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Objective:To investigate the efficacy of additional treatment (chemoradiotherapy or esophagectomy) after endoscopic submucosal dissection (ESD) for superficial esophageal squamous cell carcinoma.Methods:Clinicopathological data of 97 patients of esophageal squamous cell carcinoma with infiltration depth of M3-SM3 who underwent ESD in Zhongda Hospital from July 2014 to April 2019 were reviewed. There were 57 patients in the additional treatment group and 40 patients in the observation group. The rate of relapse-free survival (RFS) was evaluated by Kaplan-Meier method (used log-rank test).Results:In the additional treatment group, 15 underwent esophagectomy after ESD, and no tumor metastases were found, but 1 patient died of upper gastrointestinal bleeding after surgery; 42 underwent chemoradiotherapy, and all patients were alive, but 3 patients experienced distant metastases. In the observation group, 13 patients experienced local recurrence, 2 patients died of tumor recurrence and 1 patient died of cerebrovascular disorder. Kaplan-Meier analysis showed that the RFS rate of the additional treatment group was higher than that of the observation group ( P=0.001). Conclusion:ESD followed by additional chemoradiotherapy or esophagectomy has good clinical efficacy and can improve prognosis for superficial esophageal squamous cell carcinoma (M3-SM3) patients.
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Objective:To investigate the medium- and long-term efficacy of peroral endoscopic myotomy (POEM) for esophageal diverticulum and the risk factors for postoperative recurrence.Methods:A retrospective study was conducted on 31 cases of esophageal diverticulum who were treated by POEM in Zhongda Hospital, Southeast University from May 1st 2016 to August 1st 2019. The Eckardt score, the operative success rate, and the recurrence rate after the operation were observed and recorded. Multivariate logistic regression analysis was performed to explore the risk factors for postoperative recurrence.Results:POEM was successfully completed in all 31 patients, who were followed up for 30.6±11.1 months (20-63 months). The Eckardt score before the operation was 8.2±2.4, and was 1.4±0.7, 1.4±1.1, 1.3±1.1, and 1.3±0.9 at 1, 6, 12 and 24 months, respectively after the operation, which significantly decreased at all follow-up time points ( P<0.001). The success rates at 1, 6, 12, and 24 months after the operation were 96.8% (30/31), 90.3% (28/31), 90.3% (28/31) and 90.3% (28/31), respectively. Three patients suffered symptom relapse, with an overall recurrence rate of 9.7% (3/31). Logistic regression analysis showed that the disease duration ( P=0.038, OR=1.041, 95% CI: 1.002-1.080) and preoperative Eckardt score ( P=0.024, OR=2.299, 95% CI: 1.117-4.728) were risk factors for postoperative recurrence of POEM. Conclusion:POEM is safe and effective for esophageal diverticulum. Patients with long disease duration and high preoperative Eckardt score are associated with recurrence.
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Objective To evaluate the demand for midwives in Yunnan province utilizing Birthrate Plus for planning and development of such workforce. Methods A convenient sample method was used to investigate 8435 maternal cases at 9 hospitals in Yunnan province in four months from 9 - 12 in 2017, and Birthrate Plus was used to calculate the demand for midwifery at each hospital. We also analyzed the two core elements of Birthrate Plus- maternal category allocation and midwife hours of each hospital. Results Maternal cases fall into five categories and maternal category allocation in hospitals is roughly the same;Maternal in higher category tended to need longer midwife hours; the average birthrate of 9 hospitals was (194. 22 ± 44. 84) case/ ( year·midwife). The number of midwives in two tertiary hospitals is obviously insufficient. Midwives at 7 secondary hospitals are more than predicted. Conclusions Midwives in Yunnan are generally faced with a large workload, especially at secondary hospitals, and midwives need to bear numerous non-midwifery workload beyond Birthrate Plus. Therefore, the Birthrate Plus can reflect the midwifery workload scientifically and reasonably in the current situation of midwifery work. But the predication for midwifery workforce requires a study of the ratio of midwifery work in the entire clinical work of the hospital.
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Objective@#To understand the current situation of maternal health care in this area, and to provide basis for further improving the quality of maternal and child health care service in this area and in the western region of China.@*Methods@#The clinical data of 8 539 pregnant women from 10 hospitals in Yunnan Province was collected, including the general situation, the situation of medication and intervention during delivery, the mode of delivery and the outcome of delivery.@*Results@#Age (χ2=149.878, P<0.01), number of pregnancies (χ2=12.251, P<0.01), times of delivery (χ2=49.141, P<0.01), number of fetuses (χ2=18.580, P<0.01) and history of pregnancy (χ2=146.688, P<0.01)all affected the incidence of complications during parturition. And whether there are maternal complications will affect the situation of medication (χ2=131.959, P<0.01), induced labor (χ2=13.129, P<0.01) and the length of midwifery service in the delivery room (Z=-14.328, P<0.01).@*Conclusion@#Paying attention to the pregnant women with pregnancy complications/complications could help to reduce the maternal mortality rate, and provide the high-level health care for mothers and children in Yunnan Province and even in the western region of China.
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Objective To study the clinical management way for HPV+/papanicolaou (Pap)-during cervical cancer screening.Methods To analyze retrospectively the data from the patients who had loop electrical excision procedure (LEEP) for biopsy confirmed cervical intraepithelial neoplasia (CIN)Ⅱ in Peking University People's Hospital from Jan.2010 to Dec.2014.Results (1) For biopsy confirmed CINⅡ,HPV positive rate was 98.5％ (135/137),Pap test positive [≥atypical squamous cell of undetermined significance (ASCUS)] rate was 69.3％ (95/137),there was significant difference between them (x5=43.32,P＜0.01).(2) For the 42 patients with HPV+/Pap-,whose cytology slides were reviewed again.Among them,the interpretations of there were 16 cases confirmed as the same before,while 26 cases were changed to abnormal (≥ASCUS).Cytology be misdiagnosed was 19.0％ (26/137) at the first review.Among the 26 cases,13 (50.0％) cases were missed for the little amount of abnormal cells,8 (30.8％) cases for mild atypical morphology changed;the other 5 (19.2％) cases missed for stain problems.(3) For the cervical LEEP samples,37 cases of the pathology diagnosis were upgrade to CIN Ⅲ+,among them,2 cases of microinvasive cervical carcinoma,1 case of invasive cancer,34 cases of CIN Ⅲ;37 cases were CINⅠ or no lesion found;63 cases were still CIN Ⅱ.Four to six months later after LEEP,the cytology abnormal rate was 11.7％ (16/137),and the HR-HPV positive rate was 34.3％ (47/137).Conclusions Compared with cytology alone,cytology combined with HPV testing increase the sensitivity of cervical high grade lesion.For the cases of HPV+/Pap-cases,the cytology slides should be reviewed.The quality control of cervical exfoliate sample collection and interpretation should be strengthened.LEEP procedure is not only a treatment method,but also it could provide samples to confirm the diagnosis.
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Objective To analyze the changes of splenic volume and blood flow detected by ultrasonography in men having been migra-ted in high-altitude area for 10 years and to explore the relationship between the splenic blood flow and volume. Methods Men migrating to high-altitude area for 10 years,male indigenous Tibetan and healthy men from planitia with 55 cases in each were involved. Ultrasonography was performed to measure the length,width and thickness of spleen to calculate the volume,and color Doppler flow imaging was applied to measure the diameter of splenic artery and the mean flow velocity to calculate the blood flow volume. The differences among groups were com-pared and the relationship between the blood flow and the volume was analyzed. Results The blood flow and the volume of spleen in men migrating to high-altitude area were higher than those in male indigenous Tibetan and healthy men from planitia (P<0. 01),and the blood flow was positively correlated with the splenic volume (r=0. 828,P<0. 01). Conclusion The splenic volume and blood flow are increased in men when have been migrated in high-altitude area for 10 years and ultrasonography is of great importance in detecting the pathophysiologic changes in high-altitude area in our country.
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Objective To explore the effect of HAPA theory based intervention on diet control behavior of patients with polycystic ovary syndrome (PCOS).Methods 64 obese PCOS patients were randomly divided into the intervention group and the control group,32 cases in each group.The control group received routine health education,while the patients in the intervention group received HAPA theory based intervention.The diet control behavior and clinical monitoring indexes of patients were investigated before and 1 and 6 months after intervention.Results The behavior level of the intervention group on 1 month and 6 month after intervention was significant higher than that of the control group.The levels of BMI,FT,blood glucose level two hours after OGTT,follicle number of the intervention group after intervention were significantly lower than those of the control group.Conclusions The HAPA theory based intervention can improve the diet control behavior of PCOS patients,improve the effect of clinical treatment.
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Objective To study the effects of duration of migration from sea-level to high-altitude on cerebral hemodynamic parameters and their ethnic differences.Methods This randomized comparative study recruited 5 groups of healthy male subjects which were native Hans at sea-level (NHS),Han migrants from sea-level to high-altitude (HMSH,where HMSH-a for residence duration of 4 days,HMSH-b for 1 year,and HMSH-c for 5 years),and native Tibetans at high-altitude (NTH).Color duplex Doppler sonography (CDDS) was used to measure bilateral vertebral and internal carotid arterial diameters,mean flow velocities.The heart rate,arterial blood pressure,and arterial oxygen saturation were also recorded simultaneously,and in combination,hemoglobin was measured to assess total cerebral blood flow (TCBF),total cerebrovascular resistance (TCVR),and total cerebral oxygen supply (TCOS).Results After migration to high-altitude,Hans' TCVR and TCBF maintained the level of NHS after transient changes during early stage (P<0.05),and the TCBF was markedly higher than that of NTH (P<0.05);while the blood pressure and TCOS increased abruptly (P<0.05) at the beginning and kept for a relatively long time at a constant level which were higher than those of NTH all the time (P<0.05).Conclusions Han migrants can acclimate to high-altitude by adaptive change of cerebral blood flow over a short time and maintain a constant adaptability which is always weaker than that of native Tibetans.CDDS can be used for non-invasive measurement of actual cerebral blood flow,and is of good value in the study on high-altitude-related cerebral hemodynamics.
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<p><b>OBJECTIVE</b>To study the chemical constituents of Exochorda racemosa.</p><p><b>METHOD</b>Compounds were isolated and purified by silica gel, Sephadex LH-20, MCI gel and RP-18 column chromatography, and their structures were determined by spectroscopic analysis.</p><p><b>RESULT</b>Twenty compounds were isolated and identified as N-p-coumaroyl-N'-caffeoylputrescine (1), sutherlandin trans-p-coumarate (2), apigenin 7-O-methylglucuronide (3), astragalin (4), nicotiflorin (5), kaempferol 3-neohesperidoside (6), rutin (7), apigenin (8), luteolin (9), linalool-1-oic acid (10), betulalbuside A (11), ursolic acid (12) , corosolic acid (13), gynuramide II (14), beta-sitosterol (15), daucosterol (16), uridine (17), adenosine (18), syringin (19), and trans4-hydroxycinnamic acid (20), respectively.</p><p><b>CONCLUSION</b>All compounds were obtained from this plant for the first time, moreover, 1 was reported as a new natural product, and 2 is a naturally rare cyanogenic glycoside.</p>