ABSTRACT
The combination of thoracic radiotherapy and immunotherapy is increasingly widely used in clinical practice, which not only brings survival benefits but also increases the incidence of pneumonitis. The occurrence of pneumonitis affects the subsequent immunotherapy and can be life-threatening in severe cases. The occurrence and severity of pneumonitis after combination therapy depends on a variety of factors, including patient's age, physical strength, pulmonary function, race, combination therapy mode, radiotherapy dose parameters, type of immune checkpoint inhibitor, history of checkpoint inhibitor-related pneumonitis or radiation pneumonitis, serum indexes and so on. At present, further research is needed to find out the influencing factors of the occurrence and severity of pneumonitis attributed to combined therapy, so as to better avoid, predict, identify and treat related pneumonitis in clinical practice.
ABSTRACT
Objective:To analyze the incidence, risk factors and occurrence time of radiation pneumonia (RP) and immune checkpoint inhibitor-related pneumonia (CIP) in patients with lung cancer and lung metastatic cancer who received both thoracic radiotherapy and immunotherapy.Methods:The clinicopathological data of 137 patients with lung cancer and lung metastatic cancer receiving thoracic radiotherapy and at least one cycle of immunotherapy from January 2019 to January 2022 in Renmin Hospital of Wuhan University were retrospectively analyzed. The occurrence of RP and CIP was determined according to the clinical symptoms and thin-slice chest CT. The risk factors of symptomatic RP were evaluated by univariate and multivariate analyses of clinical data and treatment plan. The relationship between the occurrence time of symptomatic RP and the sequence of thoracic radiotherapy and immunotherapy was compared.Results:In the 137 patients with lung cancer and lung metastatic cancer who received both thoracic radiotherapy and immunotherapy, symptomatic RP was observed in 42 patients (30.7%) , including grade 2 RP in 33 patients (24.1%) , grade 3 RP in 6 patients (4.4%) , grade 4 RP in 1 patient (0.7%) , and grade 5 RP in 2 patients (1.5%) . The incidence of symptomatic RP was 40.0% (28/70) in patients who received thoracic radiation concurrent with immunotherapy and 20.9% (14/67) in non-synchronous patients, and the incidence of severe RP was 10.0% (7/70) and 3.0% (2/67) respectively. CIP was observed in 11 (8.0%) of 137 patients, including grade 2 CIP in 4 patients (2.9%) , grade 3 CIP in 6 patients (4.4%) , grade 5 CIP in 1 patient (0.7%) . There were 54.5% (6/11) of CIP patients with prior or concurrent symptomatic RP. Univariate analysis showed that smoking history ( χ2=9.85, P=0.002) , chronic obstructive pulmonary disease (COPD) history ( χ2=31.34, P<0.001) , thoracic radiotherapy concurrent with immunotherapy ( χ2=5.88, P=0.015) , total radiotherapy dose ( χ2=8.57, P=0.003) were associated with symptomatic RP. Multivariate logistic regression analysis showed that COPD history ( OR=9.96, 95% CI: 3.40-29.14, P<0.001) , thoracic radiotherapy concurrent with immunotherapy ( OR=2.84, 95% CI: 1.15-7.00, P=0.024) , and total radiotherapy dose ≥60 Gy ( OR=4.76, 95% CI: 1.68-13.50, P=0.003) were independent risk factors for symptomatic RP. RP occurred earlier in patients who received immunotherapy before thoracic radiotherapy [68.5 d (47.0 d, 101.8 d) ] than in patients who received immunotherapy after thoracic radiotherapy [117.5 d (79.0 d, 166.3 d) ], with a statistically significant difference ( Z=2.54, P=0.010) . Conclusion:The incidence of symptomatic RP is high in patients who receive both thoracic radiotherapy and immunotherapy. The history of COPD, thoracic radiotherapy concurrent with immunotherapy, and the total radiotherapy dose ≥60 Gy are independent influencing factors of symptomatic RP in patients with thoracic radiotherapy combined with immunotherapy. Symptomatic RP occurs earlier in patients who receive immunotherapy before thoracic radiotherapy than in patients who receive immunotherapy after thoracic radiotherapy.
ABSTRACT
@#Objective To compare the effect of motor development massage and neural development approach on the children with cerebral palsy. Methods The children with cerebral palsy were selected with layered matching as they accepted motor development massage or neural development approach, and reviewed with their score of Gross Motor Function Measure (GMFM-66). Results There were 24 children in each group. The GMFM-66 score increased after treatment in both groups, but there was no statistical difference between these groups. Conclusion The gross motor function can be improved in the children with cerebral palsy with motor-development massage and neural development approach similarly.
ABSTRACT
Objective To compare the effect of motor development massage and neural development approach on the children with cere-bral palsy. Methods The children with cerebral palsy were selected with layered matching as they accepted motor development massage or neural development approach, and reviewed with their score of Gross Motor Function Measure (GMFM-66). Results There were 24 chil-dren in each group. The GMFM-66 score increased after treatment in both groups, but there was no statistical difference between these groups. Conclusion The gross motor function can be improved in the children with cerebral palsy with motor-development massage and neu-ral development approach similarly.
ABSTRACT
@#ObjectiveTo explore the reliability of Modified Ashworth Scales(MAS) measuring muscular tone of lower extremities of children with spastic cerebral palsy(CP).Methods31 children with spastic CP(19 males, 12 females) were included in this study. The mean age for the children was （51.3±26.8） months; 20 diplegia, 7 quadriplegia, 4 hemiplegia. The muscle tone of hip adductor, hamstring, soleus muscles were tested bilaterally with MAS in lower extremity of the children. Two evaluators used the MAS to assesse the muscles tone of children. To compare with the relativity of the results of interrater and intrarater, the reliability was confirmed.ResultsThe reliability of interrater was poor, the total ICC value was 0.68, while better for the reliability of intrarater, the total ICC value was 0.83.ConclusionIt should be cautions in assessment of spasticity of muscles in the lower extremities of children with spastic CP by MAS.
ABSTRACT
Objective To determine the reliability of hand-held electronic dynamometer (HHD) tests for lower limb muscle strength measurement in children with spastic cerebral palsy (CP). Methods Twenty-eight children ( 15 boys and 13 girls; mean age 5 years 8 months) with different types of CP (2 with spastic quadriplegia,8 spastic diplegia, 6 hemiplegia, 1 triplegia and 1 monoplegia) , and at different functional levels ( 19 graded at gross motor function classification system level Ⅰ, 6 level Ⅱ, 2 level Ⅲ and 1 level Ⅳ ) were recruited from the Rehabilitation Center of the Children's Hospital of Fudan University. Standardized HHD protocols were used to measure the strength of their hip, knee and ankle muscles. The HHD test was performed by the same examiner twice with an interval of 10 min in between. The HDD test was also performed with 15 randomly selected CP children by 2 examiners with an interval of 10 min in between. The test-retest and inter-rater reliabilities of the HDD readings were determined by calculating the intra- and inter-class correlation coefficients. Results The HHD measurements showed fine testretest reliability ( ICC = 0.74-0.97 ) and inter-rater reliability ( ICC = 0.63-0.97 ) in measuring lower-limb muscle strength of children with spastic CP, with the highest test-retest reliability for the hip flexion, foot plantar flexion and knee extension muscle groups. The highest inter-rater reliability was achieved with the hip flexion and foot dorsiflexion muscle groups. Conclusions Standardized HHD testing of lower-limb muscle strength in children with spastic CP shows fine test-retest and inter-rater reliability. The HHD can reliably assess the lower-limb muscle strength of children with spastic CP.
ABSTRACT
Objective To analyze the activities of daily living (ADL) performance in children with cerebral palsy (CP) with different gross motor function and the correlation between gross motor function and ADL perform-ance. Methods A total of 118 children (81 boys and 37 girls; mean age: 47.7 months, SD: 20.1 months, age range: 18-90 months) with CP were recruited from three different rehabilitation centers in Shanghai. Types of CP included hemiplegia (n = 27), spastic diplegia (n = 53), spastic quadriplegia(n = 29), athetoid (n = 4), dystonic (n = 4), ataxic (n = 1). Gross motor function classification system (GMFCS) and Gross motor function measure (GMFM) were adopted to assess and classify the gross motor function. Pediatric evaluation of disability inventory (PEDI) was adopted to assess ADL performance. Differences of PEDI scores were compared among different levels of GMFCS; and the correlation between GMFCS levels, GMFM scores and PEDI scores were analyzed. Resnlts PEDI scores showed significant differences among CP children with different levels of GMFCS. The PEDI score usually de-creased with the increase of the GMFCS level, and mobility ability was the lowest. Significant correlations were found between PEDI scaled scores and GMFCS (rs = 0.85～0. 50, P < 0.001). Various levels of correlations (r = 0. 85～ 0.54, P<0.001) were found between GMFM scores and PEDI scaled scores. Higher correlations were found between GMFCS levels, GMFM scores and mobility ability. Conclusion ADL performance was significantly different among CP children with different gross motor function. The higher the gross motor function, the better the performance of ADL. Mobility would be improved by promoting gross motor function in CP children. The training of self-care and so-cial communication ability should be emphasized.
ABSTRACT
@#Objective To study the application value of electroencephalogram and CT in children with cerebral palsy.Methods Electroencephalogram and CT examinations were carried out in 224 children with cerebral palsy.Results Abnormal prevalence of electroencephalogram was 47.77%, 58.88% of which were found as epileptic discharge. Abnormal prevalence of CT was 79.46%. The abnormal rate of CT was significantly higher than that of electroencephalogram ( P<0.001). The abnormal rates of electroencephalogram and CT among different types of cerebral palsy were not significantly different ( P>0.05).Conclusion Combination of CT and electroencephalogram will be helpful for the diagnosis and treatment in children with cerebral palsy.
ABSTRACT
@#Objective To work out the Cerebral Palsy-Gross Motor Function Questionnaire(CP-GMFQ) and evaluate the reliability,validity and responsiveness of CP-GMFQ.Methods 160 children with cerebral palsy(CP)(97 males and 63 females;average age: 47.7±20.1 months,range: 18～90 months) were involved.The first 27 children received second assessment to assess test-retest reliability with a interval of 7 to 18 days.Criterion-related validity was evaluated by comparing CP-GMFQ scores with Gross Motor Function Classification System(GMFCS) levels and scores of Gross Motor Function Measure(GMFM).21 children were randomly selected for responsiveness analysis by effect size.After a interval of 3 to 7 months the re-assessment GMFQ and GMFM were tested.30 children were randomly selected for comparative testing time of GMFQ and GMFM.Results GMFQ had excellent test-retest reliability(ICC=0.9940);criterion-related validity was excellent between GMFQ scores and GMFCS levels and GMFM scores(r=0.77～0.92).Effect size of GMFQ(0.34) between GMFM88 and GMFM66,testing time of GMFQ(average 4.7±1.6 min) were significantly less than testing time of GMFM(average 17.7±4.6 min)(P<0.001).Conclusion The reliability,validity and responsiveness of GMFQ are satisfying.The gross motor functions of children with cerebral palsy could be easy and reasonably measured by GMFQ.