Effectiveness of modified complex decongestive physiotherapy for preventing lower extremity lymphedema after radical surgery for cervical cancer: a randomized controlled trial.

BACKGROUND: There is a lack of evidence in support of any prophylactic measure to prevent secondary lower extremity lymphedema after radical hysterectomy among patients with cervical cancer. This study aimed to determine the effectiveness of modified complex decongestive physiotherapy in reducing the risk of secondary lower extremity lymphedema after radical surgery. METHODS: A randomized single-blind clinical trial was conducted in 120 patients with cervical cancer who underwent laparoscopic radical hysterectomy with pelvic lymphadenectomy between January 2016 and April 2017 in the Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China. Participants were randomly assigned to a modified complex decongestive physiotherapy intervention group (n=60) or control group (n=60). The intervention group received a modified complex decongestive physiotherapy program, which included manual lymph drainage, compression hosiery, regular exercise, and health education. The control group only received a health education program. The main outcome was the incidence of secondary lower extremity lymphedema. RESULTS: A total of 117 patients with cervical cancer completed a 1-year follow-up. Twenty-eight (23.9%) patients developed secondary lower extremity lymphedema (20 (34.5%) patients in the control group and 8 (13.6%) in the intervention group). The incidence of secondary lower extremity lymphedema was significantly higher in the control group than in the intervention group (p=0.008; OR 0.30 (95% CI 0.12 to 0.75). The median percentage of excess volume was significantly less in the intervention group (2.1%, IQR 0.5-3.4%) than in the control group (2.96%, IQR 1.1-4.98%); (p=0.042). The mean (SD) onset time of lymphedema was 8 (2.00) months vs 4.6 (2.82) months in the intervention and control groups, respectively (p=0.004). CONCLUSIONS: This randomized trial showed that modified complex decongestive physiotherapy is effective for preventing lower extremity lymphedema in patients with cervical cancer after laparoscopic radical hysterectomy with pelvic lymphadenectomy.

[Three-dimensional analysis of pharyngeal airway in skeletal Class III patients after sagittal split ramus osteotomy].

OBJECTIVE: To analyze the three-dimensional changes of pharyngeal airway in patients with skeletal Class III malocclusion after the combined orthodontic and orthognathic treatment. METHODS: Twenty patients (9 males, 11 females) and 40 subjects with normal occlusion were involved in the study. Cone-beam computed tomography (CBCT) were performed on patients one week and six months after treatment. Raw data were reconstructed into three-dimensional model and sagittal and transversal measurements, cross sectional areas, partial and total volumes were computed. RESULTS: After treatment, the sagittal diameters of each section were significantly reduced by (2.7 ± 3.5), (3.0 ± 3.8), (2.7 ± 3.3) mm, respectively (P < 0.05). The transversal diameter of laryngopharyngeal airway constricted significantly by (4.8 ± 4.1) mm (P < 0.05). Cross sectional areas and volumes of each part in patients after surgery were significantly narrower compared with those of the controls. CONCLUSIONS: After combined therapy the pharyngeal airway space decreased.

[Effects of qingyi II recipe on the intestinal barrier function of severe acute pancreatitis rats].

OBJECTIVE: To observe the effects of Qingyi II Recipe (QR) on the intestinal barrier function (IBF) of severe acute pancreatitis (SAP) rats. METHODS: Forty-eight SD rats were selected to prepare SAP model. After modeling, they were randomly divided into the model group and the QR treatment group, 24 in each group. Another 8 rats were selected as the sham-operation group. The intervention was started just when they came to resuscitation from anesthesia. Rats in the QR treatment group was administered with QR (1 mL/100 g) by gastrogavage, while an equal volume of normal saline was given to rats in the sham-operation group and the model group by gastrogavage. The gastrogavage was performed once every 6 h. Eight rats were selected from each group 6, 12, and 24 h after intervention. The ascites amount was measured after opening abdomens. The concentrations of serum diamine oxidase (DAO) and D-lactate were measured. Pathological changes of pancreas and ileum were observed. The pathological scoring of the pancreas was performed. The ileum were scanned by electron microscope. RESULTS: There was no ascites in the sham-operation group. There was no obviously pathological abnormality in the pancreas or ileum. Compared with the sham-operation group, the ascites amount, serum DAO, D-lactate, and pathological scoring all increased at 6 h in the model group, showing statistical difference (P<0.05). In the model group, the serum DAO, D-lactate, and pathological scoring increased gradually at 6 -24 h with statistical difference (P<0.05). Results under microscope showed disarranged structure, interstitial edema, hemorrhage, a large amount of neutrophil infiltration, local foci or lamellar intestinal necrosis. The 24-h ascites amount increased more at 24 h than at 12 h in the model group with statistical difference (P<0.05). The serum D-lactate and patho- logical scoring increased gradually at 6 -24 h in the QR treatment group with statistical difference (P<0.05). The 24-h ascites amount and DAO increased more at 24 h than at 12 h in the model group with statistical difference (P<0.05). Compared with the model group at the same time point, each index decreased at 6 -24 h in the QR treatment group with statistical difference (P<0.05). Results under microscope showed edema and congestion of the intestinal mucosa tissue, little amount of neutrophil infiltration. But the degrees were milder when compared with those of the model group. CONCLUSION: QR protected IBF of SAP rats.