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Objective:To evaluate the efficacy and safety of apatinib in combination with chemoradiotherapy for head and neck squamous cell carcinoma (HNSCC).Methods:37 patients orally received apatinib at 250 mg/d during concurrent chemoradiotherapy until completion of radiotherapy, complete remission assessed by imaging examination, the onset of unacceptable toxicity or death. Baseline characteristics, objective response rates (ORR) and adverse events were assessed in all enrolled patients with complete baseline and safety data. Progression-free survival (PFS) and overall survival (OS) were calculated by Kaplan-Meier method. Prognostic factors were statistically identified using Cox regression models.Results:The ORR was 85%(95% CI: 72%-98%). The median PFS was 17.9 months and the 2-year OS rate was 62%(95% CI: 48%-80%). Ineffective short-term efficacy ( HR=0.035, 995% CI: 0.02-0.652, P=0.025) was an independent risk factor for poor OS. In addition, ineffective short-term efficacy ( HR=0.104, 95% CI: 0.017-0.633, P=0.014) and lymphocytopenia ( HR=17.539, 95% CI: 2.040-150.779, P=0.009) were independent risk factors for poor PFS. Common adverse events (>60%) included lymphocytopenia (76%), leukopenia (68%) and irradiation-induced mucosal injury (65%). The most common treatment-associated grade 3 adverse event was lymphopenia (49%). Conclusions:Apatinib combined with chemoradiotherapy yield significant anti-tumor activity for HNSCC with controllable toxicity. For patients with advanced HNSCC, short-term efficacy and lymphocytopenia may be potential predictors for clinical efficacy of apatinib combined with chemoradiotherapy.
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Ballistocardiogram (BCG) and electrocardiogram (ECG) can realize the detection of cardiac function from mechanical and electrical dimensions respectively. By extracting the corresponding characteristic parameters of the two signals and carrying out joint analysis, an important cardiac physiological index such as cardiac contractility, can be reflected. To overcome the shortcomings of complication and heaviness of the existing acquisition equipment, a wearable BCG-ECG signal acquisition system is designed in this paper, which realizes BCG signal acquisition based on accelerometer and ECG signal acquisition based on conductive rubber electrodes. The signals of 6 healthy persons were collected, and BCG signals collected by piezoelectric films were used as reference signals. The waveform characteristics of signals were compared, and the difference of cardiac cycle acquisition was analyzed. The waveform characteristics of the two signals acquired by the device were consistent with the standard signals, and there was no significant difference in the acquisition of the cardiac cycle between the proposed method and the traditional method. The results show that the system can accurately collect human BCG signals and ECG signals. The system provides a basis for subsequent research on BCG signal formation mechanism and health applications.
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Objective To investigate the efficacy of radiotherapy,as well as the prognostic factors of survival in patients with extracranial oligometastases. Methods A total of 164 patients who underwent intensity-modulated radiotherapy ( IMRT ) of the extracranial oligometastases, from January 2013 to December 2016, were enrolled in the study. The short-term efficacy, local control rate, overall survival, progression free survival and adverse effects of treatment were observed. Results Short-term efficacy was assessed within the first 1-3 months after the end of radiotherapy. The objective response rate (CR+PR) was 78. 7% and the short-term efficacy is mainly related to the T stage of primary tumor ( P＝0. 004).Until the last follow-up,all patients with 1-,2-and 3-year LC were 89. 8%,82. 5% and 74. 9% respectively.Univariate analysis showed that the influencing factors of LC include tumor size and gross tumor volume dose ( all P＜0. 05),multivariate analysis found no significant influence factors. The 1-,2- and 3-year OS were 83. 4%, 69. 6% and 54. 6% respectively. Univariate and multivariate analysis showed that the primary tumor sources, metastasis organs,whether synchronous or adjuvant chemotherapy and short-term efficacy were independent prognostic factors in patients of OS ( P＜0. 05 ).Main toxicity-associated events were grade 1-2 acute reactions,with only 6 patients experiencing grade 3 toxicity;no grade≥4 toxic reactions or treatment-related deaths occurred. Conclusions Radiation therapy for the treatment of extracranial oligometastases can achieve good curative effect,is well-tolerated and has low toxicity.
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ObjectiveTo investigate the correlation between neutrophil to lymphocyte ratio (NLR) and cerebral microbleeds (CMBs) in patients with acute ischemic stroke.MethodsThe consecutive inpatients with acute ischemic stroke were prospectively enrolled.Gradient echo-T2*-weighted imaging was used to evaluate CMBs and their quantity.Univariate analysis was used to compare the baseline data between the CMB group and the non-CMB group.Multivariable logistic regression analysis was used to identify the independent correlation between NLR and CMBs.ResultsA total of 218 patients with acute ischemic stroke were prospectively enrolled, including 66 (30.3%) with CMBs.The age (64.7±6.6 years vs.66.9±8.6 years;t=2.052, P=0.041), high sensitive C-reactive protein (7.0[2.3-13.9] mg/L vs.8.9[4.0-28.1] mg/L;Z=2.008, P=0.045) and NLR (1.9[1.4-2.9] vs.2.3[1.7-3.6];Z=2.071, P=0.038) in the non-CMB group were significantly lower than those of the CMB group.Multivariate logistic regression analysis showed that NLR (odds ratio 1.276, 95% confidence interval 1.008-1.670;P=0.045) and age (odds ratio 1.044, 95% confidence interval 1.002-1.087;P=0.040) were the independent risk factor for CMBs.Spearman correlation analysis showed that NLR was significantly positively correlated with the severity of CMBs (r=0.210, P=0.007).ConclusionsIn patients with acute ischemic stroke, NLR was associated with CMBs and their severity, suggesting that inflammatory reaction might be involved in the occurrence of CMBs.
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<p><b>OBJECTIVE</b>To compare the heart rate variability (HRV) measurements between ballistocardiogram (BCG) and electrocardiography (ECG).</p><p><b>METHODS</b>The signals of BCG and ECG of 21 patients were collected synchronously. JJ intervals of BCG and RR intervals of ECG were used to calculate the cardiac periods. The parameters of HRV analysis were calculated in time domain analysis, frequency domain analysis and nonlinear analysis. The results derived from BCG and ECG were compared.</p><p><b>RESULTS</b>The parameters of HRV analysis calculated from BCG and ECG had high similarity. The correlation coefficients of SDNN, TP, LF, HF and SD2 between the BCG and ECG methods were high (r = 1). The correlation coefficients of rMSSD and SD2 were 0.99 and of PNN50 and LF/HF were 0.98 between the two methods. HRV analysis results derived from the two methods were similar (P > 0.05).</p><p><b>CONCLUSION</b>HRV could also be measured reliably by calculating the JJ interval from BCG.</p>
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Humanos , Balistocardiografía , Electrocardiografía , Corazón , Fisiología , Frecuencia CardíacaRESUMEN
Objective:To analyze the effect of endoscopic submucosal tunnel dissection on patients with large esophageal superficial neoplasms.Methods: Chosen patients with large esophageal superficial neoplasms in our hospital as research object, randomly divided into control group treated by endoscopic mucosal dissection (ESD) and observation group treated by endoscopic submucosal tunnel dissection(ESTD), compared surgery related indicators, complications and treatment outcomes.Results: 1)Observation group patients’ tumor stripping rate (23.17±4.73)/min was significantly higher than control group patients’ (12.65±2.19)/min; Intraoperative blood loss(9.14±0.67)ml, total length of hospital stay (7.34±1.89) d, were significantly less than control group patients with intraoperative blood loss(21.38±3.14)ml, total length of hospital stay (13.21±3.05)d, t value was 4.965, 5.395, 4.932, respectively(t=4.965,t=5.395,t=4.932;P<0.05); 2)Observation group patients esophageal bleeding ESTD rate(5.26%), esophageal stricture rate(31.58%), mediastinal emphysema rate(5.26%), esophageal perforation rate of 0, were significantly less than control group patients with esophageal bleeding rate(31.58%), esophageal stricture rate(5.26%), mediastinal emphysema rate(21.05%), esophageal perforation rate (26.32%), t value were 4.378, 4.378, 4.471, 5.758, (t=4.378,t=4.378,t=4.471,t=5.758;P<0.05); 3)Observation group patients with no recurrence during the follow-up period, control group patients with local recurrence rate of 21.05%, t value 8.623,P<0.05(t=8.623, P<0.05).Conclusion: Endoscopic tunnel mucosal stripping technique can effectively improve the complete tumor removal rate, during the process of optimization operation at the same time reduce the occurrence of complications, to the improvement of the prognosis of patients with positive clinical significance.
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Objective To study the dosimetry characteristics of VMAT plan in the esophageal carcinoma radiotherapy.Methods Application of 0.6 cm3 ionization chamber and COMPASS threedimensional dose verification system,20 cases of upper and middle chest esophageal carcinoma on the VMAT plans for absolute dose and relative dose verification.Dose volume histogram (DVH) comparison treatment target,lungs,heart,and differences in the spinal cord irradiation dose and volume,and analyses γpass rate of GTV,CTV,PTV and organs at risks.Results The center dose of upper and middle chest esophageal carcinoma accurate rates were above 99％.Thoracic segment esophageal:GTV,PTV and organs at risks of γ pass rate above 97％.D95％ and Dmean of GTV,CTV and PTV were relatively undervalued within 3％.D1％ of spinal cord is 2.21％ overvalued.Left and right pulmonary V5 were slightly overvalued by about 0.5％,V10-D30,Dmean undervalued within 2％.In period of middle chest esophageal carcinoma:the gamma passed rate of GTV,CTV,PTV and organs at risks of above 97％,GTV,CTV,PTV D95％,Dmean were relatively undervalued within 2％.Spinal cord D1％ is 2.04％ overvalued.Left and right pulmonary V5-D30 to V10 as a trend of gradually to be underestimated,at 1.5％.Heart Dmean was undervalued by 2.68％.Conclusion VMAT technology is applicable in the chest esophageal carcinoma radiotherapy.
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OBJECTIVE: To investigate feasibility and effectiveness of pedicle screw bi-cortical fixation in lumbar spondylolisthesis or destabilization of aged people. METHODS: The statistical significance of the distance between the anterior edge of vertebral body and the anterior major blood vessels at the level of pediculus arcus vertebrae by CT scan at random were measured and analyzed. 82 cases of lumbar spondylolisthesis or destabilization, aged 65 years (range 51 to 75 years), including 35 males and 47 females, were treated pedicle screw bi-cortical fixation, with the anterior edge of the vertebral body penetrated by one screw thread. The function was evaluated by Macnab backleg pain scale standards. RESULTS: There was significant difference in the distance of the anterior edge and the major vessels between the old and the young (P< 0.05). All the 82 cases were operated successfully, and the mean time was 145 minutes and the mean amount of bleeding was 530 mL. The 43 cases including 15 males and 28 females were followed up for 18 months (range 3 to 53 months). There was one case of rupture of the spinal dura mater with no sequela after the suture. There were 3 cases of transient paralysis and pain of lower limbs, which were alleviated after 2 months' treatment. No complications of nerve root or vessel injuries were found. All incisions healed well at the primary stage. The lumbocrural pain of all 43 cases was alleviated to a certain content. There were 31 cases of excellent, 10 of good, and 2 of fair; the excellent and good rate was 97%. CONCLUSION: It is feasible and safe to treat the lumbar spondylolisthesis or destabilization in the old with the pedicle screw bi-cortical fixation.