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Our Thoughts on Medicine and Philosophy

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Chinese Medical Journal 2017年第3期130卷 253-255页

作者： Zheng-Xing he jing-he lang Department of Obstetrics and Gynecology Peking Union Medical College Hospital Chinese Academy of Medical Science and Peking Union Medical College Beijing 100730 China

PHILOSOPHY ORIGINATED FROM MEDICINE, WHILE MEDICINE NESTS IN PHILOSOPHY Wherever there are humans, exploration of the inherent relationship between humans and nature is always examined. Belbre rational thinking was fully developed, ht, man beings tried to explain natural phenomena and the impact of nature on themselves using myths and primitive religions.

关键词： Medicine Medical Model Philosophy

URETERAL INJURY DURING GYNECOLOGICAL LAPAROSCOPIC SURGERIES: REPORT OF TWELVE CASES

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Chinese Medical Sciences Journal 2007年第1期22卷 13-16页

作者： Jin-song Gao Jin-hua Leng Zhu-feng Liu Keng Shen jing-he lang Department of Obstetrics and Gynecology Peking Union Medical College Hospital Chinese Academy of Medical Sciences ＆ Peking Union Medical College Beijing 100730

Objective To investigate ureteral injury during gynecological laparoscopic *** From January 1990 to December 2005, 12868 gynecological laparoscopic surgeries were conducted in Peking Union Medical College Hospital with 12 ureteral injuries reported. The present study investigated several aspects, including surgical indications, uterine size, pelvic adhesion, operative procedures, symptoms, diagnostic time and methods, injury site and type, subsequent treatment, and prognosis. Results The incidence of ureteral injury was 0.093% (12/12868) in all cases, 0.42% (11/2586) in laparoscopic hysterectomy [laparoscopically assisted vaginal hysterectomy (LAVH) or total laparoscopic hysterectomy (TLH)], and 0.01% (1/10282) in non-LAVH surgeries. Enlarged uterus, pelvic adhesion, and endometrosis were risk factors associated with ureteral injury. Only one injury was found intraoperatively while others were found postoperatively. The injury sites were at the pelvic brim (2 cases) or the lower part of ureter (10 cases). Patients were treated with ureteral stenting (effective in 2 cases) or laparotomy and open repair. Prognoses were favorable in most cases. Conclusions Most laparoscopic ureteral injuries occur during laparoscopic hysterectomy. Further evaluation is required when ureteral injury is suspected, and surgical repair is the major treatment for ureteral injury.

关键词： ureteral injury laparoscopy iatrogenic complication

CLINICAL ANALYSIS OF PRIMARY MALIGNANT MELANOMA OF The CERVIX

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Chinese Medical Sciences Journal 2005年第4期20卷 257-260,页

作者： Shui-qing Ma Chun-mei Bai Sen Zhong Xiao-hong Yu jing-he lang Department of Obstetrics and Gynecology Peking Union Medical College Hospital Chinese Academy of Medical Sciences ＆ Peking Union Medical College Beijing 100730

Objective To investigate the clinical and pathological characteristics of primary cervical malignant melanoma, and its prognosis. Mothods The clinical and pathological data of four patients with primary malignant melanoma of the cervix were analyzed retrospectively. Nerve tissue protein S-100 and monoclonal antibody to melanoma （HMB-45） were measured in all cases by immunohistochemical method. All four patients received radical hysterectomy. Three of them received chemotherapy preoperation or postoperation, and one of them received biotherapy with interferon-3, and interleukin-2 at the same time. All the cases were followed up. Results The average age of four patients was 45 years. Clinical symptoms presented with irregular vaginal bleeding, postcoital bleeding, or increase of vaginal discharge. Gynecologic examination showed polypus papilla cauliflower-shaped or nodulated black-brown or black-blue mass on the cervix. All the four cases were pathologically diagnosed with cervical malignant melanoma. S-100 and HMB-45 were positive in all patients. Two patients died at 6 and 41 months postoperation, respectively. The other two patients survived for 3.5 and 7 years postoperation, respectively. Conclusion S-100 protein and HMB-45 play very important roles in the diagnosis of primary malignant melanoma of cervix. Radical hysterectomy, chemotherapy combined with dimethyl triazemo imidazole carboxamide and biological therapies may improve the prognosis of the primary malignant melanoma of cervix if the disease could be diagnosed in an early stage.

关键词： melanoma cervical neoplasms

Expression of Potassium Channels in Uterine Smooth Muscle Cells from Patients with Adenomyosis

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Chinese Medical Journal 2016年第2期129卷 200-205页

作者： jing-Hua Shi Li Jin Jin-Hua Leng jing-he lang Department of Obstetrics and Gynecology Peking Union Medical College Hospital Peking Union Medical College Chinese Academy of Medical Sciences Beijing 100730 China

Background： Adenomyosis （AM） has impaired contraction. This study aimed to explore the expression of potassium channels related to contraction in myometrial smooth muscle cells （MSMCs） of AM. Methods： Uterine tissue samples from 22 patients （cases） with histologically confirmed AM and 12 （controls） with cervical intraepithelial neoplasia were collected for both immunohistochemistry and real-time polymerase chain reaction to detect the expression of large conductance calciumand voltage-sensitive K＋ channel （BKCa）-a/β subunits, voltage-gated potassium channel （Kv） 4.2, and Kv4.3. Student＇s t-test was used to compare the expression. Results： The BKCa-a/β subunits, Kv4.2, and Kv4.3 were located in smooth muscle cells, glandular epithelium, and stromal cells. However, BKCa-β subunit expression in endometrial glands of the controls was weak, and Kv4.3 was almost undetectable in the controls. The expression of BKCa-a messenger RNA （mRNA）（0.62 ± 0.19-fold decrease, P 〈 0.05） and Kv4.3 mRNA （0.67 ±0.20-fold decrease, P 〈 0.05） decreased significantly in the MSMCs of the control group compared with the AM group. However, there were no significant differences in BKCa-β subunit mRNA or Kv4.2 mRNA. Conclusions： The BKCa-a mRNA and the Kv4.3 mRNA are expressed significantly higher in AM than those in the control group, that might cause the abnormal uterus smooth muscle contractility, change the microcirculation of uterus to accumulate the inflammatory factors, impair the endometrium further, and aggravate the pain.

关键词： Adenomyosis Potassium Channels Uterine Contraction Uterus Smooth Muscle Cells

Proteomic Analysis of the Uterosacral Ligament in Postmenopausal Women with and without Pelvic Organ Prolapse

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Chinese Medical Journal 2015年第23期128卷 3191-3196页

作者： Zhi-jing Sun Lan Zhu jing-he lang Zhao Wang Shuo Liang Department of Obstetrics and Gynecology Peking Union Medical College Hospital Peking Union Medical College Chinese Academy of Medical Sciences Beijing 100730 China Core Facility of Instruments Institute of Basic Medical Sciences Chinese Academy of Medical Sciences School of Basic Medicine Peking Union Medical College Beijing 100005 China

Background： Pelvic organ prolapse （POP） is a major health problem in adult women that involves many factors. No proteomic analysis has been conducted exclusively in POP patients. This study aimed to identify the differential expression of proteins that may be involved in POP by proteomic analysis.Methods： Samples of the uterosacral ligament （USL） were collected from five POP patients and five non-POP patients matched according to age, parity, and menopausal status and analyzed using two-dimensional electrophoresis and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry （MALDI-TOF-MS）. Quantitative real-time polymerase chain reaction （qRT-PCR） was used to verify the mRNA expression of proteins that showed differential expression in the proteomic analyses. Results： Proteins differentially expressed between POP and non-POP patients were detected. Eight proteins that were down-regulated in the POP group were identified by MALDI-TOF-MS. These proteins included electron transfer flavoprotein, apolipoprotein A-I, actin, transgelin, cofilin-1, cyclophilin A, myosin, and galectin-1, and their expression was verified by qRT-PCR. Conclusion： Using comparative proteomics, we identified eight differentially expressed proteins （including four cytoskeleton proteins and three proteins related to apoptosis） in the USL that may be involved in apoptosis associated with the tissue effects in POP pathophysiology.

关键词： Apoptosis Cytoskeleton Pelvic Organ Prolapse Proteomics Uterosacral Ligament

Trocar-site hernia after gynecological laparoscopic surgery: a 20-year, single-center experience

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Chinese Medical Journal 2019年第22期132卷 2677-2683页

作者： Ya-Pei Zhu Shuo Liang Lan Zhu Zhi-jing Sun jing-he lang Department of Obstetrics and Gynecology Peking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100730China

Background:Trocar-site hernia(TSH)is a serious complication after laparoscopic *** it is a rare entity,it have life-threatening *** study aimed to retrospectively analyze the potential associated factors for TSH following gynecologic laparoscopy and summarize prevention strategies based on our ***:We searched for gynecological laparoscopic surgeries in the medical records system of Peking Union Medical College Hospital(PUMCH)from August 1998 to July 2018 and further sifted through the results for cases involving *** included patients were divided into different groups according to patient characteristics,and the rate of TSH was compared among ***,the detailed information of all patients with TSH was recorded and *** analyses were performed with GraphPad Prism ***:The approximate total rate of post-operative TSH among gynecologic laparoscopy procedures performed at PUMCH in the last 20 years was 0.016%(9/55,244).The rate of TSH was significant higher in elder patients(>60 years old;3/2686,0.112%)than in younger patients(he approximate rate of TSH was significantly higher after single-incision laparoscopic surgery(SILS,2/534,0.357%)than conventional laparoscopic surgery(7/54,710,0.013%,P=0.003).The average age of patients with TSH was 53.4 years(range,35.0-79.0 years).Two of the nine patients had late-onset TSH following SILS;the other seven had early-onset TSH following conventional *** TSH cases occurred at right lateral port sites,and the remaining three occurred at the umbilical port *** patients underwent repair surgery,and one required small bowel ***:Older age and SILS are potential associated factors for TSH development,while reducing excessive manipulation and improving suturing skills,especially at the umbilical trocar site following SILS and the right lateral trocar site,can avoid herniation.

关键词： Prevention Risk-factors Single-incision laparoscopic surgery Trocar-site hernia

PHASE Ⅱ STUDY OF GEMCITABINE COMBINED WITH PLATINUM CheMOTheRAPY FOR RECURRENT EPITheLIAL OVARIAN CANCER

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Chinese Medical Sciences Journal 2007年第3期22卷 177-182页

作者： Peng Peng Keng Shen Jia-xin Yang Ming Wu Hui-fang Huang Ling-ya Pan jing-he lang Department of Obstetrics ＆ Gynecology Peking Union Medical College Hospital Chinese Academy of Medical Sciences ＆ Peking Union Medical College Beijing 100730

Objective To evaluate the anti-tumor effect and toxicity of gemcitabine combined with platinum chemotherapy on recurrent epithelial ovarian cancer. Methods Phase Ⅱ study of gemcitabine combined with platinum chemotherapy was carried out in 22 patients with recurrent epithelial ovarian cancer. Median age of patients was 50. 5 years old. Seven patients were platinum-sensitive and 15 patients were platinum-resistant or -refractory. All patients received gemcitabine combined with carboplatin or oxa/iplatin chemotherapy. Patients＇ response rate （RR） and toxicity of gemcitabine combined with platinum chemotherapy were evaluated. Results A total of 98 gemcitabine-based chemotherapy cycles were performed. Total RR was 36. 4%, RR of platinum-sensitive patients was 4/7 and platinum-resistant and -refractory patients was 4/15. The estimated median survival time was 10.0 months （95% CI. 7.0-13.0） after initiation of gemcitabine combined with platinum chemotherapy. There was no significant difference in survival time between platinum-resistant/refractory group and platinum-sensitive group （P = 0. 061 ）. Side effects of gemcitabine combined with platinum chemotherapy were observed in 81.8% of patients. Grade Ⅱ/Ⅲ anemia （54. 5% ） and grade Ⅲ/Ⅳ neutropenia （54. 5% ） were most common toxicities. Ten （45.5%） patients had to delay their chemotherapy cycles or reduce the dose of chemotherapeutic drugs because of the severe side effects. Fourteen （63.6%） patients received granulocyte colony-stimulating factor to relieve neutropenia, and 8 （ 36. 4% ） patients received component blood transfusion to treat anemia or thrombocytopenia. There was no treatment-associated death. Conclusion Gemcitabine combined with platinum chemotherapy appears to be an effective and well-tolerant treatment for recurrent epithelial ovarian cancer, including platinum-resistant or -refractory diseases.

关键词： second-line chemotherapy gemcitabine ovarian cancer phase Ⅱ

Tension-free Polypropylene Mesh-related Surgical Repair for Pelvic Organ Prolapse has a Good Anatomic Success Rate but a High Risk of Complications

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Chinese Medical Journal 2015年第3期128卷 295-300页

作者： Lei Zhang Lan Zhu Juan Chen Tao Xu jing-he lang Department of Gynecology and Obstetrics Peking Union Medical College Hospital Peking Union Medical College Chinese Academy of Medical Sciences Beijing 100730 China Department of Epidemiology and Statistics Institute of Basic Medical Sciences Chinese Academy of Medical Sciences and School of Basic Medicine Peking Union Medical College Beijing 100730 China

Background： Food and Drug Administration announcements have highlighted the standard rate of mesh-related complications. We aimed to report the short-term results and complications of tension-free polypropylene mesh （PROSIMATM） surgical repair of pelvic organ prolapse （POP） using the standard category （C）, timing （T）, and site （S） classification system. Methods： A prospective cohort study of 48 patients who underwent PROS1MATM mesh kit-related surgical repairs were followed for two years at Peking Union Medical College Hospital. Recurrence was defined as symptomatic POP quantification （POP-Q） Stage II or higher （leading edge ≥ -1 cm）. The Patient Global Impression of Change Questionnaire, the Chinese version of the Pelvic Floor Impact Questionnaire short-form-7 and POP/Urinary Incontinence Sexual Questionnaire short-form- 12 were used to evaluate the self-perception and sexual function of each patient. Mesh-related complications conformed to the International Urogynecological Association/International Continence Society joint terminology. The paired-sample t-test, one-way analysis of variance, Fisher＇s exact test, Kaplan-Meier survival analysis and log-rank test were used to analyze data. Results： All patients were followed up for ≥12 months; 30 （62.5%） patients completed the 24 months study. We observed a 93.8% （45/48） positive anatomical outcome rate at 12 months and 90.0% （27/30） at 24 months. Recurrence most frequently involved the anterior compartment （P 〈 0.05）. Pelvic symptoms improved significantly from baseline （P 〈 0.05）, although the patients＇ impressions of change and sexual function were not satisfying. Vaginal complication was the main complication observed （35.4%, 17/48）. The survival analysis did not identify any relationship between vaginal complication and anatomical recurrent prolapse （POP-Q 〉 Stage II）（P = 0.653）. Conclusions： Tension-free polypropylene mesh （PROSIMA^TM）-related surgical repair of POP has better short-term anatomical outcomes at

关键词： Pelvic Organ Prolapse Postoperative Complication PROSIMATM Mesh Kit Quality of Life

Clinical Characteristic and Management of Acquired Uterine Arteriovenous Malformation

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Chinese Medical Journal 2018年第20期131卷 2489-2491页

作者： Ya-Pei Zhu Zhi-jing Sun jing-he lang Jie Pan Department of Obstetrics and Gynecology Peking Union Medical College Hospital Peking Union Medical College Chinese Academy of Medical Science Beijing 100730 China Department of Radiology Peking Union Medical College Hospital Peking Union Medical College Chinese Academy of Medical Science Beijing 100730 China

To the Editor： Arteriovenous malformations （AVM）, also referred to as cirsoid aneurysm, arteriovenous aneurysm, arteriovenous fistula, and cavernous hemangioma, can occur in any organ in the body. Uterine AVM is a rare entity that is classified as either congenital or acquired. Congenital uterine AVM is thought to develop from a defect during embryologic differentiation leading to abnormal vascular connections, whereas acquired uterine AVM has been reported to occur due to a previous uterine trauma, such as curettage or cesarean delivery, or to be associated with neoplastic disorders, including gestational trophoblastic disease （GTD） and endometrial adenocarcinoma.

关键词： EMBOLIZATION