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Objective:To explore the effect of breathing exercises on motor, balance, respiration and ability in the activities of daily living (ADL) of patients with Parkinson′s disease.Methods:Sixty patients with idiopathic Parkinson′s disease who met the inclusion criteria were divided at random into a control group and a treatment group, each of 30. Both groups received routine drug therapy and 60 minute of rehabilitation training daily, including core muscle group control training, relaxation training, joint motion training, posture training, balance function training, gait training and facial muscle control training. There were 3 sessions a week for 24 weeks. The treatment group was also given breathing exercises, including training in abdominal breathing with the expiration time twice the inspiration time and inspiratory muscle training. The abdominal breathing training included 15 abdominal breaths, repeated twice after a 2-minute break; the inspiratory muscle training required 10 respirations and expirations at the maximum volume, repeated twice after an interval of 2 minutes. The training lasted 24 weeks, five times a week. The subjects′ motor functioning, balance, walking, respiration and daily living ability were evaluated before the treatment and after 12 and 24 weeks of treatment using the Parkinson′s Disease Rating Scale (part III) (UPDRS ⅲ), the Berg Balance Scale (BBS), the 6-minute walk test (6MWT), walking distance and the modified Barthel Index (MBI). Forced expiratory volume in the first second (FEV 1), forced vital capacity (FVC) and their ratio (FEV 1%) were also observed. Results:After 12 weeks of treatment, significant improvement was observed in the average UPDRS iii, BBS, 6MWT, MBI, FEV 1, FVC and FEV 1% results of both groups, but the improvement in the treatment group was significantly greater on average. After another twelve week the average UPDRS iii, BBS, 6MWT, MBI, FEV 1, FVC and FEV 1% results of the treatment group had improved significantly more than those of the control group. Conclusion:Breathing exercises can significantly improve the motor function, balance, walking, respiratory function and ADL ability of persons with Parkinson′s disease.
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Objective To evaluate the feasibility and safety of transabdominal ultrasound-guided suction curettage to treat cesarean scar pregnancy (CSP) and investigate factors affecting prognosis of CSP. Methods This was a retrospective case study of 43 cases who were diagnosed as CSP and treated by suction curettage under transabdominal ultrasound guidance as an initial treatment of CSP in Obstetrics and Gynecology Hospital of Fudan University over past 7 years (from 2007 to 2013);factors affecting prognosis of CSP were investigated. Results 39 of the 43 cases (91%) were successfully treated. There were no statistically significant differences in maternal age, gravidity, abortion frequency, and the time interval between current CSP and last cesarean delivery, the myometrium thickness between the gestational sac and the bladder wall between the success group and the failure group (all P>0.05). Statistically significant difference was found in crown-rump length (CRL) between the two group (median of the two group was 18.5, 2.0 mm) by rank sum test (P=0.047). Univariate logistic regression analysis demonstrated that CRL was strongly associated with the prognosis and the OR for no complications was 18.50, comparing CRL≤6 mm versus CRL>6 mm (P=0.020). Conclusion Transabdominal ultrasound-guided suction curettage is effective and safe in the treatment of CSP with CRL≤6 mm.
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Objective To investigate the treatment effects and toxicities of extended-field intensity modulated radiation therapy (EF-IMRT) and intra-cavitary brachytherapy combined with chemotherapy for stage Ⅰ b1-Ⅳa cervical cancer with positive para-aortic lymph nodes.Methods A total of 46 stage Ⅰ b1-Ⅳa cervical cancer patients with positive para-aortic lymph nodes treated at Fudan University Shanghai Cancer Center between 2009 and 2011 were reviewed.Neoadjuvant,concomitant and adjuvant chemotherapy with paclitaxel and carboplatin were administrated for one cycle before radiation therapy,two cycles during radiation therapy or three cycles after radiation therapy.All patients received EF-IMRT and intra-cavitary brachytherapy.The positive lymph nodes received an additional boost dose.Results All patients received EF-IMRT to 50.4 Gy (1.8 Gy per fraction).Twenty-six patients was treated with boost dose of 6.0-8.0 Gy in 2.0 Gy per fraction to positive para-aortic lymph nodes.Thirty-seven patients received a positive paraaortic lymph nodes boost or(and) parametrial boost.All patient also received a high-dose-rate intra-cavitary brachytherapy at the point A dose of 20.0-30.0 Gy in 5.0 Gy per fraction.Total chemotherapy cycles were 189,and the average patient received 4.1 courses.Two cases (4％,2/46) experienced grade Ⅲ gastrointestinal toxicities,no patients suffered grade Ⅳ gastrointestinal toxicities.Fifteen cases (33％,15/46) experienced grade Ⅲ hematological toxicities,and 3 (7％,3/46) experienced grade Ⅳ hematological toxicities.Late grade Ⅲ-Ⅳ toxicity was seen in 3 cases (7％,3/46).The 3 year progressionfree survival rate was 46.2％,and the 3 years overall survival rate was 61.2％.Conclusion EF-IMRT and intra-cavitary brachytherapy combined with chemotherapy is safe and effective for stage Ⅰ b1-Ⅳa cervical cancer with positive para-aortic lymph nodes.
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Background and purpose:More than 70 percent of ovarian cancer patients were diagnosed in the advanced stage. Currently the 5-year disease free survival (DFS) of stageⅢC-Ⅳovarian cancer patients wsa about 10 percent after first line chemotherapy. This study aimed to improve the 5-year DFS by three-step chemotherapy according to the mechanisms of ovarian cancer biological characteristics, cytodynamics and pharmacology. Methods:In arm A, the patients received three-step chemotherapy after primary debulking surgery, step one with paclitaxel plus carboplatin (TC regimen), every 3 weeks for 6 to 8 cycles;step two with etoposide plus cyclophosphamide, every 4 weeks for 6 cycles;step three wit carboplatin plus cyclophosphamide every eight weeks for six cycles. In control arm B, we retrospectively analysed 51 cases withⅢC-Ⅳstage ovarian cancer, who had completely response after standard chemotherapy with six to eight cycles of TC after primary surgery during 2007. We compared the 5-year DFS between the two arms. Results:The 5-year DFS of 15 cases in arm A was 80%(12/15), which was signiifcantly higher than that of arm B (5.9%, 3/51, P<0.01). Conclusion: The three-step chemotherapy after optimal debulking surgery in stageⅢC-Ⅳ can improve the 5-year DFS. This regimen is high efficacy, mild side-effect witn low cost, which deserves further exploration.
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Objective To research the relationship between high temperature and population death in cardio-cerebrovascular diseases in Shijiazhuang.Methods The time series of maximum daily temperature and daily death number of cardio-cerebrovascular diseases were described,and the relationship between daily maximum temperature and daily mortality of cardio-cerebrovascular diseases in summer was analyzed.The impact of daily highest temperature in summer from 2009 to 2011 on daily death of cardio-cerebrovascular diseases was analyzed.Results In summer,the highest temperature which could reach to 41.7℃ emerged mostly in July and August,and when the highest temperaiure was higher than 34℃,cardio-cerebrovascular diseases death increased obviously as the temperature increasing.The relative humidity was more than 70％ in most time of the year round.The excessive death in hot days accounted for 10.9％ in which the old people occupied the majority.Conclusion The extreme high temperature may obviously increase the cardio-cerebrovascular death in Shijiazhuang.
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Background and purpose:Cisplatin-based concurrent chemoradiotherapy(CCRT) has become the standard treatment for locally advanced cervical cancer(LACC) . But no marked survival benefi t was found for stage Ⅲ-ⅣA patients,and the high toxicity of cisplatin warrants evaluation of other chemotherapeutic agents to increase effi cacy and decrease toxicity. This study was done to evaluate the effi cacy and toxicity of paclitaxel(TXL) and nedaplatin(NDP) administered concurrently with radiotherapy followed by consolidation chemotherapy in the treatment of locally advanced squamous cell cervical carcinoma(LASCC) . Methods:29 Patients with LASCC(FIGO stage ⅡB-ⅢB) were enrolled into this study from February 5,2007 through December 10,2007. The median age was 48 years old(35-64) . Radiotherapy included external beam radiotherapy to pelvic(stageⅡB 45Gy,stage Ⅲ 50 Gy) and 192Ir brachytherapy(stageⅡB 50 Gy,stage Ⅲ 35Gy) . TXL 35 mg/m2 and NDP 20 mg/m2 were given every week for 6 weeks concurrently with radiotherapy. After one month of CCRT,TXL 135 mg/m2 and NDP 60mg/m2 were administered every 3 weeks for 4 cycles. Results:All patients completed CCRT. For the consolidation chemotherapy,25 patients received 4 cycles,2 patients 3 cycles and 2 patients 2 cycles. The clinical complete response rate was 89.7%(95%CI,78.6%-100%) ,partial response rate 10.3%(95%CI,0-21.4%) After a median follow-up of 14 months(range,8.7-18.8 months) ,the disease-free and overall survival rates were 86.2%(95% CI,73.7%-98.7%) and 96.7%(95% CI 90.2%-100%) ,respectively. One patient died due to disease progression.During CCRT,Grade 3 leukopenia occurred in 3.6%(6/169) of the cycles,Grade 3 diarrhea 0.6%(1/169) ;During consolidation chemotherapy,Grade 3 leukopenia and neutropenia occurred in 8.7%(9/104) of the cycles. There were 2 patients who developed Grade 3 late rectum toxicity. Conclusion:CCRT with paclitaxel and nedaplatin followed by consolidation chemotherapy is well tolerated and effective in patients with LASCC. A prospective randomized trial to compare this treatment strategy with standard CCRT seems to be worthwhile.