar among the three groups (p = 0.210).Conclusions: Surgical volume of LRH may not be a prognostic factor for patients with stage IB1 cervical cancer. Surgery at high-volume surgeon is associated with decreased operative time and blood loss.

Background Several adverse reactions to tigecycline, which is widely used in patients with severe infections, have been documented. Coagulopathy is a lesser known side effect of tigecycline. Aim of the review We summarize the characteristics, possible mechanisms, and treatment of tigecycline-induced coagulopathy. Method PubMed, Ovid, Embase, ISI Web of Knowledge, CNKI, and Wanfang were searched up to March 5, 2019. All articles concerning coagulopathy induced by tigecycline were included. The article types and languages were not limited. The retrieved articles were screened by two experienced clinicians by reading the titles, abstracts, and full texts. Results Ultimately, 17 articles were targeted, including 13 case reports and 4 retrospective observational studies. Tigecycline-induced coagulopathy usually manifests as the dose-dependent prolongation of prothrombin time and activated partial thromboplastin time and a reduction in the fibrinogen level. Tigecycline and its metabolites may have multiple effects on coagulation, influencing the extrinsic or intrinsic pathway and even the common pathway. There is no specific treatment for tigecycline-induced coagulopathy, but it can be reversed by withdrawing tigecycline. Conclusion Tigecycline acts on the coagulation system in a dose-dependent manner, and the most severe adverse event is bleeding. Overdose and prolonged use should be avoided, suspected coagulopathy must be recognized in time, and tigecycline should be withdrawn to prevent severe adverse events. Also, drug clearance disorders can develop in patients with liver and/or renal dysfunction. For patients with severe hepatic or renal impairment, the maintenance dose should be reduced, and indicators of coagulation function should be closely monitored.

BackgroundIn 2018 the International Federation of Gynecology and Obstetrics (FIGO) revised the staging system of cervical cancer. This study aimed to assess the quality of staging early cervical cancer in China before the revision.MethodsThis multicenter retrospective study included 34 tertiary hospitals in China. Medical records of patients with cervical cancer who underwent primary surgical treatment between January 2010 and December 2015 were reviewed retrospectively. All patients were clinically staged according to the 2009 FIGO staging system. Eligibility criteria included: histopathologically confirmed cervical cancer; 2009 FIGO stage IA–IIA2 based on 2009 FIGO staging system; primary surgical treatment including extrafascial, type II or type III radical hysterectomy; radical trachelectomy; with or without pelvic lymphadenectomy; regardless of surgical route via laparotomy or laparoscopy; and complete clinical and pathological data. Patients who received non-surgical treatment, neoadjuvant treatment, or those with incomplete data were excluded. The accuracy of clinical staging was assessed by comparison between clinical and pathologic stage using the latter as the reference standard.ResultsA total of 23 933 cases of cervical cancer were identified and 12 681 fulfilled the inclusion criteria. Of these patients, 69.6% were staged accurately, 9.4% were clinically understaged, and 21.0% were clinically overstaged. The accuracy of stage IA, IB1, IB2, IIA1, and IIA2 was 90.0%, 87.5%, 57.4%, 20.3%, and 25.5%, respectively. The causes of stage inaccuracy were as follows: vaginal involvement (62.3%), maximal tumor diameter (24.6%), extent of cervical stromal invasion (7.1%), parametrial invasion (5.8%), bladder or rectal infiltration (0.1%), and distant metastases (0.1%).ConclusionThe accuracy of staging early cervical cancer in China was suboptimal before the revision of the staging system, especially for IIA1 and IIA2. The most common reasons for staging inaccuracy were vaginal involvement and tumor diameter.

Purpose: To evaluate the impact of pelvic magnetic resonance imaging (MRI) on staging of IB1-IIA2 cervical cancer in routine clinical practice. Patients and Methods: A total of 1,016 patients with IB1-IIA2 cervical cancer who underwent primary surgery and preoperative pelvic MRI between January 2009 and December 2015 were identified in a retrospective multicentre study. Data on clinical stage, MRI reports and surgicopathologic findings were extracted from medical records. The impact of MRI on clinical staging was evaluated by comparison before and after combination of MRI. Using surgicopathologic findings as the reference standard, the impact of pelvic MRI on the accuracy of clinical staging was evaluated. Furthermore, the impact on the accuracy of individual staging parameters such as maximal tumor diameter, vaginal involvement or parametrial infiltration were also evaluated. Results: After combination of pelvic MRI, clinical stage remained unchanged in 59.7%, upstaged in 17.2%, and downstaged in 23.0% of the patients. The overall accuracy of clinical staging increased from 61.0% to 81.4% in our study (P 0.05). The AUC for parametrial infiltration was also suboptimal (AUC=0.56, P

Objective: Compare the outcomes associated with laparoscopic radical hysterectomy (LRH) and abdominal radical hysterectomy (ARH) for cervical cancer. Design: Retrospective, multicenter observational analysis Setting: Select patients of LRH and ARH from cervical cancer database and compare their outcomes. Population: Patients with stage IA1 (Lymphovascular space invasion [LVSI]-positive) and stage IIA2 cervical cancer (N=6804) were enrolled, of whom 3003 underwent laparoscopy (LRH group), and 3801 underwent laparotomy (ARH group). Methods: Kaplan-Meier survival analysis,propensity score matching (PSM) and Cox regression. Main Outcome Measures: Five-year overall survival (OS) and 5-year disease-free survival (DFS) Results: Before PSM, there was no difference in outcomes between the groups (5-year OS: LRH 89.2% vs. ARH 90.6%, P=0.903.; 5-year DFS: LRH 84.5% vs. ARH 87.1%, P=0.155). Surgical approach did not affect 5-year OS; however, it did affect 5-year DFS (hazard ratio [HR]=0.827, 95% confidence interval [CI]: 0.711-0.962, P=0.014). After PSM, there was no difference in 5-year OS between the LRH (N=1828) and ARH (N=1828) groups (91.0% vs. 93.1%, P=0.220); but there was a significant difference in 5-year DFS between the LRG and ARH groups (86.2% vs. 90.6%, P=0.002). Cox regression revealed that the surgical approach did not affect 5-year OS; however, it did affect 5-year DFS (HR=0.701, 95% CI: 0.563-0.874, P=0.002). Conclusions: For IA1 (LVSI-positive) and IIA1 cervical cancers, the recurrence rate following laparoscopic surgery was higher than that following open surgery, regardless of the surgeon’s experience.

To compare oncological outcomes of laparoscopic radical hysterectomy (LRH) and abdominal radical hysterectomy (ARH) for low-risk cervical cancer.We retrospectively compared the 3-year overall survival (OS) and 3-year disease-free survival (DFS) of 1269 low-risk cervical cancer patients with FIGO 2009 stage IA2, IB1 and IIA1 with a tumour size 2 cm, no lymphovascular space invasion (LVSI), superficial stromal invasion and no lymph node involvement on imaging, and who received LRH (n = 672) and ARH (n = 597) between 2009 and 2018 at 47 hospitals.In the total study population, LRH and ARH showed similar 3-year OS (98.6% vs. 98.9%, P = 0.850) and DFS rates (95.7% vs. 96.4%, P = 0.285). LRH was not associated with worse 3-year OS (HR 0.897, 95% CI 0.287-2.808, P = 0.852) or DFS (HR 0.692, 95% CI 0.379-1.263, P = 0.230) as determined by multivariable analysis. After propensity score matching in 1269 patients, LRH (n = 551) and ARH (n = 551) still showed similar 3-year OS (98.4% vs. 98.8%, P = 0.704) and DFS rates (95.5% vs. 96.3%, P = 0.249). LRH was still not associated with worse 3-year OS (HR 0.816, 95% CI 0.262-2.541, P = 0.725) or DFS (HR 0.694, 95% CI 0.371-1.296, P = 0.251).Among patients with low-risk cervical cancers 2 cm, no LVSI, superficial stromal invasion, and no lymph node involvement on imaging, no significant differences were observed in 3-year OS or DFS rates between LRH and ARH.

OBJECTIVE To assess the impact of neoadjuvant chemotherapy on postoperative pathology for stage IB2 and IIA2 cervical squamous cell carcinoma. METHODS Postoperative pathology was compared between patients who received neoadjuvant chemotherapy followed by radical hysterectomy (NACT group) and patients who received upfront radical hysterectomy (URH group). Then, patients in the NACT group were divided into a chemotherapy-sensitive group and a chemotherapy-insensitive group according to their response to chemotherapy. RESULTS After 1:1 propensity score matching (PSM), the positive rates of lymphovascular space invasion (LVSI) (7.9% vs 17.7%, P = 0.001) and cervical deep stromal invasion (60.4% vs 76.2%, P

Objectives In Uighur medicine, abnormal Savda Munziq (AMSq) is an adjuvant therapy for cancer patients with abnormal Savda syndrome (ASS) who exhibit the highest degree of pathogenicity and malignancy. The aim of the study was to understand the role(s) of AMSq in cancer patients with ASS. Methods A total of 125 rats were divided into groups: control (NC) (n = 15), ASS (n = 25), ASS with hepatic carcinoma (ASSHC) (n = 25) as well as ASSHC treated with low dose (ASSHC-L, n = 20), medium dose (ASSHC-M, n = 20) and high dose (ASSHC-H, n = 20) AMSq. Changes in the unfolded protein response (UPR) and autophagy were analyzed by RT profiler PCR array kits, which covered 84 UPR and 84 autophagy related genes. Protein expression analyses of LC3B, ATG8, GRP78 and CHOP were carried out using western blotting. Results CHOP and GRP78 expression was enhanced in ASS and ASSHC compared to NC rats and further increased AMSq dose-dependently, indicating an UPR triggering effect of AMSq. The ratios of ATG8/LCB3II-LCB3I protein were reduced in ASSHC rats, an effect which was partly reversed by AMSq. Compared to NC rats in the ASS group, 24 UPR genes were significantly upregulated and 3 downregulated, whereas only 5 autophagy genes were significantly upregulated and 5 downregulated. Compared to NC rats in the ASSHC group, 15 UPR genes were significantly upregulated and 10 downregulated, whereas 16 autophagy genes were significantly upregulated and 8 downregulated. The RT profiler data indicated a shift from UPR in the ASS to the autophagy response in ASSHC rats. ASMq effects on ASSHC rats comprised significant downregulation of 10 autophagy and 2 UPR genes. Conclusion The transformation into hepatic cancer cells included a shift from endoplasmic reticulum stress-related UPR to autophagy gene activation, an effect which could be partly reversed by ASMq.

Osteosarcoma (OS) is the most common bone malignant tumor with a high rate of lung metastasis and principally emerges in children and adolescents. Although neoadjuvant chemotherapy is widely used around the world, a high rate of chemoresistance occurs and frequently generates a poor prognosis. Therefore, finding a new appropriate prognostic marker for OS is a valuable research direction, which will give patients a better chance to receive proper therapy. Actin-binding proteins (ABPs) are a group of proteins that interact with actin cytoskeleton and play a crucial role in the regulation of the cell motility and morphology in eukaryotes. Meanwhile, ABPs also act as a bridge between the cytomembrane and nucleus, which transmit the outside-in and inside-out signals in cytoplasm. Furthermore, ABPs alter the dynamic structure of actin and regulate the invasion and metastasis of cancer. Hence, ABPs have a wide application in predicting the prognosis, and may be new targets, in tumor therapy. This review focuses on a series of ABPs and discusses their modulatory functions. It provides a new insight into the classification of ABPs' functions in the process of invasion and metastasis in OS and illuminates the potential ability in predicting the prognosis of OS patients.

Purpose: To evaluate the impact of pelvic magnetic resonance imaging (MRI) on staging of IB1–IIA2 cervical cancer in routine clinical practice. Patients and Methods: A total of 1,016 patients with IB1-IIA2 cervical cancer who underwent primary surgery and preoperative pelvic MRI between January 2009 and December 2015 were identified in a retrospective multicentre study. Data on clinical stage, MRI reports and surgicopathologic findings were extracted from medical records. The impact of MRI on clinical staging was evaluated by comparison before and after combination of MRI. Using surgicopathologic findings as the reference standard, the impact of pelvic MRI on the accuracy of clinical staging was evaluated. Furthermore, the impact on the accuracy of individual staging parameters such as maximal tumor diameter, vaginal involvement or parametrial infiltration were also evaluated. Results: After combination of pelvic MRI, clinical stage remained unchanged in 59.7%, upstaged in 17.2%, and downstaged in 23.0% of the patients. The overall accuracy of clinical staging increased from 61.0% to 81.4% in our study (P0.05). The AUC for parametrial infiltration was also suboptimal (AUC=0.56, P

Backgrounds: A large number of studies have reported the relationships between serum lactate dehydrogenase (LDH) and prognosis of osteosarcoma. However, the result is still controversial and no consensus has been reached. Therefore, we performed a meta-analysis to evaluate the prognostic role of serum LDH in osteosarcoma patients. Methods: We performed the systematic computerized search for eligible articles from PubMed, Embase, and Cochrane databases until December 21, 2017. The pooled hazard ratio (HR) and 95% confidence intervals (CIs) of overall survival (OS) and event-free survival (EFS) were obtained to assess the prognostic value of serum LDH. Results: A total of 18 studies with 2543 osteosarcoma patients were included. Overall, 15 studies assessed the elevated serum LDH level on OS and the pooled HR was 1.87 (95% CI = 1.58–2.20). Meanwhile, the pooled HR to evaluate the relationship between serum LDH and EFS in 9 studies was 1.78 (95% CI = 1.51–2.10). The same results were acquired when these studies were stratified by Enneking stage, geographic region, and sample size. No heterogeneity existed between these subgroups (P > .05). Begg's funnel plot and Egger's test (OS: P = .04; EFS: P = .34) showed that possible publication bias might exist in OS studies. Sensitivity analysis suggested the pooled HR was robust. Conclusions: This meta-analysis demonstrates that elevated serum LDH level is apparently associated with lower EFS rate and serum LDH could be a prognostic biomarker for osteosarcoma patients.

Rationale:Colchicine can inhibit cell division and intracellular transport in affected organs by fixing intracellular tubulin and preventing its polymerization into microtubules. A lethal dose of colchicine is considered to be 0.8 mg/kg. The wide distribution of colchicine through 70% of the

To evaluate patient survival with combined liver-kidney transplantation (CLKT) and to identify factors of death in these patients.Among 554 cases of liver transplantations (LTs) performed between January 1999 and October 2006, there were 19 cases (3.43%) of CLKT recipients. To compare the patient survival, 50 matched LT patients out of these patients were analyzed retrospectively. Furthermore, causes of death in CLKT patients were investigated.Within a mean follow-up of 25.2 months (range 1-96 months), 7 CLKT patients had died (mortality: 36.8%). There were 4 (21.1%) that died in hospital within 1 month, and 3 late mortality cases (deceased after hospital discharge). Actuarial survival was 73.7% at 1 year, 59.5% at 3 years, and 59.5% at 5 years. Cumulative patient survival was significantly worse among CLKT patients compared with LT patients. After excluding patients who died during the first month in the 2 groups, cumulative patient survivals were comparable between the 2 groups. The survival rate in CLKT patients was 87.5% at 1 year, 70.7% at 3 years, and 70.7% at 5 years.CLKT has relatively high hospital mortality as compared to LT. Beyond the hospital discharge, however, the long-term survival does not differ from LT.

To discuss the effect of lamivudine as prophylaxis against hepatitis B virus (HBV) reinfection following orthotopic liver transplantation (OLT).40 patients with HBV-related diseases received lamivudine, 100 mg/day, as prophylaxis against HBV reinfection after OLT. Hepatitis B serum markers, HBsAg, HBeAg, HBcAb-IgM, and HBcAg were detected every 2 weeks by immunohistochemistry. Serum HBV-DNA was examined by PCR every 2 weeks. Liver biopsy was conducted to the donor livers during operation and to the transplanted livers postoperatively in regular interval. HBsAg and HBcAg in the liver specimens were examined by immunohistochemistry. YMDD mutation sequencing was done to those patients with conversion of positive HBV DNA postoperatively.The positive rates were 100%, 25%, and 30% for the serum HBsAg, HBeAg, and HBV DNA of the patients respectively before OLT. All 40 donor liver specimens showed negative HBsAg and HBcAg. HBV reinfection rates were 12.2% and 23.5% 6 months and 12 months after OLT respectively. HBeAg had been positive in 4 out of the 6 cases with postoperative reinfection and had been positive in 8 out of the 34 cases without reinfection (P = 0.4505). HBV DNA had been positive in 5 out of the 6 cases with postoperative reinfection, and had been positive in 7 out of the 34 cases without reinfection (P = 0.0461). After OLT HBV DNA converted to positive in 4 cases, mutation of YMDD locus (YMDD-YIDD) had been found in 3 of which.Lamivudine monotherapy is effective against HBV reinfection after OLT. Given the lamivudine monotherapy, HBV reinfection causes mutation in YMDD locus on the HBV DNA polymerase gene. OLT does not apply in patients with positive HBV DNA. For those patients to be operated upon, lamivudine should be used to convert HBV DNA to negative beforehand.

To assess the feasibility and outcome of orthotopic liver transplantation (OLT) with no veno-venous bypass (VVB) in adult patients.Between 1999 and June 2001, 43 adult patients were subjected to orthotopic liver transplantations with veno-venous bypass (28), or no veno-venous bypass (15).There was no significant difference in mean serum creatinine on day 3 and gas discharge time in patients with veno-venous bypass or not. With no veno-venous bypass, the average operative time was 5.6 +/- 1.4 h, median amount of blood loss during operation was 4 200 +/- 850 ml, median amount of blood transfused intraoperatively was 4 800 +/- 920 ml, and median intensive care unit stay was 6.3 days. All these were lower or shorter than those of the patients with veno-venous bypass.Orthotopic liver transplantation with no veno-venous bypass is safe and can be performed in the majority of adult patients. Liver transplantation with no veno-venous bypass is associated with shorter total operating time, lower blood product usage, and shorter intensive care unit stay compared with standard technique of OLT with routine use of VVB.