Clinical study of intensity modulated radiotherapy and three-dimensional conformal radiotherapy with three-dimensional brachytherapy and concurrent chemotherapy for patients with advanced cervical cancer / 中华妇产科杂志

Objective To compare the dose, clinical efficacy and acute adverse reactions of intensity modulated radiotherapy(IMRT)and three-dimensional conformal radiotherapy(3D-CRT)combined with three-dimensional brachytherapy (3D-BT) in the treatment of concurrent radiotherapy and chemotherapy for advanced stage cervical cancer patients. Methods Data collection was performed from January 2011 to November 2015 in Chinese PLA General Hospital and Inner Mongolia Cancer Hospital.All 89 patients with advanced stage (Ⅱb-Ⅲb) cervical cancer were treated by pelvic radiotherapy and concurrent chemotherapy, 46 cases of them received IMRT and 3D-BT(IMRT group), 43 cases received 3D-CRT and 3D-BT(3D-CRT group),along with cisplatin chemotherapy.The dose accumulation of external beam radiotherapy and 3D-BT was calculated by deformable image registration to analyze clinical efficacy, acute adverse reactions and prognosis of the two groups.Results (1)Dose of radiotherapy:planning target volume(PTV)coverage of IMRT group and 3D-CRT group were respectively(95.4±4.7)% and(95.1±5.1)%, without significant differences (t=0.289, P=0.773). Compared with the patients treated with 3D-CRT, the volumn receiving at least 30 Gy (V30), V50of rectum, colon, bladder and small intestine and V20of bone marrow in the IMRT group were significantly decreased (P<0.05). Regarding the combined dose, the maximum dose (Dmax) and the minimum dose received by the most exposed 2 cm3volume of the analyzed organ(D2CC)of rectum,colon,bladder and small intestine of IMRT group were significantly lower than those of 3D-CRT group (P<0.05). (2) Short-term efficacy: the effective rate of IMRT and 3D-CRT group were respectively 93% (43/46) and 91% (39/43), with no significant differences (χ2=0.237,P=0.626). (3) Acute adverse reactions: compared with 3D-CRT, IMRT could significantly reduce grade 1-2 acute toxicity in gastrointestinal [63%(29/46) vs 84%(36/43)], genitourinary [17%(8/46) vs 37%(16/43)] and hematologic [57%(26/46) vs 79%(34/43)] system (all P<0.05). There were no significant differences of grade 3 acute adverse reactions of gastrointestinal,genitourinary and hematologic system between two groups(all P>0.05). No grade 4 acute adverse reactions were observed. (4) Prognosis: the overall survival rate at 1, 2-year of IMRT and 3D-CRT group were respectively 95.6%,89.1% and 93.1%,86.1%.The progression-free survival rateat 1, 2-year of IMRT and 3D-CRT group were 91.1%, 89.1% and 88.4%, 86.1%, respectively. There were no significant differences in overall survival rate and progression-free survival rate between two groups (P>0.05). Conclusions Compared with 3D-CRT, IMRT combined with 3D-BT has dosimetry advantages based on dose accumulation algorithms by deformable image registration. IMRT could ensure clinical efficacy and significantly reduce the incidence rate of acute toxicities.

Prognosis and reproductive outcome of laparoscopic intracapsular myomectomy / 南方医科大学学报

<p><b>OBJECTIVE</b>To assess the prognosis and reproductive outcomes of laparoscopic intracapsular myomectomy.</p><p><b>METHODS</b>A total of 673 women received subserosal and intramural intracapsular laparoscopic myomectomy between March, 2007 and March, 2012, and their post-operative complications, the need for subsequent surgery, symptomatic relief and reproductive outcomes were analyzed.</p><p><b>RESULTS</b>Of these patients, 42.4% had subserosal myomas and 57.6% had intramural myomas. The mean total operative time was 96∓41 min with a mean blood loss of 128∓46.2 ml, and 82.3% of the patients were discharged 48 h after the operation without early complications. A small fraction (2.3%) of the patients had a second laparoscopic myomectomy for recurrent fibroids. Of the fertility-demanding women who underwent myomectomy, 71% achieved pregnancy, 49.8% underwent caesarean section, 8% had operative vaginal deliveries, and 42.2% had spontaneous deliveries; uterine rupture occurred in none of the cases.</p><p><b>CONCLUSION</b>Laparoscopic intracapsular myomectomy, by preserving the fibroid pseudocapsule and myometrial integrity, has no early postoperative complications and ensures good fertility rates and reproductive outcomes.</p>

Comparison of mental health between aircrew and ground crew at ratio of 1:1 among 122 army airmen / 中国组织工程研究

BACKGROUND: The training task for aircrew of army airmen is very heavy, the evaluation of flight personnel on psychological diathesis is performed to early discover and deal with corresponding questions.OBJECTIVE: To compare the difference of mental health between aircrew and ground crew of army airmen and provide reference data for implementing corresponding norms.DESIGN: Chester sampling investigation and paired design were applied.SETTING: the 71687 Force of Chinese PLA, the 71521 Force of Chinese PLA, Department of Epidemiology, Fourth Military Medical University of Chinese PLAPARTICIPANTS: By chester sampling, 122 aircrew and 122 ground crew of one army airmen in one stationed training troop were randomized in February 2001. The pairs were made at ratio of 1:1 according to age difference less than 3 years and same sex and nationality. The investigated persons were all male, of Han and aged varied from 23 to 52 years.METHODS: Cornell health questionnaire was adopted respectively in investigation of aircrew and ground crew of army airmen. The investigated persons finished and handed in questionnaire independently on the spot in manner of secretion and centralized filling-up. Cornell health questionnaire is composed of 18 sections, including 195 questions, involving 4 aspects,named somatic symptoms, medial and family history, general health and habit and mental symptoms. The total score of Cornell health questionnaire ≥ 30 indicates somatic and mental disturbance and the score of mental section ≥ 10 indicates mental disturbance, both of which are taken as the criteria in comparison of psychological health in receptors of two groups.MAIN OUTCOME MEASURES: Every factor score and total score in somatic and mental sections in Cornell health questionnaire for aircrew and ground crew.RESULTS: The tested results of each 122 cases in either aircrew group or ground crew group entered result analysis. Evaluated results of somatic and mental symptoms in receptors of two groups: the total score was low in Cornell health questionnaire (0-14 scores), of which, the total score in aircrew group was higher than that in ground crew group (81.5% and 59.8%,P ＜ 0.05); the score in mental section was low (0-9 scores), of which, that in aircrew group was higher remarkably than that in ground crew group (99.2% and 91.8%, P ＜ 0.01); the score for the receptors with somatic and mental disturbance (total score≥30, score in mental section ≥ 10) in aircrew group was lower than those in ground crew group (4.1% and 12.3%, P ＜ 0.05); the score for the receptors with mental disturbance (score in mental section≥ 10) in aircrew group was lower remarkably than ground crew group (0.8% and 8.2%, P ＜ 0.01). For somatic section in aircrew group, except the factors of muscle, skeleton and skin, their scores were higher than those in ground crew group (P ＞ 0.05), the scores of the rest factors were all lower than those in ground crew group, of which, the difference was significant in evaluation of factors of eye, ear, nervous system, urinary reproductive system and fatigue in comparison of two groups (P ＜ 0.05). The score of every factor in mental section of aircrew group was lower than those in ground crew group. Except tension factor, in comparison of the rest factors in two groups, the significant difference was present (P ＜ 0.05).CONCLUSION: Overall psychological health state in Cornell questionnaire of aircrew in army airmen was superior to ground crew. Aircrew still presents a part of psychological health questions, mainly in somatic section and inadaptability was the most positive response in mental section, suggesting that aircrew probably presents inadaptable phenomena.