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Objective To evaluate the efficacy and toxicity of postoperative chemoradiation for D2 dissection gastric cancer,and to compare the difference of toxicity between confromal and traditional radiotherapy.Methods Sixty four patients with T3-4,N + or R1 were enrolled.Radioation was given to a total dose of 46Gy delivered in 23fractions by use of 3D-CRT or 4 fields traditional radiotherapy.Chemothrepy was administered with paclitaxel 135 mg/m2 day 1 and 29,cisplantin 20 mg/m2 day 1 ～3 and day 29 ～31 during radiotherapy.Results The median follow-up time was 40 months.The 3-year overall and relapse-free survival rates were 78.2% and 70.9%,respectively.Eighteen patients had tumor relapse.Fifty-three patients completed chemoradiotheray.Toxicities on grade 3 or above included gastrointestinal toxicity (28.1% ),eutropenia (21.8 % ) and alopecia ( 18.7% ).One patient died of hemorrhage of upper digestion tract.Conclusion Adjuvant radiotherapy with paclitaxol and cisplatin yielded satisfactory overall survival and disease-free survival in gastric cancer patients.The toxicity was manageable.Conformal radiotherapy seems to decrease the gastrointestinal toxicities compared to that occurred in the traditional radiotherapy.
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Objective To study the factors affecting the activities of daily life (AOL) of patients after the first stroke of cerebral infarction in order to formulate the intervention strategy for improving the capability of ADL of patients. Method A total of 149 patients with the first stroke of cerebral infarction admitted from Oct. 2008 to Dec.2008 were enrolled in this study. The demographics of patients, cerebral infarction risk factors, apopletic score as per National Institute of Health stroke scale (NIHSS), white blood cell count (WBC) and plasma glucose (PG) were recorded on the first day of admission, and many other laboratory examinations were done on the next morning. The occurrences of infection in lung and urinary tract, and atrial fibrillation were recorded during hospi-talization. The NIHSS score and score of Glasgow Coma Scale (GCS) were taken within 24 hours after admission, on the 14th day and at the end of the third month after cerebral infarction respectively. Barthel index (BI) was taken in the second week as well as at the end of third month by follow-up in the OPD or by telephone. The correlation analysis and multiple linear stepwise regression analysis were used to find the risk factors. Results The PG level, WBC count and NIHSS score were independently associated with ADL in the second week as well as at the end of the third month after cerebral infarction. Besides, the urinary tract infection during hospital stay was also independently associated with ADL at the end of the third month after cerebral infarction. Conclusions The plasma glucose level, WBC count, NIHSS score and urinary tract infection are the risk factors. Positive measures should be taken to control these risk factors so as to improve the capability of ADL of the patients after cerebral infarction.
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ObjectiveTo investigate the current situation of postoperative fluid therapy in general surgery department of grade Ⅲ-A general hospitals in Beijing and Tianjin. Methods Postoperative patients in general surgery department who were fasting for 3 days were retrospectively investigated, and 600 cases were recruited without considering age, gender, denomination of disease and operation type.The general information of patients, laboratory examination before and after operation, postoperative fluid therapy for 3 days, postoperative complications and infusion reaction were collected.Results In total 588 valid cases, the volume of average fluids supplement was (3030±638)ml per day, With the prescribed glucose (142+67)g per day, potassium chloride (59.9±23.9) mmol per day and sodium chloride (179.5±66.7) mmol per day. 85.2 % of total patients received nutrition support and the ratio of parenteral nutrition/enteral nutrition (PN/EN) was 28/1.There were 549 patients with BMI>18.5 before operation, and among them, 470 cases (85.6%)received parenteral and enteral nutrition treatment. There were 39 patients with BMI < 18.5 and 27 cases (69.2%) received parenteral nutrition support without enteral nutrition treatment. During the 3 days after operation, there were 36 cases with fluid therapy without potassium chloride supplement.ConclusionsThe proportions of receiving nutrition support and parenteral nutrition treatment are relatively high in grade Ⅲ-A general hospitals in Beijing and Tianjin. Ready-to-use preparation canreduce mistake and will be benefit to patients.
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Objective To evaluate the effect of late course accelerated hyperfractionation radiotherapy(LCAHR) for esophageal carcinoma. Methods Six clinical trials on LCAHR for esophageal carcinoma were reviewed by means of Meta analysis . Results The 1 and 3 year survival rates in the LCAHR group derived from the fixed effect model were 2.39 (1.58～3.62) and 3.05(1.96～4.74) times higher than the conventional fractionation group. With the random effect model,the 1 and 3 year survival rates in the LCAHR group were 2.43(1.54～3.82) and 2.99(2.08～4.30) times higher than the conventional fractionation group.Conclusion For esophageal carcinoma,the better outcome of LCAHR makes it advisable in extensive clinical practice.