Research progress on immunological properties of ESAT-6 secreted by Mycobacterium tuberculosis and its role in new vaccines / 细胞与分子免疫学杂志

Early secreted antigenic target of 6 kDa protein (ESAT-6) is the major virulence factor of Mycobacterium tuberculosis (MTB), which can resist the clearance of MTB in bodies by inhibiting macrophage phagocytosis and autophagy reaction, thus impeding the immune defense function of the body against MTB infection. In addition, ESAT-6-induced apoptosis of macrophage and massive necrosis of innate immune cells can foster MTB proliferation and colonization, leading to systemic MTB infection. Moreover, ESAT-6 hampers the protective immune response of Th1 cells, reducing the secretion of pro-inflammatory cytokines and contributing to immune dysfunction, thus accelerating the course of MTB infection. During the process, the high immunogenicity of ESAT-6 can be leveraged as a dominant antigen in the development of new TB vaccines, making it a promising candidate with broad prospects for further development.

Impact analysis of emergency intervention on 120 ambulance dispatchers in Chongqing city with regression discontinuity designs / 中华急诊医学杂志

Objective:To explore the impact of emergency response to public health emergencies on the efficiency of pre-hospital emergency work, and study the degree of impact on 120 ambulance dispatchers in Chongqing city during pre-periods and post-periods of the emergency intervention.Methods:Taking 120 phone answering and ambulance operation efficiency as the research subjects, we collected pre-hospital emergency case data from a city's emergency medical center, covering the period from November 10, 2021 to January 6, 2023. The cases were divided into groups according to the time periods of emergency response. A regression discontinuity design method was employed to compare the response of emergency intervention to the predictions (virtual cases) without the emergency intervention, obtaining the average intervention effect.Results:During the study period of 27 days, the number of 120 calls picked up within 10 seconds increased from 11 000 to 19 000, but the answering rate slightly decreased within 10 seconds. The vacancy rate of 120 ambulances during emergency response decreased from 0.39% to 0.20%, but the completion rate within 18 minutes decreased from 72% to 30%. In this particular emergency response period, the number of patient complaints (such as high fever and difficulty breathing) increased compared to the pre-period of emergency response.Conclusion:Emergency response significantly impacts pre-hospital emergency work such as emergency phone answering and ambulance operation efficiency. This study provides empirical research results and decision-making support for urban emergency medical services to respond to public health emergencies.

Research progress on nutritional support for gastrointestinal graft-versus-host disease / 中华临床营养杂志

Gastrointestinal graft versus host disease is one of the most severe complications after hematopoietic stem cell transplantation, which can occur in patients of any age groups. Its clinical manifestations include nausea, vomit, abdominal pain, diarrhea and the like. Severe gastrointestinal graft versus host disease could directly influence the patients' clinical prognosis and therapeutic efficacy of transplantation. Here we had a review of the research progress on nutritional support and diet management strategies for gastrointestinal graft versus host disease. It is of great clinical significance to form a step-wise nutritional support model to reduce the risk of malnutrition in patients with gastrointestinal graft versus host disease, which would contribute to improving patients' general condition, relieving digestive tract symptoms, and reducing the risk of complications.

Relation of future self-continuity to family support and meaning in life in college students / 中国心理卫生杂志

Objective:To evaluate the relationship among future self-continuity,family support and meaning in life in college students.Methods:A total of 912 college students(448 males and 464 females)were selected and assessed with the Future Self-Continuity Questionnaire(FSCQ),Family Support Scale(PSS-Fa)and Meaning in Life Questionnaire(MLQ).Results:The average score of FSCQ was(3.3±1.1),and those who were female,25 years old,senior,nonlocal census register,only child had lower FSCQ scores(P＜0.001).Regression analysis results showed that the scores of PSS-Fa and the MLQ scores of search for life meaning and presence for life mean-ing were positively correlated with the FSCQ scores(β=0.80,0.69,0.74).Conclusion:The study shows that the future self-continuity is at a medium level and improving family support and meaning in life may help to enhance their future self-continuity in college students.

Effect of music therapy on depression and anxiety in patients with maintenance hemodialysis: a randomized controlled study / 中华肾脏病杂志

Objective:To investigate the effect of music therapy on depression and anxiety status in maintenance hemodialysis (MHD) patients.Methods:The study was a single-center, open, and randomized controlled trial. The patients with regular hemodialysis of more than 3 months and the Beck depression inventory (BDI) scores ≥10 in China Rehabilitation Research Center from March 1 to April 24, 2021 were selected. Random envelope method was used to divide the enrolled patients into music group and control group. The music therapist selected the treatment music and established the preset repertoire library in the music therapy programs, and the total duration of music was about 2 hours. The music group received listening music therapy of 1.0 to 1.5 hours 3 times a week during routine hemodialysis treatment, while the control group only received routine hemodialysis treatment. All the enrolled patients completed treatment of 8 weeks. The BDI and state-trait anxiety inventory (STAI) were used to assess the psychological status of MHD patients before and after treatment.Results:A total of 64 MHD patients were enrolled, aged (59.19±11.61) years old, among whom 38 patients (59.38%) were males. There were 32 patients in the music group and 32 patients in the control group. BDI scores [2 weeks (9.81±6.25) scores, 8 weeks (8.30±8.49) scores, F=49.75, P<0.001] and STAI scores [2 weeks (49.30±7.27) scores, 8 weeks (47.07±7.39) scores, F=13.09, P<0.001] in the music group decreased significantly after 2 weeks of treatment and remained stable for 8 weeks. After treatment, the BDI scores in the music group were significantly lower than those in the control group [2 weeks (9.81±6.25) scores vs (14.13±7.33) scores, t=-2.53, P=0.014; 8 weeks (8.30±8.49) scores vs (12.56±5.67) scores, t=-2.34, P=0.023], and STAI scores in the music group were significantly lower than those in the control group [2 weeks (49.30±7.27) scores vs (54.00±8.36) scores, t=-2.06, P=0.043; 8 weeks (47.07±7.39) scores vs (51.34±8.87) scores, t=-2.06, P=0.044]. Conclusion:Music therapy can improve depression and anxiety of MHD patients quickly and effectively.

Gait abnormalities among elderly persons with type 2 diabetes and peripheral neuropathy / 中华物理医学与康复杂志

Objective:To explore the features the gait of elderly persons with type 2 diabetes and peri-pheral neuropathy.Methods:Twenty patients no less than 60 years old with type 2 diabetes and peripheral neuropathy (DPN) formed a DPN group, while 20 counterparts with type 2 diabetes but without peripheral neuropathy composed the DM group, and another 20 healthy counterparts served as a control group. The three groups were tested using the Swedish Qualisys motion capture system and their walking speed, step length, step width, stride frequency and stride length, bipedal foot support phase time, single foot support phase time, peak plantar pressure, and regional-holding time were collected and compared.Results:The average walking speed, stride length and stepping frequency of the DPN group were all significantly lower than the other 2 groups′ averages. Their bipedal support phase was significantly longer, but their single foot support phase time was significantly shorter. And in the DPN group the average first and second peak plantar pressures and the second peak pressure time were significantly greater than the other groups′ averages.Conclusions:Elderly patients with type 2 diabetes and peripheral neuropathy have significant gait abnormalities, decreased walking stability, as well as increased plantar pressure and plantar compression time.

Expression significance of serum miR-27, miR-93, BMP-15 in patients with polycystic ovary syndrome / 中华内分泌外科杂志

Objective:To explore the expression significance of serum MicroRNA-27 (miR-27), MicroRNA-93 (miR-93) and bone morphogenetic protein 15 (BMP-15) in patients with polycystic ovary syndrome (PCOS) .Methods:63 PCOS patients admitted to Yantai Yantaishan Hospital from Aug. 2015 to Jan. 2019 were selected and divided into the obese group (obese PCOS, BMI≥25 kg/m 2, n=22) and the non-obese group (non-obese PCOS, BMI<25 kg/m 2, n=41) according to body mass index (BMI). 30 healthy women with normal physical examination during the same period were selected as the healthy group. Serum miR-27, miR-93 expression levels and bone morphogenetic protein 15 (BMP-15) concentration of the three groups were analyzed, and endocrine metabolism indicators of the three groups were compared. Receiver operating characteristic curve (ROS) was used to evaluate the predictive value of serum miR-27, miR-93 and BMP-15 for PCOS and obese PCOS patients. Results:(1) Endocrine indicators: Compared with the healthy group, FSH was lower in the obese group and the non-obese group, and T, LH/FSH and IR were higher ( P<0.05) ; Compared with the non-obese group, T and IR were higher in the obese group ( P<0.05) ; (2) Serum miR-27, miR-93 and BMP-15: Compared with the healthy group, serum BMP-15 concentration was lower in the obese group and the non-obese group, and serum miR-27, miR-93 expression levels were higher ( P<0.05) ; Compared with the non-obese group, the serum miR-27 and miR-93 expression levels in the obese group were higher ( P<0.05) ; (3) miR-27, miR-93 and BMP-15 had predictive value for PCOS, and the area under the curve of BMP-15 was the highest ( P<0.05) ; (4) miR-27 and miR-93 had predictive value for obese PCOS, and the area under the curve of miR-93 was the highest ( P <0.05) . Conclusions:In addition to significant endocrine index disorders in obese PCOS patients, serum miR-27 and miR-93 are highly expressed and the level of BMP-15 is relatively low. BMP-15 can be used as an effective parameter to assist in the diagnosis of PCOS, and miR-93 can be used as an effective parameter to assist in the diagnosis of obese PCOS.

Application of random forests regression in impact of family early disadvantaged risks on internalization problems in adolescents / 中华行为医学与脑科学杂志

Objective:To investigate the relationship between the type of exposure to early family disadvantaged risks and internalization problems in adolescents.Methods:Totally 746 adolescents were assessed with family disadvantaged risk items and Chinese version of Achenbach youth self-report (YSR-CV). The Welch's ANOVA test and post-hoc test were used to compare the scores of three different risk factors on internalization problems.The independent sample t-test was adopted to compare the scores of internalization problems between experienced 5 or more kinds of risk factors and less than 5.Pearson correlation analysis was used to test the correlation between the number of family risk factors experienced and the scores of internalization problems.Random forest regression analysis was used to test the variable importance(VI) of the internalization problem. Results:The differences in anxiety/depression and withdrawal scores between higher or lower-level risks group were significant ( P<0.05). The scores of adolescents with five or more adverse experiences on anxiety/depression(7.7±3.5), withdrawal (8.8±4.0) and physical problems(4.1±3.7) were higher than those with fewer than five risk factors(5.5±3.8), (6.7±3.4), (2.6±3.6). The cumulative family disadvantaged risk items was positively correlated with anxiety/depression( r=0.29, P<0.01), withdrawal( r=0.29, P<0.01), and physical symptoms ( r=0.26, P<0.01). The most important factor associated with anxiety/depression(VI=0.84, P=0.002; VI=0.56, P=0.022), withdrawal(VI=0.58, P=0.013; VI=0.89, P=0.001), and physical symptoms was marital relationship of parents and health status of family members. Conclusion:The parents’ marital relationship and health status of family members are the specific factors that influence the internalization problems, and the higher the level of risk adolescents experience, the more likely they are to develop internalization problems.

Role of nuclear receptor in the development and progression of primary biliary cholangitis / 临床肝胆病杂志

Primary biliary cholangitis (PBC) is an chronic progressive intrahepatic cholestasis autoimmune liver disease with unknown causes, and at present, the etiology and pathogenesis of PBC remain unclear. Nuclear receptor is a ligand-dependent transcription factor superfamily that regulates cell growth and differentiation by establishing a relationship between signal molecules and transcriptional responses. The human nuclear receptor family consists of 48 members, including peroxisome proliferator-activated receptors, pregnane X receptor, constitutive androstane receptor, liver X receptors, farnesoid X receptor, vitamin D receptor, and glucocorticoid receptor, which have attracted wide attention. These nuclear receptors regulate the key enzymes and transporter genes of bile acid metabolism at the transcriptional level and thus regulate the level of bile acid in the body and participate in inflammatory response. Bile acid metabolism disorder and persistent inflammation may be the key factors for the development and progression of PBC. This article reviews the research advances in nuclear receptors in the development and progression of PBC, in order to provide a theoretical basis for exploring the pathogenesis of PBC and new therapeutic targets.

Effect of health promoting lifestyle on job burnout of college counselors in Shanghai City / 中国职业医学

OBJECTIVE: To analyze the relationship between health promoting lifestyle and job burnout of college counselors in Shanghai. METHODS: Using stratified cluster sampling method, 294 counselors from 4 colleges were selected and investigated by Maslach Burnout Inventory Educator's Survey and Health Promoting Lifestyle Profile II. RESULTS: The median scores of emotional exhaustion, deindividualization and low sense of achievement of counselors in Shanghai were 3.3, 3.2 and 1.6 respectively. In each dimension, the ratio of moderate burnout were 93.5%, 95.2% and 26.5% respectively. The ratio of high level burnout were 6.5%, 4.8% and 73.5%. The median total score of health promoting lifestyle was 127.1, and the ratio of poor, average and good lifestyle standard was 8.5%, 50.3% and 41.2%.The total score of health promoting lifestyle was negatively correlated with the score of emotional exhaustion and deindividualization(P<0.01) and positively correlated with the score of low sense of achievement(P<0.01). The score of physical exercise, interpersonal relationship, stress management and self realization in health promoting lifestyle had positive predictive effect on the score of emotional exhaustion and deindividualization(P<0.05). The score of physical exercise and self realization had negative predictive effect on the score of low sense of achievement(P<0.01). CONCLUSION: The prevalence of job burnout in college counselors is above the intermediate level. There is a correlation between health promoting lifestyle and job burnout and cultivating a health promoting lifestyle is helpful to alleviate job burnout.

Expression and clinical significance of the NK cell-activating receptor NKG2D and its ligand in liver tissue of patients with primary biliary cholangitis / 临床肝胆病杂志

ObjectiveTo investigate the association of the expression of the NK cell-activating receptor NKG2D, its ligand major histocompatibility complex class I chain-related gene A (MICA), and related cytokines ［interferon-γ (IFN-γ), interleukin-10 (IL-10), and interleukin-15 (IL-15)］ with intrahepatic inflammation in primary biliary cholangitis (PBC). MethodsLiver biopsy specimens were collected from 30 patients with PBC (PBC group), 15 patients with chronic hepatitis B (CHB group), and 10 patients with nonalcoholic fatty liver disease (NAFLD group), who were hospitalized in The Second Affiliated Hospital of Kunming Medical University from August 2014 to June 2015. The degree of liver inflammation (G) and fibrosis degree (S) of the liver specimens were determined, and immunohistochemistry was used to measure the expression of NKG2D, MICA, IFN-γ, IL-10, and IL-15 in liver tissue (the scores were determined based on the number of cells stained and the degree of staining to evaluate the expression of each marker). A one-way analysis of variance was used for comparison of continuous data between multiple groups, and the t-test was used for comparison between two groups; a Spearman correlation analysis was used to investigate correlation. ResultsIn the PBC group, the expression of NKG2D increased with the degree of inflammation, and the patients with G3-4 inflammation had significantly higher expression than those with G1-2 inflammation (G1 vs G2 vs G3 vs G4: 1.4±0.05 vs 1.56±0.05 vs 1.86±0.11 vs 2.60±0.17, F=150.8, P＜0.05); the expression of NKG2D decreased with fibrosis degree (S3 vs S4: 2.30±0.17 vs 1.56±0.05, t=-1.52, P＜0.05). In the PBC group, there was no significant difference in MICA between G3 and G4 (0.11±0.01 vs 0.20±0.03, t=-2.20, P＞0.05) and between S3 and S4 (0.12±0.02 vs 0.18±0.03, t=-2.64, P＞0.05). In the PBC group, there was a significant difference in the expression of IL-15 between the patients with different degrees of inflammation (G1 vs G2 vs G3 vs G4: 0.70±0.10 vs 1.50±0.10 vs 1.93±0.11 vs 2.60±0.17, F=251.3, P＜0.05), while there was no significant difference between the patients with different fibrosis degrees (S3 vs S4: 2.00±0.05 vs 2.40±0.30, t=-1.62, P＞0.05). In the CHB group, there was a significant difference in the expression of IL-15 between the patients with different degrees of inflammation (G1 vs G2 vs G3: 0.73±0.15 vs 1.96±0.15 vs 2.50±0.17, F=150, P＜0.05) and between the patients with different fibrosis degrees (S1 vs S2 vs S3: 0.70±0.10 vs 21.96±0.15 vs 2.50±0.17, F=158.7, P＜0.05). In the PBC group, the expression of IL-10 was only observed in the patients with G1 inflammation (0.16±0.01), and in the CHB group, the expression of IL-10 was observed in the patients with G1 and G2 inflammation, with no significant difference (G1 vs G2: 0.19±0.01 vs 0.13±0.01, t=-1.522, P＞0.05). In the patients with PBC, the expression of IL-15 in liver tissue was positively correlated with the levels of alkaline phosphatase (ALP) and gamma-glutamyl transpeptidase (GGT) (r=0.241 and 0.407, P=0.014 and 0.045). ConclusionThe NK cell-activating receptor NKG2D affects the degree of intrahepatic inflammation in PBC, and the NKG2D ligand MICA is expressed in the advanced stage of PBC and can downregulate NKG2D. The expression of IL-15 increases with the degree of inflammation in PBC and is positively correlated with the levels of ALP and GGT, suggesting that the activation of NK cells and abnormal secretion of cytokines are involved in the development and progression of PBC and IL-15 may be used as an auxiliary index for the diagnosis of PBC.

Fetal right atrial isomerism diagnosed on prenatal ultrasound: a case report / 中华围产医学杂志

We reported a case of fetus with right atrial isomerism diagnosed by ultrasound prenatally. Right atrial isomerism was suspected based on several kinds of abnormalities detected at 24 gestational weeks by ultrasound imaging, such as levocardia complicated by complex cardiovascular malformations (double outlet of right ventricle, atrioventricular septal defect, pulmonary artery dysplasia, bilateral superior vena cava and infracardiac total anomalous pulmonary venous drainage), abnormal right-sided stomach bubble, midline liver, suspicious absence of the spleen, juxtaposition of the abdominal aorta and the inferior vena cava to the left side, and mirror-image right bronchia. Autopsy confirmed all of the prenatal diagnosis with an additional finding of splenic dysplasia. Right atrial isomerism should be considered when ultrasound findings indicate complex cardiovascular malformations. Given the high mortality rate of right atrium isomerism, prenatal diagnosis is of great importance.

Suspected fetal congenital glaucoma identified by prenatal ultrasound: a case report / 中华围产医学杂志

We report a case of suspected fetal congenital glaucoma detected by prenatal ultrasound. The mother had no history of cold, medication, or radiation exposure in the first trimester. Routine prenatal ultrasound at 23 +2 weeks of gestation found a 2.5 mm ventricular septum defect, and the sagittal and transverse diameters of the left and right eyeballs were all greater than the normal range of the same gestational weeks, which were noted at 18.57 mm and 17.26 mm, 18.21 mm and 17.22 mm, respectively. Dynamic observation revealed that the bilateral eyelids were unable to close with cornea being exposed to amniotic fluid. The pregnancy was terminated at 23 +6 weeks and a stillborn female weighing 650 g was delivered two days later. Congenital glaucoma was highly suspected by postnatal ophthalmic examination, accompanied by a deformity of the left thumb. No abnormality was detected on fetal chromosome karyotyping or whole-exon sequencing. When unilateral or bilateral megalophthalmos in the fetus is detected by prenatal ultrasound, congenital glaucoma should be considered.

Effect of stereotactic body radiation therapy on the survival of patients with pancreatic cancer recurrence after surgery / 中华胰腺病杂志

Objective To identify the effect of stereotactic body radiation therapy (SBRT) on the survival of patients with recurrent pancreatic cancer after surgery.Methods The data of 104 patients with recurrent pancreatic cancer after surgery who underwent SBRT in the Department of Radiation Oncology of Changhai Hospital,Navy Medical University from February 2012 to December 2016 were retrospectively analyzed.The prescription doses ranged from 35-40 Gy/4-8 f.Survival analysis was performed using the Kaplan-Meier method,and relevant factors affecting patients' survival were screened by the Cox proportional hazards model.Results The median overall survival (OS) and progression free survival (PFS) was 12.5 (11.0-14.0) months and 7.3 (6.0-8.7) months,respectively,while the 1-year rate of OS and PFS was 55.8％ and 22.1％,respectively.Multivariate analysis indicated that tumor stage,biological effect dose (α/β =10,BED10),the decrease of CA19-9 level after treatment,and follow-up chemotherapy were all related factors affecting overall survival;tumor stage,BED10,the degree of pain relief and the decrease of CA19-9 level after treatment were related factors affecting PFS.Conclusions Patients suffering recurrent pancreatic cancer with early tumor stage,normal CA19-9 level and mild pain before treatment could be better treated by SBRT,BED10 ≥60 Gy and follow-up chemotherapy after radiotherapy can prolong the survival of patients.

Survey on consultation length and waiting time of community general practice clinics / 中华全科医师杂志

Objective To survey the consultation length and waiting time of general practice clinics in community health service centers(CHSC).Methods Three CHSCs were selected from urban areas,urban-rural junction and rural areas Beijing Chaoyang District.The length of consultation,waiting time and the satisfaction of patients were surveyed by self-designed questionnaires among 373 patients visiting these three CHSCs between July to August 2018.Results In 364 patients who completed the questionnaire 69.0％(251/364) had a consultation length between 5 to 10 min,and the proportion of consultation length＜ 5 min was the highest (27.9％) in urban-rural junction.The waiting time was＜5 min in 43.7％ patients (159/364),only 9.3％ of patients waited for＞30 min.The proportion of patients with waiting＜5 min was the lowest (20.7％) in urban area.The distribution of consultion length was different among groups of the reason of consultion,frequently seen doctor and the familarity with the doctor(P＜0.05).Most patients were satisfied with the length of consultation (85.4％) and waiting time (74.5％).The satisfaction of patients in urban areas with the consultation length (75.2％) and waiting time (49.6％) was lower than that in urban-rural junction and rural areas.Conclusion The consultation length in general practice clinics of CHSC is relatively short,but patients are basically satisfied with the current status of consultation length and waiting time.However,consultation length and wating time should be regularly monitared,to promote the quality of care in general practice clinics.

Complete cor triatriatum sinister misdiagnosed as atresia of the common pulmonary vein on prenatal ultrasound / 中华围产医学杂志

Cor triatriatum sinister (CTS) is characterized by the presence of a fibromuscular membrane dividing the left atrium into two chambers. The postero-superior and proximal chamber of CTS receives blood from four pulmonary veins, whereas the antero-inferior and distal chamber (true left atrium) connects to mitral valve and left atrial appendage (LAA). CTS can be classified into two types, complete and partial CTS. We reported a case of fetal autopsy-confirmed complete CTS that had been misdiagnosed as atresia of the common pulmonary vein on prenatal ultrasound. At 25 gestational weeks, fetal sonography revealed that the pulmonary venous angle on the top of the left atrium disappeared and no vertical vein was found around the common pulmonary venous cava formed by bilateral pulmonary veins. Thus, atresia of the common pulmonary venous cava was considered. Fetal autopsy after induction further confirmed the case was complete CTS.

Demonstration and reference of DRGs case management in a medical center in Taiwan of China / 中华医院管理杂志

Since the first edition of Tw-DRGs was developed in Taiwan in 2002, the system introduction of the hospital management level has been successfully completed. This paper detailed the organizational structure of DRGs case management in local hospitals ( DRGs promotion group, front-end medical care, ICD end, and the medical expenses reporting). It also introduced the operation process of identifying, locking and adjusting process of the pre-hospital, in-hospital and post-hospital aspects of inpatients, and provides in the end useful experiences for the promotion of DRGs case management in China′s mainland hospitals.

Complete cor triatriatum sinister misdiagnosed as atresia of the common pulmonary vein on prenatal ultrasound / 中华围产医学杂志

Cor triatriatum sinister (CTS) is characterized by the presence of a fibromuscular membrane dividing the left atrium into two chambers. The postero-superior and proximal chamber of CTS receives blood from four pulmonary veins, whereas the antero-inferior and distal chamber (true left atrium) connects to mitral valve and left atrial appendage (LAA). CTS can be classified into two types, complete and partial CTS. We reported a case of fetal autopsy-confirmed complete CTS that had been misdiagnosed as atresia of the common pulmonary vein on prenatal ultrasound. At 25 gestational weeks, fetal sonography revealed that the pulmonary venous angle on the top of the left atrium disappeared and no vertical vein was found around the common pulmonary venous cava formed by bilateral pulmonary veins. Thus, atresia of the common pulmonary venous cava was considered. Fetal autopsy after induction further confirmed the case was complete CTS.

Organ endangering dose and side effects in two courses of stereotactic body radiation therapy for pancreatic cancer / 中华胰腺病杂志

Objective To assess the cumulative doses and side effects after two courses of stereotactic body radiation therapy (SBRT) for pancreatic cancer. Methods Twenty-four pancreatic cancer patients who received two courses of SBRT were enrolled. Organ endangering dose accumulations were calculated by rigid and non-rigid registration. All doses were recalculated to an equivalent dose of 2 Gy per fraction. Results The median of accumulated maximal dosage (Dmax) and dosage per 1cc(D1cc) of the stomach,duodenum and the bowel were 43.87 and 35.28 Gy 3,35.53 and 26.59 Gy3,45.08 and 36.18 Gy3; and the median volume under the dosage of 10Gy (V10) was 107.40,23.98 and 169.26cc, respectively. The median accumulated Dmaxand the dosage of 35% volume(D0.35) of the spinal cord was 8.42 and 7.83Gy3. The median cumulative Dmeanand D2/3of the left and right kidney were 5.18 and 3.65 Gy3, 3.50 and 2.57 Gy3, respectively. The median cumulative Dmeanand D50%of the liver was 5.18 and 3.64Gy3,respectively. The median summed dose to the overlapping radiation field of the two courses was 93.38 Gy3. No grade 3-4 toxicity occurred. Conclusions The cumulative doses to organs at risk as dose constraints were safe and acceptable,which could be used as a reference to evaluate whether a second SBRT could be done after initial SBRT for pancreatic cancer.

Efficacy and safety of stereotactic body radiation therapy for very elderly patients with pancreatic cancer / 中华胰腺病杂志

Objective To investigate the efficacy and safety of stereotactic body radiation therapy (SBRT) for very elderly patients with pancreatic cancer.Methods The clinical data of a total of 149 patients aged from 75 to 90 years with locally advanced or metastatic pancreatic cancer treated by SBRT in Changhai Hospital from January 2012 to December 2016 were retrospectively reviewed.Prescription doses ranged from 3.6-9Gy/fractions,and the total doses were 19.5-49Gy in 3-8 fractions.The level of serum cancer antigen 19-9(CA19-9) before and 3 months after treatment was compared and the radiotherapy biological effective dose (BED10) was calculated.The adverse events of the radiotherapy were observed.Overall survival (OS) and progression-free survival (PFS) were recorded through follow-up,and the factors influencing the patients' survival were investigated by univariate and multivariate analysis.Results All the patients' median OS and PFS were 12.9and 8.3 months,respectively.One-year OS and PFS rate were 55.9％ and 19.5％,respectively.Tumor stage and the decrease of CA19-9 levels ＞50％ at 3 months after treatment and BED10 were independent factors of OS and PFS.No grade 3 or higher toxicities were recorded in all the patients.Conclusions SBRT is safe and effective for very elderly patients with locally advanced or medically inoperable pancreatic cancer.Tumor stage,the decrease of CA19-9 levels after treatment and BED10 were associated with prognosis.