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Objective To analyze the endoscopic observation of gastroduodenal ulcer radioactive injury induced by pancreatic cancer radiotherapy, and to preliminary investigate the risk factors of radiation-induced ulcer after radiotherapy in patients with pancreatic cancer. Methods A total of 112 patients with pancreatic cancer who accepted gastroscopy before and after radiotherapy at Air Force General Hospital were collected. Self-comparative study of gastroscopic findings was performed on these patients. Single factor analysis and the logistic regression analysis model were used to analyze whether the clinical factors were likely to affect the radiation-induced ulcer or not. Results The total incidence of radiation-induced ulcer was 42.0 % (47/112) in 112 patients. The history of ulcer and grade 2 or more acute gastrointestinal symptoms (P= 0.036, P= 0.030) were the independent risk factors of radiation-induced ulcer. The rest clinical factors had no influence on the radiation-induced ulcer (all P>0.05). Conclusion In the radiotherapy of pancreatic cancer, patients who has the history of ulcer or grade 2 or more acute gastrointestinal symptoms should be alert to the occurrence of radiation-induced ulcer.
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Objective To describe the endoscopic observation of pancreatic cancer radiotherapy induced gastro-duodenal radioactive injury, and investigate the influence of radiation-induced ulceration by concurrent chemoradio-therapy with S-1 (Tegafur Gimeracil Oteracil Potassium Capsule) and gemcitabine. Methods Self-comparative study of endoscopic performance were performed on patients received endoscopy before and after pancreatic cancer Chemoradiotherapy with S-1 or gemcitabine or radiotherapy only, from February 2010 to May 2015. Pearson chi-square test was used to analyze whether Concurrent Chemoradiotherapy groups and radiotherapy group are different in radiation-induced ulceration occurrence rate. Results The incidence of radiation-induced ulceration of radiother-apy group, S-1 group and gemcitabine group are 44.1 % (26/59), 50.0 % (10/20) and 46.7 % (7/15), respectively. Radiation-induced ulceration incidence was no statistical difference among the three groups. Conclusion From the angle of safety, patients can according to their self-condition for choosing S-1 or gemcitabine chemotherapy. Wether the concurrent chemoradiotherapy treatment was adopted or not, the occurrence rate of radiation-induced ulceration has no significant difference.
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Objective To explore the correlation between acute gastrointestinal side effects caused by radiotherapy in pancreatic cancer and degree of gastroduodenal radioactive injury under gastoendoscopy.Methods From February 2010 to May 2015,112 patients with pancreatic cancer and received radiotherapy were enrolled.The correlation between gastroscopic findings and degree of gastrointestinal side effects (grade zero to five) was analyzed.The effects of different radiotherapy on the formation of radiation ulcers were also investigated.Chi-square test and Spearman correlation analysis were performed for statistically analysis.Results The incidence of radioactive gastroduodenitis was 57.1 ％ (64/112).The incidence of radiation-induced ulcer was 42.0 ％ (47/112).Among the 112 patients with pancreatic cancer and received radiotherapy,patients with over grade two nausea,vomiting,dyspepsia and constipation received symptomatic treatment.Thirty-one patients (27.7 ％) of them received appetitestimulating treatment,53 patients (47.3％) were given anti-nausea treatment,39 patients (34.8％)received therapy of promoting digestion,and 24 patients (21.4 ％) received therapy of relieving constipation.The incidence of radiation-induced ulcer in patients with grade one acute gastrointestinal side effects was 25.8 ％ (8/31),lower than that of patients with over grade two acute gastrointestinal side effects (48.1％,39/81),and the difference was statistically significant (x2 =4.595,P=0.032).The grade of acute gastrointestinal side effects was positively correlated with that of radiation-induced injury under gastroendoscopy (r=0.295,P =0.002).The incidences of radiation-induced ulcer of gamma knife radiotherapy and helical tomotherapy were 50.0 ％ (15/30) and 39.2 ％ (31/79),respectively,and the difference was not statistically significant (x2 =1.032,P =0.301).Conclusions The occurrence of radiation ulcers should be alerted if over grade two acute gastrointestinal side effects presented in patients with pancreatic cancer and received radiotherapy.The radiotherapy caused gastrointestinal side effects can not be evaluated just according to clinical symptoms.Endoscopic findings and pathological diagnosis are the gold standard.
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Objective To investigate the risk factors and patterns of radiation induced gastroduodenal complications in patients with pancreatic cancer following tomotherapy (TOMO) using endoscopy.Methods Patients with pancreatic cancer who were treated TOMO in Air Force General Hospital from February 2010 to May 2015 were collected.All patients underwent endoscopic examination before and after radiotherapy.The radiation injuries were observed,and factors influencing radiation-induced gastroduodenal complications were analyzed.Results The median time of gastroscopy after radiotherapy was 1 month,radiation gastritis and duodenitis were 41 cases (58.6％),radiation gastric and duodenal ulcers were 30 cases (42.9％),and hemorrhage 7 cases (10.0％),scar formation 3 cases (4.3％),6 cases (8.6％) had newly developed gastric retention,and 4 cases (5.7％) had newly developed gastric varix.Univariate analysis showed that relieving jaundice and radiation protection (amifostine) were associated with the development of radiation gastric ulcers (x2 =4.186,P =0.041;x2 =5.679,P =0.017).Conmon terminology criteria for adverse events (CTCAE) ≥2 was associated with the development of radiation duodenal ulcers (x2 =3.960,P =0.047).Mean dose (Dmean) ＞ 13.39 Gy and Dmean ≤13.39 Gy gastric ulcers rates were 25.0％ and 9.1％,respectively (AUC =0.740,P =0.048).Conclusion The TOMO induced gastroduodenal injury in patients with pancreatic cancer is frequent.Relieving jaundice is the protection of radiation gastric ulcer.Dmean ＞ 13.39 Gy is independent predictive factors for radiation gastric ulcers.Patients after TOMO should be examined by endoscopy early.
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Objective:To conduct a survey on the difference in medical staff remuneration level and satisfaction within the eastern, central and western township health centers, explore the influencing factors on remuneration satis-faction, and put forward some suggestions. Methods:909 medical staff and 104 township health centers from 9 coun-ties in the eastern, central and western regions were investigated. The Descriptive, ANOVA and Hierarchical Linear Model ( HLM) methods were used to analyze the survey results. Results:Average annual medical staff remuneration was 28 324 Yuan in 2011 and the remuneration satisfaction was 2. 77 in five-point scale. The difference between the remuneration level (F=140. 16,P<0. 001) and remuneration satisfaction (F=240. 84,P<0. 001) among three re-gions was statistically significant. The HLM analysis indicated that the working time, workload per day in individual level and whether by practicing the policy of separation between revenue and expenditure, the number of average monthly discharged patients and the fiscal appropriation income in the township health centers level affected the remu-neration satisfaction. Conclusions:The medical staff remuneration level and satisfaction in the township health centers were low, both having a great regional difference. Therefore, the improvement of the medical personnel remuneration satisfaction is obtained through improving the revenue and expenditure, and the performance-based pay system.