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Objective:To evaluate clinical prognosis and prognostic factors of patients with early stage (Ⅰ stage) and locally advanced (Ⅱ/Ⅲ stage) lung cancer treated with carbon ion radiotherapy (CIRT).Methods:Clinical data, treatment, adverse reactions, survival and so on of 54 lung cancer patients who received CIRT and follow-up in the Heavy Ion Center of Wuwei Cancer Hospital of Gansu Province from March 2020 to September 2022 were retrospectively analyzed. The survival curve was plotted using Kaplan-Meier method. Difference tests were performed using log-rank test. Logistic regression analysis was used to identify prognostic factors.Results:According to inclusion and exclusion criteria, 54 patients were enrolled in the study, including 10 patients with early stage lung cancer and 44 patients with locally advanced lung cancer. The median follow-up time for 10 patients with early stage lung cancer was 11.0 (6.75, 17.25) months, and the median dose of irradiation was 60 Gy [relative biological effect (RBE)]. Upon the last follow-up, 3 patients had complete response (CR) and 3 patients had partial response (PR). Four patients had stable disease (SD) and no progressive disease (PD). The 1-year and 2-year local control rates (LCR), progression-free survival (PFS) rates and overall survival (OS) rates were 100%. During treatment and follow-up, 2 patients developed grade 1 radiation pneumonia, 1 case of grade 2 radiation pneumonia, 1 case of chest wall injury (chest wall pain), and there were no adverse reactions greater than grade 2. The median follow-up time of 44 patients with locally advanced stage was 12.5 (4.25, 21.75) months, and the median irradiation dose was 72 Gy (RBE). Thirty-two (73%) patients received concurrent chemotherapy during treatment, 20 (45%) patients received sequential chemotherapy after treatment, 14 (32%) patients received immune maintenance therapy and 3 (7%) patients obtained PD and received targeted drugs. Upon the last follow-up, 3 (7%) patients had CR, 17 (39%) patients had PR, 19 (43%) patients obtained SD, and 5 (11%) patients had PD. The 1-year and 2-year LCR were 96.0% and 87.3%, 90.9% and 84.1% for the 1-year and 2-year PFS rates, and 93.2% and 86.4% for the 1-year and 2-year OS rates, respectively. The median OS and PFS of patients were not reached. Multivariate logistic regression analysis showed that maintenance therapy after radiotherapy ( P=0.027) and clinical target volume (CTV) irradiation volume ( P=0.028) were the factors affecting PFS. Simultaneous chemoradiotherapy ( P=0.042) and maintenance therapy after radiotherapy ( P=0.020) were the factors affecting OS. And gross tumor volume (GTV) ≥215 ml ( P=0.068) might be an independent risk factor for grade 2 and above radiation pneumonia. Conclusions:The domestic carbon ion system has definite clinical effect and controllable toxic and side effects in the treatment of early stage and locally advanced lung cancer. The combination of synchronous chemotherapy and further maintenance treatment can significantly improve clinical prognosis of patients without significantly increasing the risk of toxic and side effects.
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Objective:To compare the adverse reactions, efficacy and survival rate of carbon ion beam irradiation in the elective lymph node (ENI) drainage area of locally advanced non-small cell lung cancer (LA-NSCLC) with relative biological effect (RBE) dose of 48 Gy using 16 and 12 fractions.Methods:A total of 72 patients with pathologically confirmed LA-NSCLC admitted to Wuwei Heavy Ion Center of Gansu Wuwei Tumor Hospital from June 2020 to December 2021 were enrolled and simple randomly divided into groups A and B, with 36 patients in each group. Patients in groups A and B were treated with carbon ion beam irradiation to the lymph node drainage area with 48 Gy (RBE) using 16 and 12 fractions. The acute and chronic adverse reactions, efficacy and survival rate were observed. The survival curve was drawn by Kaplan-Meier method. Difference test was conducted by log-rank test.Results:The median follow-up time was 13.9 (8.8-15.7) months in group A and 14.6 (6.3-15.9) months in group B. Sixteen (44.4%) patients were effectively treated in group A and 9 (25%) patients in group B. Thirty-four (94.4%) cases achieved disease control in group A and 30 (83.3%) cases in group B. Statistical analysis showed that the overall survival rate in group B was similar to that in group A ( χ2=1.192, P=0.275). Comparison of planning parameters between two groups showed CTV volume, D mean, V 5 Gy(RBE), V 20 Gy(RBE) and V 30 Gy(RBE) of the affected lung, cardiac V 20 Gy(RBE), V 30 Gy(RBE) and D mean, esophageal V 30 Gy(RBE), V 50 Gy(RBE), D max and D mean, D max of the trachea and spinal cord had no significant difference (all P>0.05). No grade 3 or 4 adverse reactions occurred in the enrolled patients during treatment and follow-up. No statistical differences were observed in the acute radiation skin reaction ( χ2=5.134, P=0.077), radiation esophagitis ( χ2=1.984, P=0.371), and advanced radiation pneumonia ( χ2=6.185, P=0.103) between two groups. Conclusions:The two dose fractionation modes of carbon ion therapy system are equally safe in the mediastinal lymphatic drainage area of LA-NSCLC, and the adverse reactions are controllable. The long-term efficacy still needs further observation.
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15q11-q13 Duplication syndrome is a rare genetic disease of the nervous system, characterized by developmental retardation, intellectual impairments, hypotonia, autism, epilepsy and so on. This article reports a 33-year-old male patient, with the clinical manifestation of early-onset intractable epilepsy and mental retardation. The high-throughout whole exome sequencing showed a 10.53 Mb repeat sequence in the 15q11.2-q13.3 region, further confirming the diagnosis of 15q11-q13 duplication syndrome. The literature reports of the pathogenic mechanism, classification, typical clinical manifestation, seizure features,accessory examination and therapy of the 15q11-q13 duplication syndrome are summarized and reviewed, so as to enhance the understanding of the disease, as well as to improve the diagnosis and treatment level of the clinicians.
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Objective@#To establish a rat model of preeclampsia (PE) in early pregnancy and to observe the changes in phenotype，pregnancy outcome and cognitive ability of offspring．@*Methods @#The pregnant rats were randomly divided into model group and control group．Ultra-low dose lipopolysaccharide (LPS) (0. 5 μg / kg) and an equal volume of normal saline were injected into the tail vein of pregnant rats on the fifth day of pregnancy．The levels of blood pressure ，12-hour urinary protein ，peripheral blood coagulation factors and placental cytokines in the two groups were measured．Furthermore，placental pathology，pregnancy outcomes，and cognitive abilities of offspring were observed. @*Results@#Blood pressure and urinary protein levels of model group were significantly higher than those of control group levels．Compared with the control group，the levels of platelet and antithrombin Ⅲ (AT Ⅲ) in the peripheral blood of pregnant rats in the model group were lower than those in the control group，while D-dimer was higher than that in the control group，the weight of the fetus and placenta in the model group decreased (P ＜0. 001) ，the expression levels of interleukin ( IL) -6，tumor necrosis factor α ( TNF-α) and interferon gamma (INF-γ) in peripheral blood increased，while the expression level of transforming growth factor β1 (TGF-β1) decreased(P＜0. 001) ．The water maze test showed that the latency of the offspring of the model group to the plat- form was longer than that of the control group (P＜0. 05) ，while the frequency of crossing the platform quadrant and the time of staying in the platform quadrant of the model group were lower than those of the control group (P < 0. 05 ) ．HE and PAS staining showed that there were infiltration of inflammatory cells in the basal layer of placenta， obvious decrease of blood vessels in labyrinthine area，slight edema of renal interstitium and degeneration of local renal tubular epithelial cells in the model group，while there were no above pathological changes in placenta and kidney in the control group．@*Conclusion@#A single injection of LPS in early pregnancy can successfully induce PE- related symptoms and adverse pregnancy outcomes such as fetal growth restriction and lead to the decline of cogni- tive ability of offspring.
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Objective:To evaluate the feasibility and safety of carbon ion radiotherapy (CIRT) in the treatment of muscle-invasive bladder cancer in phase Ⅰ/Ⅱ clinical trials.Methods:Clinical stage T 2-3 patients with muscle-invasive bladder cancer (without distant metastasis) were studied. A three-fraction treatment was applied, including the local irradiation with the dose from 12 Gy to 24 Gy and 11 fractions of whole-bladder irradiation with a dose of 44 Gy. The carbon ion irradiation dose is determined with relative biological effectiveness (RBE) of 3.0. The total dose for bladder tumor was 56-68 Gy in 14 fractions. The primary endpoints included tumor treatment-related side effects, dose-limiting toxicity (DLT) responses, and local control (LC) rate, and the secondary endpoints included progression-free survival (PFS). Results:Nine patients received CIRT of various doses in the clinical trials, with the dose gradually increasing to 68 Gy. The patients did not suffer from DLT response, acute adverse effects of radiation therapy of grade ≥3, and late radiation adverse reactions during follow-up. When the dose to the tumor reached 68 Gy, there were 2 cases of grade 2 acute urogenital tract reaction and 1 case of acute lower gastrointestinal tract symptom. For the group with a dose above 62 Gy, three cases of grade 1 late radiation bladder reaction were observed and their symptoms included urinary frequency and microscopic hematuria. At the end of treatment, hematuria disappeared, dysuria was relieved, and urine red blood cell value significantly decreased for all the patients. Three months and six months after treatment, the LC rates were 100% and 88.9%, respectively, and the objective response rates were both 88.9%. One patient developed local recurrence and was treated with salvage surgery six months after treatment.Conclusions:The preliminary efficacy observation of CIRT in the treatment of muscle-invasive bladder cancer showed significant short-term efficacy, obvious symptom relief, and good tolerability for patients, without DLT. Therefore, CIRT is safe and feasible.
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Objective:To explore the effect of continuous nursing on the psychology and quality of life of patients with mild traumatic brain injury.Methods:A review of 120 patients with mild traumatic brain injury who were hospitalized in the Second Affiliated Hospital of Wenzhou Medical University from January 2016 to December 2019 were selected. According to the order of admission, sample numbers were drawn from the random number list and entered into groups. There were 60 cases in the control group and the intervention group. The control group received routine general nursing, and the intervention group received continuous nursing. The Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD), and Quality of Life Scale (SF-36) were used to evaluate the psychology and quality of life of patients on the day of discharge and one week, one month, and three months after discharge.Results:There was no significant difference in the scores of HAMA, HAMD and SF-36 between the two groups on the day of discharge ( P>0.05). The HAMA scores at 1 week, 1 month and 3 months after the intervention of the intervention group were (18.2±8.6), (13.7±5.8) and (5.6±2.3), which were significantly lower than those of the control group (24.2±11.2), (20.4±8.2), (8.9±3.6), the differences were statistically significant ( t values were 2.32, 3.67, 4.13, P<0.05). The HAMD scores at 1 week, 1 month and 3 months after the intervention of the intervention group were (24.3±7.1), (10.9±4.2), (6.8±2.9), which were significantly lower than those of the control group (28.6±8.5), (15.3±8.3), (14.8±4.6), the differences were statistically significant ( t values were 2.11, 2.57, 7.99, P<0.05). The SF-36 scores at 1 week, 1 month and 3 months after the intervention of the intervention group were (77.2±8.9), (85.2±9.7), (87.8±12.9), which were significantly higher than those of the control group (72.3±8.2), (79.4±10.9), (81.0±11.5), the differences were statistically significant ( t values were -2.23, -2.14, -2.13, P<0.05). Conclusions:Continuing care can be extended to the patient's family, so that the health problems faced by the patient after discharge from the hospital can be effectively solved, relieve psychological pressure and improve the quality of life, and it is worthy of clinical application.
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Clinical residual biological specimens are invaluable for medical research and can be reused for medical research. This paper expounded the possibility, necessity and applied range of the medical research reuse of clinical residual biological specimens and put forward some suggestions on how to standardly supervise clinical residual biological specimens for medical research reuse. The authors raised four aspects of concern: how to strengthen the management of ethical review; how to establish strict privacy protection and information confidentiality system; how to keep samples reasonably to ensure clinical examination; and how to ensure the compliance treatment of residual biological specimens after reuse, so as to promote clinical residual biological specimens more normatively and effectively used in medical research.
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Objective This study aimed to explore the practice and effect of PAD Class (presentationassimilation-discussion Class) in the teaching of Medical Genetics.Methods We randomly selected a teaching class (117) for PAD Class and the other class (115) for lecture-style teaching.The two classes took the same exam in the end,with the PAD class taking an extra questionnaire on teaching conditions at the same time.The average scores of the two classes were tested by SPSS 19.0.Results The scores of the final exams for PAD and control classes were (72.21 ± 7.42) and (69.77 ± 8.89),differences were statistically significant (t=2.27,P=0.02).Questionnaire results showed that in PAD Class,68.81％ (75/109) of the students could complete homework,93.58％ (102/109) thought that PAD class had (obviously) increased their initiative and enthusiasm for learning,and 53.21％ (58/109) were very satisfied with their learning results.Conclusion PAD Class is suitable for the teaching of Medical Genetics and improves the teaching efficiency.
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Two hundred women with singleton pregnancy at full term undergoing cesarean section with combined spinal-epidural anesthesia were randomly assigned into 2 groups (n=100 in each group). During anesthesia the polyvinyl chloride epidural catheter was used in control group and the wire-reinforced epidural catheter was used in study group.The results showed that the number of patients in whom blood or blood-tinted fluid was withdrawn from epidural catheter was significantly lower in study group than that in control group.The domestic wire-reinforced epidural catheter can reduce the incidence of blood vessel injury induced by insertion of epidural catheter.
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Objective To investigate the correlation of the polymorphisms of angiotensin Ⅱtype 1 receptor (AT1R)gene A1166C and angiotensinogen(AGT)gene M235T and blood biochemical indicators with essential hypertension(EH)in the male of Yi nationality in Yunnan province. Methods 92 hypertensive and 70 normotensive of Yi people were recruited in Yunnan province. Their basic information and blood biochemical indicators were obtained by questionnaire and standardized physical examination. The genes polymorphisms were determined by polymerase chain reaction-restriction fragment length polymorphism(PCR-RFLP)technique. Results(1)For the male EH patients of Yi nationality,1166C and 235T allele frequencies were 0.038 and 0.772. No significant differences in allele frequency or genotype frequency were observed between the two groups(P > 0.05).(2)The levels of TC,LDL-C and TG in EH were significantly higher than those in controls(P < 0.05). Conclusion The AT1R A1166C and AGT M235T polymorphisms were not related to the pathogenesis of EH in the male of Yi people. However,the high levels of TC,TG and LDL-C might be the risk factors of EH.
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OBJECTIVE@#To examine the psychometric features of the body image after breast cancer questionnaire-Chinese version (BIBCQ-C) in Chinese women with breast cancer.@*METHODS@#A total of 545 women with breast cancer received a demographics investigation: BIBCQ-C and hospital anxiety and depression scale (HAD). Four weeks later, 31 patients were selected randomly to finish BIBCQ-C again.@*RESULTS@#The Cronbach's alpha coefficient for the total scale was 0.90, and that for the 6 factors ranged from 0.62 to 0.87. The mean inter-item correlation coefficient of the total scale was 0.16, and the mean inter-item correlation coefficient of the subscales ranged from 0.21 to 0.57, and the test-retest reliability of the total scale and 6 factors was over 0.60. The confirmatory factor analyses supported the 6-factor model, and BIBCQ-C were significantly correlated with the symptom scales of anxiety and depression (r=0.20, 0.21, P<0.01).@*CONCLUSION@#BIBCQ-C is reliable and valid, which can effectively assess body image of Chinese women with breast cancer.
Sujets)
Femelle , Humains , Anxiété , Asiatiques , Image du corps , Tumeurs du sein , Psychologie , Dépression , Psychométrie , Reproductibilité des résultats , Enquêtes et questionnairesRésumé
ObjectiveTo explore relationship between psychological resilience and life events of Tibetan nursing students receiving free vocational nursing education.Method The questionnaire of Symptom Checklist 90(SCL-90)and ASLEC were used in the survey among 120 nursing students to investigate the psychological resilience and life events and SPSS 17.0 was used to look into the correlations between them.Results The scores on psychological resilience of Tibetan nursing students was higher than the norm (P<0.05).There were negative correlations between life events and psychological resilience(P<0.05).Their psychological resilience was positively related to personal relations and health conditions(P<0.05)but negatively to learning pressure,punishment and losses (P<0.05).Conclusion The school and hospital should make teaching measures to psychologically support them in daily life to strengthen the abilities to handle failure and adjust to the society.
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Objective To improve the teaching quality of medical genetics. Methods A medi-cal genetics questionnaire survey was designed and conducted among 2012 grade undergraduates of Kunming Medical University. The results of the questionnaire were statistically analyzed by Kruskal-wallis test. Results The students felt that, there were differences in the importance and difficulty of teaching sections (Z=395.818,Z=117.786,P<0.001). The practical abilities were different after learn-ing (Z=139.364,P<0.001). Most of the students had strong demand for clinical practice and genetic counseling, there were differences in the degree of demand in students of different majors (Z=8.432, P=0.038). Conclusion Method of adjusting teaching content and method was proposed and adding clinical practice in the future was recommend to improve the teaching quality .
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Objective To investigate the effects of peri-operative enteral nutrition (EN) and antibiotics on intestinal flora balance in patients with esophageal carcinoma.Methods Sixty patients were randomly divided into six groups:Group B,treated with antibiotics for 3 days and supported with EN before and after operation; Group C,treated with antibiotics for 3 days and supported with parenteral nutrition (PN) before operation and EN after operation ; Group D,treated with antibiotics for 3 days and supported with PN before and after operation ; Group E,treated with antibiotics for 7 days and supported with EN before and after operation; Group F,treated with antibiotics for 7 days and supported with PN before operation and EN after operation ; and Group G,treated with antibiotics for 7 days and supported with PN before and after operation.The first stool after surgery was obtained and tested for Bacteroides,Bifidobacterium,Lactobacillus,Escherichia coli,and Enterococcus.Ten healthy adults were enrolled as the blank control group.The numbers of the flora and ratio of Bifidobacteria to Enterococci (B/E) were compared.Complications such as incision infections,lung infections,and anastomotic fistula were recorded.Results The numbers of Bifidobacterium [(10.59 ± 0.39) vs.(10.88 ± 0.10) lg10n/ml,P =0.186),Lactobacillus [(8.59±0.31) vs.(8.72 ±0.22) lg10n/ml,P=0.534],Escherichia coli [(8.43 ±0.50) vs.(8.67 ±0.24) lg10n/ml,P=0.266],Enterococcus [(7.40 ±0.61) vs.(7.78 ±0.16) lg10n/ml,P =0.111],and B/E value [(1.2589 ± 0.0644) vs.(1.2560 ± 0.0330),P =0.825] in the Group B were not significantly different from the blank control group.The numbers of Bacteroids [(11.08 ± 0.48),P =0.139 ; (9.23 ± 0.42),P =0.000; (10.80±0.26),P=0.004; (10.24±0.45),P=0.000; (8.05±0.53),P=0.000vs.(11.36±0.48) lg10n/ml],Bifidobacterium [(10.19 ±0.49),P=0.062; (9.00 ±0.52),P=0.000; (9.31 ±0.45),P=0.000; (8.47±0.56),P=0.000; (6.99 ±0.56),P =0.000 vs.(10.59±0.39) lg10n/ml],Lactobacillus [(7.99 ± 0.58),P =0.006 ; (6.84 ± 0.47),P =0.000 ; (7.72 ± 0.35),P =0.000 ; (6.93 ±0.43),P =0.000; (5.93 ±0.76),P=0.000 vs.(8.59 ±0.31) lg10n/ml],Escherichia coli [(8.19 ±0.43),P=0.258; (7.93±0.60),P=0.020; (7.47±0.43),P=0.000; (6.90±0.42),P=0.000; (6.58±0.57),P =0.000 vs.(8.43 ± 0.50) lg10n/ml],and Enterococcus [(6.90 ± 0.54),P =0.037 ; (5.89 ± 0.68),P =0.000; (6.20±0.52),P=0.000; (5.91 ±0.39),P=0.000; (5.14±0.58),P=0.000 vs.(7.40±0.61) lg10n/ml] of groups C,D,E,F,and G decreased compared with those of the Group B.The values of B/Ein the D and G groups decreased significantly when compared to the blank control group (1.1433 ±0.1350,P =0.025 ; 1.0706 ± 0.1413,P =0.000 vs.1.2560 ± 0.0330).The incidences of pulmonary infections (x2 =3.647,P =0.601) and anastomotic leak (x2 =5.000,P =0.416) among all groups were not significantly different.Conclusions EN applied 3 days before surgery and after surgery is beneficial for maintaining the balance of intestinal flora.Long-term administration of antibiotics may cause dysbacteriosis and even increase complications.
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In order to improve the quality of teaching in medical genetics,we adopted a lot of measures in medical genetics teaching program according to the requirements of basic course and the characteristics of lower grade undergraduates.Firstly,cultivating students' awareness of genetic diseases; Secondly,integrating related courses and selecting teaching contents seriously; Thirdly,guiding the class by introducing cases of illness.The results showed that these methods can promote the understanding of medical genetics and improve the quality of study in lower grade undergraduates.
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Objective To assess the MRI features of cerebrum in idiopathic hypoparathyroidism (IHP). Methods MR images of 27 IHP patients were analyzed retrospectively emphasized on the location, appearance and signal intensity of the lesions. Results MRI showed symmetric abnormal signals in basal ganglia in 27 patients, in thalami and dentate nucleus in 21 patients, and in corona radiata-centrum ovale in 9 patients. All the lesions were hyperintensity on T1WI. Local hypointensity in basal ganglia was found in 4 patients, while hyperintensity or slight hyperintensity on both T2WI and T2-FLAIR were found in 26 patients, and slight hyperintensity with hypointensity on both T2WI and T2-FLAIR in 1 patient. Conclusion MRI of IHP has some features. Symmetric high signals on both T1WI and T2WI in basal ganglia, thalami and dentate nucleus have important diagnostic value for IHP.
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The effects of naphthylmethyl isoquinoline (NI) and verapamil (Ver) on contractile tension and volume of oxygen consumption were compared on isolated guinea pig left atrips and cat papillary muscles. The results showed that NI and Ver diminished the Ca++-dependent contractile tension and volume of oxygen consumption by electrically driven preparations. Under the influence of increasing doses of NI (10 ~100?mol/L)and Ver(0.72~3.6?mol/L) linear reduction of contractile tension and volume of oxygen consumption were seen. These effects were reversed by increasing the extracellular Ca++ concentration. These results indicate that NI may be an effective calcium-antagonist very similar to Ver.