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Drug-induced hyperglycemia/diabetes is a global issue. Some drugs induce hyperglycemia by activating the pregnane X receptor (PXR), but the mechanism is unclear. Here, we report that PXR activation induces hyperglycemia by impairing hepatic glucose metabolism due to inhibition of the hepatocyte nuclear factor 4-alpha (HNF4α)‒glucose transporter 2 (GLUT2) pathway. The PXR agonists atorvastatin and rifampicin significantly downregulated GLUT2 and HNF4α expression, and impaired glucose uptake and utilization in HepG2 cells. Overexpression of PXR downregulated GLUT2 and HNF4α expression, while silencing PXR upregulated HNF4α and GLUT2 expression. Silencing HNF4α decreased GLUT2 expression, while overexpressing HNF4α increased GLUT2 expression and glucose uptake. Silencing PXR or overexpressing HNF4α reversed the atorvastatin-induced decrease in GLUT2 expression and glucose uptake. In human primary hepatocytes, atorvastatin downregulated GLUT2 and HNF4α mRNA expression, which could be attenuated by silencing PXR. Silencing HNF4α downregulated GLUT2 mRNA expression. These findings were reproduced with mouse primary hepatocytes. Hnf4α plasmid increased Slc2a2 promoter activity. Hnf4α silencing or pregnenolone-16α-carbonitrile (PCN) suppressed the Slc2a2 promoter activity by decreasing HNF4α recruitment to the Slc2a2 promoter. Liver-specific Hnf4α deletion and PCN impaired glucose tolerance and hepatic glucose uptake, and decreased the expression of hepatic HNF4α and GLUT2. In conclusion, PXR activation impaired hepatic glucose metabolism partly by inhibiting the HNF4α‒GLUT2 pathway. These results highlight the molecular mechanisms by which PXR activators induce hyperglycemia/diabetes.
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Substrate stiffness is one of the important mechanical parameters of extracellular matrix. Different substrate stiffness will affect the proliferation, movement and phenotype of tumor cells. It is found that the change of substrate stiffness is also related to the chemotherapy and radiotherapy sensitivity of tumor cells. Substrate stiffness can cause changes in the characteristics of tumor stem cells, which are related to the activation or inactivation of some signaling pathways, mainly involving ABCG2 protein and Akt/mTOR/Sox2 signaling pathway. Further study on the role of substrate stiffness in radiotherapy, chemotherapy and targeted therapy of malignant tumor is expected to provide basis for the clinical treatment of malignant tumor.
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The clinical data of 380 patients undergoing loop electrosurgical excision procedure(LEEP) conization for cervical intraepithelial neoplasia grade 3(CIN3) at the Affiliated Hospital of Xuzhou Medical University from January 2017 to December 2019 were retrospectively analyzed. Univariate and multivariate logistic regression analyses were used to determine the risk factors of positive margin and residual lesions following conization. One hundred and twelve cases (29.5%) had positive margins, and the risk factors for positive margins were positive high-risk human papillomavirus ( OR=4.92, 95% CI: 1.81-13.36), high-grade lesions on thin cytologic test (TCT)screening ( OR=3.95, 95% CI: 2.42-6.42), and glandular involvement ( OR=3.58, 95% CI: 1.93-6.63). The hysteretomy was performed following conization in 169 hundred and sixty-nine patients who had difficulty in follow-up or no fertility intension, among whom 51 (30.2%) had residual lesions; logistic regression analysis showed that positive margins on LEEP were a risk factor for residual lesions at the time of hysterectomy ( OR: 2.83, 95% CI: 1.44-5.59). The study indicates that positive HR-HPV, high-grade TCT lesions, and lesions involving glands are risk factors for positive margins in CIN3 patients undergoing LEEP conization; and positive margins is risk factor for residual lesions following conization,to which more attention should be paid in clinical practice.
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Endometrial cancer is one of the malignant tumors of female reproductive system. The prognosis of advanced endometrial cancer is poor. How to improve the overall survival rate and improve the prognosis of patients with advanced endometrial cancer is still one of the clinical problems. In recent years, the research on tumor gene changes is increasing gradually. Epigenetics is the study of genetic changes in gene expression without changing the nucleotide sequence of genes. Epigenetics includes many phenomena, such as DNA methylation, microRNA expression and gene silencing, chromatin remodeling. These changes may be important factors in the occurrence and development of tumors, and may become new therapeutic targets for tumors. With the study on epigenetics of endometrial cancer in the future, new therapeutic targets may be found. Meanwhile, those study may provide new ideas for targeted therapy of endometrial cancer.
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Endometrial cancer is one of the most common gynecological malignancies, which is closely related to metabolic syndrome such as diabetes mellitus. In recent years, epidemiological studies have found that metformin has a positive effect on the prevention and treatment of endometrial cancer, and a large number of basic and clinical studies have supported this theory, indicating that metformin may become the new treatment for patients with endometrial cancer, especially with advanced and recurrent endometrial cancer, and endometrial dysplasia.
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Globally, cervical cancer continues to be one of the most common cancers among females. Although screening for cervical cancer has been gradually carried out, the incidence and mortality of cervical cancer in China are still at a high level. So the prevention and treatment of cervical cancer in China still has lots of work to do. The International Federation of Obstetrics and Gynecology (FIGO) gynecological oncology committee revised the staging of cervical cancer in 2018. The new staging changed in terms of stage ⅠB and stage Ⅲ compared with previous FIGO staging. FIGO also provided prevention and treatment strategies and the treatment regimens of each stage, which had an important impact on the prevention and treatment of cervical cancer as well as an important enlightenment for China.
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Objective To evaluate the clinical outcomes and feasibility of multi-modality adjuvant chemotherapy and radiation, which was conducted as postoperative chemotherapy, radiation, and consolidation chemotherapy (CRC) mode for the treatment of advanced endometrial cancer. Methods A retrospective analysis of 124 patients with International Federation of Gynecology and Obstetrics (FIGO) stages Ⅲ and Ⅳ endometrial cancer from Jan. 2004 to Oct. 2012 was conducted in Peking University People′s Hospital and Beijing Obstetrics and Gynecology Hospital. Inclusion criteria were comprehensive staging procedure including hysterectomy, bilateral salpingo-oophorectomy, and (or) selective pelvic aortic lymphadenectomy, and treatment with adjuvant chemotherapy and (or) radiation. The average age of these patients was (55.9 ± 8.4) years old (range from 23 to 79 years old). According to different postoperative adjuvant treatment modes, the patients were divided into CRC group, chemotherapy-radiotherapy (CR) group and single chemotherapy (C) group. The survival and side effects of the three groups were compared. Results (1) One hundred and twenty-four patients with advanced stage endometrial cancer were identified and received postoperative adjuvant therapies.Sixty-one (49.2％, 61/124) cases of them received postoperative CRC fashion, 19 (15.3％, 19/124) received postoperative CR and 44 (35.5％, 44/124) cases received C. The age, stage, grade and type of surgery of the three groups were not significantly different (all P>0.05);while, the pathology, chemotherapy cycles and chemotherapy regimens differed significantly (all P<0.05). (2) The progression-free survivals (PFS) of the patients with CRC, CR, and C group were (121±7), (68± 15), and (100±11) months, respectively. The 3-year PFS rates were 87.9％, 43.7％, and 61.4％, respectively. The 5-year PFS rates were 82.2％, 36.4％, and 61.4％, respectively. The above indicators were significantly higher in the CRC group than in the CR group (all P<0.01), and there was no difference between the CRC group and the C group (P=0.037). The overall survival (OS) of patients with CRC, CR, and C group were (128 ± 6), (80 ± 12), and (99 ± 10) months, respectively. The 3-year OS rates were 87.8％, 72.4％, and 67.1％, the 5-year OS rate were 84.2％, 54.3％, and 64.1％, respectively. The above indicators were significantly higher in the CRC group than those in the CR group and C group (all P<0.01). (3) There was no difference in the frequency of adverse effects either chemotherapy, such as severe bone suppression or radiotherapy;hepatotoxicity,blood transfusion, dose modifications;or cycle delays between the CRC, CR and C group (all P>0.05). (4) In the univariate analysis shown that, stage, the fashion of postoperative adjuvant therapy and type of surgery were risk factors for tumor progression in patients with advanced endometrial cancer (P<0.05). After adjusted for FIGO stage and type of surgery, the tumor progression hazard ratio (HR) was 3.931 (95％CI:1.734-8.914, P=0.001) for the CR group and 2.188 (95％CI:1.010-4.741, P=0.047) for the C group, compared to the CRC group. Conclusion Sequential CRC delivered in a"sandwich"fashion for the treatment in advanced endometrial cancer could significantly improve the 3-year and 5-year OS rates and have a similar adverse effect profile compared with other sequencing modalities.
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Objectives To explore the clinical value of preoperative three-dimensional ultrasound imaging for ovarian tumors for reflecting the anatomy postoperatively.Methods Forty-seven patients with ovarian cystic-solid or solid masses from Beijing Obstetrics and Gynecology Hospital,Capital Medical University were evaluated by two-dimensional (2D) and three-dimensional (3D) ultrasound examination within one week before surgery from January 2008 to December 2009.Every ovarian mass was examined by three-dimensional ultrasound and tomographic ultrasound imaging (TUI) and the results was compared with the specimen postoperatively.Results Forty-seven ovarian masses were confirmed by pathology,including 23 benign masses and 24 malignant masses (six borderline tumors).Compared with the postoperative specimens,the accuracy of preoperative 3D ultrasound imaging of ovarian tumors for the anatomical structures was 89.4％ (42/47).The misdiagnosis causes in 5 cases included failure to detect tiny papillae on the Sturface and small cysts in the mass,failure to display the compressed structures accurately,wrongly believe the teeth on the tumor wall as papillae and wrongly believe two adjacent ovarian tumors as one unilateral mass.Conclusions Compared with postoperative specimens,the anatomy of ovarian tumors could be reflected accurately by 3D ultrasound imaging preoperatively.It could be helpful for differential diagnosis between benign and malignant ovarian tumors and the decision of surgical plan.
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Objective To compare the clinical efficacy of different treatments based on radical surgery in stage Ⅰ b2 and Ⅱ a2 cervical cancer through prospective randomized controlled study. Methods A total of 133 patients with stage Ⅰb2 and Ⅱa2 cervical cancer treated at Beijing Obstetrics and Gynecology Hospital of Capital Medical University during January 2009 to December 2012 were enrolled and randomly assigned to receive one of the following three treatments: preoperative intracavitary irradiation (PII) group, radical hysterectomy (RH) group, and neoadjuvant chemotherapy (NACT) group. Operation method included uterine extensive resection, pelvic lymph node excision, with or without para-aortic lymph node resection. The recent curative effect and side effect of preoperative treatment were observed. The operation time, intraoperative blood loss, surgical complications, postoperative pathological risk factors and postoperative adjuvant therapy and side effect, the survival situation were evaluated among the 3 groups. Results (1)The response rates were 88%(37/42) and 82%(37/45) respectively of the PII group and NACT group. The difference was insignificant (P=0.528). Side effects were less in the PII group. Only 5 patients (12%,5/42) had slight gastrointestinal reaction. Myelosuppression and gastrointestinal reaction in NACT group were 76%(34/45) and 67%(30/45) respectively, which were more serious than that in group PII group (P0.05). NACT group could shorten operation time compared with the RH group (P0.05). The lymph-vascular space involvement (LVSI) in NACT group was significantly lower than that in RH group [31%(14/45) vs 57%(26/46), P=0.015]. The number of patients with histological risk factors in NACT group was higher thanthat in RH group [27%(12/45)vs 9%(4/46),P=0.024]. All surgery were successfully completed and no treatment-related deaths occurred in three groups. The incidence of 3-4 grade adverse reactions evaluated by the common terminology criteria for adverse event (CTCAE) was 13% (6/46), 14% (6/42), 18% (8/45) in RH group, PII group and NACT group respectively (P=0.855). Three-year disease free survival (PFS) were 74.0%, 78.5%and 80.0%, and 3-year overall survival (OS) were 80.4%, 83.3%and 84.4%in RH group, PII group and NACT group respectively (all P>0.05). Conclusions The recent curative effect of PII and NACT were similar. They couldn′t improve 3-year of PFS and OS of the patients withⅠb2 andⅡa2 stage cervical cancer. But NACT can reduce the operation difficulty and can reduce the incidence of postoperative pathological risk factors, which could reduce postoperative adjuvant therapy.
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Endometrial carcinoma is the most common malignancy of the female genital tract. The traditional treatment of endometrial cancer is surgical excision supplemented by radiotherapy, chemotherapy or combined radio-chemotherapy. According to the individual condition of postoperative patients with endometrial carcinoma, choosing appropriate postoperative adjuvant therapy discreetly, which can effectively improve disease-free survival and long-term survival rate. But, for patients with endometrial carcinoma, how to choose the postoperative adjuvant treatment method is still controversial. The purpose of this article is to review of the research progress of endometrial carcinoma postoperative adjuvant therapy, and summariz.
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Objective To investigate diagnostic approaches of cervical glandular intraepithelial neoplasia (CGIN) for improving the diagnostic levels of CGIN.Methods Clinical data of 106 cases with CGIN admitted in hospital from Jan.2008 to Dec.2010 were analyzed retrospectively.All data from preoperative thin-prep cytologic test (TCT),cervical biopsies and postoperative pathological examination of the excised cervical tissues were reviewed.Results Among 106 patients,62 cases (58.5％,62/106) were low grade CGIN (L-CGIN),44 cases (41.5％,44/106) were high grade CGIN (H-CGIN) ; 25 cases (23.6％,25/106) were pure CGIN and 81 cases (76.4％,81/106) were CGIN mixed with cervical intraepithelial neoplasia (CIN).Fifteen cases (14.2％,15/106) were found atypical glandular cell (AGC)by TCT..In the 15 cases,there were 4 cases (6.5％,4/62) L-CGIN,and 11 cases (25.0％,11/44)H-CGIN,there was significant difference between the two groups (P ＜ 0.05) ; among 15 cases with AGC,11 cases of them (44.0％,11/25) were pure CGIN,4 cases (4.9％,4/81) mixed with CIN,in which there were significant difference (P ＜0.01).Seven cases (25.0％,7/28) were detected glandular lesions in 28 cases by endocervical curettage (ECC).Totally 23 cases (22.8％,23/101) were detected CGIN by colposcopy-directed biopsy,11 cases (19.0％,11/58) were with L-CGIN,12 cases (27.9％,12/43)H-CGIN,there was no significant difference between them (P ＞ 0.05).Among the 23 cases,13 eases(52.0％,13/25) were pure CGIN,10 cases (12.3％,10/81) CGIN mixed with CIN,which showed significant difference (P ＜ 0.01).All 106 patients were treated,101 cases treated with cervical conization and 5 cases performed hysterectomy; 23 cases were diagnosed CGIN preoperation,the ratio of preoperative diagnosis was 21.7％ (23/106),83 cases (80.3％,83/106) diagnosed postoperatively.Conclusions Routine diagnostic methods of CGIN were not satisfaction,most CGIN were diagnosed after cervical resection.Cervical conization may play a very important role in diagnosis of CGIN.The positivity of TCT in H-CGIN was higher than L-CGIN.There was no different in diagnosing different CGIN grades by colposcopy-directed biopsy.The ratio of preoperative diagnosis of pure CGIN was higher than those with CGIN mixed with CIN.
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Objective To evaluate the maternal and fetal outcomes of planned delay in treatment for cervical microinvasive squamous cancer during pregnancy.Methods A prospective study of pregnant women was done from August 1,2007 to May 31,2010.Pregnant women who had not been carried out cervical cytological screening within one year were got thin-prep cytology test (TCT) screening at their initial prenatal visit.Patients with abnormal cytological results were performed colposcopic examination and directed biopsy.Women with cervical microinvasive cancer were followed up every 8 to 12 weeks.If lesion progression were suspected,compared with previous image,repeated biopsy directed by colposcopy should be performed.Once worsening invasive cancer was confirmed,the pregnancy should be terminated timely.All patients should be reevaluated 6 to 12 weeks postpartum with repeated colposcopic examination and biopsy.All mothers were performed cold knife conization (CKC) at 6 to 12 weeks postpartum.Results We totally diagnosed 17 cases cervical microinvasive squamous carcinoma during pregnancy.The positive rate is 6.2/10 000 (17/27 230).After informed consent,15 pregnant women decided to delay treatment until fetal maturation.The mean gestational age of initial diagnosis was (19.3 ± 5.9) weeks.The women were followed up 2 to 4 times during pregnancy.Only 1 patient was verified lesion progression by directed biopsy at 34 weeks and delivered by cesarean section.The progression rate during pregnancy was 1/15.The mean delivered time was (37.1 ± 1.8) weeks (ranged from 34 to 40 weeks).The mean diagnosis-to-delivery interval was (18.4 ± 5.2) weeks.All patients were delivered by cesarean section and all newborns had good outcomes.Finally we confirmed 1 case with cervical cancer stage Ⅰ a2,11 cases with stage Ⅰ al,3 cases with cervical intraepithelial neoplasia (CIN) Ⅲ by pathological diagnosis after CKC during 6 to 12 weeks postpartum.All cases were disease free after follow-up ranged from 22 to 48 months.Conclusions It is necessary to perform TCT screening for pregnant women who have not been carried out cervical cytology screening within 1 year.If cervical microinvasive squamous cancer were suspected during pregnancy,in order to achieve fetal maturity it is acceptable for the women who desired pregnancy to delay treatment under closely monitoring until postpartum.
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Objective To investigate the relationship between cervical intraepithelial neoplasia (CIN) and high-risk (HR)HPV infection among late pregnant women.Methods From Aug.2007 to Feb.2010,168 women at 13 to 32 gestational weeks undergoing prenatal examination in Beijing Obstetrics and Gynecology Hospital went through three stage cervical disease screening,including 21 women with cervicitis and 147 women with C1N (42 women with CIN Ⅲ,37 women with CIN Ⅱ and 68 women with CIN Ⅰ ).Hybrid capture assay version Ⅱ ( HC- Ⅱ ) test was used to measure HR-HPV DNA load,and the logarithmic transtormation (log10) was performed.All 168 women were followed up to postpartum 3 -6 months.HR-HPV infections rates of cervicitis and different CIN,the rate of HR-HPV infection turned naturally negative at postpartum of 3 to 6 months,and HR-HPV load at pregnancy and 3 -6 months postpartum were observed.Results ( 1 ) HR-HPV infection rate:CIN Ⅲ,Ⅱ,Ⅰ and cervicitis pregnant women's HR-HPV positive infection rates were 98％ (41/42),86％ ( 32/37 ),76％ ( 52/68 ) and 62％( 13/21 ) respectively,which reached statistical difference (P =0.002).(2) HR-HPV naturally negative:the rate of pregnant women with different levels of CIN who turned HR-HPV naturally negative within 3 -6 months of postpartum were CIN Ⅲ 5％ (2/41),CIN Ⅱ 47％ (15/32),CIN Ⅰ 52 ％ (27/52) and cervicitis 10/13,which also reached statistical difference among those four groups (P =0.000).(3) HR-HPV load:pregnant women with different grade of CIN and cervicitis HR-HPV DNA load were CIN Ⅲ 2.02 ng/L(1.53,2.67 ng/L),CIN Ⅱ 1.94 ng/L ( 0.75,2.75 ng/L),CIN Ⅰ 2.04 ng/L (0.08,2.95 ng/L) and cervicitis 1.98 ng/L( -0.07,2.47 ng/L).There was no significantly different HPV load in women with cervicitis and different CIN (P =0.719).At 3 -6 months postpartum,HR-HPV load was CIN Ⅲ1.55 ng/L(0.90,2.10 ng/L),which was significantly higher than the amount of CIN Ⅱ 0.09 ng/L(-0.69,1.74 ng/L),CIN Ⅰ 0.48 ng/L( -0.56,2.2 ng/L) and cervicitis -0.46 ng/L ( -0.78,1.40 ng/L,P =0.036).Conclusions With the increasing of CIN grade,the rate of HR-HPV infection in pregnant women was increased,however,the rate of HR-HPV turning negative naturally at 3 -6 months postpartum decreased.With different CIN grade during pregnancy,HR-HPV DNA load did not change significantly,but HR-HPV DNA load increased at 3 -6 months of postpartum.HR-HPV DNA loads with the same grade of CIN and cervicitis during pregnancy higher than that of postpartum among pregnant women.
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Objective To analyze the relative factors of bone marrow suppression after chemotherapy with different-dose carboplatin and paclitaxel (TC) on the patients with ovarian cancer.Methods Sixty-two patients with ovarian cancer admitted in Beijing Obstetrics and Gynecology Hospital from January 2002 to December 2007, using TC regimen ,a total of 196 cycles of chemotherapy ,were divided into two groups by the doses of carboplatin [area under concentration-time curve(AUC) 4 -6 for low-dose,AUC >6 -7 for hight-dose, the carboplatin dose calculated with AUC] or by the doses of paclitaxel (135 -< 150 mg/m2 low-dose,150 - 175 mg/m2 hight-dose). After each TC cycle, the routine blood was test to determine the graduation of the marrow suppression, and then the correlation factors were analyzed with logistic regression. Results (1) The occurrence rate of bone marrow suppression:there were 159 cycles (81.1%) grade 0 - Ⅱ bone marrow suppression, while 37 cycles (18.9%) of grade Ⅲ - Ⅳ. (2) Factors related to bone marrow suppression:the results shown that there were not related to bone marrow suppression,which incluced cellular differentiation, tumor type, height, weight and paclitaxel dose(P>0.05). While,the different cycle, age, the later stages of tumor, serum creatinine concentration, endogenous creatinine clearance rate, AUC values were the relative factors of bone marrow suppression(P =0.000,0.000,0.018,0.033,0.001,0.000). Seven variables were conducted into the logistic regression and the results shown that the different cycles, the age, AUC grades were independent risk factors (P = 0.030,0.043,0.009).(3) When low-dose of paclitaxel was given, the occurrence of bone marrow suppression was related to the carboplatin dose AUC. The higher AUC values for carbopaltin were chosen, the higher of severe bone marrow suppression would happen. (4/14 vs 0,P=0.015). When the dose of high grade of paclitaxel was given, the occurrence of bone marrow suppression in cases with hight-dose carboplatin was statistically significant than that in cases treated with low-dose carboplatin [45.7%(16/35) vs 13.7% (17/124), P=0.000]. Conclusions The independent risk factors of myelosuppression after chemotherapy with TC regime on the patients with ovarian cancer including the cycles, age and AUC values. The carboplatin dose calculating with AUC is related to the occurrence of bone marrow suppression, the higher AUC values for carbopaltin would chosen,the higher of severe bone marrow suppression would be happen.
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Objective To investigate the value and safety of biopsy guided by colposcopy in diagnosis of cervical diseases in pregnant women.Methods From Aug.2007 to Feb.2009.17 828 pregnant women who receive antenatal examination underwent cervical cytological screening thinprep cytology test(TCT)in Beijing Obstetrics and Gynecology Hospital.If abnormal cytological results were found,those preguant women were administered by eolposcopic examination and biopsy after they signed informed consent.Results (1)TCT:the abnormal TCT results of 1502 preguant women(8.425%,1502/17 828) were found in 17 828 cases.(2)Colposeopie examination:two hundred and four pregnant women underwent colposcopic examination.The rate of satisfied colposcopic imaging wag 92.6%(189/204),colposcopic examination identified 125 cages with cervical inflammation or cervical intraepithelial neoplasia (CIN)Ⅰ,25 cases with CIN Ⅱ and 54 cases with CIN Ⅲ or microinvasive squamous carcinoma (MIVC) of squamous cervical carcinoma(SCC).(3)The results of biopsy guided by colposcopy:among 204 cases,it was found 33 cases with cervical inflammation or wart,95 cases with CIN Ⅰ,28 CIN Ⅱ,36 cases with CIN Ⅲ and 12 cases with MIVC. (4) The rate of concordance: compared with biopsy pathologic examination, colposcopy examination found 113 cases with cervical inflammation and CIN Ⅰ , the rate of concordance was 90. 4%(113/125). And 54 cases with CIN Ⅲ or SCC diagnosed by colposcopy examination, however biopsy pathologic examination confirm 23 cases with CIN % and 10 cases with SCC at stage Ⅰ a, the concordance rate was 61% (33/54). (5) Complication: eight (3.9%, 8/204) pregnant women underwent cervical wound suturing due to continuous bleeding after colposcopy exam or biopsy. No other complications were recorded. Conclusions It is necessary that TCT should be performed in pregnant women without cytological screening within one year. Colposcopic examination and biopsy were indicated if pregnant woman with abnormal cytological result were found. Pregnant women with cervicitis or CIN Ⅰ diagnosed by colposcopy should be followed up. If pregnant woman was suspected with CIN Ⅱ or advanced disease, biopsy guided by colposcopy should be performed.
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Objective To evaluate the clinical value of different radiotherapy protocols in the treatment of advanced cervical cancer. Methods From 1976 to 2006,763 patients with stage Ⅲ cervical cancer(722 with squamous cell carcinoma and 41 with adenocarcinoma)were treated by radiotherapy in our hospital. 113 patients were treated by two-field whole pelvic irradiation in conventional fractionation plus brachytherapy (CF group), 44 by four-field whole pelvic irradiation in accelerated hyperfractionation plus brachytherapy( AHF group), and 606 by concomitant four-field unconventional fractionation radiotherapy and brachytherapy(FRT group). Sixty-one patients were treated by radiotherapy and chemotherapy. Among 350 patients who had complete data, the short-term efficacy and toxicities were compared. Results For patients in CF,AHF and FRT groups, the 3-year overall survival rates (OS) were 65.7%, 66.8% and 44.3%, respectively (P=0.000), and the 5-year OS were 65.7 % ,66.8 % and 36.3 %, respectively (P=0.000). The 10-year OS were 43.3% and 31.9% in CF and FRT groups(P=0.200). For squamous cell carcinoma,the OS was higher of patients with chemotherapy than those without. In 350 patients who had complete data,the local control rates of CF, AHF and FRT groups were 83.0% ,93.2% and 86.1%, respectively(X2=2.70, P=0.259);AHF group had the lowest side effect rate, especially skin reaction (9.1%,X2=20.25,P=0.002) ;CF group had the lowest acute bone marrow suppression rate(X2=25.95,P=0.000);for squamous cell carcinoma, the OS was higher in patients with chemotherapy than those without;the acute bone marrow and intestinal toxicities were more in patients with chemotherapy than those without. Conclusions CF and AHF groups have similar 5-year OS of patients with advanced cervical cancer. AHF group has less toxicities, shorter treatment course and a trend of better local control. Concurrent chemoradiation could improve survival and local control of the patients with advanced squamous cell cervical cancer while increase the side effects. The individual condition should be considered to choose the treatment protocol.
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<p><b>OBJECTIVE</b>To estimate the feasibility and the efficacy of early extubation and sequential non-invasive mechanical ventilation (MV) in chronic obstructive pulmonary disease (COPD) with exacerbated hypercapnic respiratory failure.</p><p><b>METHODS</b>Twenty-two intubated COPD patients with severe hypercapnic respiratory failure due to pulmonary infection (pneumonia or purulent bronchitis) were involved in the study. At the time of pulmonary infection control window (PIC window) appeared, when pulmonary infection had been significantly controlled (resolution of fever and decrease in purulent sputum, radiographic infiltrations, and leukocytosis) after the antibiotic and the comprehensive therapy, the early extubation was conducted and followed by non-invasive MV via facial mask immediately in 11 cases (study group). Other 11 COPD cases with similar clinical characteristics who continuously received invasive MV after PIC window were recruited as control group.</p><p><b>RESULTS</b>All patients had similar clinical characteristics and gas exchange before treatment, as well as the initiating time and all indices at the time of the PIC window. For study group and control group, the duration of invasive MV was (7.1 +/- 2.9) vs (23.0 +/- 14.0) days, respectively, P < 0.01. The total duration of ventilatory support was (13 +/- 7) vs (23 +/- 14) days, respectively, P < 0.05. The incidence of ventilator associated pneumonia (VAP) were 0/11 vs 6/11, respectively, P < 0.01. The duration of intensive care unit (ICU) stay was (13 +/- 7) vs (26 +/- 14) days, respectively, P < 0.05.</p><p><b>CONCLUSIONS</b>In COPD patients requiring intubation and MV for pulmonary infection and hypercapnic respiratory failure, early extubation followed by non-invasive MV initiated at the point of PIC window significantly decreases the invasive and total durations of ventilatory support, the risk of VAP, and the duration of ICU stay.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Hypercapnia , Therapeutics , Pulmonary Disease, Chronic Obstructive , Respiration, Artificial , Methods , Respiratory Insufficiency , TherapeuticsABSTRACT
Objective:To explore the influence of ADHD on academic achievement of undergraduates Method:104 undergraduates were randomly selected and divided into two groups by characteristics of adults with ADHD according to DSM-IV criteria Their academic achievements were also recorded SAS was used to assess their anxiety level Result:After controlled influence of anxiety and gender, academic achievement of undergraduates in ADHD group was significantly lower than that in non-ADHD group Conclusion:ADHD has negative influence on academic achievement of undergraduates
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Objective To evaluate the efficacy of radiation therapy on primary vaginal cancer with high dose rate brachytherapy alone or in combination with external radiation Methods Fifty one cases with primary vaginal cancer who were treated with high dose rate brachytherapy alone or in combination with the external radiation in Cancer Hospital, Chinese Academy of Medical Sciences from 1989 to 1999 were retrospectively studied,including stage Ⅰ 10 cases,stage Ⅱ 13 cases,stage Ⅲ 23 cases and stage Ⅳ 5 cases WD HDR18 after loading equipment was used in the brachytherapy and 6 or 8 MV linear accelerator was used in the external radiation Results The overall 5 year survival rate with WD HDR18 was 58 8%, with 80 0% for stage Ⅰ,76 9% for stage Ⅱ,65 2% for stage Ⅲ,and 0 0% for stage Ⅳ The comparison of treatments with WD HDR18 and radium therapy showed the 5 year survival rates of the cases of each stage treated with WD HDR18 were higher Conclusion Treatment results obtained with high dose rate brachytherapy are at least similar to traditional radium therapy for primary vaginal cancer