Clinical Analysis of Oxaliplatin-related Thrombocytopenia in Patients with Digestive System Malignancy / 肿瘤防治研究

Objective To investigate the changing trend and correlation of platelet count and spleen diameter in patients with digestive system malignancy receiving oxaliplatin-based chemotherapy. Methods We retrospectively analyzed clinical data of 72 patients with digestive system cancer, recorded and analyzed platelet count and spleen diameter during and after oxaliplatin-based chemotherapy. Results The incidence of thrombocytopenia in all patients was 65.3%. The median time of thrombocytopenia after the beginning of chemotherapy was 2.53±0.49 months, and the median cumulative dose of oxaliplatin was 520±35.81 mg/m2; the median time of lowest platelet count after the beginning of chemotherapy was 4.03±0.49 months, and the median cumulative dose of oxaliplatin was 780±36.32 mg/m2. Splenomegaly occurred in 52(72.2%) patients during the follow-up. The median increase rate was (18.82±0.01)%. The median time of splenomegaly after the beginning of chemotherapy was 2.15±0.19 months, the median time for the largest spleen diameter was 4.68±2.89 months; after the end of chemotherapy, the median time for spleen contraction was 3.28±0.44 months, and the median time for spleen recovery was 8.80±1.05 months. Conclusion Oxaliplatin-based chemotherapy can cause thrombocytopenia and splenomegaly, and it is difficult to recover to baseline for a long time after the end of chemotherapy. The increase of spleen diameter was positively correlated with splenomegaly and thrombocytosis.

Clinical analysis of third-line combination therapy with S-1 plus apatinib for advanced colorectal cancer / 中国肿瘤临床

Objective: To investigate the efficacy and toxicity of apatinib combined with S1 as a third-line therapy for advanced colorectal cancer. Methods: Forty-four patients with adavanced colorectal cancer from Tongji Hospital Cancer Center were enrolled from April 2016 to August 2018. The median follow-up period was 8 months. Data related to efficacy and adverse effects were recorded. Results: The median progression-free survival (PFS) time was 3.93 months (95%CI: 2.72-5.15 months), and the median overall survival (OS) time was 7.77 months (95%CI: 5.36-10.18 months). Patients with left hemicolon cancer and rectal cancer group had a longer PFS than patients with right hemicolon cancer group (4.94 months vs . 3.89 months, P=0.024); the OS for left hemicolon cancer and rectal cancer was 12.5 months, the OS for right hemicolon cancer was 7.4 months, P=0.080; gender, previous bevacizumab use and liver metastasis had no statistically significant effect on PFS and OS; the PFS was 4.48 months and 1.10 month, in the patients with ECOG 0-1 and ECOG 2; the OS was 9.67 months and 2.90 month, in these two groups respectively. The major adverse effects of the combination therapy were fatigue (52.3%), hypertension (45%), hand-foot syndrome (22.7%), leukopenia (15.9%), and neutropenia (15.9%), thrombocytopenia (22.7%), elevated transaminase levels (13.6%), diarrhea (15.9%). Conclusions: The results suggest that the combination of apatinib and S-1 is safe and effective as a third-line treatment for advanced colorectal cancer.

Role of oncologic radiotherapy in multidisciplinary team treatment of malignant acute abdomen / 中华胃肠外科杂志

Malignant acute abdomen is a emergency with abrupt onset, rapid progress and often a complex etiology, presenting difficulties for treatment and high mortality. Therefore, multidisciplinary team (MDT) treatment modality is required. Compared with single-discipline diagnosis and treatment modality, diagnosis made from MDT discussion is more accurate, where specialists can improve efficiency and quality of the treatment through better communication. A good MDT can cover all stages from the diagnosis to the assessment and treatment of the disease, and combine them into a more coherent process. This article discusses the development of radiotherapy-related malignant acute abdomen and the role of radiotherapy in the treatment of malignant acute abdomen from the perspective of oncologic radiotherapy. Common causes of radiotherapy-related acute abdomen from gastric cancer include gastric hemorrhage, upper gastrointestinal obstruction and gastric perforation, while those of radiotherapy-related acute abdomen from colorectal cancer include lower gastrointestinal hemorrhage, intestinal obstruction, intestinal perforation and intestinal fistula. For patients with acute bleeding from gastric cancer that can not be treated by surgery, endoscopic hemostasis or embolization, palliative radiotherapy should be considered. Palliative hypofractionated radiotherapy has the advantage of reducing tumor burden in addition to relieving symptoms of gastric cancer. In patients with acute lower gastrointestinal hemorrhage, as relatively few studies have been established, short course of hypofractionated radiotherapy can be selectively applied. For patients with obstruction, palliative radiotherapy may be considered when surgical assessment is not feasible or tolerable. As malignant acute abdomen has rapid onset and progress, complex etiology and high rate of comorbidity MDT should be fully carried out. For patients with mild symptoms and slow development, radiotherapy can be applied with caution. Emergency treatment such as surgery and intervention should be given when necessary. Passive observation can result in missing the treatment opportunity and should be avoided.

Development of the School Refusal Behavior Questionaire for Children / 中国心理卫生杂志

Objective:To develop a Child School Refusal Behavior Rating Scale(SRBQC)and examine its reliabilities and validities. Methods:Based on literature review,interview,and open-ended questionnaire,124 origi-nal items were developed. Totally 573 students were recruited to complete the test version. After item and explorato-ry factor analysis,the formal scale-SRBQC was got. Totally 946 students were tested with formal version for further confirmatory factor analysis,internal consistency reliability and composite reliability. The criterion validity was test-ed with the Social Anxiety Scale for Child (SASC). Totally 41 students were retested for test-retest reliability with 2 weeks interval. Results:The formal version of SRBQC included 19 items. Exploratory factor analysis generated 5 factors which account 59. 793% of the variance in all,the results of confirmatory factor analysis showed that SR-BQC had a good construct validity (χ2 =329. 51,df=142,χ2/df=2. 32,CFI=0. 97,GFI=0. 93,IFI=0. 97,NFI=0. 95,NNFI=0. 96,RMSEA=0. 05,SRMR=0. 05). The SRBQC scores were positively correlated with the SASC scores (r=0. 18-0. 34,Ps<0. 05 ). The Cronbach coefficients were 0. 87 for the total questionnaire and 0. 55 -0. 78 for the 5 factors. The test-retest reliabilities were 0. 84 for the total questionnaire and 0. 66 -0. 78 for the 5 factors. Conclusion:The reliability and validity of the School Refusal Bevior Questionaire for Children(SRBQC) meet the needs of psychometrics.

Gene analysis in a family of hereditary hemorrhagic telangiectasia / 中华血液学杂志

<p><b>OBJECTIVE</b>To investigate the clinical feature of a family with hereditary hemorrhagic telangiectasia (HHT), and to study the mutation of its related genes.</p><p><b>METHODS</b>Medical histories of the family were analyzed to detect HHT patients according to the diagnostic criteria. ENG and ALK-1 genes of the proband and her two daughters were analyzed. DNA from the three patients' peripheral blood was extracted. The exons 2-10 and their intron-exon boundaries of ALK1 were amplified with PCR, and then the PCR products were sequenced and analyzed to identify the mutation.</p><p><b>RESULTS</b>There were 11 people in 41 family members of 4 generations were diagnosed as HHT. The proband and her two daughters suffered from multiple organ damage, the younger daughter appeared only imaging features instead of corresponding clinical symptoms. A missense mutation at the 1321 bp of cDNA (c.1321G>A) was detected in the exon 9 of ALK1, which resulted in valine 441 to methionine replacement in ALK-1 protein (p.Val441Met).</p><p><b>CONCLUSION</b>A Chinese family with HHT was studied and a missense mutation (c.1321G>A, p.Val441Met) of ALK-1 was discovered. This mutation is the genetic basis of the family with HHT and is reported for the first time in China. This research will not only help to further investigate molecular mechanism of pathogenesis of HTT, but also provide evidences and references for the following gene screening and genetic counseling on HTT family members.</p>

Re-operation of gynecological laparoscopy: An analysis of 47 cases / 中国微创外科杂志

Objective To study the feasibility of re-operation of gynecological laparoscopy.Methods Clinical records of 47 patients with gynecological diseases undergoing a re-laparoscopy from December 1995 December 2003 were analyzed retrospectively.Results The re-operations of laparoscopy were successfully accomplished in 46 patients(97.9%) while a conversion to open surgery was required in 1 patient.The re-operation time was 30~80 min(mean,50 min),and the in-hospital stay was 2.5~5 days(mean,3.5 days).No long-term complications were noted in 44 patients on a postoperative follow-up for(1~4) years.Out of 19 patients with infertility, 1 patient had a natural pregnancy and 6 patients were pregnant with the help of artificial reproductive techniques.Supportive medical treatment had been given in patients with endometriosis postoperatively,3 of whom experienced symptomatic improvements and 1 of whom had a natural pregnancy.Conclusions For patients with a history of laparoscopy,a re-operation of gynecological laparoscopy is safe and feasible.