Volume 105 · Issue 08 · 2025

Accurate staging is crucial for the treatment and prognosis of patients with endometrial cancer. Based on the 2009 staging system, the International Federation of Gynecology and Obstetrics (FIGO) published updated staging system in 2023, incorporating factors such as tumor tissue type, histological grading, lymphovascular space invasion, low-volume lymph node metastasis and molecular profiling. However, the real world clinical application value of the new staging is still unclear. Therefore, this review focused on the updation details and discussed the clinical significance of FIGO 2023 staging system, comparing the difference and the clinical practice impact between the "new" and "old" staging systems. Through this review, it is expected that the accurate diagnosis and treatment of endometrial cancer could be improved, and practical guidance for the clinical diagnosis and treatment of endometrial cancer would be provided.

The International Federation of Gynecology and Obstetrics (FIGO) staging system for endometrial cancer (EC) integrates various clinicopathological factors associated with EC prognosis to aid in prognosis prediction and treatment guidance. Although the 2009 FIGO staging criteria excluded ascites/peritoneal flushing fluid cytology, the importance of this factor remains controversial. This review thoroughly analyzed the current problems in ascites/peritoneal flushing fluid cytology sample submission and investigates the association between positive ascites/peritoneal flushing fluid cytology (PAC/PPC) and EC prognosis across different patient groups, including various stages, histological types, risk stratifications, and molecular subtypes. The findings demonstrated that PPC significantly impacted patient prognosis. Therefore, based on current evidence, the author advocates for the continued submission of ascites/peritoneal flushing fluid cytology as a crucial and indispensable step in the surgical staging of EC. In clinical practice, emphasis should be placed on the accuracy, reliability, and submission rate of EC cytology testing. The necessity for more aggressive treatment approaches requires the validation through large-scale prospective studies.

To investigate the clinicopathological characteristics and molecular features of synchronous endometrial and ovarian endometrioid carcinoma (SEO-EC).

A total of 28 patients diagnosed with SEO-EC at the Peking University Third Hospital, Hunan Cancer Hospital and Peking University People′s Hospital between September 2016 and July 2023 were included retrospectively. Next-generation sequencing (NGS) was performed to assess the clonal relatedness of 28 paired endometrial and ovarian tumors. Extra-uterine-ovarian disease specimens in four patients diagnosed with SEO-EC were further tested with comprehensive NGS analysis. Normal tissue/blood samples of 27 patients were available for NGS analysis. All cases were classified according to WHO 2020 histologic criteria and FIGO 2023 staging system. Relevant clinicopathological features were also analyzed.

The age of 28 patients was (47.3±8.5)years. Most patients (85.7%, 24/28) were premenopausal. In most instances, ovarian and endometrial carcinomas exhibited consistent morphology (82.1%, 23/28) as well as molecular subtypes (96.4%, 27/28). NGS confirmed a clonal relationship in all cases. The most common somatic mutations shared between endometrial and ovarian tumors were PTEN (64.3%, 18/28), PIK3CA (46.4%, 13/28), ARID1A (28.6%, 8/28), CTNNB1 (25.0%, 7/28), and KRAS (21.4%, 6/28). A majority of patients (82.1%, 23/28) exhibited a favorable prognosis, with only 5 patients identified as the WHO high-risk group and FIGO advanced-stage experiencing recurrence and tumor-specific death. In addition, 22.2% (6/27) of patients carried pathogenic germline mutations.

In this study, there is a high degree of concordance between the histologic and molecular subtypes of the endometrial and ovarian tumors in SEO-EC. We confirmed a clonal relationship in all tested paired SEO-EC. Patients identified as the WHO high-risk group and advanced FIGO stages may exhibit a poor prognosis in SEO-EC.

To investigate the clinicopathological features and prognostic characteristics of endometrial clear cell carcinoma (ECCC), and evaluate the 2023 Federation International of Gynecology and Obstetrics (FIGO) staging system on prognosis of ECCC.

The information of patients with ECCC who underwent primary surgery in Peking Union Medical College Hospital from March 2012 to December 2023 was collected. ECCC early and advanced stages were defined as Stage Ⅰ-Ⅱ and Stage Ⅲ-Ⅳ, respectively. Cox proportional hazard regression was applied to evaluate the prognosis of patients with potential risk factors [age, body mass index (BMI), comorbidities, surgical completeness, histology, lymph vascular space invasion (LVSI), deep myometrial invasion (DMI), parametrial involvement, lymphatic metastasis, stage, adjuvant therapies including chemotherapy and radiotherapy], in combined with the 2023 FIGO staging system.

A total of 125 patients with ECCC were included, with mean age of (60.4±11.0) years, 76 cases of early stage patients (60.8%) and 49 cases of advanced stage patients (39.2%). The age, BMI, comorbidities, histology and receiving adjuvant chemotherapy were not statistically different between early and advanced stage patients (all P>0.05), while higher proportion of LVSI [53.1% (26/49) vs 9.2% (7/76)], DMI [69.4% (34/49) vs 23.7% (18/76)] and receiving adjuvant chemoradiotherapy [51.0% (25/49) vs 25.0% (19/76)] was observed in advanced stage (all P<0.01). With a median follow-up time [M (Q₁, Q₃)] of [66.1 (38.3, 101.5)] months, multivariate Cox proportional hazard regression model analysis showed that advanced age (HR=1.05, 95%CI: 1.01-1.09, P=0.008), suboptimal cytoreductive surgery (HR=5.81, 95%CI: 1.55-21.82, P=0.009), and advanced stage of tumor (HR=1.43, 95%CI: 1.29-12.97, P=0.017) were associated with tumor recurrence in ECCC patients; advanced age (HR=1.07, 95%CI: 1.03-1.13, P=0.002) and suboptimal cytoreductive surgery (HR=18.07, 95%CI: 3.15-103.61, P=0.001) were associated with patient death. According to the staging criteria of FIGO 2023, the 5-year progression free survival rates of patients with stage Ⅰ-Ⅳ were 100.0%, 90.2%, 53.6%, and 25.5%, respectively; the 5-year overall survival rates were 100.0%, 92.0%, 64.4%, and 52.7%, respectively (P<0.001).

The proportion of patients with ECCC of advanced stage at diagnosis is relatively high, and suboptimal cytoreductive surgery and advanced stage of the disease are the independent high-risk factors for the recurrence. The 2023 FIGO staging system is capable of evaluating the prognosis of ECCC patients.

To explore the impact of peritoneal cytology (PC) test results on prognosis in patients with uterine serous carcinoma (USC).

Medical record information including history of tubal ligation and preoperative hysteroscopy, pathology, surgery, adjuvant therapy, etc. of USC patients admitted to the Cancer Hospital, Chinese Academy of Medical Sciences from January 2004 to December 2020 was retrospectively collected and the cytological sections of PC were reviewed. Positive peritoneal cytology (PPC) patients were classified as PPC group while negative peritoneal cytology (NPC) patients were NPC group. The survival analyses were performed by Kaplan Meier method and prognostic factors of USC patients were analyzed by Cox proportional hazards regression model.

A total of 147 USC patients were included, aged [M(Q₁,Q₃)] 60 (54, 64) years. There were 43 cases (29.3%) in the PPC group and 104 cases (70.7%) in the NPC group. The follow-up time was [M(Q₁,Q₃)] 60 (34, 73) months, with 52 cases of USC recurrence and 30 patients deaths. The 5-year progression free survival rate was 66.5% and the 5-year overall survival rate was 79.2%. Both 5-year progression free survival rate (41.2% vs 77.0%) and 5-year overall survival rate (58.6% vs 87.1%) were lower in PPC group than those in NPC group (both P<0.001). In 102 patients without pelvic abdominal involvement (stage Ⅰ, Ⅱ, and stage Ⅲ patients with only lymph node metastasis), PPC was associated with USC recurrence (HR=4.191, 95%CI: 1.729-10.165) and USC patients death (HR=4.306, 95%CI: 1.351-13.731). Among 45 patients with pelvic abdominal involvement, PPC was not associated with USC recurrence (HR=1.450, 95%CI: 0.637-3.303) or patient death (HR=1.520, 95%CI: 0.488-4.730).

In USC patients, compared with NPC, PPC patients have poorer prognosis. PPC is a factor for prognosis in USC patients without pelvic abdominal involvement.

To explore the application value of surface respiratory muscle electromyography and its ratio to tidal volume in the assessment of airway hyperresponsiveness in bronchial asthma patients.

A case-control study was conducted to retrospectively analyze the data of 29 asthma patients who visited the outpatient department of respiratory medicine of the First Affiliated Hospital of Guangzhou Medical University from October 2015 to May 2017 and 27 non-asthmatic subjects who were recruited as the control group.Changes in surface respiratory muscle electromyography [parasternal electromyogram(EMG_para); diaphragmatic electromyogram (EMG_di)], and its ratio to tidal volume (EMG_para/VT, EMG_di/VT) before and after the histamine challenge test were compared between the asthma group and the control group; and their receiver operating characteristic (ROC) curves were plotted.

The age of 29 patients in the asthma group was (50±13) years (male: female=14∶15), while that of 27 subjects in the control group was (35±13) years (male: female=11∶16). After the histamine challenge test, EMG_di, EMG_di/VT, EMG_para, and EMG_para/VT［M（Q₁，Q₃）］in the 29 asthma patients were 16.5 (11.4, 19.7)μV, 1.8 (1.4, 2.3) μV·kg/ml, 11.9 (10.0, 15.0) μV, and 1.3 (1.0, 1.7) μV·kg/ml, respectively, which were significantly higher than those at baseline [12.0 (8.5, 6.0) μV, 0.9 (0.7, 1.3) μV·kg/ml, 9.4 (7.2, 12.8) μV, and 0.8 (0.7, 1.1) μV·kg/ml, all P<0.001]. Changes of EMG_di, EMG_di/VT, EMG_para, and EMG_para/VT(ΔEMG_di, ΔEMG_di/VT, ΔEMG_para, and ΔEMG_para/VT) in the asthma group before and after the provocation test were 37.2% (16.2%, 60.5%), 77.1% (40.3%, 145.9%), 28.9% (15.4%, 50.9%), and 62.2% (36.6%, 109.1%), respectively, which were significantly greater than those in the control group [0.9% (-17.2%, 9.0%), 0.7% (-13.3%, 20.1%), 3.9% (-11.0%, 10.0%), and -2.0% (-12.7%, 21.4%), all P<0.001]. The sensitivities of ΔEMG_di, ΔEMG_di/VT, ΔEMG_para, and ΔEMG_para/VT for diagnosing airway hyperresponsiveness were 79.3%, 86.2%, 75.9%, and 79.3%, respectively, while the specificities were 85.2%, 96.3%, 92.6%, and 92.6%, respectively. The areas under ROC curves (AUC) for ΔEMG_di, ΔEMG_di/VT, ΔEMG_para, and ΔEMG_para/VT were 0.842 (95%CI: 0.720-0.926), 0.917 (95%CI: 0.812-0.974), 0.843 (95%CI: 0.721-0.926), and 0.916 (95%CI: 0.810-0.973) respectively, with no statistically significant differences among these AUC values (all P>0.05).

EMG_pora, EMG_di and its ratio to tidal volume can accurately reflect the changes of airway resistance during bronchial provocation test, and differentiate asthma patients from non-asthmatic subjects, which therefore could be an alternative for the asthma diagnosis.

To evaluate the effect of low-dose s-ketamine on cough response during extubation period in patients undergoing suspension laryngoscopic surgery.

From November 2023 to January 2024, 66 adult patients (41 males and 25 females) scheduled for suspension laryngoscopic surgery in Beijing Tongren Hospital Affiliated to Capital Medical University were enrolled, with age of (49.6±11.1) years and American Society of Anesthesiologists (ASA) grade Ⅰ-Ⅱ. The patients were divided into two groups using a random number table method: treatment group (n=33) and control group (n=33). Patients in the treatment group received 0.25 mg/kg s-ketamine intravenously after induction, and the control group received the same volume of normal saline. The main outcomes included the incidence of cough response and moderate to severe cough response during extubation. The secondary outcomes included heart rate and mean arterial pressure (MAP) at the time of entering the operation room (T0), before intubation (T1), 1 min after intubation (T2), 1 min after suspending laryngoscope (T3), 5 min after suspending laryngoscope (T4), at the end of surgery (T5), and immediately after intubation (T6). Extubation time, the modified Aldrete scores on entering and exiting post-anesthesia care unit (PACU), length of stay in PACU, the numerical rating scale (NRS) scores on exiting PACU and 6 h after surgery and adverse events were also recorded.

There were no significant differences in age, gender, ASA grade, body mass index and operation time between the two groups (P>0.05). The incidence of cough response and moderate to severe cough response in the treatment group was 39.4% (13/33) and 12.1% (4/33), respectively. They were significantly lower than those in the control group [66.7% (22/33), 36.4% (12/33)] (all P<0.05). There was no significant difference in the changes of heart rate and MAP between the two groups at any time point (P>0.05). There were no significant differences in extubation time, the modified Aldrete scores on entering and exiting PACU, length of stay in PACU and NRS scores on exiting PACU and 6 h after surgery between the two groups (all P>0.05). No adverse events such as increased secretions, laryngospasm, agitation, nightmare, hallucination, blurred vision and headache were observed in either group.

Infusion of low-dose s-ketamine can effectively alleviate cough response in patients undergoing suspension laryngoscopic surgery during extubation period and has no effect on intraoperative hemodynamics, postoperative recovery, or adverse events.

To compare perioperative outcomes between transumbilical laparoendoscopic single-site surgery (TU-LESS) and conventional multi-port laparoscopic surgery (MLS) in patients with endometrial cancer (EC), and evaluate the safety, feasibility, and efficacy of the "Chopstick Technique" TU-LESS. The single-center retrospective study included 535 patients who underwent surgical treatment between August 2018 and August 2021. Patients treated with the "Chopstick Technique" TU-LESS were assigned to the TU-LESS group, and those treated with MLS were assigned to the MLS group. After propensity score matching, 39 patients in the TU-LESS group and 76 patients in the MLS group were included. The age of the included patients was (50.8±7.8) years, and there were no significant differences between the TU-LESS and MLS groups in terms of age, body mass index, obstetric history, history of abdominal and pelvic surgery, International Federation of Gynecology and Obstetrics (FIGO) 2014 staging, or histological grade (all P>0.05). The TU-LESS group had a longer operative time compared to the MLS group [(175.2±57.1) vs (152.9±56.4) min, P=0.048], but had lower postoperative visual analog scale pain scores [1 (1, 2) vs 2 (2, 3) scores, P<0.001] and higher postoperative incision satisfaction scores [(5.7±0.5) vs (5.2±0.7) scores, P=0.001]. There were no significant differences between the two groups in terms of intraoperative blood loss, number of pelvic and paraaortic lymph nodes removed, incidence of perioperative complications, or length of postoperative hospital stay (all P>0.05). Compared to traditional laparoscopic techniques, the "chopstick technique" TU-LESS had advantages, such as less postoperative pain and higher patient satisfaction with the incision, with a similar efficacy to MLS.

The current study aimed to explore clinical outcomes of endoscopic stapedotomy under continuous irrigating mode (CIM) for otosclerosis. Patients who underwent CIM of endoscopic ear surgery (CIM-EES) at the Department of Otolaryngology Head and Neck Surgery, Renmin Hospital of Wuhan University between March 2022 and February 2023 were retrospectively included. Relevant clinical data were collected, and the safety of and effectiveness of CIM-EES was explored. A total of 18 patients (19 ears) (3 males and 15 females) aged (31.4±10.4) years were included in the study. Compared with preoperative results, the patient′s average bone conduction threshold did not increase 3 months after surgery [(17.23±4.67) vs (17.30±4.68) decibel hearing level (dB HL), P=0.920]. However, the average air conduction threshold [(27.04±6.18) vs (52.63±8.01) dB HL, P<0.001] and the air-bone gap [(9.80±4.63) vs (35.33±8.62) dB HL, P<0.001] were significantly improved. The current study indicates that CIM-EES has good efficacy in stapedotomy.

A retrospective analysis was conducted on the clinical data of 103 patients who underwent type Ⅰ tympanoplasty under endoscopy at the Department of Otorhinolaryngology Head and Neck Surgery, Tianjin First Central Hospital between January 2020 and February 2023. Among them, 36 were males and 67 were females, with a median age M [(Q₁, Q₃)] of 49 (35, 59) years. After a three-month follow-up, the tympanic membrane healing rate was 92.2% (95/103). Multivariate logistic regression model analysis showed that the absence of preoperative hypertension (OR=1.48, 95%CI: 1.13-1.75), a preoperative sound compliance value>0.2 (OR=1.77, 95%CI: 1.28-3.92), a preoperative wet ear condition (OR=2.27, 95%CI: 1.02-5.06), and the use of perichondrium for repair during surgery (OR=1.42, 95%CI: 1.27-3.52) were influencing factors of hearing improvement. Notably, patients with wet ears exhibited higher improvement in air-bone gap at low frequencies (250, 500, and 1 000 Hz) compared to those with dry ears (all P<0.05). These findings suggest that type Ⅰ tympanoplasty under endoscopy achieves favorable clinical outcomes. Preoperative blood pressure control, and the intraoperative use of perichondrium grafts can effectively enhance post-operative hearing improvement.

Osimertinib has become the most common first-line standard of care for patients with advanced non-small cell lung cancer (aNSCLC) with epidermal growth factor receptor (EGFR) mutations. Its first-line drug resistance mechanism can be divided into primary drug resistance mainly with EGFR co-mutation and EGFR20 exon insertion, and secondary drug resistance mainly with on-target resistance and off-target resistance. In addition to specific therapeutic strategies for specific gene or target mutations, previous clinical trials have found that the use of targeted, immune, anti-angiogenic, and antibody-drug conjugates (ADCs) treatment regimens alone or in combination can also effectively overcome some drug resistance mechanisms. This article reviews the different mechanisms and coping strategies of osimertinib in the first-line treatment of aNSCLC patients after drug resistance, aiming to provide new ideas for its precise treatment.

Scoliosis (Cobb angle ≥10°) is the most common spinal deformity. With the increase of bending angle, the lung function of patients gradually decreased. When Cobb angle>40°, surgical treatment can significantly improve the prognosis of patients. Perioperative pulmonary complications are a common cause of postoperative death in patients with scoliosis, so perioperative pulmonary protection is particularly important. This article summarizes perioperative lung protection strategies and research progress in scoliosis orthopedic surgery from the aspects of effective preoperative airway and cardiopulmonary function assessment, personalized and customized pre-rehabilitation exercise program, physical therapy and nutritional support, intraoperative ventilation and volume management, anti-inflammatory stress management and monitoring, and postoperative multimodal analgesia and active rehabilitation training, aiming to help reduce the risk of pulmonary complications and provide reference for perioperative anesthesia management.