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Objective:To analyze the survival efficacy, prognostic factors and failure patterns of patients with esophageal squamous cell carcinoma (ESCC) underwent postoperative radiotherapy (PORT) using modified clinical target volume (CTV) based on postoperative high-frequency recurrence regions, so as to provide reference for the further optimization of CTV of PORT.Methods:The patients with ESCC underwent radical operation in Comprehensive Cancer Center of Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School from April 28, 2014 to November 29, 2018 were retrospectively analyzed. Patients with stage pT 3-4aN 0 or N +, who underwent PORT with modified CTV based on postoperative high-frequency recurrence regions, were included in the study. Kaplan-Meier method was used to calculate overall survival (OS) and locoregional recurrence free survival (LRFS) , adverse events of patients were evaluated, Cox proportional hazards model was used for univariate and multivariate survival analysis, and the failure patterns of patients after PORT were analyzed. Results:A total of 85 patients were included in this study, and the median follow-up time was 52.6 months. The median OS of the whole group was 74.1 months. The 1-year, 2-year and 3-year OS rates were 97.6%, 84.7% and 71.7% respectively. The median LRFS was not reached, and the 1-year, 2-year and 3-year LRFS rates were 92.9%, 78.6% and 71.5% respectively. The incidence of grade 3-4 adverse events was 17.6% (15/85) , mainly including lymphopenia, bone marrow suppression, gastrointestinal reaction and skin reaction. Univariate analysis of OS after PORT showed that the degree of differentiation (set G1+G1-2+G2 group as the control group, G2-3+G3 group HR=4.19, 95% CI: 1.91-9.17, P<0.001; NA+basal-like group HR=4.16, 95% CI: 1.29-13.44, P=0.017) and postoperative stage ( HR=2.19, 95% CI: 1.09-4.39, P=0.030) were the influencing factors of OS. Cox multivariate analysis showed that the degree of differentiation was an independent prognostic factor for OS after PORT (set G1+G1-2+G2 group as the control group, G2-3+G3 group HR=5.24, 95% CI: 2.30-11.93, P<0.001; NA+basal-like group HR=4.83, 95% CI: 1.33-17.62, P=0.017) . The first failure patterns analysis showed that 39 cases (45.9%) had recurrence, among which, 22 cases (25.9%) had locoregional recurrence with the median onset time of 15.2 months after operation, 19 cases (22.4%) had distant metastasis with the median onset time was 14.1 months after operation, and 2 cases (2.4%) were mixed failure mode. Among the locoregional recurrence, 16 cases (72.7%) recurred in the radiation field. Among all the local recurrence sites, the lymph node drainage regions in the supraclavicular, upper middle mediastinum and upper abdominal perigastric/celiac artery trunk areas were the most common sites. Among the distant metastatic organs, lung, bone and liver metastases were the most common. Conclusion:Patients of ESCC with high risk of recurrence after radical esophagectomy have long survival time and high safety after PORT with modified CTV according to the high-frequency recurrence regions. It is worthy of further confirmation by multicenter, large sample and prospective clinical trials.
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Objective To analyze the effects of different supplements on anemia related indexes in rural children. Methods A stratified method was adopted, and six villages (towns) in and around Qinghai Province were selected as intervention sits for the present study. A total of 304 children from 2 to 6 years old at each intervention site meeting the inclusion criteria were screened and divided into three groups (A, B, and C), who were intervened for 3 months. Serum vitamin A, vitamin D and hemoglobin levels were measured before and after the intervention. Results The hemoglobin level of 304 children before intervention was (118.65±16.07) g /L, and the prevalence of anemia was 9.54%. The vitamin A value, vitamin D value and hemoglobin value were increased after three months of the intervention. The changes of vitamin A value, vitamin D value and hemoglobin value in rural children in group C were significantly higher than those in groups A and B. The increase in vitamin A value in rural children aged 3 years was significantly higher than that in other age groups, and the increase in hemoglobin in rural children of 1 year old was significantly higher than that in other age groups. The increase in vitamin A value of rural children of other ethnic groups (mainly Tibetans) was significantly higher than that of Han and Hui nationalities, and the increase of hemoglobin value in Hui rural children was significantly higher than that in Han and other ethnic groups. Conclusion Vitamin A combined with iron dextran tablets was effective in preventing anemia in rural children.
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Objective To evaluate the value of transperineal pelvic ultrasound(TPUS) on long-term stress urinary incontinence (SUI) after total abdominal hysterectomy (TAH).Methods Thirty patients with TAH at least 2 years after operation were diagnosed as SUI according to clinical criteria and ultrasound criteria.They were divided into non-SUI group (Group Ⅱ,66 cases) and SUI group (Group Ⅲ,54 cases),72 cases of healthy patients were selected as the control group (group Ⅰ).TPUS was performed.The bladder neck rotation angle (△vBA),bladder urethral relief angle (rUJV,vUJV),urethral rotation angle (△vUIA),bladder neck mobility (BND),and the displacement of the bladder neck (vsB) were measured and recorded during the rest period and Valsalva state.Results According to the findings of ultrasound combined with pelvic floor parameters,the absolute values of △vBA,rUJV,vUJV,△vUIA,BND,vsB were increased in group Ⅱ compared with group Ⅰ (P＜0.05),which indicated that supportive function of the long-term pelvic floor tissue after TAH for a long-term was reduced.Compared with the non SUI group,the absolute values of △vBA,rUJV,vUJV,△vUIA,BND and vsB increased in the SUI group after TAH for a long term (P＜0.05).The absolute values of △vBA,rUJV,vUJV,△vUIA,BND,and vsB increased in the SUI group compared with the non-SUI group (P＜0.05),which indicated that after TAH,compared with non-SUI patients,the value of pelvic ultrasound parameters in patients with SUI increased more significantly.Conclusion The pelvic floor support function decreased after TAH,and pelvic floor function could be dynamically detected by TPUS in the early stage of TAH.
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Objective To observe the changes of artery elasticity in patients with High-Normal Blood Pressure(HNBP) by ET, and search bound values in diagnosis by ROC. Methods Comparative analysis of artery IMT and β, Ep, AC, PWVβ with HNBP and normal group, which were analyzed by ROC. Results Compared with the normal group, β, Ep, PWVβ were increased in HNBP group, AC was lower significantly. Conclusion The peripheral artery elasticity have reduced before the artery IMT didn′t appear morphological change.
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BACKGROUND: Short-form-36 health survey(SF-36) has good reliability and validity, which is applicable to assess quality of life (QOL) in European and American population.OBJECTIVE: To study the reliability, validity and feasibility of SF-36 scale in the rural elder and evaluate their QOL.DESIGN: It is a cross-sectional study, all participants are sampled by two-phase random sampling.SETTING: Institute of Epidemiology and Hygienic Statistics, China Union Medical University and institute of epidemiology and hygienic statistics in a university.PARTICIPANTS: Totally 687 old people were randomly selected from six villages in Bao' an District of Shenzhen from May to July 2002. Inclusion criteria: All the people were residents and aged 60 years or above. Exclusion criteria: People with severe auditory or mental obstacles were excluded. Totally 666 questionnaires were valid, among them 264 were male and 402 were female.METHODS: All participants were interviewed face to face with SF-36 questionnaire by trained investigators. The feasibility, reliability and validity were the main measures of SF-36 scale.MAIN OUTCOME MEASURES: Split-half reliability, internal consistency, criterion-related validity, discriminant validity and construct validity.RESULTS: SF-36 scale had a good internal consistency, and all Cronbach' α coefficients were equal or more than 0. 8 in 8 dimensions. The split-half reliability of every dimension was preferable and Pearson correlation coefficients were 0.7 or higher except mental health(MH) . Discriminant validity and criterion related validity were obtained and satisfied. Two factors were got by factor analysis, which could account for 63.14% of total variance. Every dimension held a moderate loading in its relevant factor except role-emotion (RE) dimension(≥0.4).CONCLUSION: SF-36 scale is applicable for QOL assessment in the rural elder after some item revisions. The vulnerable elder should be given more attention and care.