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Objective:To analyze the treatment efficacy, safety and dose parameters of optimized hippocampus-avoidance prophylactic cranial irradiation (HA-PCI) in limited-stage small cell lung cancer (LS-SCLC) and explore the corresponding dosimetric parameters under the condition of narrowing the hippocampus avoidance region as hippocampus region plus 2 mm in three dimensions.Methods:Clinical data of patients with LS-SCLC receiving HA-PCI (hippocampus avoidance region defined as hippocampus region plus 2 mm in three dimensions) in Cancer Hospital Chinese Academy of Medical Sciences from August 2014 to June 2020 were retrospectively analyzed. Dose parameters of HA-PCI and adverse events were analyzed using descriptive statistics analysis. Changes of neurocognitive function, such as mini-mental state examination (MMSE) and Hopkins verbal learning test-revised (HVLT-R) scores, were evaluated by analysis of variance and Kruskal-Wallis H test. Overall survival (OS), progression-free survival (PFS) and intracranial PFS (iPFS) were calculated using Kaplan-Meier method. The cumulative incidence of local-regional recurrence (LRR), extracranial distant metastases (EDM), and locoregional recurrence (LR) were investigated under competing risk analysis. Results:A total of 112 patients were included, the median follow-up time was 50 months (95% CI: 45.61-54.38). The median volume of hippocampus was 4.85 ml (range: 2.65-8.34 ml), with the average dose ≤9 Gy in 106 patients (94.6%), ≤8 Gy in 92 patients (82.1%). The median volume of hippocampus avoidance area was 15.00 ml (range: 8.61-28.06 ml), with the average dose ≤12 Gy in 109 patients (97.3%), ≤10 Gy in 101 patients (90.2%). The 2-year cumulative LRR, EDM, LR rates were 16.9%, 23.2% and 28.5%, respectively. The 5-year cumulative LRR, EDM, LR rates were 23.2%, 26.9% and 33.3%, respectively. The 2-year iPFS, PFS and OS rates were 66.1% (95% CI: 57.9%-75.4%), 53.6% (95% CI: 45.1%-63.7%) and 80.4% (95% CI: 73.3%-88.1%), respectively. The most common grade I-Ⅱ adverse events were nausea (33.9%) and dizziness (31.3%), and only 1 patient developed grade Ⅲ nausea and dizziness. MMSE ( n=57) and HVLT-R tests ( n=56) showed no significant decline. Conclusions:Optimized HA-PCI can achieve similar dose limitation with favorable efficacy and light toxicity. No significant decline is observed in short-term neurocognitive function in evaluable patients.
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Objective:To establish the first Mini-Formative Evaluation of Radiation Oncology (Mini-FERO) scale in China and evaluate its preliminary application value in the standardized training for radiation oncology resident physicians.Methods:Based on the educational curriculum and examination requirements for the standardized training for radiation oncology resident physicians, as well as the standardized Mini-Clinical Evaluation Exercise (Mini-CEX) scale commonly used in clinical practice, the Mini-Formative Evaluation of Radiation Oncology (Mini-FERO) scale was developed to facilitate the standardized training for resident physicians in the field of radiation oncology. In this prospective study, a randomization method using a random number table was employed to select a cohort of 26 resident physicians who completed their rotations in Department of Radiation Oncology at the Cancer Hospital, Chinese Academy of Medical Sciences from March 1, 2021 to December 31, 2021. The Mini-FERO scale was administered in the initial, middle, and final stages during the rotation period. The differences in evaluation scores before and after the assessments were analyzed by paired t-test. Furthermore, participating resident physicians and supervising teachers provided satisfaction ratings, and a comprehensive evaluation of the Mini-FERO scale was conducted. Results:The average scores of the three examinations of 26 resident physicians demonstrated a successive improvement, with individual performance in each assessed category also showing progressive enhancement. The second evaluation exhibited a more pronounced score increase compared to the first evaluation, with a mean improvement of (1.43±1.02) points ( t=7.13, P<0.001); while the third evaluation had a mean improvement of (0.41±0.50) points ( t=4.07, P<0.001) compaired to the second evaluation, with a mean difference of (1.02±1.15) points between the two ( t=4.53, P<0.001). The average time required for the assessments was (34.31±24.46) min. Overall satisfaction ratings from the evaluated resident physicians for the Mini-FERO scale were (8.42±0.85) points, and supervising teachers reported an overall satisfaction rating of (8.45±0.85) points. The satisfaction rate was 96% (25/26). Conclusions:In this study, the Mini-FERO scale was successfully developed and validated in the context of clinical teaching practice for radiation oncology resident physicians. The Mini-FERO scale is proven to be a feasible tool for assessing the gradual improvement of resident physicians throughout their learning process in the field of radiation oncology. Importantly, it offers the advantages of short assessment time, thereby avoiding additional burden on supervising teachers. The adoption of the Mini-FERO scale addresses current limitations of lacking of formative evaluation in the standardized training for radiation oncology resident physicians.
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Objective:To study the epidemic characteristics of human brucellosis in Shandan County, Zhangye City, Gansu Province, and provide reference basis for formulating effective prevention and control measures.Methods:The surveillance data of brucellosis were collected from the China Disease Prevention and Control Information System and Shandan Center for Disease Control and Prevention to describe the three-compartment distribution (population, time, region distribution), and were analyzed by SPSS 19.0.Results:A total of 482 cases of brucellosis were reported with an average annual incidence of 48.99/100 000 from 2016 to 2021 in Shandan County, and farmers were the mainly occupation (84.85%, 409/482). The sex ratio of men and women was 3.16 ∶ 1.00 (366/116). The onset time was mainly concentrated in summer and autumn. Breeding cattle and sheep (feeding, cleaning pens, etc.) resulted in 107 cases of direct contact infection, accounting for 22.20% of the total cases (107/482). Incidence rate of different years was quite different (χ 2 = 121.09, P < 0.001). The average annual incidence rate of brucellosis in Laojun Township (95.72/100 000) was statistically different from that in other towns (χ 2 = 20.49, P < 0.001). Conclusions:The overall high prevalence of human brucellosis in Shandan County from 2016 to 2021. The animal husbandry department should strengthen the control of infectious sources, and the health department should increase publicity and education to curb the spread of the epidemic as soon as possible.
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Objective:To evaluate the efficacy and safety of hippocampal avoidance whole-brain irradiation with simultaneous integrated boost in the treatment of brain metastases of lung cancer.Methods:Forty lung cancer patients with brain metastases who received whole-brain radiotherapy with simultaneous integrated boost and hippocampal avoidance in Cancer Hospital, Chinese Academy of Medical Sciences from 2014 to 2020 were enrolled in this study. Brain MRI, survival follow-up and evaluation of side effects were performed before radiotherapy and at 1, 3, 6 and 12 months after radiotherapy, respectively. Overall survival (OS), progression-free survival (PFS) and changes in cognitive function were analyzed. Continuous data were described as Mean ± SD. Categorical data were described by frequency and composition ratio or percentage. Survival analysis was conducted by Kaplan-Meier method. Influencing factors of survival were identified by univariate and multivariate Cox's regression analyses.Results:A total of 40 patients were enrolled in the study. The median follow-up time was 14.2 months and the median OS, PFS and intracranial PFS of all patients were 14.8 months, 6.7 months and 14.8 months, respectively. Multivariate analysis showed that male gender and newly diagnosed stage Ⅳ disease were associated with worse OS and PFS, respectively. The Hopkins verbal learning test-revised (HVLT-R) scores at baseline and 1, 3 and 6 months after radiotherapy were 21.94±2.99, 20.88±3.12, 20.03±3.14, and 19.78±2.98, respectively. The HVLT-R score at 6 months after radiotherapy was decreased by approximately 9.8% compared with the baseline. No grade 3 or above toxic and side effect occurred in the entire cohort.Conclusion:Hippocampal avoidance whole-brain irradiation with simultaneous integrated boost is a safe and effective treatment for brain metastases of lung cancer, which is expected to reduce the impact of radiotherapy on cognitive function.
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Gastrointestinal fistula (GIF) is one of the serious complications in the middle to late stage of acute pancreatitis (AP). The co-existence of AP and GIF can significantly prolong the course of the disease and increase the risks of infection and bleeding. Understanding the relevant mechanisms and influencing factors of GIF and taking effective measures to prevent its occurrence is crucial. The diagnosis of AP with GIF is relatively difficult. Therefore, it is essential to understand the related influencing factors and diagnostic methods of AP complicated with GIF, and to implement individualized comprehensive treatment measures, which is the key to improve the prognosis of the patient to the greatest extent. This article reviewed the influence factors and progress in diagnosis and treatment of AP complicated with GIF.
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Objective:To evaluate the safety and tolerance of sequential thoracic radiotherapy combined with PD-1/PD-L1 inhibitors in patients with extensive-stage small cell lung cancer (ES-SCLC) after induction systemic therapy.Methods:ES-SCLC patients from a phase I trial and a real-world study were enrolled for those who received thoracic radiotherapy after induction systemic treatment (chemotherapy/chemotherapy combined with PD-1/PD-L1 inhibitors) and consolidated with PD-1/PD-L1 inhibitors. These two studies were both approved by the Ethics Committee of Chinese Academy of Medical Sciences Cancer Hospital (Clinical Trials.gov number, NCT03971214, NCT04947774).Results:Between January 2019 and March 2021, a total of 11 patients with ES-SCLC were analyzed, aged 52-73 years, with a median age of 62 years. Among them, five patients (45.5%) received induction chemotherapy and six patients (54.5%) received chemotherapy combined with PD-1/PD-L1 inhibitor, and then all received intensity-modulated thoracic radiotherapy after evaluation of systemic treatment efficacy. Two patients developed treatment-related grade G3-5 toxicity (18.2%, 1 treatment-related pneumonitis and 1 radiation esophagitis). G 1-G 2 hematologic toxicity, pneumonia, and anorexia were common mild toxicities. Only one patient (9.1%) terminated immunotherapy due to immune-related pneumonitis. During a median follow-up time of 12.5 months (range: 3.5-16.4 months), the median disease progression-free survival and overall survival was 7.4 months (95% CI: 6.9-8.0 months) and 14.6 months (95% CI: 9.0-20.2 months), respectively. Conclusions:Sequential thoracic radiotherapy followed by PD-1/PD-L1 inhibitor is safe and feasible in patients with ES-SCLC after induction therapy. Given that both thoracic radiotherapy and immunotherapy benefits the ES-SCLC in survival, this comprehensive treatment modality warrants further investigation.
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Objective:Simultaneous integrated boost radiation technique in limited-stage small cell lung cancer is lack of evidence. This prospective study aims to evaluate whether the simultaneous integrated boost is as efficacious and safe as conventional fractionated radiotherapy.Methods:Patients diagnosed with treatment-naive and confirmed limited-stage SCLC were eligible. Participants were randomly assigned (1: 1) to receive simultaneous integrated boost radiotherapy (PGTV 60.2 Gy/2.15 Gy/28F, PTV 50.4 Gy/1.8 Gy/28F) or conventional fractionated radiotherapy (PTV 60 Gy/2 Gy/30F). The primary endpoint was 2-year progression-free survival, and the secondary endpoints were 2-year overall survival, 2-year local-regional recurrence-free survival and toxicity.Results:Between February 2017 and July 2019, 231 patients were enrolled. We analyzed 216 patients whose follow-up time was more than 2 years or who had died, among whom 106 patients in the conventional fractionated radiotherapy group and 110 patients in the simultaneous integrated boost radiotherapy group. The median follow-up time was 37 months (95% CI: 35.2-38.7). The 2-year progression-free survival rates were 45.2% vs. 38.2%( HR=1.22, 95% CI: 0.87-1.72, P=0.2). The 2-year overall survival rates were 73.5% vs. 60.9%( HR=1.35, 95% CI: 0.90-2.04, P=0.14). The 2-year local-regional recurrence-free survival rates were 68.7% vs. 69.9%( HR=0.98, 95% CI: 0.62-1.56, P=1.0). Multivariate analysis showed that early radiotherapy yielded better 2-year progression-free survival, overall survival and local-regional recurrence-free survival than delayed radiotherapy in two groups ( HR=1.69, 95% CI: 1.18-2.41, P=0.003; HR=1.72, 95% CI: 1.09-2.70, P=0.018; HR=1.66, 95% CI: 1.01-2.73, P=0.046). Tumor staging was an influencing factor of overall survival (stage Ⅲ vs. stage Ⅰ-Ⅱ, HR=3.64, 95% CI: 1.15-11.57, P=0.028). The most common grade 3-4 adverse events were myelosuppression (21.7% vs. 15.4%, P=0.83), radiation pneumonitis (4.7% vs. 2.7%, P=0.44) and radiation esophagitis (3.8% vs. 1.8%, P=0.51). Conclusions:Simultaneous integrated boost radiotherapy yields equivalent efficacy and toxicities to conventional fractionated radiotherapy for limited-stage small cell lung cancer. Early radiotherapy can enhance clinical prognosis.
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Objective:To explore the effect of pretreatment body mass index (BMI) on the prognosis of patients with unresectable locally advanced non-small cell lung cancer (NSCLC) after chemoradiotherapy.Methods:The clinical data of 711 patients with locally advanced NSCLC treated with radiotherapy, sequential chemoradiotherapy or concurrent chemoradiotherapy from January 2013 to December 2017 in Cancer Hospital of Chinese Academy of Medical Science and Peking Union Medical College were retrospectively analyzed. Radiotherapy was performed with intensity-modulated radiotherapy (IMRT) or volumetric-modulated arc therapy (VMAT), and the chemotherapy regimens were paclitaxel+carboplatin, pemetrexed+cisplatin or etoposide+cisplatin. The effects of pretreatment BMI and other clinical factors on overall survival (OS) of patients were analyzed. Survival analysis was performed by using Kaplan-Meier method; univariate and multivariate analyses were performed by using Cox proportional hazards model.Results:According to the World Health Organization (WHO) recommended BMI grouping method for Asian, the median OS time of low BMI group (<18.5 kg/m 2, 23 cases), normal BMI group (18.5-23.9 kg/m 2, 293 cases) and high BMI group (≥24.0 kg/m 2, 395 cases) was 17 months (95% CI 11-29 months), 29 months (95% CI 22-36 months) and 30 months (95% CI 27-34 months), respectively. OS in the low BMI group was poorer than that in the normal BMI group and high BMI group ( χ2 = 11.20, P = 0.004). Maximally selected rank statistics was used to determine the optimal cut-off value of BMI for prediction of survival as 21.31 kg/m 2, according to which patients were divided into low BMI group (BMI<21.31 kg/m 2, 130 cases) and high BMI group (BMI≥21.31 kg/m 2, 581 cases), the median OS time of the two groups was 20 months (95% CI 17-27 months) and 32 months (95% CI 28-35 months), respectively. OS in the low BMI group was poorer than that in the high BMI group ( χ2 = 12.30, P < 0.001). Multivariate analysis showed that age ≥ 65 years old, male, Karnofsky score < 80 points, low BMI, smoking, histological type of squamous cell carcinoma and radiotherapy alone were independent risk factors for OS (all P < 0.05). Conclusions:For patients with unresectable locally advanced NSCLC who received chemoradiotherapy, those with low pretreatment BMI have poor prognosis.
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Congenital Myasthenic syndrome (CMS) is a group of partially treatable genetic disorders characterized by dysfunction of neuromuscular junction signaling.With the popularization of high-throughput sequencing and in-depth understanding of the disease in recent years, more than thirty pathogenic genes have been discovered and there is a correlation between genotype and clinical phenotype.Misdiagnosis and missed diagnosis are common in clinical practice. This paper summarized the molecular mechanisms, clinical features, electrophysiologic, pathological features and treatment of main subtypes of CMS to deepen the understanding of the disease.
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Objective:To explore the expression and detection significance of peripheral blood interferon-gamma (IFN-γ) and hepcidin-25 (Hepc-25) in primary gastric cancer combined with thalassemia minor.Methods:One hundred and fifty primary gastric cancer combined with thalassemia minor patients admitted to of Jiangsu Province Official Hospital from January 2017 to December 2019 were selected as the research group, and 150 cases of primary gastric cancer without thalassemia minor admitted in the same period were selected as the control group. The levels of peripheral blood IFN-γ and Hepc-25 in the two groups were determined by enzyme-linked immunosorbent assay, and the receiver operating characteristic curve (ROC) was used to evaluate the diagnostic sensitivity and specificity of peripheral blood IFN-γ and Hepc-25 on primary gastric cancer combined with thalassemia minor. The level of hemoglobin (Hb) was measured by the cyanmethemoglobin method, and the Pearson correlation analysis was used to analyzed the relationship among the peripheral blood IFN-γ, Hepc-25 and Hb levels in the research group.Results:The levels of peripheral blood IFN-γ and Hb in the research group were lower than those in the control group: (115.18 ± 27.05) ng/L vs. (137.17 ± 35.66) ng/L, (88.44 ± 10.71) g/L vs. (120.60 ± 29.46) g/L; the level of Hepc-25 in the research group was higher than that in the control group: (49.32 ± 15.05) μg/L vs. (32.66 ± 12.22) μg/L, and the differences were statistically significant ( P<0.05). There were no significant differences in the levels of peripheral blood IFN-γ, Hepc-25 and Hb between the patients with α-thalassemia and β-thalassemia ( P>0.05). The area under the curve (AUC) of thalassemia predicted by of peripheral blood IFN-γ level was 0.709.When the cut-off value was≤138.89 ng/L, its diagnostic sensitivity and specificity were 81.33% and 70.67% respectively, and when the serum AUC of Hepc-25 was 0.811 and cut-off value was ≥ 40.13 μg/L, its diagnostic sensitivity and specificity were 75.33% and 74.00% respectively. Pearson correlation analysis showed that in the research group IFN-γ and Hb had positive correlation ( r = 0.245, P<0.05), Hepc-25 and IFN-γ had negative correlation ( r = - 0.378, P<0.05); Hepc-25 and Hb had negative correlation ( r = - 0.647, P<0.05). Conclusions:The low level of IFN-γ and the high level of Hepc-25 in peripheral blood of patients with primary gastric cancer combined with thalassemia minor are related to Hb and have certain diagnostic value for thalassemia.
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Objective:To evaluate the clinical efficacy and failure patterns of prophylactic cranial irradiation (PCI) in patients with limited-stage small cell lung cancer (LS-SCLC) on the basis of modern chemoradiotherapy and diagnostic techniques.Methods:In this retrospective study, clinical data of 201 LS-SCLC patients treated with chemotherapy (EP/CE regimens, ≥4 cycles) and intensity-modulated radiotherapy (IMRT) in Cancer Hospital of Chinese Academy of Medical Sciences from 2006 to 2014 were reviewed. All patients were primarily managed with concurrent or sequential chemoradiotherapy and achieved complete response (CR) or partial response (PR). Ninety percent of patients were revaluated for brain metastasis (BM) by MRI and 10% by CT scan. Long-term survival and failure patterns were compared between the PCI ( n=91) and non-PCI groups ( n=110). Results:The median follow-up time was 77.3 months (95% CI 73.0-81.5 months). The median overall survival (OS), 2-and 5-year OS rates were 58.5 months, 72.5% and 47.7% in the PCI group, and 34.5 months, 61.7% and 35.8% in the non-PCI group ( P=0.075). The median progression-free survival (PFS), 2-and 5-year PFS rate were 22.0 months, 48.0% and 43.4% in the PCI group, significantly higher than 13.9 months, 34.4% and 26.7% in the non-PCI group ( P=0.002). The 2- and 5-year cumulative incidence of BM were 6.6% and 12.2% in the PCI group, and 30.0% , 31.0% in the non-PCI group ( P=0.001). The median time and rate of BM as an isolated first site of relapse were 11.9 months and 4.4% in the PCI group, and 8.7 months and 25.5% in the non-PCI group ( P<0.001). Multivariate analysis showed that response after chemoradiotherapy ( P<0.001) and PCI ( P=0.033) were the independent prognostic factors for PFS. Stratified analysis demonstrated that PCI significantly improved the 5-year PFS in patients who achieved CR (72.7% vs. 48.0%, P=0.013), while it did not improve the 5-year PFS in patients who obtained PR (26.1% vs. 20.2%, P=0.213). Conclusion:In the new era of standard chemoradiotherapy and more accurate diagnostic methods for BM, PCI was associated with improved PFS and lower incidence of BM in LS-SCLC patients.
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Objective:To systematically evaluate effects of different treatment schemes before allogeneic-hematopoietic stem cell transplantation (allo-HSCT) on the long-term relapse and survival of patients with myelodysplastic syndrome (MDS) after transplantation.Methods:The related literatures were searched from databases of Ovid, Cochrane Library, PubMed, Embase, CNKI, VIP, WanFang and CBM from inception to December 2019. And then 2 reviewers independently extracted data, assessed methodological quality and crosschecked on the included literatures. According to the treatment methods, the cases included in the literatures were divided into demethylation drug (decitabine or azacytidine) treatment (demethylation treatment group) and traditional treatment regimen (including chemotherapy and support treatment) (traditional treatment group). RevMan 5.3 software was used to analyze overall survival (OS), recurrence, non-relapse mortality (NRM) and relapse free survival (RFS).Results:Finally, 10 articles were included. The results of meta-analysis showed that in the traditional treatment group, the differences of 3-year OS rate [44.6% (146/327) vs. 35.5%(138/389); OR = 0.93, 95% CI 0.38-2.27, P = 0.87], the recurrence rate [32.4% (106/327) vs. 37.3% (145/389); OR = 1.00, 95% CI 0.49-2.05, P = 0.99], NRM [26.3% (86/327) vs. 27.0% (105/389); OR = 1.05, 95% CI 0.75-1.49, P = 0.77], RFS rate [9.2% (30/327) vs. 12.6% (49/389); OR = 0.74, 95% CI 0.26-2.10, P = 0.57] between the chemotherapy group and the support treatment group were not statistically significant. The differences of 3-year OS rate [40.7% (165/405) vs. 45.9% (290/632); OR = 0.98, 95% CI 0.71-1.36, P = 0.28], recurrence rate [32.6% (132/405) vs. 38.3% (242/632); OR = 1.05, 95% CI 0.79-2.05, P = 0.25], NRM [27.2% (110/405) vs. 24.8% (157/632); OR = 0.81, 95% CI 0.59-1.11, P = 0.68], RFS rate [46.7% (189/405) vs. 42.2 (267/632); OR = 0.84, 95% CI 0.63-1.12, P = 0.85] between demethylation treatment group and traditional treatment group were not statistically significant. There were no significant differences in 3-year OS rate, recurrence rate, NRM and RFS rate between demethylation treatment group and chemotherapy group, demethylation treatment group and support treatment group (all P > 0.05). Conclusion:Different treatment regimens before allo-HSCT have no significant effect on survival or recurrence after transplantation for patients with MDS.
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Objective:To summarize the clinical, pathological and molecular biological characteristics of one patient of paranodal disease with anti-contactin-associated protein 1 (Caspr 1) antibodies.Methods:The patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) admitted to Qilu Hospital of Shandong University from August 2018 to December 2020 were retrospectively studied. The clinical data of one acute onset CIDP patient with anti-Caspr 1 antibodies were collected and retrospectively analyzed with literature review. Anti-nodal/paranodal IgG and their subclasses in serum and cerebrospinal fluid (CSF) were investigated by immuno?uorescence assays. Pathological characteristics were explored by sural nerve biopsy further.Results:The patient presented with tremor, ataxia and neuropathological pain besides symmetrical limb muscle weakness and hypaesthesia. The CSF protein was elevated significantly. The brachial plexus and lumbosacral plexus magnetic resonance imaging showed enlarged nerve roots. The patient was responsive well to intravenous immunoglobulin and steroids in acute phase, while the symptoms improved significantly with rituximab in chronic phase. Autoantibodies against Caspr 1 were detectable in serum and CSF, with IgG4 predominant. Sural nerve biopsy revealed segmental demyelination and myelin digestion chamber. Dispersed lamellae of myelin sheath and axonal degeneration were confirmed by electron microscopy.Conclusions:Tremor, ataxia, neuropathic pain, significantly elevated CSF protein and enlarged nerve roots are suggestive of paranodal diseases with anti-Caspr 1 antibodies. For patients with suspected Guillain-Barre syndrome/CIDP and above phenotypes, nodal/paranodal antibodies and antibody subtypes should be detected to optimize the treatment.
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Objective To investigate localized regional recurrence after chemotherapy and chest radiotherapy in limited stage small cell lung cancer (LS-SCLC),and explore the relationship between recurrence location and radiotherapy and chemotherapy and its influencing factors.Methods From 2006 to 2014,pathological LS-SCLC treated in CAMS,125 patients had local recurrence,Kaplan-Meier statistical method was used to analyze the survival rate and PFS of each recurrence site.Log-rank was used to compare the survival rate of each group.Univariate analysis includes Chi-squareand t-test for the factors for the recurrence site.Multivariate analysis using Logistic regression.Results The 1-,2-and 5-year overall survival rates were 92.0％,46.4％ and 14.7％,respectively.The median progression time was 12.96 months,The median survival time after progression was 1 1.5 months,and the 1-,2-,and 5-year overall survival rates were 45.0％,23.0％,and 10.0％,respectively.The recurrence sites include intrapulmonary recurrence (67 patients),regional lymph nodes (21 patients),simultaneous intrapulmonary and regional lymph nodes (28 patients),and contralateral or supraclavicular lymph nodes (9 patients).The median survival time were 23.96 months,24.76 months,23.23 months,and 18.66 months,and the 2-year survival rates were 49％,52％,46％,and1 1％,respectively (P=0.000,0.004,0.008).In 6 patients (4.0％),5 patients were located in the supraclavicular region,and 1 patient (0.8％) in the field.Conclusions For LS-SCLC undergoing IMRT and chemotherapy,the local failure location is mainly located in the pulmonary,and further treatment of the split dose and targets requires further clinical exploration.
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Objective:To evaluate the effectiveness of strengthening management in the bronchial asthma control among community patients.Methods:One hundred and eighteen community patients with bronchial asthma were recruited from January 2017 to January 2018. The patients were divided into community strengthening management group ( n=60) and control group ( n=58), the annual times of acute attack, time to first exacerbation and annual medical expenses were compared between the two groups. The proportion of inhaled corticosteroid (ICS) administration was documented; the Asthma Control Test (ACT), the Mini Asthma Quality of Life Questionnaire (MiniAQLQ), Leicester Cough Questionnaire (LCQ), Fractional exhaled nitric oxide(FeNO) and pulmonary function were evaluated in two groups. Results:The management group had greater improvements in the proportion of ICS administration [45(75.0%) vs.36(62.1%), χ 2=4.143], ACT [(20.7±3.9) vs.(18.1±4.1), t=3.213], LCQ [(13.5±5.3) vs.(10.8±3.0), t=2.603], FeNO [(29.8±12.8) vs. (37.1±11.1), t=2.018] than the control group after six months of management (all P<0.05). There were significantly greater improvements in proportion of ICS treating [50(83.3%) vs. 34(58.6%), χ 2=5.748], ACT [(22.1±2.8) vs. (19.5±2.3), t=2.241], LCQ [(16.5±4.2) vs. (11.6±3.2),=5.603], miniAQLQ [(83.2±11.1) vs.(68.1±13.3), t=3.186] and FeNO [(28.2±13.1) vs.(38.1±16.3), t=2.176] in management group than those in control group after one year of management (all P<0.05); but no differences were seen in FEV 1%, FVC%, FEV 1/FVC (all P>0.05) between two groups. The LCQ score [(16.5±4.2) vs. (13.5±5.3), t=3.186] and the MiniAQLQ score [(83.2±11.1) vs. (69.1±14.3), t=5.603] of the management group were significantly improved after 1 year of management than those after 6 months. There was significant improvement in time to first exacerbation [182(92, 284) vs. 92(58, 176), Z=4.384] and the annual exacerbation was significantly reduced [0(0, 1) vs. 2(1, 3), Z=-3.187], annual medical costs of management group were significantly lower than those of control group [(10 523.0±550.5)Yuan vs. (15 787.1±1 421.2)Yuan, t=2.653]. Conclusion:The strengthening management can effectively improve the control rate of bronchial asthma, reduce acute exacerbation, improve clinical symptoms and improve the quality of life in community patients with bronchial asthma.
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Objective@#To explore the effectiveness eye caring theme based intervention model in the improvement of students’ vision, and to provide a systematic method for pupils’ visual intervention.@*Methods@#A total of 965 students in the same grade of the three schools were divided into intervention group(482) and control group(483) at a 1∶1 ratio match. The intervention group received a one year intervention through the design of the series of eye caring theme activities, and the control group did not receive any intervention.@*Results@#The mean values of visual related knowledge literacy improvement in the intervention group and the control group were 7.08 and 2.18, respectively, with a significant difference( t =92.18, P <0.05); The mean values of improvement of vision related belief literacy in the intervention group and the control group were 7.88 and 4.57, respectively, and the difference was statistically significant( t =45.57, P <0.05); The mean values of visual related behavior literacy improvement in the intervention group and the control group were 17.41 and 2.21. The differences were statistically significant( t =117.37, P <0.05); The mean values of total vision improvement in the intervention group and the control group were 10.80 and 2.99, respectively, and the differences were statistically significant( t =87.74, P <0.05); The mean values of the parents’ improvement in children’s vision health care in the intervention group and the control group were 13.33 and 0.80, respectively, and the difference was statistically significant( t =128.76, P <0.05); The mean values of visual acuity reduction in the intervention group and the control group were 0.07 and 0.71, respectively, and the differences were statistically significant( t =128.00, P <0.05).@*Conclusion@#Theme based intervention can improve students’ visual literacy, especially visual behavior literacy, and can effectively slow down the deterioration of students’ vision.
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Objective To investigate the value of next-generation sequencing (NGS) technology in the prognosis monitoring and treatment guidance for molecular minimal residual disease (MRD) in acute myeloid leukemia (AML) patients with complete remission (CR). Methods The clinical data of 68 AML (non-acute promyelocytic leukemia) patients who received gene mutation spectrum by using NGS technology at initial diagnosis and in CR phase in Tangdu Hospital of Air Force Military Medical University from January 2016 to July 2018 were retrospectively analyzed. The recurrence and survival of both molecular MRD positive group and negative group were analyzed and compared, and the value of NGS technology and multiparameter flow cytometry (MFC) were also analyzed in MRD monitoring. Results There were 39 males (57.4% ) and 29 females (42.6%) in 68 patients, and the median age was 52 years old (8-82 years old). Molecular MRD positive group included 38 patients, while negative group included 30 patients. Residual mutation gene type in CR phase was most frequently detected in epigenetic regulator gene mutations, such as ASXL1, TET2, DNMT3A and IDH1/IDH2. Statistical analysis showed that the 2-year cumulative recurrence rate (CIR) in the molecular MRD positive group was higher than that in the molecular MRD negative group (86.8% vs. 51.3%;χ 2＝ 9.249, P＝ 0.002); the 2-year relapse-free survival (RFS) rate in the molecular MRD positive group was lower than that in the molecular MRD negative group (13.2% vs. 48.7%; χ2＝ 9.249, P＝ 0.002); the 2-year overall survival (OS) rate in the molecular MRD positive group was lower than that in the molecular MRD negative group (58.0% vs. 100%; χ 2 ＝ 4.122, P＝ 0.042). Up to follow-up date, 3 patients with molecular MRD positive and 1 patient with molecular MRD negative who received allogeneic hematopoietic stem cell transplantation (allo-HSCT) were still in disease-free survival. The results of monitoring MRD showed high consistency (76.7%, 33/43) in NGS and MFC. Compared with the other groups, the patients with both positive NGS and MFC had a higher relapse rate, and the difference was statistically significantly (P < 0.05). Conclusions Molecular MRD of AML patients is detected by using NGS technology, which could be used to predict the relapse and survival, suggesting that molecular MRD may guide post-remission treatment regimens and the determination of allo-HSCT indications.
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Objective@#To investigate the value of next-generation sequencing (NGS) technology in the prognosis monitoring and treatment guidance for molecular minimal residual disease (MRD) in acute myeloid leukemia (AML) patients with complete remission (CR).@*Methods@#The clinical data of 68 AML (non-acute promyelocytic leukemia) patients who received gene mutation spectrum by using NGS technology at initial diagnosis and in CR phase in Tangdu Hospital of Air Force Military Medical University from January 2016 to July 2018 were retrospectively analyzed. The recurrence and survival of both molecular MRD positive group and negative group were analyzed and compared, and the value of NGS technology and multiparameter flow cytometry (MFC) were also analyzed in MRD monitoring.@*Results@#There were 39 males (57.4%) and 29 females (42.6%) in 68 patients, and the median age was 52 years old (8-82 years old). Molecular MRD positive group included 38 patients, while negative group included 30 patients. Residual mutation gene type in CR phase was most frequently detected in epigenetic regulator gene mutations, such as ASXL1, TET2, DNMT3A and IDH1/IDH2. Statistical analysis showed that the 2-year cumulative recurrence rate (CIR) in the molecular MRD positive group was higher than that in the molecular MRD negative group (86.8% vs. 51.3%; χ2 = 9.249, P = 0.002); the 2-year relapse-free survival (RFS) rate in the molecular MRD positive group was lower than that in the molecular MRD negative group (13.2% vs. 48.7%; χ2 = 9.249, P = 0.002); the 2-year overall survival (OS) rate in the molecular MRD positive group was lower than that in the molecular MRD negative group (58.0% vs. 100%; χ2 = 4.122, P = 0.042). Up to follow-up date, 3 patients with molecular MRD positive and 1 patient with molecular MRD negative who received allogeneic hematopoietic stem cell transplantation (allo-HSCT) were still in disease-free survival. The results of monitoring MRD showed high consistency (76.7%, 33/43) in NGS and MFC. Compared with the other groups, the patients with both positive NGS and MFC had a higher relapse rate, and the difference was statistically significantly (P < 0.05).@*Conclusions@#Molecular MRD of AML patients is detected by using NGS technology, which could be used to predict the relapse and survival, suggesting that molecular MRD may guide post-remission treatment regimens and the determination of allo-HSCT indications.
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Objective Via the analysis of clinical effect of combined traditional Chinese and western medicine in treating severe heatstroke (HS), to explore the rescue therapeutic measures of combined Chinese and western medicine for HS. Methods A case of HS patient admitted to the Department of Emergency Intensive Care Unit (EICU) of Shuguang Hosipital Affiliated to Shanghai University of Traditional Chinese medicine (TCM) was treated with the combination of traditional Chinese and western medicine. The physical hypothermia with ice-blanket and ice-cap and supportive therapy were immediately given to the patient after admission; then the TCM prescription Siwei Xiangru decoction plus or minus was additionally given; the ingredients of the decoction were as follows: elsholtziae 9 g, white lentil coat 15 g, poria cocos 20 g, rhizome atractylodis 15 g, tangerine peel 6 g, processed pinellia ternate 9 g, codonopsis 10 g, licorice 3 g, 1 dose, 2 times per day. The changes of HS patient's laboratory indexes, symptoms and signs were observed. Results After the combined treatment with traditional Chinese and western medicine, the respiratory rate of the patient was improved significantly, and the oxygenation was maintained at 0.99-1.00, no symptoms of fever, cough, sputum were seen. On the fourth day after treatment, the patient was transferred to local hospital, on the day of discharge, the patient had no fever or shortness of breath, urine volume and color were normal, and vital signs stable. Conclusions Effective continuous and controlled cooling is not only the main treatment measure in modern western medicine but also in TCM. Meanwhile, because 'heat must carry moisture, and heat often damage body fluid', it is necessary to observe the patient's dynamic changes of heat and damp evil. When clearing summer heat and damp evil, simultaneously, the measures of strengthening spleen and stomach, enhancing qi and nourishing fluid to prevent further consumption of the body fluid should be paid attention to.
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Objective@#To investigate the antimicrobial resistance and molecular epidemiology of foodborne Yersinia (Y.) enterocolitica in Pudong New District of Shanghai.@*Methods@#Four kinds of raw food samples were collected in retail circulation sites in Pudong from 2012 to 2016. Cold enrichment method was used to isolate Y. enterocolitica and further detection of biotype, serotype, virulent genes, antimicrobial susceptibility of the isolates and pulsed field gel electrophoresis (PFGE) were conducted.@*Results@#A total of 3 900 raw food samples were collected during this period, including poultry product (n=590), livestock product (n=1 074), aquatic product (n=1 488), vegetable (n=748), in which 111 (2.8%) were contaminated by Y. enterocolitica. The detection rates of Y. enterocolitica in poultry product samples (5.3%, 31/590) and livestock product samples (4.5%, 48/1 074) were higher than those in aquatic product samples (1.6%, 24/1 488) and vegetable samples (1.1%, 8/748). The predominant biotype was 1A (95.5%) and predominant serotype was O∶8 (42.3%). All the strains lacked ail, ystA, yadA and virF genes, which encoded pathogenic Y. enterocolitica. Seventy six (68.5%) strains harbored ystB gene, in which 35 (31.5%) belonged to 1A/O∶8/ystB pattern. Most strains were resistant to ampicillin (74.8%) and amoxicillin/clavulanic acid (70.3%), and non-sensitive rate to Cefoxitin was over 50.0%. No third generation cephalosporin or fluoroquinolone resistant strains were detected, but 38.7% (43/111) strains were multidrug resistant (MDR). Serotype O∶8 and O∶5 strains had 44 and 18 PFGE patterns, respectively.@*Conclusions@#The main foodborne exposure sources of Y. enterocolitica in raw food were poultry and livestock products in Pudong New District. 1A/O∶8/ystB was the predominant pattern with potential pathogenicity despite lacks of typical pathogenic virulent genes. The antimicrobial resistant rates of Y. enterocolitica were at a low level, but MDR strains still existed. Molecular types of the isolates showed highly genetic diversity.