ABSTRACT
Objective To investigate the clinical effect of McDonald cervical cerclage and the affecting factors. Methods Between January 2002 to December 2013 in Peking University First Hospital we performed McDonald cervical cerclage for 116 single pregnant women. They were defined as the successful group who deliveried the live babies after 28 weeks after the cerclage and the failure group who deliveried in the second trimester. According to the surgical indications they were divided into preventive cerclage group and therapeutic cerclage group. Then we analyzed the curative effect and the affecting factors in the groups. Results (1) In the 116 cases, 12 cases (10.3%) failed, and 104 cases (89.7%) succeeded. In the successful group, 37 cases (35.6%,37/104) deliveried pretermly and 67 cases (64.4%) deliveried termly. And there were 56 cases of vaginal delivery (53.8%), and 48 cases (46.2%) of cesarean section. (2) Among the 116 cases, 48 cases (41.4%) were included in prophylactic cerclage group, the gestational age was (16.3± 2.2) weeks, 68 (58.6%) cases were included in therapeutic group, the gestational age was (24.0±2.2) weeks. The operation time was (22±9) minutes in preventive group and (24±13) minutes in therapeutic group,there was no statistical difference between the two groups (P>0.05). Live-birth rate between preventive cerclage group and therapeutic cerclage group was no statistically significant difference (P>0.05). The term birth rate (72.9%, 35/48) in preventive group was higher than that in therapeutic group (47.1%, 32/68), the difference was statistically significant (P0.05). (4) There were 68 cases in the therapeutic group, 7 cases failed, and 61 cases succeeded;the preoperative cervical os in failure group [ (21 ± 20) mm] was wider than that in successful group [(14±5) mm], the difference was statistically significant (P0.05). Conclusions The McDonald cervical cerclage for cervical incompetence is a simple, safe and high successful rate of intervention measures. The term labor rate of prophylactic cervical cerclage was higher than that of the therapeutic cerclage. Older maternal age and preoperative invasive procedure may be the risk factors for cerclage. The infection may play an important factor leading to the failure of McDonald cervical cerclage.
ABSTRACT
ObjectiveTo analyze the correlation between the changes of myocardial enzyme level in serum before and after radiotherapy and dose - volume histogram ( DVH ) parameters of the heart.Methods A total of 102 patients with 68 cases of lung cancer and 34 cases of esophageal cancer were recruited.All patients received three-dimensional conformal radiotherapy (3DCRT) or intensity-modulated radiotherapy (IMRT),with the radiation beams passing through the heart.Aspertate aminotransferase (AST),creatine kinase (CK),creatine kinase isozyme ( CK-MB ),lactate dehydrogenase ( LDH ),α-hydroxybutyrate dehydrogenase (α-HBDH) were determined in the serum before and after radiotherapy.All the enzyme levels before and after radiotherapy were compared through paired t-test.Independent sample t-test was conducted between sub-groups.And the dose-volume histogram (DVH) parameters of the heart were calculated ( the volume percentage of heart receiving dose equal to or exceeding x Gy ( Vx ).The correlation between myocardial enzyme level and DVH parameters was analyzed through Pearson method.Results Serum AST,CK-MB,LDH,α-HBDH levels increased significantly after radiotherapy ( 19.42∶ 27.89,14.72∶19.57,178.80 ∶ 217.57,140.32 ∶ 176.25,t =-3.39 - -6.92,all P=0.000).In Group IMRT,significant correlations between the increase of myocardial enzyme concentration and DVH parameters of the heart are found,AST with V20,V25,V30 of heart ( r=0.302 - 0.431,P =0.039 - 0.003 ),CK with V30of heart (r=0.345,P=0.013),and CK-MB,LDH,α-HBDH with V25,V30(r=0.465 -0.376,P=0.001-0.005).In Group CRT,there are significant correlations between changes of CK-MB,LDH level and V30 of heart (r =0.330,0.274,P=0.014,0.033),α-HBDH and V25,V30,and V35 of heart (r=0.270-0.331,P=0.046-0.014).When the irradiation dose was more than 50 Gy,significant correlations were found between the concentration changes of AST,LDH,α-HBDH and V25,V30 of heart (r=0.256-0.359,P =0.019-0.006),CK-MB and V30(r=0.233,P=0.037).When the irradiation dose was 50 Gy or less,only the concentration change of serum CK has significant correlation with V5 and V45 of heart (r=0.581,0.536,P=0.023,0.043).ConclusionsThere exists certain correlations between changes of myocardial enzymes level before and after radiation and DVH parameters of the heart,which indicates that the DVH parameters of heart are helpful to evaluate the radiation-induced myocardial damage.