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Objective To analyze the efficacy and safety of erlotinib associated conformal intensity modulated radiotherapy in treatment (IMRT) of locally advanced pancreatic carcinoma. Methods The clinical data of 23 patients with locally advanced pancreatic carcinoma were retrospectively analyzed. The patients′ therapeutic methods: erlotinib was taken continuously and orally at 100 mg/time, 1 time/d until disease progressed or serious adverse reactions happened; intensity modulated radiotherapy (IMRT) was used combined with erlotinib at 50.4 Gy, 1 time/d, 1.8 Gy/time, 5 times/week, total 28 times. Tumor response was evaluated at the end of radiotherapy after 4 weeks. Results In 23 patients, there was partial response in 10 cases, stable disease in 9 cases and progress disease in 4 cases. The objective response rate was 43.5%(10/23), and the median survival time was 11.3 months. Adverse reactions included fatigue, rash, bone marrow suppression, nausea and diarrhea. The adverse reactions were mostly tolerable with grade 1-2. Conclusions Erlotinib combined with IMRT is safe and effective in patients with locally advanced pancreatic carcinoma, which is worthy of further study.
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Objective To investigate the risk factors for colorectal cancer adjuvant chemotherapy induced leucopenia. Methods The basic clinical data of 108 patients with colorectal cancer who had received radical operation and adjuvant chemotherapy were retrospectively evaluated. The patients were divided into two groups: normal white blood cell group (39 patients) and leucopenia group (69 patients). The data were analyzed with SPSS 22.0 software, t test, χ2 test , univariate analysis and multifactor Logistic regression analysis, and analysis of variance to investigate the risk factors for colorectal cancer adjuvant chemotherapy induced leucopenia. Results Univariate analysis revealed that the female patients and the ones who received radiotherapy were more prone to leucopenia (P<0.01), while hypertension, the levels of white blood cell, neutrophil counting and serum creatinine before chemotherapy were protective factors for leucopenia (P<0.05 or<0.01). Multifactor Logistic regression analysis revealed that the level of serum creatinine before chemotherapy was an independent risk factor for leucopenia, OR = 0.950 (95% CI: 0.906- 0.996, P<0.05). The further analysis showed the lower the level of serum creatinine, the more severe the leucopenia would be (P = 0.04). Conclusions The level of serum creatinine before chemotherapy was an independent risk factor for colorectal cancer adjuvant chemotherapy induced leucopenia.
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Objective To analyze the incidence and causes of stillbirth in 11 hospitals of Guangdong province, and to explore the appropriate interventions. Methods Clinical data of stillbirth in 11 hospitals of Guangdong province were collected from January 2014 to December 2016. The gestational weeks,causes,maternal conditions and other factors were analyzed.Results (1)From 2014 to 2016,103 472 newborns were delivered in the 11 hospitals,and the number of stillbirth was 2 204,with the incidence of 2.13%. Among them, 0.71%(738/103 472) was therapeutic induction, 1.42%(1 066/103 472) was natural stillbirth.At different gestational age(<28 weeks,28-<37 weeks and≥37 weeks),the incidence of stillbirth was 55.63% (1 226/2 204), 28.45% (627/2 204) and 15.92% (351/2 204), respectively, with statistically significant difference (P<0.01). (2) For stillbirth<28 weeks, the first reason was therapeutic induction, accounting for 53.34%(654/1 226).For stillbirth during 28-37 weeks,pre-eclampsia was the major cause, accounting for 40.67% (255/627). And for full-term stillbirth, the causes were umbilical cord factors (19.37%, 68/351), abnormal labor (17.09%, 60/351). (3) In all the stillbirth cases, the incidence of fetal growth restriction (FGR) <28 weeks was significantly higher than that during 28-37 weeks [23.49%(288/1 226)vs 18.02%(113/627), P<0.01]. (4) The stillbirth rate during labor was significantly higher in women ≥35 years old than in younger women [63.88%(191/299)vs 36.12%(108/299);χ2=9.346, P=0.000]. For the causes of stillbirth during labor, the incidence of severe maternal obstetrical complications [61.11%(33/54)vs 38.89%(21/54);χ2=3.323,P=0.002],abnormal labor[65.82%(52/79)vs 34.18%(27/79);χ2=4.067,P=0.001]and abnormal fetal position[66.63%(26/39)vs 33.37%(13/39);χ2=3.002,P=0.013] were higher in women ≥35 years old than in younger women. (5) Cesarean section during labor accounted for 33.77%(101/299)of stillbirth,including 76 cases of emergency cesarean section or converted to cesarean section during labor. Conclusions (1) The incidence of stillbirth in the 11 hospitals is high, and the causes are different at different gestational ages, therefore,different interventions are needed to reduce the incidence in different gestational weeks. Supervision of therapeutic induction should be strengthened <28 gestational weeks;standard management of pregnancy might decrease the occurrence of natural death ≥28 weeks. (2) Attention should be paid to fetal body weight during pregnancy, especially FGR. (3) The stillbirth rate is high in elderly pregnant women, so it is important to strengthen the management of the elderly pregnant women.
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Objective To study the feasibility and safety of trial of labor after cesarean section (TOLAC). Methods Retrospective analysis of five medical center of Guangdong province from January 2011 to December 2015 hospitalized delivery information, compare the same scar TOLAC (research group) with the scar pregnancy (control group) pregnancy outcomes, to study the feasibility and safety of TOLAC. Results (1)During 2011-2015, total delivery 95 600 cases in five medical center, 13 824 cases of thme with uterine scar pregnancy, including 12 027 cases elective repeat cesarean section and 1 797 cases (13.00%, 1 797/13 824) with scar uterus vaginal trial of labor. Among 1 308 cases of vaginal delivery,the success for trial of labor rate was 72.79% (1 308/1 797). From 2011 to 2015, there were increased rate of pregnancy after cesarean section, which were respectively 10.71%, 13.28%, 14.45%, 15.54%and 16.98%. The will of vaginal birth were rising and the rate were respectively 11.85%, 12.25%, 13.49%, 13.82%and 12.93%. (2) There were 489(27.21%,489/1 797) cases of scar uterus maternal emergency cesarean section in the trial of labor, reason for“social factors”require for cesarean delivery have 68 cases, the percentage was 13.91% (68/489), compared with control group (7.18%, 206/2 869), the difference was statistically significant difference (χ2=27.356,P=0.000). Doctors diagnosed as“aura uterine rupture”in the labor was 11.86% (58/489), compared with that in control group (1.43%, 41/2 869), the differences were statistically significant difference (χ2=1 578.223,P=0.000). (3) The incidence of uterine rupture of the research group(0.74%,9/1 211)was significantly higher than that of control group (0.01%,2/31 200;χ2>2 000,P=0.000). The incidence of postpartum hemorrhage in research group was 6.94% (84/1 211), compared with that in the control group (3.05%, 951/31 200), there was statistically significant difference (χ2=16.328,P=0.000). While, there were no statistical significancefor the labor time limit,birth rate of severe asphyxia and neonatal birth weight average differences between two groups (P>0.05). Conclusions The rate of pregnancy after cesarean section is increasing year by year, and the will of vaginal birth is increasing, while it still are generally low. TOLAC is safe and feasible, but also significantly higher risk, strictly labor monitoring and can proceed fast cesarean delivery in delivery room is an important guarantee of safe delivery.
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BACKGROUND:There are many positive effects by activation of peroxisome proliferator activated receptor-gamma (PPARγ) signal pathway in cardiovascular system. Angiotensin II is closely related with myocardial fibrosis, however, there are few articles demonstrating that the activation of PPARγsignal pathway can weaken the expression of angiotensin II to improve the radiation-induced heart injury. OBJECTIVE:To evaluate the effect of angiotensin II type 1 receptor in the rat model of radiation-induced heart injury after PPARγsignal pathway is activated. METHODS:Sixty rats were randomly and equal y divided into five groups:control, pioglitazone, model, radiation+low-dose pioglitazone, radiation+high-dose pioglitazone. In the model, radiation+low-dose pioglitazone, radiation+high-dose pioglitazone groups, rats received 6 MV high energy X-ray irradiation at the range of 1.5 cm × 1.5 cm and the irradiation dose of 300 cGy/min, for 6 hours. Furthermore, rats in the radiation+low-dose pioglitazone and radiation+high-dose pioglitazone groups were given 10 and 20 mg/kg pioglitazone by lavage, for 30 days;rats in the model group were given 2 mL distil ed water. In the pioglitazone group, rats were treated with 10 mg/kg pioglitazone by lavage. RESULTS AND CONCLUSION:After rats were treated with pioglitazone, the heart injury and the heart fibrosis in the irradiated rats were decreased. The expressions of angiotensin II type 1 receptor mRNA and protein in the heart tissue were down-regulated. Experimental findings indicate that, pioglitazone intervention downregulates the expression of angiotensin II type 1 receptor in the rat models of radiation-induced heart injury and activation of PPARγsignal pathway al eviates the radiation-induced heart injury.
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Objective To explore whether pioglitazone can ameliorate radiation-induced fibrosis in rat heart.Methods A total of 46 Sprague-Dawley rats were divided into six groups (control group, pioglitazone (Pio) 10 mg·kg-1 ·d-1 group, Pio 20 mg·kg-1 ·d-1 group, 18 Gy irradiation + placebo group;18 Gy irradiation + Pio 10 mg·kg-1 ·d-1 , and 18 Gy irradiation + Pio 20 mg·kg-1 ·d-1 group).Experimental animals were exposed to radiation at the chest, then administered Pio or placebo for one month.At 3 months later, the rats were killed and their heart tissues were collected for Masson staining, Western blot analysis and real-time polymerase chain reaction assay (real-time PCR).Results Masson staining revealed significant myocardial fibrosis in rats exposed to radiation, while these changes were reduced when the rats were given Pio.Western blot analysis showed that the PPAR-γ protein expression in the heart tissue of irradiated rats were higher than in the non-irradiated group (F =12.435, P ＜ 0.05).Real-time PCR assay showed that PPAR-γ mRNA expression in the irradiation + Pio 20 mg· kg-1· d-1 group was higher than that in the Pio 20 mg· kg-1 ·d-1 group (F =2.333, P ＜ 0.05).The expression of TGF-β1 protein in the irradiation + placebo group were higher than those in the other five groups (F =17.578 ,P ＜0.05), and the CDK5 protein expression had a high level in the three irradiated groups while only the irradiation + placebo group was statistically higher than controls (F =3.651, P ＜ 0.05).Conclusions Pioglitazone may ameliorate radiation fibrosis in the rat heart through its anti-fibrotic activity, perhaps via inhibiting Cdk5-mediated PPAR-γ phosphorylation.
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Objective To investigate the hepatitis B virus (HBV) infection status quo among childbearing age women to provide the theoretical basis for adopting the effective intervention ,treatment and blocking measures in pre-pregnant women .Methods The enzyme-linked immunosorbent assay (ELISA) and the time-resolved fluorometric immunoassay were adopted to detect HbsAg in 68 682 children bearing age women ,including outpatient and hospitalized patients ,in this hospital from February 2012 to September 2013 .The detect results were analyzed according to the age ,place of residence and medical departments .Results Among 68 682 children bearing age women ,3 260 cases were found positive for HbsAg with the HBsAg positive rate of 4 .70% .The statistically significant differences in the HBV infection positive rate existed among different age groups ,the positive rates in the age groups of 16- <20 years ,20 - < 25 years ,25 - < 30 years ,30 - < 35 years ,35 - < 40 years ,40 - < 45 years and 45 - < 50 years were 3 .83% ,4 .89% ,4 .96% ,4 .91% ,4 .18% ,4 .40% and 4 .18% respectively ,the differences among them had statistical significance (χ2 =15 .76 ,P=0 .015) ,in which the age 25- <30 years group had the highest HBV infection rate .At the same time the signifi-cant differences in the geographical distribution and medical departments existed .The HBV infection positive rate in rural area was significantly higher than that in city with statistical difference (χ2 =27 .47 ,P<0 .05) ,and the HBV infection positive rate in the outpatient departments was higher than that in the inpatient departments with statistical difference (χ2 =46 .88 ,P<0 .05) .Conclu-sion Children bearing women at 20-34 years old show the highest HBV infection rate .The HBV screening and the works of pre-vention and treatment during this age period should be strengthened ,which conduces to discover the HBV infection positive patients in time and prevent the mother-to-fetus transmission .
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ObjectiveTo demonstrate the project scope of the afferent nerves of the lumbar intervertebral disc,on which basis to explore the mechanism of the symptoms of discgenic low back pain.MethodsThirty Wistar rats were divided randomly into three groups of 10 rats each:the L4-5,L5-6,and L6 S1 group.Each group was further divided randomly into two subgroups,the experimental group and the control group,5 rats for each group.Intervertebral disc was exposed through the posterior approach under peritoneal cavity anesthesia,after the nerve roots were pull away,2 μl of 30％ cholera toxin-horseradish peroxidase (CT-HRP) was injected into the inner layer of the intervertebral disc in the experimental group,while 2 μl of 0.9％ Nacl was used in the control group.Forty-eight hours after the surgery,all rats were perfused and bilateral dorsal root ganglions(DRGs) of T10-L3 were resected and fixxied.Each DRG was sectioned at 30 μm thickness and processed by DAB method.The sections of DRGs were coverslipped and observed by optical microscopy for the neurons or axons labelled by CT-HRP.It was judged as positive that brownish-black particles were in the neurons or axons.ResultsNot in a single dorsal root ganglions,but in a scope of dorsal root ganglions axons labled by CT-HRP could be seen in the rats in the experimental groups.No CT-HRP labled neurons or axons were seen in dorsal root ganglions in the contral groups.ConclusionAfferent nerves of the lumbar intervertebral disc project to a scope of dorsal root ganglions,which is the anatomic basis of the mechanism of the symptoms of discgenic low back pain.