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OBJECTIVE@#To investigate serum thyroid stimulating hormone (TSH) level and its changes with age in apparently healthy Chinese elderly population and analyze the differences between TSH levels detected using Roche and Snibe electrochemiluminescence immunoassay analyzers.@*METHODS@#General clinical data and frozen fasting serum samples were collected from 5451 apparently healthy Chinese elderly individuals (> 60 years) from 10 centers in different geographic regions in China. Thyroid function indexes including TSH level were detected using Roche and Snibe electrochemiluminescence immunoassay analyzer, and the median (2.5% and 97.5% quantiles) TSH level was calculated. The variations of TSH level among the participants with geographic regions, gender, and age (with an interval of 5 years) were analyzed to determine the influence of these factors on TSH level.@*RESULTS@#The reference ranges of serum TSH level established using Roche and Snibe electrochemiluminescence immunoassay analyzers were 0.42-9.47 mU/L and 0.36-7.98 mU/L, respectively, showing significant differences between the two methods (P < 0.001). The TSH levels measured at two centers in Western China were significantly higher than those at the other centers (P < 0.05). In elderly male population, serum TSH level tended to increase with age, which was not observed in elderly female population. At the age of 60-75 years, women generally had higher serum TSH level than men, but this difference was not observed in the population beyond 75 years.@*CONCLUSION@#In elderly population, serum TSH level can vary with geographic region, gender, and age, but there was no need for establishing specific reference ranges for these factors. The differences between different detection methods should be evaluated when interpreting the detection results of TSH level.
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Aged , Female , Humans , Male , Middle Aged , Asian People , China , Fasting , Health Status , Thyrotropin/bloodABSTRACT
Objective: To investigate the influence of the number of high-risk cytogenetic abnormalities (HRCA) on the clinical characteristics and prognosis of patients with newly diagnosed multiple myeloma (MM) . Methods: A total of 360 patients with newly diagnosed MM admitted to Jiangsu Province Hospital between November 2013 and September 2020 were included in this study. Cytoplasmic light chain immunofluorescence with fluorescence in situ hybridization (cIg-FISH) was used to detect HRCA. Cytogenetic abnormalities were combined with clinical characteristics and outcomes for further analysis. Results: Among the 360 patients, 120 patients (33.3%) presented with no HRCAs, and 175 (48.6%) , 61 (16.9%) , and four (1.1%) patients had one, two, and three HRCA (s) , respectively. Patients were divided into three groups, including the no-HRCA group, one-HRCA group, and ≥two-HRCA group, according to the number of HRCAs. There were significant differences in the R-ISS stage, hemoglobin level, albumin level, and the proportion of bone marrow plasma cells among the three groups (P<0.05) . The COX proportional-hazards model identified extramedullary disease (P=0.018) , HRCA ≥ 2 (P=0.001) , and absence of autologous hematopoietic stem cell transplantation (P<0.001) as independent risk factors for progression free survival (PFS) and identified lactate dehydrogenase (LDH) level ≥ 220 U/L (P<0.001) , HRCA ≥2 (P=0.001) , and absence of autologous hematopoietic stem cell transplantation (P=0.005) as independent risk factors for overall survival (OS) . The median PFS was 28 months, 22 months, and 14 months (P=0.005) for the three cohorts, and their OS was not reached,60 months, and 30 months (P=0.001) , respectively. Conclusions: HRCA ≥ 2 is an independent risk factor for decreased survival in patients with newly diagnosed MM. More HRCAs result in heavier tumor burden, as well as a higher risk of disease progression and death.
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Humans , Chromosome Aberrations , Hematopoietic Stem Cell Transplantation , In Situ Hybridization, Fluorescence , Multiple Myeloma/genetics , Prognosis , Retrospective Studies , Transplantation, AutologousABSTRACT
Hyaluronic acid is widely used in biomaterials, cosmetics, clinical medicine and other fields due to its good biocompatibility, degradability, hydrophilicity, tumor targeting, viscosity and other characteristics. Pharmacodynamic activities of natural small molecular products which derived from traditional Chinese medicine (TCM) are significant, but their low solubility and poor targeting limit the clinical application. Based on supramolecular properties of hyaluronic acid, in this review, numerous studies were reviewed on the improvement of solubility, bioavailability, targeting and suitable dosage forms of small molecular compounds in TCM by domestic and foreign scholars using hyaluronic acid as carrier. It provides new ideas and inspirations for exploring the potential application value of small molecule compounds in TCM and even for the research and development of new drugs.
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Acupoint selection rules of neurogenic dysphagia treated with acupuncture and moxibustion from pre-Qin to late Qing Dynasty in were analyzed based on data mining. The literature regarding acupuncture and moxibustion for neurogenic dysphagia was searched and screened according to the inclusion and exclusion criteria in (5th Edition), the prescriptions were extracted according to the principle of acupoint extraction.The SPSS 21.0 and Clementine 12.0 were used to perform the cluster analysis and association rule analysis.A total of 191 acupuncture and moxibustion prescriptions were screened and extracted，including 45 acupoints. The top 5 acupoints of acupuncture and moxibustion for neurogenic dysphagia in frequency were Jiache (ST 6), Dicang (ST 4), Lieque (LU 7), Lianquan (CV 23), Shuigou (GV 26). The most involved meridians were the stomach meridian, the governor vessel and the conception vessel. The main acupoints were distributed in the scalp face neck and upper limbs. The most frequently used specific acupoints was crossing points,next was eight confluence points. There were 11 acupoint combinations with strong association according to the association rule analysis, and the top one acupoint combination was Hegu (LI 4)-Jiache (ST 6). There were 9 acupoint cluster groups according to the cluster analysis. Hegu (LI 4), Jiache (ST 6), Dicang (ST 4), Shuigou (GV 26) and Chengjiang (CV 24) were core acupoints for neurogenic dysphagia treated with acupuncture and moxibustion in ancient times, besides，selecting proximal and distal acupoints and selecting acupoints according to symptoms were emphasized.
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<p><b>OBJECTIVE</b>To analyze the clinical and laboratory features of acute myeloid leukemia (AML) with cuplike nuclei morphology.</p><p><b>METHODS</b>One hundred and seventy patients diagnosed with AML (M1andM2) between December 2009 and December 2016 were included in the study. Bone marrow smears were prepared for morphologic alanalysis, the immunophenotype was analyzed by flow cytometry and the RHG-banding was for conventional cytogenetic assay (CCA) ,gene mutation was detected by sequencing.</p><p><b>RESULTS</b>Among the 170 AMLpatients, 67 were diagnosed as M1 and 103 patients was diagnosed as M2, 43 patients(25.3%) defined as cuplike nuclei-positive, among them 38patients (88.4%) were M1 while only 5 patients (11.6%) were with M2(P<0.01). No significant value about sex(P> 0.05) between cuplike nuclei-positive and -negative group, while older patients were found in cuplike nuclei-positive group (P<0.05). Higher peroxydas (POX) ratio (P<0.05) and integration (P<0.05) were found in cuplike nuclei- positive group. Furthermore, the patients with cuplike nuclei-positive lack the expressions of CD34 (P<0.01) and HLA-DR(P<0.01) while no other immunophenotype markers were found. Among the 152 patients (89.4%) for genetic analysis ,83.8% karyotype of the cuplike nuclei-positive group were normal while only 54.8 of negative group was normal by CCA. Molecular biology analysis showed that the patients in cuplike nuclei-positive group have significantly highe rNMP1 (P<0.01) and FLT3(P<0.01) mutations as compared with the negative group. Furthermore, the relationship of the ratio o fcuplike nuclei and the type of gene mutations were investigated, and no significant associations were found. However, it was found that the patients with FLT3 mutation displayed more biological nuclear invagination than the patients with NPM1 mutations (P<0/01).</p><p><b>CONCLUSION</b>AML patients with positive cuplike nuclei have characteristic morphological changes, typical immunophenotype with HLA-DR- and CD34, normal karyotype accompanied by NPM1 and FLT3 mutations.</p>
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Humans , Cell Nucleus , Leukemia, Myeloid, Acute , Mutation , Nuclear Proteins , Prognosis , fms-Like Tyrosine Kinase 3ABSTRACT
Objective The recurrence rate is alarmingly high in patients with positive lymph node metastasis (pN+) esophageal squamous cell carcinoma (ESCC) after two-field surgery.This study aims to retrospectively evaluate the value of pN+ region in predicting postoperative recurrence in patients with pN+ thoracic ESCC after two-field radical esophagectomy.Methods A total of 329 patients with pN+ thoracic ESCC after two-field R0 esophagectomy were enrolled in this study.After surgery,pN+ region was located at the upper abdomen in 116 patients,mediastinum in 119 and upper abdomen plus mediastinum in 94,respectively.The enumeration data were analyzed by chi-square test.Logistic multivariate regression analysis was performed to evaluate the risk factors of postoperative recurrence.Cumulative recurrence rate was statistically analyzed by using Kaplan-Meier method,Log-rank test and Cox model multivariate analysis.Results The overall recurrence rate was 72.4％ (239/329).The overall locoregional recurrence (LR) rate was 58.1％(139/329) including 14.6％ in the neck,42.9％ in the mediastinum and 10.0％ in the upper abdomen.Multivariate logistic and Cox regression analyses demonstrated that pN + region was the only independent factor affecting the overall recurrence and LR rates (both P＜0.05).The overall recurrence and LR rates were 57.8％ and 44.0％ for patients with pN+ region in the upper abdomen,77.3％ and 62.3％ for those with pN+ region in the mediastinum and 85.1％ and 72.3％ for their counterparts with pN+ region in the upper abdomen and mediastinum,respectively.Additionally pN+ region was also the independent factor of the recurrence in the mediastinum or upper abdomen (both P＜0.05) rather than the neck (P＞0.05).The recurrence rates in the mediastimun and upper abomen were 27.6％ and 12.9％ for patients with pN+ region in upper abdomen,47.1％ and 4.2％ for those with pN+ region in the mediastinum,and 56.4％ and 13.8％ for patients with pN+ region in the upper-abdomen plus mediastinum,respectively.Conclusions LR is the main cause of failure in patients with pN + thoracic ESCC after two-field R0 surgery.pN + region can be utilized to predict the overall recurrence and LR rates,especially for patients with postoperative recurrence in the the mediastinum and upper abdomen.The findings in this investigation contribute to the design of the target volume of postoperative adjuvant radiotherapy.
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Objective: To determine the frequency of anti-HCV antibody positivity in patients with non-liver disease complaints, to explore whether anti-HCV positive patients had been properly advised and visited hepatologists for further assessments, and to investigate their clinical characteristics as well as the HCV treatment status. Methods: A hospital based survey of non-liver disease patients with anti-HCV positive and their attending physicians was conducted to determine: 1. were the patients adequately advised of the implication of anti-HCV positive finding; 2. to what extent the patients were aware of potential chronic liver disease associated with HCV infection and whether they sought for further assessments and care of hepatologists. Results: A total of 295 294 non-liver disease patients were tested for anti-HCV antibody, and 2 778 of them were found to be positive (0.94%). However, only 45.10% (1 253/2 778) of the anti-HCV antibody (+) patients were referred to hepatologists and received HCV RNA test. In addition, 34.10% (312/915) and 1.42% (13/915) of them had already advanced to cirrhosis and hepatocellular carcinoma (HCC), respectively. Further analysis showed that the patients who declined antiviral therapy were older, with lower education and lower income, possessed poorer knowledge on the risk of chronic hepatitis C, and had more severe liver diseases. Surprisingly, 65% of the surveyed physicians did not know the genotype-guided treatment duration suggested by the guidelines. Alarmingly, 22% of the surveyed physicians did not know the standard assays for the diagnosis of HCV infection. Conclusions: Our findings highlight the challenge and hidden enormous burden of chronic HCV infection among patients with non-liver disease complaints in China.
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Objective:To determine the frequency of anti-HCV antibody positivity in patients with non-liver disease complaints, to explore whether anti-HCV positive patients had been properly advised and visited hepatologists for further assessments, and to investigate their clinical characteristics as well as the HCV treatment status.Methods:A hospital based survey of non-liver disease patients with anti-HCV positive and their attending physicians was conducted to determine: 1. were the patients adequately advised of the implication of anti-HCV positive finding; 2. to what extent the patients were aware of potential chronic liver disease associated with HCV infection and whether they sought for further assessments and care of hepatologists.Results:A total of 295 294 non-liver disease patients were tested for anti-HCV antibody, and 2 778 of them were found to be positive (0.94%). However, only 45.10% (1 253/2 778) of the anti-HCV antibody (+) patients were referred to hepatologists and received HCV RNA test. In addition, 34.10% (312/915) and 1.42% (13/915) of them had already advanced to cirrhosis and hepatocellular carcinoma (HCC), respectively. Further analysis showed that the patients who declined antiviral therapy were older, with lower education and lower income, possessed poorer knowledge on the risk of chronic hepatitis C, and had more severe liver diseases. Surprisingly, 65% of the surveyed physicians did not know the genotype-guided treatment duration suggested by the guidelines. Alarmingly, 22% of the surveyed physicians did not know the standard assays for the diagnosis of HCV infection.Conclusions:Our findings highlight the challenge and hidden enormous burden of chronic HCV infection among patients with non-liver disease complaints in China.
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Objective To investigate the effect of repetitive transcranial magnetic stimulation (rTMS) on the brain functional reorga-nization of aphasia after stroke, with functional magnetic resonance imaging (fMRI). Methods From January, 2017 to February, 2018, six eligible stroke patients with aphasia were recruited in experimental group, and nine age-gender matched healthy adults were recruited in healthy control group. Subjects in both groups received task-fMRI, and the experimental group was assessed with Chinese version of Western Aphasia Battery (WAB) examination before and after rTMS treatment. Four patients underwent rTMS at the right inferior frontal gyri pars triangularis marked by neuro-navigation-guided system, 1 Hz, five times per week for two weeks. The fMRI data were processed by SPM 12. The differences of brain activation and voxel changes be-tween two groups were compared. The fMRI data including the differences in brain activation, voxel volume and activation voxel indices (AVI) and WAB scores were analyzed before and after rTMS. Results The cerebral hemisphere activation in the experimental group was higher than that of the healthy control group, including the regions of interest (ROI) such as bilateral supplementary motor area and middle frontal gyrus, and the non-ROI (n-ROI) such as left praecuneus, left postcentral gyrus, right hippocampus, right paracingulate cor-tex, etc., while the activation reduced in the areas of left pars triangularis and n-ROI such as left calcarine fissure cortex, left gyrus lingualis, the right anterior cingulate and the paracingulate cortex. Cases 1 and 2 had shorter course of disease, smaller lesion volume, and activation increased in bilateral cerebral hemispheres before treat-ment. AVI showed that their hemispheric dominance was right, and activation reduced in bilateral cerebral hemi-sphere after treatment, but the high-efficiency language function area of ROI, such as the left pars triangularis, turned from inactive to active, and the hemispheric dominance lateralized from right to left, with the improve-ment of language function. For the case 3 and case 4, the disease courses were longer, the lesions sizes were larg-er, and both cerebral hemisphere activations were reduced before treatment. AVI showed that the hemispheric dominance of case 3 was right and was left in case 4. After treatment, bilateral cerebral hemispheres were activat-ed more than before, and the hemispheric dominance of language function was in the right hemisphere; the left middle frontal gyrus and right middle temporal gyrus were activated from no activation before treatment in case 3. The activation of the supplemental motor area on the right side was increased. In case 4, there was no activa-tion in ROI before treatment. After treatment, the bilateral supplementary motor area, right pars opercularis, and the right middle temporal gyrus were activated. Conclusion Low-frequency rTMS could improve the language function by optimizing bilateral cerebral hemisphere brain areas related with language function in patients with aphasia after stroke.
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Objective To investigate the effect of human bone marrow mesenchymal stem cells (BM-MSCs) stimulated by platelets in vitro on the metastasis of cancer cells.Methods The BM-MSCs were isolated and cultured in vitro and platelets from the peripheral blood of healthy persons were purified.The MSCs (control),platelets + MSCs,and platelets treated with culture media (CM) of SGC-7901 tumor cells + MSCs (T-platelets + MSCs) were cultured,respectively,and the MSCs and supernatants (MSCs-CM and SGC-7901-CM) were collected,respectively,after 24 hours.The expressions of markers of cancer-associated fibroblasts (CAF),such as α-SMA and Vimentin,were determined by Western-blotting.The immigration ability of BM-MSCs were analyzed by Transwell assay.The levels of P-selectin in platelets stimulated by MSCs-CM or SGC-7901-CM were detected with flow cytometry.The metastasis model of gastric cancer SGC-7901 cells was established in BALB/c nude mice by the injection of tail vein,and the tumor metastasis in vivo was observed.Results The expression levels of P-selectin in platelets stimulated by MSCs-CM ([21.37 ± 1.00] ％) or SGC-7901-CM ([31.4 ± 1.71] ％ were significantly higher than that in the control ([3.17 ± 0.40] ％,t =27.85 and 29.18,P ＜ 0.01).The expression levels of α-SMA and Vimentin in platelets + MSCs group (0.79 ± 0.08 and 0.88 ± 0.01) and T-platelets + MSCs group (0.90 ±0.06 and 0.96 ±0.04) were significantly higher than that in the control (0.64 ±0.02 and 0.75 ±0.05,t =2.96 and 6.45 forα-SMA,t =4.73 and 5.73 for Vimentin,P ＜0.01).The amounts of immigration cells in platelets + MSCs group (340.3 ±27.7) and T-platelets ± MSCs group (424.3 ± 17.6) were significantly higher than that in the control (220.7 ± 19.4,t =6.14 and 13.48,P ＜ 0.01).The in vivo experimental results showed that the metastatic foci in platelets ± MSCs group (4 ± 2) and T-platelets ± MSCs group (21 ± 4) were significantly higher than that in the control (0.33 ± 0.06,t =3.051 and 8.857,P ＜ 0.01).Conclusion Platelets promote the immigration and the enhanced tumor metastasis in vivo of BM-MSCs.
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Objective To investigate the effect of social support and childbirth self-efficacy-enhancing intervention on primiparas' childbirth self-efficacy,coping ability and pain during labor.Methods A randomized controlled trial was used with double blindness design.One hundredand six primiparas were recruited as the intervention group and control group,53 cases in each group.The two groups adopted the routine prenatal care.In addition,the intervention group participated in twice childbirth self-efficacy-enhancing educational courses.The Chinese Childbirth Self-Efficacy Inventory (CBSEI) was used to conduct the comparison between before and after intervention;the interventional effects in the natural childbirth pregnant women were compared between the two groups by adopting the Visual Analogue Scale (VAS) and Childbirth Coping Behavior Scale (CCB);the Multidimensional Scale of Perceived Social Support (MSPSS) was adopted to analyze correlation between the social support level with the CBSEI and CCB.Results The intervention group finally had 52 cases of effective sample and the control group had 51 cases of effective sample.The CBSEI score after intervention in the intervention group was 282.04± 27.38,which was higher than 236.69± 45.39 before intervention.The CCB score in the intervention group was 56.78 ± 6.95,which was significantly higher than 48.03 ± 6.26 in thecontrol group,and the VAS score in the intervention group was 6.96 ± 1.39,which was lower than 8.35 ± 1.43 in the control group,the difference was statistically significant(P＜0.01).The MSPSS score in the two groups was positively correlated with the OE score,efficacy expectancy (EE) score and CBSEI score before intervention(r=0.269,0.289,0.317,P＜0.01).Conclusion Launching the childbirth self-efficacy-enhancing educational intervention of the social support system can effectively improve the childbirth self-efficacy and coping ability of primiparas,and reduce the intrapartum pain level.
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Objective To explore the effect of the midwife-leading labor pain management model on the pregnancy outcomes and pain control satisfaction.Methods The randomized grouping and single blind trial design were performed.One hundred and ten pregnant women were recruited and randomized into the control group (n=55) and intervention group (n=55).The control group received the routine prenatal examination by the outpatientdepartment obstetric doctors and intrapartum nursing care during labor.On this basis the intervention group participated in the labor pain educational course in the midwife clinic,and received the repeated pain assessment and pain management intervention during labor.Results There was no statistical difference in the delivery mode between the two groups(P＞0.05).The cesarean section rate without indication in the intervention group was significantly lower than that in the control group,the difference was statistically significant(x2 =6.798,P＜0.05).The average each item score of the labor pain education and pain control satisfaction in the intervention group was significantly higher than that in the control group,the difference was statistically significant(P＜0.01).Conclusion The midwife-leading labor pain management model can reduce the cesarean section rate without indication,and improves the satisfaction of labor pain education and pain control in pregnant women and parturients.
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Objective To retrospectively analyze the value of postoperative adjuvant therapy in the treatment of stageⅢthoracic esophageal squamous cell carcinoma ( ESCC) . Methods From 2008 to 2011, a total of 395 patients with stageⅢthoracic ESCC undergoing radical resection were enrolled as subjects. In those patients.97 received surgery alone (S).212 postoperative adjuvant chemotherapy (POCT),and 86 postoperative radiotherapy (PORT).Comparison of categorical data was made by chi?square test. The survival rates were calculated by the Kaplan?Meier method. The log?rank test was used for between?group comparison and univariate analysis. Results All patients were followed up for at least 3 years.125 cases were followed up for at least 5 years. The 5?year overall survival ( OS) rates in patients treated with S,POCT and PORT were 17. 1%,29. 2% and 36. 4%,respectively (P=0. 000).POCT and PORT could mainly increased OS in patients of males.upper?and middle?segment,severe ahhesion at surgery.well?or middle?differentiation,stageⅢa andⅢb(P=0. 000?0. 049);whenever ages.tumor lesion,two?/three field esophagectomy.and the number of removal lymph nodes. PORT could improved OS also (P=0. 001?0. 047).POCT could also improve OS in patients of ages≤60, tumor lesion<6 cm and removal lymph nodes<10 ( P=0. 002?0. 049 ) . The 5?year progression?free survival (PFS) were 19. 0% with S,28. 8% with POCT,36. 4% with PORT,respectively (P=0. 012).PORT could improve PFS (P=0. 012);especially for patients of males,ages ≤60,upper?and middle segment ESCC,tumor lesion ≥6 cm,severe ahhesion at surgery,removal lymph node<10 and ≥10,well or middle differentiation,stageⅢa andⅢb(P=0. 001?0. 042).But POCT could not increased PFS (P=0. 119) . Conclusions In the treatment of patients with stage Ⅲ thoracic ESCC undergoing radical resection,both POCT and PORT can improve the OS rate, particularly in patients with stage Ⅲa or Ⅲb middle and upper thoracic ESCC, severe adhesion formation during surgery. and moderately or well differentiated squamous cell carcinoma. The DFS rate is improved in patients treated with PORT,but not in those treated with POCT.
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Objective@#To investigate the postoperative prognosis and the related factors of patients with stage pT2N0-1M0 of thoracic esophageal carcinoma(EC).@*Methods@#From 2008 to 2011, clinical data of 275 cases with stage pT2N0-1M0 of thoracic EC treated by esophagectomy were enrolled. These cases includ 180 male and 95 female. Among them, 32 cases were upper thoracic EC, 186 cases were middle thoracic EC and 57 cases were lower thoracic EC. Alternatively, 205 cases were stage pN0, 70 cases were stage pN1. 155 cases received esophagectomy alone and 120 cases received esophagectomy and postoperative adjuvant therapy.@*Results@#The end of follow-up time was on September 30th, 2014. The 1-, 3-, 5-year overall survival (OS) rates were 91.6%, 70.2% and 63.7%, respectively. The 1- 3-, 5-year progression-free survival (PFS) rates were 83.9%, 64.0% and 60.0%, respectively. The result of univariate analysis showed that the depth of tumor invasion, pathological type, pN stage and number of metastatic lymph nodes were significantly associated with OS (all of P<0.05). Moreover, the gender, the depth of tumor invasion, pathological type, pN stage and number of metastatic lymph nodes were significantly associated with PFS (all of P<0.05). Cox multivariate analysis showed that the location of primary tumor and pN stage were the independent factors of OS (both P<0.05). The gender, pN stage and postoperative adjuvant therapy were the independent factors of PFS (all of P<0.05).@*Conclusion@#Among the patients with pT2N0~1M0 stage of thoracic EC, patients with upper thoracic EC or pN1 stage have poorer postoperative prognosis compared with others, and postoperative adjuvant treatment is recommended for these patients.
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Objective@#To evaluate the patterns of recurrence and their value on target delineation for postoperative radiotherapy (RT) in patients with stage Ⅲ thoracic esophageal squamous cell carcinoma (ESCC) after esophagectomy.@*Methods@#395 patients (302 male and 93 female) of stage Ⅲ thoracic ESCC after radical resection were enrolled in this study. Among them, 375 patients were treated with two-field and other 20 with three-field esopahgectomy. 97 patients were treated with surgery alone, 212 with adjuvant postoperative chemotherapy (CT), 56 with radiotherapy (RT) and 30 with CT plus RT. Diagnosis of recurrence was primarily based on CT images, some of which were biopsy confirmed. The location and patterns of tumor recurrence were analyzed.@*Results@#The overall failure rates was 75.7% (299/395). Locoregional recurrence (LR) was found in 48.4% of the patients, distant metastasis (DM) in 16.2%, and LR plus DM in 4.3%. There were 208 patients occurred with LR, 26.9% (56) recurred in supraclavicular/neck (51 in supraclavicular), 69.7% (145) in mediastinum (88.7% in upper-mediastinum), and 19.7% (41) in upper abdomen (38 in para-aortic lymph node). Chi-square test and logistic multivariate regression analysis showed that TNM stage and adjuvant therapy were significantly associated with LR (P<0.05). Postoperative RT reduced LR (mainly LR in mediastinum), but postoperative CT did not decrease LR.@*Conclusions@#The recurrence rate is very high in stage Ⅲ thoracic ESCC patients, LR is the main pattern of failure. TNM stage is one of the most important factors for LR. Postoperative radiotherapy can reduce LR but postoperative chemotherapy does not decrease LR. Upper-mediastinum is the most common site of recurrence, followed by supraclavicular and para-aortic regions; these areas should be considered as the key target of postoperative radiotherapy.
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Objective:The study aimed to characterize the difference of the fungal microbiota between the inflamed and non-inflamed intestinal mucosa in patients with Crohn's disease (CD) and explore the potential relation between their changes and the pathogenesis of CD.Methods:Seven patients with active CD were enrolled and the specimens was obtained from the inflamed and non-inflamed mucos a during operation.Tissue DNA was extracted and then amplified by nested polymerase chain reaction (PCR) with the premier sets NS 1/FR1 and EF390/GC-FR1.Denaturing gradient gel electrophoresis was subsequently conducted to profile the structure and composition of the fungal microbiota.Results:Compared to those of noninflamed region,the species richness and diversity of the fungal microbiota in inflamed region were significantly increased (P ＜ 0.05).The predominant fungal composition in inflamed region was significantly altered,mainly characterized by the increase of opportunistic pathogens including Candida albicans,Candida tropicalis,Gibberella moniliformis,Alternaria brassicicola and Cryptococcus neoformans relative to that of noninflamed region (P ＜ 0.05),compared with those of noninflamed region.Conversely,the proportion of the commensals,for example Saccharomyces cerevisiae,Saccharomy,ces castellii,Penicillum chrysogenum and Laccaria bicolor,were significantly decreased in inflamed region (P ＜ 0.05).Conclusion:The fungal microbiota of the inflamed intestinal mucosa is severely dysbiotic in CD patients.The colonization of some pathogenic fungi could participate and result in inflammatory damage.
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Objective To assess the therapeutic efficacy and prognostic factors in elderly patients with stage Ⅲ non-small cell lung cancer (NSCLC) after three-dimensional conformal radiotherapy (3DCRT).Methods A retrospective analysis of 124 stage Ⅲ NSCLC patients aged 70 or over who had received treatment with 3DCRT was conducted retrospectively in this study.There were 99 male and 25 female patients,with a median age of 74 years(range:70-84).The median dose was 60 Gy(range 50-72 Gy).Eighty-three patients were treated with radiotherapy alone,27 with sequential and 14 with concurrent radiochemotherapy.Results The end date of follow-up was August 30,2013.After 3DCRT,the 1-,3-and 5-year overall survival (OS) were 61.1％,23.8％ and13.2 ％,respectively,and the median survival time was 18 months.Univariate analysis revealed that gender,obstructive pneumonia,dosage,method of therapy and immediate effect were related to OS(x2 =3.957,6.398,7.147,12.307 and 11.035,respectively;P=0.047,0.011,0.008,0.002 and 0.001,respectively).Multi-variable analysis indicated that age,gender,obstructive pneumonia,dosage and method of therapy were independent prognostic factors for OS.The OS time was longer inpatients who were female,aged over 75,with no obstructive pneumonia or dosage≥ 60 Gy.Compared with radiotherapy alone,sequential radiochemotherapy increased OS while concurrent radiochemotherapy decreased OS.Conclusions Sex,age,obstructive pneumonia and dosage affect the survival of elderly stage Ⅲ NSCLC patients treated with three-dimensional conformal radiotherapy.Concurrent radiochemotherapy should be considered with caution
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<p><b>OBJECTIVE</b>To investigate the distribution of T helper (Th9) cells and its relationship with clinical characteristics of patients with acute myeloid leukemia (AML), and to analyze the activating levels of different transcriptional factors in Th9 cells.</p><p><b>METHODS</b>The peripheral blood specimens of 102 AML patients and 83 healthy persons as controls were collected, then the T cells of peripheral blood in AML patients and controls were isolated by using CD3 magnetic beads, the mRNA expression of IL-9 was detected by real-time quantitative PCR, the Th9(CD4IL-9) cell levels in diffrent stages and activating level of Th9 coexpression with IL-9 were detected by flow cytometry.</p><p><b>RESULTS</b>The mRNA expression of IL-9 in peripheral blood of AML M2 and M3 patients was significantly higher than that in control groups (P<0.01), at same time the CD4IL-9cell rate was significantly higher than that in control group also(P<0.01). The results of dynamically monitoring the distribution of Th9 cells in AML-M2 and M3 patients showed that the Th9 cell rate and the mRNA expression of IL-9 in newly diagnosed M2 and M3, and relapsed M2 groups were significantly higher than those of M2 and M3 in remission (P<0.01); the detection results of IL-9co-expression with transcriptional factors (SMAD3, IRF-1and IRF-4) indicated that the percantage of Th9 pSMAD3cells in peripheral blood of newly diagnosed and relapsed M2 and M3 patients was significantly higher than that in M2 and M3 patients in remission (P<0.01); on the contrary, the percentage of Th9 IRF-1cells in peripheral blood of M2 and M3 patients in remission was significantly higher than that in newly diagnosed M2 and M3 patients (P<0.01).</p><p><b>CONCLUSION</b>The distribution of T helper cells in peripheral blood of AML-M2 and M3 patients significantly increases, moreover, correlates with disease status. The prediction of Th9 cell functions should be performed in combination with it transcriptional factors which have inmportant significance for microenvironment of tumors in AML patients.</p>
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Objective To investigate the optimization of therapeutic regimen through the adjustment of the minimum sub-field area in intensity-modulated radiotherapy (IMRT) for cervical cancer,under the premise of no influence on the dose to target volume or organs at risk.Methods A total of 12 patients with pathologically confirmed cervical cancer were enrolled,and the prescribed dose to the planning target volume (PTV) was 50 Gy in 25 fractions.The Pinnacle 8.0m treatment planning system was used for all patients,and 16 IMRT plans were developed for each patient,with the application of 9 evenly distributed fixed incidence directions (0°,40°,80°,120°,160°,200°,240°,280°,and 320°),a minimum sub-field number of 80,and a minimum sub-field hop count (MU) of 5 MU.The range of sub-field area was 2-81 cm2.Direct machine parameter optimization was used for inverse-planned optimization calculation,and all the plans met the requirements of the clinical prescribed dose.The dose-volume histogram was used to evaluate the dose distribution in target volume and organs at risk.Results With the sub-field area increasing from 2 cm2 to 81cm2,the total hop count of IMRT plan was reduced from (1405±170) MU to (490±47) MU (P=0.000),and when the sub-field area increased above 6 cm×6 cm,the total hop count was reduced significantly (P=0.000).In the IMRT plan with a minimum sub-field area of 2-49 cm2,there was no significant difference in dose between the target volume and the organs at risk (P＞0.05).The dose to the rectum,the bladder,and both femoral heads showed no significant differences across the IMRT plans with different minimum sub-field areas (P＞0.05).Conclusions When the Pinnacle 8.0m treatment planning system is used to develop IMRT plans for cervical cancer,the requirements for clinical dose can still be met with a minimum sub-field area reaching 7 cm×7 cm,and there are significant reductions in sub-field hop count and total hop count.
ABSTRACT
Objective To evaluate the efficacy of three-dimensional conformal radiotherapy (3DCRT) and prognostic factors for stage Ⅲ non-small cell lung cancer (NSCLC).Methods From 2000 to 2010,474 patients with stage Ⅲ NSCLC undergoing 3DCRT were enrolled as subjects.Those patients,consisting of 382 males and 92 females,had a median age of 63 years.In those patients,211 had stage ⅢA NSCLC and 263 had stage ⅢB NSCLC;165 were treated with radiotherapy alone and 309 with chemoradiotherapy;55 were treated with conventional radiotherapy plus 3DCRT,340 with 3DCRT,and 79 with intensity-modulated radiotherapy;the median equivalent dose was 60 Gy (44-77 Gy).The Kaplan-Meier method,log-rank test,and Cox model were used for survival rate calculation,univariate analysis,and multivariate analysis,respectively.Results The follow-up rate was 96.6％.In all patients,the 1-,3-,and 5-year overall survival rates were 63.0％,24.9％,and 17.8％,respectively;the median survival time was 18 months.The univariate analysis showed that sex,age,immediate response,radiotherapy method,fractionation scheme,chemotherapy,and radiation pneumonitis (RP) were prognostic factors (P=0.004,0.001,0.000,0.007,0.004,0.009,0.049).The multivariate analysis showed that sex,age,immediate response,radiotherapy method,and RP were independent prognostic factors (P=0.006,0.000,0.000,0.003,0.048).Patients with radiation doses of 60-66 Gy had the best prognosis of all.Conclusions In patients with stage Ⅲ NSCLC undergoing 3DCRT,female patients,patients at a young age,patients with satisfactory immediate response,patients treated with full-course 3DCRT,and patients with grade 0-1 RP have better prognosis than others.3DCRT combined with chemotherapy improves survival in patients.A radiation dose of 60-66 Gy is recommended.