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Objective:To investigate the therapeutic effects of Tiaojing Xiaozhi Decoction combined with auricular acupoint embedding acupuncture on polycystic ovary syndrome in obese patients. Methods:A total of 120 obese cases of polycystic ovary syndrome (spleen and kidney deficiency syndrome) treated in Ningbo Municipal Hospital of Traditional Chinese Medicine from July 2020 to June 2021 were included in this study. They were randomly assigned to undergo treatment with either Tiaojing Xiaozhi Decoction (Chinese medicine group, n = 40), auricular acupoint embedding acupuncture (ear acupuncture group, n = 40), or Tiaojing Xiaozhi Decoction and auricular acupoint embedding acupuncture (combined therapy group, n = 40). Traditional Chinese medicine (TCM) syndrome integral, body mass index, waist circumference, hip circumference, waist- to-hip ratio, testosterone, luteinizing hormone, follicle-stimulating hormone, luteinizing hormone/follicle-stimulating hormone, estradiol, prolactin, recombinant human leptin, adiponectin, tumor necrosis factor α, interleukin-6, and clinical efficacy were compared among groups before and after treatment. Results:Total response rate in the combined therapy group was 87.5%, which was slightly but not significantly, higher than 77.5% in the Chinese medicine group and 80.0% in the ear acupuncture group, and there was no significant difference in total response rate among the three groups (all P > 0.05). After treatment, TCM syndrome integral in the combined therapy was (10.40 ± 2.38) points, which was significantly lower than (12.35 ± 3.32) points in the Chinese medicine group and (14.18 ± 3.51) points in the ear acupuncture group ( F = 14.78, P < 0.05). The body mass index, waist circumference, hip circumference, and waist-to-hip ratio in the combined therapy group were superior to those in the Chinese medicine and ear acupuncture groups ( F = 4.11, 18.59, 3.62, 13.33, all P < 0.05). Luteinizing hormone and luteinizing hormone/follicle-stimulating hormone in the combined therapy group were superior to those in the Chinese medicine and ear acupuncture groups (all P < 0.05). After treatment, recombinant human leptin and adiponectin in the combined therapy and Chinese medicine groups were superior to those measured before treatment (both P < 0.05). After treatment, only adiponectin was significantly increased in the early acupuncture group compared with before treatment ( P < 0.05). After treatment, tumor necrosis factor α and interleukin-6 in the combined therapy group were (4.12 ± 1.54) μg/L and (3.09 ± 1.41) ng/L respectively, which were significantly decreased compared with before treatment ( t = 21.66, 10.42, both P < 0.05). Conclusion:Tiaojing Xiaozhi Decoction combined with auricular acupoint embedding acupuncture can decrease body mass index, fat factor, and inflammatory factor levels, which can help decrease sex hormone levels and TCM syndrome integral, and has an obvious therapeutic effect on polycystic ovary syndrome.
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Objective:To investigate the effect of enteral nutrition on hematological complications in children with malignant solid tumors during chemotherapy.Methods:A total of 103 children with malignant solid tumor admitted to our hospital from March 2020 to December 2020 were enrolled in the study. The children were randomly divided into enteral nutrition group ( n=51) and control group ( n=52). Children in enteral nutrition group were given enteral nutrition support on the basis of routine diet, while children in control group were only given routine diet. The levels of leukocytes, neutrophils, hemoglobin and platelets in peripheral blood of children during chemotherapy were analyzed. The incidence of infection and the transfusion of red blood cells and platelets after chemotherapy were documented and compared between two groups. Results:The levels of white blood cells, neutrophils, hemoglobin and platelets before chemotherapy were significantly higher than those after chemotherapy both in enteral nutrition group ( Z=-5.91, -5.59, -5.54, -5.66, all P<0.05) and in control group ( Z=-6.14, -5.84, -5.75, -4.75, all P<0.05). The overall hemoglobin levels in enteral nutrition group before and after chemotherapy was significantly higher than those in control group ( t=5.68, 5.62, P<0.05), and there were no significant differences in the levels of white blood cells, neutrophils and platelets between the two groups before chemotherapy ( Z=-0.71, -0.12, -1.29, all P>0.05) and after chemotherapy ( Z=-0.39, -0.86, -0.94, all P>0.05). Compared with the control group, the degree of anemia during chemotherapy was significantly improved in enteral nutrition group (χ2=10.45,6.12, all P<0.05), but there was no significant difference in the reduction degree of white blood cells, neutrophils and platelets between the two groups (before chemotherapy: χ2=1.17, 0.10, 0.49; after chemotherapy: χ2=0.18, 1.10, 0.97, all P>0.05). The number of children receiving red blood cell transfusion in enteral nutrition group was significantly lower than that in control group (χ2=14.06, P<0.05), and there was no significant difference in the number of children with infection and platelet transfusion between the two groups (χ2=1.20, 0.29, all P>0.05).There was no significant difference in the duration of neutrophil deficiency between enteral nutrition group and control group ( t=-1.75, P>0.05). Conclusion:Enteral nutrition support can significantly improve the hemoglobin level in children during chemotherapy, effectively alleviate the severity of anemia, and reduce the incidence of red blood cell transfusion after chemotherapy, which has high clinical application value.
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Objective:To explore the risk factors for disease progression and the prognosis with different disease events in a historical cohort of 56 pediatric patients with head and neck rhabdomyosarcoma (HNRMS).Methods:From June 1, 2013 to June 30, 2019, 56 pediatric patients diagnosed as HNRMS treated in the Department of Pedia-trics, Beijing Tongren Hospital, Capital Medical University were recruited in the present study.Clinical data, including general information about the diagnosis, treatment, prognostic factors, and follow-up results were collected.Patients were divided into non disease-progression (NPD) groups, including non-event (NE) group and disease-relapse (RD) group, and disease-progression (PD) group based on the disease event.Clinical data and the prognosis in NE group, RD group and PD group were compared.Risk factors for disease progression in pediatric patients with HNRMS were further analyzed by univariate and multivariate analyses of NPD group and PD group.Results:The median follow-up time of all 56 patients was 31.8 months (3.5-74.6 months). There were 30, 12, and 14 patients in NE group, RD group and PD group, respectively.The estimated 5-year overall survival rate was 100.0%, 82.5%, and 11.9% in NE group, RD group and PD group, respectively, which was statistically significant ( P<0.001). Compared with those of NE group, significantly higher rates of patients with a minimum tumor size of 5 cm ( P=0.008) and non-initial radiation therapy ( P=0.001) were detected in PD group.In addition, a significantly higher rate of patients with a minimum tumor size of 5 cm ( P=0.002), and more advanced postoperative pathological stage ( H=12.982, P=0.009) and risk of disease severity( H=18.679, P<0.001) were detected in PD group than those of RD group.The univariate analysis demonstrated that tumor size > 5 cm, alveolar rhabdomyosarcoma, non-initial radiation therapy, advanced postoperative pathological stage and high risk of disease severity were significant risk factors for disease progression of HNRMS.The multivariate analysis result showed that tumor size > 5 cm ( OR=6.75, 95% CI: 1.02-44.78), alveolar rhabdomyosarcoma ( OR=7.10, 95% CI: 1.08-46.57), and non-initial radiation therapy ( OR=15.26, 95% CI: 2.38-97.70) were independent risk factors for disease progression of HNRMS. Conclusions:Pediatric patients with HNRMS in disease progression have a significantly worse overall survival rate, and their prognosis quite differs from those with disease relapse or non-disease events.A minimum tumor size of 5 cm, alveolar rhabdomyosarcoma and non-initial radiation therapy are independent risk factors for disease progression of HNRMS.Pediatric patients with disease progression of HNRMS are susceptible to advanced pathological stage and risk of disease severity.
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Objective:To investigate the clinical characteristics and prognosis of infants with retinoblastoma (RB).Methods:The clinical data of 217 (335 affected eyes) infantile RB patients admitted to the Department of Pediatrics, Beijing Tongren Hospital, Capital Medical University from July 1, 2009 to June 30, 2019 were collected for analyzing the clinical efficacy and prognosis after comprehensive treatment.Results:(1) Clinical characteristics: 217 infantile RB patients included 129 males and 88 females, with the ratio of male to female being 1.47∶1.00; the median age was 6.06 months; there was monocular disease in 99 cases, and binocular disease in 118 cases, with the incidence ratio of binocular to monocular disease being 1.19∶1.00; all the 5 cases with family history of RB had binocular disease; the first symptoms included white pupils and yellow-white reflections in pupils (183 cases, 84.3%), followed by strabismus (18 cases, 8.3%). There were 335 affected eyes, of which 304 counts were in the intraocular stage (90.7%), most commonly in stage D (146 counts, 43.6%); 26 counts (7.7%) in the extraocular stage, mainly invading the optic nerve and/or optic nerve stump; 5 counts (1.5%) in the metastasis stage.(2) Survival analysis: the medical follow-up continued to March 31, 2020, with a median follow-up time of 67 months.There were 2 cases with a loss of follow-up, 21 relapsed cases, and 19 death cases, with the overall survival rate being 91.2%.According to Kaplan-Meier survival analysis, the expected 5-year survival rate was 91.1%; the survival rate was 96.2% in the intraocular stage and 73.1% in the extraocular stage.All 5 cases died during the distant metastasis stage, and the difference was statistically significant ( χ2=7.492, P<0.001); there was also a statistical difference in the survival rate between the monocular disease (95.9%) and binocular disease (87.3%) ( χ2=4.335, P=0.023). (3) Eyeball removal and eye protection: the eye protection rate of 217 children was 68.9%, 100.0% in stage A, B and C, 80.1% in stage D and 35.1% in stage E, which showed significant differences ( χ2=6.573, P=0.004). There were 35 children who underwent eye extraction before chemotherapy and 67 cases after chemotherapy, among which the difference was statistically significant ( χ2=6.076, P=0.012) in eye removal rates before and after chemotherapy in stage D and E(6 and 11 cases before chemotherapy, 22 and 36 cases after chemotherapy). (4) Adverse reactions: according to the World Health Organization′s classification of adverse reactions to chemotherapy, there were 26 cases in grade 0 (12.0%), 98 cases in grade Ⅰ (45.1%), 59 cases in grade Ⅱ (27.2%), 23 cases in grade Ⅲ (10.6%), and 11 cases in grade Ⅳ (5.1%), mainly manifested as bone marrow suppression after chemotherapy (132 cases). No second tumors appeared, and only 4 cases had transient hearing abnormalities, which returned to the normal state in the subsequent review. Conclusions:Infantile RB has its own characteristics.Such factors as different eye types and different clinical stages can affect the prognosis of children.The survival rate of such children can be improved significantly and the rate of eyeball removal can be reduced after treatment.
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Objective:To summarize the clinical characteristics of infantile fibrosarcoma(IFS) and analyze the high risk factors that affect IFS prognosis.Methods:Totally, 16 patients were diagnosed IFS in Department of Pedia-trics, Beijing Tongren Hospital, Capital Medical University from October 2013 to December 2019.The clinical features and the high risk factors were analyzed by using SPSS 21.0 software.Results:(1)The median age at diagnosis was 0.13 years (0 to 4.92 years), predominantly in males(14/16 cases, 87.5%). (2)Focus site: 10 cases were located in the extremities, 3 cases in the head and neck, and 3 cases in the trunk.(3)Treatment plan was mainly surgical combined chemotherapy.The initial treatment was " Vincristine + Cyclophosphamide + Actinomycin D" . Among the 15 cases receiving chemotherapy, 3 cases were insensitive to chemotherapy and 12 cases were sensitive to chemotherapy.There were 14 cases of tumor resection and 2 cases of biopsy.(4) The median follow-up time was 3.5 years, and 3 patients′ parents gave up the treatment due to the progress of the disease after chemotherapy and died.The remaining 13 cases were completely relieved until the follow-up period, of which 2 cases relapsed (2/16 cases, 12.5%) and the overall 5-year survival rate was about 70%.Grouped by pathological grade, the total 5-year survival rate of children with G1 and G2 was 100%, and G3 was only 30%, with statistically significant differences ( χ2=4.853, P=0.028). Conclusions:The overall prognosis of IFS is favorable.Tumor grade and lesion size are important factors that affect the prognosis.Adjuvant chemotherapy is beneficial to complete tumor resection, and chemotherapy is recommended for children with high risk factors.
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Objective:To explore the cellular protective effect and adverse reactions of amifostine in the chemotherapy of malignant solid tumor in children.Methods:A total of 62 children with malignant solid tumors receiving 253 times of chemotherapy who were admitted to the Pediatrics Single Center of Beijing Tongren Hospital from April 2018 to April 2020 were selected and divided into the experimental group (amifostine was used before chemotherapy, 113 times in total) and the control group (amifostine was not used before chemotherapy, 140 times in total) according to stratified random sampling. The self-control method was used to compare the therapeutic effects and adverse effects of the use of amifostine or not in the same child under the same chemotherapy regimen.Results:Compared with the control group, the duration of agranulocytosis [(6.7±3.0) d vs. (9.5±4.3) d, t = 3.788, P < 0.05], the duration of platelet reduction (<20×10 9/L) [(3.6±1.3) d vs. (5.4±3.2) d, t = 2.037, P < 0.05], the time of receiving recombinant human granulocyte colony-stimulating factor (rhG-CSF) treatment [(6.5±3.5) d vs. (10.0±2.8) d, t = 3.049, P < 0.05] and the time of antibiotic treatment during infection [(5.0±2.5) d vs. (8.2±2.5) d, t = 3.558, P < 0.05] in the experimental group were all shorter; the amount of platelet input required [(0.7±0.5) U vs. (1.5±0.8) U, t = 2.873, P < 0.05] was less than that of the control group. Oral mucosal ulceration occurred in only 4 (3.5%) times in the experimental group, which was lower than that in the control group [12 (8.6%) times] ( χ2 = 4.634, P = 0.033). Regardless of the cost of amifostine itself, there was a statistically significant difference in treatment cost between the experimental group and the control group ( P = 0.034), and the length of hospital stay in experimental group was relatively short ( P = 0.012). The patients were more prone to nausea and vomiting and hypocalcemia when treated with amifostine. Conclusions:Amifostine can effectively protect normal tissue cells in chemotherapy of children with malignant solid tumor and its adverse reactions are mild.
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Objective:To investigate the clinical features and adjuvant chemotherapy of children with medulloblastoma(MB).Methods:Clinical data of 21 pathologically confirmed MB children admitted to the department of pediatrics of Beijing Tongren Hospital affiliated to Capital Medical University from May 2012 to November 2017 were collected to analyze the clinical efficacy and prognosis of multidisciplinary combined treatment.Results:There were 21 children enrolled in the study(15 males and 6 females; median age: 6 years and 3 months). The majority of tumors were from the fourth ventricle(66.7%, 14/21 cases). The most common type of pathological tissue was classic medulloblastoma(61.9%, 13/21 cases). Most of the molecular types was type 4(47.6%, 10/21 cases). There were 15 cases(71.4%)in the high-risk group and the remaining 6 cases(28.6%)in the low-risk group without metastasis(M0 stage). Total tumor resection was performed in 16 cases(76.2%). The patients were followed up to December 2019(median follow-up time was 29 months). After comprehensive treatment, 11 patients died and 6 patients relapsed.The 2-year survival rate was 61.5%, and the 5-year survival rate was 51.1%.Cox regression multivariate analysis showed that the survival rate of children with no tumor spread, short time interval between radiotherapy and surgery was higher( P<0.05). Conclusion:The incidence of MB in boys is higher than that in girls.Whether the tumor is disseminated or not, the time interval between radiotherapy and surgery are independent risk factor affecting the prognosis.Multidisciplinary combination therapy can effectively improve the long-term prognosis.
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Objective:To investigate the pathogen types and drug resistance of catheter-related bloodstream infection (CRBSI) in children with solid tumor after chemotherapy.Methods:The clinical characteristics, pathogenic bacteria composition and drug sensitivity test results of children hospitalized with chemotherapy and indwelling periphe-ral venous catheter (PICC) and central venous catheter (CVC) in the non-Intensive Care Unit (ICU) of the Pediatric Ward of Beijing Tongren Hospital, Capital Medical University from January 2014 to December 2015 were retrospectively summarized.Results:A total of 3 361 cases received chemotherapy, 3 300 cases received PICC and CVC, and the blood cultures of 64 cases were sent for test. Twenty-four cases had CRBSI, 4 of who were of fungal infection. The infection rate of CRBSI was 0.7% and the infection rate of fungi was 0.12%. A total of 14 pathogenic bacteria were isolated, including 3 strains of Gram-negative bacteria (21.4%), 9 strains of Gram-positive bacteria (64.3%), and 2 strains of fungi (14.3%). The main pathogenic bacteria detected positive in 24 cases (12 cases were drug-resistant) included the methicillin-resistant coagulase-negative staphylococci (3 cases), carbapenem-resistant Klebsiella pneumoniae (7 cases) and extended spectrum beta-lactamases(ESBLs)producing Escherichia coli (2 cases), and their detection rates were 12.5%, 29.2% and 8.3%, respectively.The sensitivity rate of coagulase-negative staphylococci to Vancomycin, Meropenem and Linezolid was 100%.Candida glabrata and candida 100% sensitive to Voriconazole, Amphotericin B and Flucytosine but not sensitive to Fluconazole and Itraconazole. Conclusions:Monitoring the occurrence and etiological changes of CRBSI in children with solid tumors is helpful to further strengthen effective prevention and control measures and provide early empirical antimicrobial therapy.
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Objective:To investigate the clinical features, diagnosis, treatment and prognosis of advanced clear cell sarcoma of kidney(CCSK) in children.Methods:The clinical data of 10 children with advanced CCSK hospitalized in Department of Pediatrics of Beijing Tongren Hospital, Capital Medical University from January 2014 to December 2017 were collected, and their clinical features, diagnosis, treatment and prognosis were analyzed retrospectively.Results:(1) Clinical features of CCSK: ten cases of CCSK included 6 boys and 4 girls, with the median onset age of 32 months; 7 cases were left CCSK and 3 cases were right CCSK.There were 9 cases of stage Ⅲ and 1 case of stage Ⅳ at the time of initial diagnosis, when 4 cases were misdiagnosed as other renal tumors at the time of initial diagnosis(40%, 4/10 cases). Five patients with stage Ⅲ CCSK had recurrence and metastasis during treatment and follow-up, and the main distant metastasis sites were lung, bone, liver and brain.(2) Treatment and prognosis of CCSK: seven cases received surgery combined with radiotherapy and chemotherapy, and 3 cases whose parents gave up treatment adopted non-standardized treatment.The median follow-up time was 33.5 months.Seven patients survived and 3 cases died.The 3-year overall survival rate of all 10 patients was 65.6%.The 3-year overall survival rate of stage Ⅲ was 74.1%, and that of stage Ⅳ was 0.The prognosis of stage Ⅲ was significantly better than that of stage Ⅳ( χ2=9, P=0.003). Among the 5 recurrent cases, only 1 case achieved completely remission, 2 cases achieved partially remission, 1 case suffered from disease progression and 1 case died.The 3 cases without recurrence were given standardized treatment of surgery, che-motherapy and radiotherapy, and all were completely remitted. Conclusions:CCSK is easy to be misdiagnosed, and the risk of recurrence and distant metastasis is high in stage Ⅲ patients during treatment and follow-up.Stage Ⅲ patients who actively receive standard treatment including surgery, chemotherapy and radiotherapy have good prognosis, while the mortality of patients with relapse and distant metastasis is high.
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Objective:To study the relationship between high-risk factors with the diagnosis, treatment and prognosis of children with high-risk head and neck rhabdomyosarcoma (RMS).Methods:Children with high-risk RMS primarily found in head and neck were selected as research objects according to the criteria of RMS risk degree formulated by Children Oncology Group (COG) and Children′s Rhabdomyosarcoma Cooperative Group, Children′s Hematological Oncology Group, China Anti-Cancer Association (CCCG-RMS), and combined treatment including puncture pathology/surgery, chemotherapy and radiotherapy were performed.The relationship with primary site, age, pathology type and metastasis and prognosis were analyzed.Results:Twenty-nine patients were collected as research object, 17 cases (58.6%) of male, and 12 cases (41.4%) of female.The primary site: orbit was 7 patients (24.1%), and para-meningeal was 22 patients (75.9%). Clinical stage: 2 cases were stage Ⅲ (6.9%), and 27 cases were stage Ⅳ (93.1%). Followed up to December 31, 2018, 14 patients were dead, 15 patients were survival, and 10 patients were event free survival.The overall survival rate was 48.3%(15/29 cases), and the event free survival rate was 34.5%(10/29 cases). According to Kaplan- Merier survival curve analysis, the average overall survival time was (76.0±12.0) months, 95% confidence interval (95% CI): (53.5-93.2)months.The event free survival time was (62.5±10.6) months, 95% CI: (47.0-83.9)months. Conclusions:The prognosis of high-risk head and neck RMS is poor.The center system metastasis is cause of death.Thus, the main task is how to close follow-up and prevention of central nervous system invasion for improving prognosis.
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Objective:To summarize the prognostic characteristics of hepatoblastoma in children undergoing pulmonary metastasectomy.Methods:The clinical data of 48 hepatoblastoma patients with pulmonary metastases who underwent pulmonary metastases resection in our hospital from January 1 2009 to December 31, 2017 were collected, and prognosis of these patients was analyzed.Results:Forty eight cases were diagnosed as hepatoblastoma with pulmonary metastasis, including 30 cases with pulmonary metastasis alone and 18 cases accompany with other high risk factors affecting prognosis. All the 48 patients underwent pulmonary metastasectomy, in which 43 patients were given pulmonary metastases resection completely and 5 patients were given partial resection of metastases. Twenty-five cases recurred after the first pulmonary metastasis resection(25/48, 52.1%), and 2 cases progressed. With the median follow-up time of 45.5 months, survival time of 48 patients with pulmonary metastasectomy was(83.59±7.01)months, and the 3-year overall survival rate was 58%. Of the groups those were patients with pulmonary metastasis alone and patients with other high risk factors affecting prognosis, the survival time and the 3-year overall survival rate showed a significant statistical differences[(95.89±8.19)months vs.(58.95±9.40)months; 79.4% vs.50%; χ2=4.849, P= 0.028)]. The survival time and 3-year survival rate of the two groups between with recurrence or progression and the group without recurrence or progression after pulmonary metastases resection were showed a significant difference[(56.84±7.22)months vs.(112.48±7.08)months; 55.6% vs.90.5%; χ2=11.03, P= 0.001)]. Results of COX regression analysis showed that the main risk factor affecting prognosis was pulmonary metastasis accompany with other high-risk factors for hepatoblastoma patients. The death risk of patients with pulmonary metastasis accompany with other high-risk factors was 3.424 times than that of patients without other high-risk factors( RR=3.424, 95% CI: 1.264~9.275). Conclusion:The overall prognosis of patients with pulmonary metastases is not good, and the proportion of postoperative recurrence is very high. Pulmonary metastasis accompanied with other high risk factors is the main risk factor affecting the prognosis of patients with pulmonary metastasectomy.
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Objective:To improve the clinicians′ understanding of central nervous system (CNS) metastasis in children with solid tumors.Methods:The clinical data of 33 cases of CNS metastasis among 611 children with malignant solid tumors in the chest and abdomen from September 2005 to December 2016 in Beijing Tongren Hospital, Capital Medical University were retrospectively analyzed. The clinical characteristics, treatment and prognosis of metastasis were statistically analyzed according to different pathological types of malignant solid tumors in children with CNS metastasis.Results:Among the 611 children with malignant solid tumors in the chest and abdomen, 15 patients were neuroblastoma with CNS metastasis (5.9%, 15/264), 13 patients were hepatoblastoma with CNS metastasis (4.8%, 13/274), two cases were Wilms tumor with CNS metastasis (3.2%, 2/63), and three cases were clear cell sarcoma of the kidney with CNS metastasis (3/10). The onset age of the malignant solid tumors was 3-189 months, and the median age of onset was 26.5 months. The time from the diagnosis of primary malignant solid tumor to diagnosis of CNS metastasis was 0-100 months, and the median time of metastasis was 18 months. The neuroimaging features of CNS metastasis were as follows:30 cases with brain metastasis, three cases with meningeal metastasis, and five cases with spinal cord involvement. Cerebrospinal fluid cytology was positive in two cases (2/3). Of the 33 patients with CNS metastasis, five underwent intracranial tumor resection combined with radiotherapy and chemotherapy, two underwent surgery alone, three underwent radiotherapy alone, and 23 underwent chemotherapy alone. After a median follow-up of 36 months, the survival time of 33 malignant solid tumors with CNS metastasis was (16.96±3.19) months, and the overall survival rate of three years was only 14.7%. The survival time of the patients with intracranial tumor surgery combined with radiotherapy and chemotherapy, surgery alone, radiotherapy alone, and chemotherapy alone was (40.50±4.32), (3.00±0), (35.50±5.50) and (10.35±2.84) months, respectively; and the three-year overall survival rates were 50.0%, 0, 50.0% and 4.3%, respectively (χ 2=15.19, P=0.002). The prognosis of the patients with intracranial tumor resection combined with radiotherapy and chemotherapy was the best. Conclusions:The highest incidence of CNS metastasis in children with malignant solid tumors in the chest and abdomen was found in the clear cell sarcoma of the kidney. The prognosis of CNS metastasis was found to be poor. But the comprehensive therapy of intracranial tumor resection combined with radiotherapy and chemotherapy can prolong survival and improve prognosis.
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Objective To study on the mRNA expression level of IN1 gene associated with the clinical efficacy and prognosis of hepatoblastoma(HB) in children and to elucidate the early warning value of IN1 gene for prognosis and chemotherapy sensitivity.Methods Forty HB patients were selected based on primary diagnosis and treated from January 2015 to May 2018 in Tongren Hospital Affiliated to Capital Medical University.The expression level of INI1 gene was detected by using fluorescence immuno-PCR.Clinical data of children with HB were collected,including staging,grouping,risk,efficacy and prognosis of chemotherapy.The relationship between the mRNA expression of IN1 gene and clinical data was analyzed by SPSS 21.0 software.Results (1) Clinical characters:the medium age of 40 HB patients was (30.50 ± 2.39) months,male 29 cases (72.5 ％),and female 11 cases (27.5 ％).There was 1 case (2.5％) of stage Ⅱ HB,13 cases (32.5％) of stage Ⅲ HB,and 26 cases (65.0％) of stage Ⅳ.The low-and intermediate-risk group had 12 cases (30.0％) of HB,and the high-risk group had 28 cases (70.0％) of HB.(2) Clinical efficacy and prognosis:by July 1st,2018,the medium following-up time was (12.2 ± 10.1) months,4 patients (10％) were treated by chemotherapy without surgery,and 36 patients (90％) were treated by surgery.All patients (100％) received chemotherapy.The average cycle of chemotherapy lasted (13.17 ± 0.02).Ten patients were dead and 30 patients survived till following-up.The overall survival (OS) rates were 75％ and the event-free survival rates were 50％ (20 patients with HB).(3) IN1 gene mRNA expression:The average PCR quantitative of IN1 gene mRNA of 40 HB patients (2-△CT) was 0.31 ± 0.70.The average mRNA quantitative of HB patients (2-△CT) with high-risk and low/intermediate-risk group was 0.23 ± 0.43 and 0.48 ± 1.13 (t =6.363,P =0.05).According to histology diagnosis,the average mRNA quantitative of small cell undifferentiated (SCU) type (12 cases)and other type (25 cases) was 0.09 ± 0.11 and 0.43 ± 0.86 (t =4.533,P =0.04).The average mRNA quantitative of patients with or without radical surgery was 0.04 ± 0.03 and 0.34 ± 0.74 (t =2.935,P =0.022).The data of children with poor chemotherapy sensitivity(19 cases)and those sensitive to chemotherapy (21 cases) were 0.03 ± 0.04 and 0.30 ± 0.82,and the difference was statistically significant (t =5.688,P =0.018).Conclusions Poor therapeutic effect results in low mRNA expression of IN1 gene in children of HB.The IN1 gene expression could be an early warning factor for treatment sensitivity and prognosis.
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Objective To kxplork thk clinical charactkristics,trkatmknt and prognosis of rhabdomeosarcoma (AMS)with intracranial kxtknsion in childrkn. Methods Thk clinical data of 12 casks of childrkn(5 malks and 7 fk-malks)with AMS and intracranial involvkmknt admittkd into thk Dkpartmknt of Pkdiatrics,Bkijing Tongrkn Hospital Lffiliatkd to Capital Mkdical Rnivkrsite from Dkckmbkr 2012 to Dkckmbkr 2017 wkrk analezkd rktrospkctivkle. Thkrk wkrk 5 malks and 7 fkmalks in 12 casks. Thk onskt agk rangkd from 1. 2 to 10. 2 ekars old,with a mkdian agk of 3. 4 ekars old. Thk clinical fkaturks,trkatmknt mkthods and prognosis wkrk summarizkd. ResuIts Thk primare sitks of 9 casks wkrk in thk hkad and nkcc(75﹪),2 casks wkrk in thk chkst and bacc(17﹪),and 1 cask was in thk pkrinkum (8﹪). Nink patiknts had obvious ckntral nkrvous sestkm involvkmknt semptoms,and cranial imaging findings wkrk studikd in all of thk 12 patiknts. Thk clinical pathological stagk and risc classification wkrk:6 casks of stagkⅣ(1 cask of ckntral aggrkssion);6 casks of stagk Ⅲ(4 casks of ckntral aggrkssion);10 casks wkrk in thk high-risc group(4 casks of stagk Ⅲ with ckntral violations),and 2 casks(stagkⅢ)in thk intkrmkdiatk risc group. Lll 12 casks rkckivkd sestkmic chkmothkrape,8 casks rkckivkd local or total cranial╱spink radiothkrape,9 casks undkrwknt primare rkskction, and 4 casks undkrwknt craniotome to rkmovk intracranial lksions. Rp to Januare 2018,4 casks of 12 childrkn survivkd (including 2 diskask-frkk patiknts)and 8 childrkn dikd. Thk ovkrall survival ratk was 33﹪(4╱12 casks)and thk diskask-frkk survival ratk was 17﹪(2╱12 casks). ConcIusions Thk prognosis of AMS with intracranial infiltration is vkre poor,and thk trkatmknt kffkct is not good. Complktk rkskction of karle lksions is thk cke to curk AMS. Aadiothkra-pe,individualizkd chkmothkrape and surgical rkmoval of intracranial lksions mae havk thk valuk in controlling diskask and prolonging survival timk.
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Objective@#To study on the mRNA expression level of IN1 gene associated with the clinical efficacy and prognosis of hepatoblastoma(HB) in children and to elucidate the early warning value of IN1 gene for prognosis and chemotherapy sensitivity.@*Methods@#Forty HB patients were selected based on primary diagnosis and treated from January 2015 to May 2018 in Tongren Hospital Affiliated to Capital Medical University. The expression level of INI1 gene was detected by using fluorescence immuno-PCR. Clinical data of children with HB were collected, including staging, grouping, risk, efficacy and prognosis of chemotherapy. The relationship between the mRNA expression of IN1 gene and clinical data was analyzed by SPSS 21.0 software.@*Results@#(1)Clinical characters: the medium age of 40 HB patients was(30.50±2.39) months, male 29 cases (72.5%), and female 11 cases (27.5%). There was 1 case (2.5%) of stage Ⅱ HB, 13 cases (32.5%) of stage Ⅲ HB, and 26 cases (65.0%) of stage Ⅳ. The low-and intermediate- risk group had 12 cases (30.0%) of HB, and the high-risk group had 28 cases (70.0%) of HB.(2)Clinical efficacy and prognosis: by July 1st, 2018, the medium following-up time was (12.2±10.1) months, 4 patients (10%) were treated by chemotherapy without surgery, and 36 patients (90%) were treated by surgery .All patients (100%) received chemotherapy.The average cycle of chemotherapy lasted(13.17±0.02). Ten patients were dead and 30 patients survived till following-up.The overall survival (OS) rates were 75% and the event-free survival rates were 50% (20 patients with HB). (3) IN1 gene mRNA expression: The average PCR quantitative of IN1 gene mRNA of 40 HB patients(2-ΔCT)was 0.31±0.70.The average mRNA quantitative of HB patients (2-ΔCT)with high-risk and low/intermediate-risk group was 0.23±0.43 and 0.48±1.13(t=6.363, P=0.05). According to histology diagnosis, the average mRNA quantitative of small cell undifferentiated (SCU) type (12 cases)and other type (25 cases) was 0.09±0.11 and 0.43±0.86(t=4.533, P=0.04). The average mRNA quantitative of patients with or without radical surgery was 0.04±0.03 and 0.34±0.74 (t=2.935, P=0.022). The data of children with poor chemotherapy sensitivity(19 cases)and those sensitive to chemotherapy (21 cases) were 0.03±0.04 and 0.30±0.82, and the difference was statistically significant (t=5.688, P=0.018).@*Conclusions@#Poor therapeutic effect results in low mRNA expression of IN1 gene in children of HB.The IN1 gene expression could be an early warning factor for treatment sensitivity and prognosis.
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Objective To analysis the prognosis of head and neck rhabdomyosarcoma (RMS) in pediatrics. Methods The clinical data of 98 pediatric patients with head and neck RMS admitted from February 2005 to September 2017 were retrospectively analyzed. The clinical staging and risk grouping were performed according to international rhabdomyosarcoma study group criterion. The treatment included chemotherapy, radiotherapy and surgery accordingly. The association of prognosis with the disease characters, treatment strategy of 98 patients RMS was analyzed by Chi-square test and Kaplan-Merier analysis with SPSS 20.0 software. Results There were 53 boys (54.1％) and 45 girls (45.9％) with a median age of 70 months (2-161 months). There were 43 cases of orbit RMS(43.9％), 46 cases of paramenigneal RMS (46.9％)and 9 cases of non-paramenigneal and non-orbit RMS(9.2％). Twenty seven patients were classified as low risk (27.6％), 42 patients as medium risk (42.9％),and 29 patients as high risk (29.5％). The patients were followed up for a medium of 42 months (9-149 months), 37 cases were dead, 60 cases were survival, and 1 lost the follow-up. Kaplan-Merier survival analysis showed that the overall survival (OS) was 61.9％(60/97), and the average survival time was (92.3±6.9) months. Univariate analysis showed that the OS of patients with paramenigneal RMS was poorer than that of patients with orbit RMS, non-paramenigneal and non-orbit RMS. The OS of high risk RMS patients was poorer than that of intermediate and low risk patients (χ2=6.132, P=0.047). Conclusions The prognosis of head and neck RMS in children is generally good, but the prognosis of paramenigneal RMS and high-risk RMS is significantly declined. The primary site of paramenigneal and high risk are independent risk factors for the prognosis of head and neck RMS in children.
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Circulating free DNA is DNA fragments in the blood,mainly from cell apoptosis,necrosis and release.Its content is significantly different in the bood of healthy human and malignant tuimor patients,which is associated with tumor characteristics.This review will summarize the research progress of CfDNA quantitative analysis for malignant solid tumor and prospect the application value for children's solid tumors.
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Objective To explore the treatment and prognosis of advanced stage childhood hepatoblastoma with pulmonary metastasis.Methods Fifty-six cases of advanced stage hepatoblastoma with pulmonary metastasis diagnosed through pathology from April 2006 to June 2014 in Department of Pediatrics,Beijing Tongren Hospital Affilia-ted to Capital Medical University were enrolled,among them 33 cases were males and 23 cases were females,and the median age was 2.33 years old(1 month-15 years and 1 month old).The clinical effects of multidisciplinary therapy were analyzed.Results (1)Follow-up studies were conducted till December 2016,in which 21 cases of 56 children achieved complete remission,the complete remission rate was 37.5%(21/56 cases),while 12 cases were partial re-mission and 14 cases were deceased,and the effective rate reached 58.9%(33/56 cases).The follow-up period of 41 children were over 24 months,in which the 2-year free event survival(EFS)rate was 37.5%,2-year overall survi-val(OS)rate was 75.0%,5-year survival rate was 42.4%,and the 95% average survival confidence interval was 35.7-55.9 months.(2)The OS rate of children with small age(≤3 years old)was 88.1%(36/42 cases),the ove-rall prognosis was better than that of >3 years old children(35.7%,5/14 cases)(P=0.003).The survival rate of children with complete tumor resection[OS rate was 89.2%(33/37 cases)]was significantly higher than that of the incomplete excision[OS rate was 47.4%(9/19 cases)],and the difference was statistically significant(P=0.001). The prognosis of epithelial type cases was better than that of other types,and the difference was statistically significant (P<0.05),while the fetal type prognosis was the best,and the difference was statistically significant(χ2=8.56,P=0.014).The growth of alpha fetoprotein was negatively correlated with the clinical efficacy and prognosis(r=-0.468, P=0.023).Conclusions Lung is the most common metastatic site of hepatoblastoma,and the marginal lung metasta-sis is more common.With insidious onset and poor prognosis.Therefore,it should be treated with early diagnosis and multidisciplinary therapy to improve prognosis.
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Objective To explore the application effect of key indicators of oncology nursing quality evaluation in the continuous improvement of specialist nursing quality. Methods The Delphi method was used to cons-truct 14 key indicators of oncology nursing quality evaluation, and the key indicators were used to control the quality of specialist nursing in the tumor area. Data were collected and a database was established. Based on the data, the quality of the nursing care and continuous quality improvement were carried out. Results The results of the data from the first year (before the intervention in 2016) and the second year (after the intervention in 2017) were compared with the data of the key indicators of the quality evaluation of the specialist nursing. The results showed that the indicators had different degrees of decline. The data before and after intervention were: chemotherapy drug extravasation rate 0.20% (33/16 861) and 0.10% (20/19 957), and the incidence of severe pain was 1.65% (1 747/106 114) and 1.43% (1 521/106 462). The incidence of anxiety was 2.17% (2 305/106 114) and 1.53% (1 633/106 462), and the incidence of depression was 2.27% (2 408/106 114) and 1.28% (1 359/106 462). The difference was statistically significant (χ2=5.80-300.90, P<0.05); The other 9 indicators of process have improved to varying degrees. Conclusions 14 key indicators of oncology nursing quality evaluation are applied to the oncology ward for specialized nursing quality management and quality improvement, which can monitor the quality of key specialist nursing in real time and dynamically. It can accurately select clinical nursing priority improvement projects and improve specialist nursing. Quality;energy evaluation to improve the quality of specialist nursing quality; help improve the quality management of specialist nursing and ensure patient safety.
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Objective To study the clinical characteristics and prognosis of children aged 5 or above with stage 3/4 neuroblastoma ( NB).Method Among 180 children with NB admitted from March 2007 to June 2015, 54 were aged 5 or above with stage 3 or 4.The clinical characteristics , therapeutic efficacy and prognosis of above 54 cases were analyzed.Results There were 36 boys and 18 girls with a male to female ratio of 2∶1.The most common of primary site was retroperitoneum (41/54, 75.5%), followed by mediastinum (10/54,18.5%), spine and pelvic cavity (3/545,6%).After treated by average 9 cycles of chemotherapy , 34 cases ( 63%) achieved complete remission ( CR ) , 13 ( 24.1%) achieved partial remission (PR), 5 (9.3%) presented disease progression (DP), and 2 died (3.7%).Patients were followed up for median 30 months ( 8 -99 months ) , 24 cases died and 30 survived with a overall survival (OS) rate of 55.6%.In 30 survival cases, there were 23 cases (76.7%) of event-free survival (EFS) ,and 6 cases (20.0%) of PR and 1 case (3.3%) of DP.There were significant differences in prognosis among patients with different responses to first therapy (χ2 =8.963, P =0.003 ).Among 20 children with stage 4 NB treated by autologous peripheral blood stem cell transplantation ( APBSCT ) , 13 cases died and 7 survived with an average survival time of (73.55 ±8.89)months.Among 29 cases without APBSCT, 11 cases died and 18 survived with an average survival time of(40.19 ±5.52)months.There was no significant difference in survival between APBSCT and no-APBSCT.Conclusion Children aged 5 or above with NB tend to have advanced stage , relapse and long treatment cycle , but the survival still can be improved with the appropriate treatment .