胸段食管癌累及野放疗与扩大野放疗对危及器官的辐射剂量学分析

目的 研究胸段食管癌逆向调强放射治疗（IMRT）中累及野照射与扩大野照射对危及器官（OAR）受照剂量的影响。方法 40例胸段食管癌患者分别行累及野靶区勾画和扩大野靶区勾画并勾画危及器官，制定IMRT计划，评估2个计划的靶区适形指数（CI）和均匀性指数（HI）及危及器官的剂量学参数，剂量学参数比较采用配对t检验。结果 2种计划的PTV均能满足处方剂量要求，PTV在CI、HI上相近（P = 0.317、0.130）。两组间平均肺剂量、两肺V₅、两肺V₂₀、两肺V₃₀、脊髓D_mean、心脏D_mean、心脏D_max、心脏V₃₀、心脏V₄₀、心脏V₆₀差异均存在统计学意义（P < 0.01）。结论 胸段食管癌患者行累及野照射与扩大野比较，可降低正常器官的受照剂量，从而降低放射性损伤风险。     

Pneumococcal meningitis before the introduction of 10-valent pneumococcal conjugate vaccine into the National Childhood Immunization Program in Poland

Background

Poland introduced the 10-valent conjugate pneumococcal vaccine (PCV10) into the childhood immunization program in January 2017. During previous decades, considerable changes had occurred in the surveillance system for invasive pneumococcal disease. Therefore, to provide baseline data on pneumococcal diseases before PCV10 introduction, we evaluated the epidemiology of pneumococcal meningitis (PM), the only syndrome monitored consistently since 1970.

耳甲电针治疗功能性消化不良的临床效果

目的:观察耳甲电针治疗功能性消化不良的疗效。方法:选取2018年6月至2019年5月北京同仁医院收治的功能性消化不良患者90例作为研究对象,按照随机数字表法分为对照组和观察组,每组45例,对照组采用对照刺激,观察组采用耳甲电针刺激,所有患者治疗前后均使用功能性消化不良主要症状评分表、功能性消化不良生命质量量表(FDDQL)、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、抑郁自评量表(SDS)评估患者症状的严重程度,并参照功能性消化不良中医诊疗专家共识意见和功能性消化不良中西医结合诊疗共识意见的疗效评估方法,对比分析观察组与对照组治疗功能性消化不良的疗效。结果:观察组和对照组治疗前主要症状评分表、功能性消化不良生命质量量表(FDDQL)、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、抑郁自评量表(SDS)差异无统计学意义(P>0.05),治疗后观察组症状及量表评分与对照组差异有统计学意义(P<0.05)。观察组治疗有效率82.22%,对照组治疗有效率57.78%,差异有统计学意义(P<0.05)。结论:耳甲电针对于功能性消化不良的各项症状具有较好的疗效。     

The German Hodgkin Study Group risk model is useful for Hodgkin lymphoma patients receiving radiotherapy after autologous stem cell transplant

PurposeTo apply the German Hodgkin Study Group (GHSG) risk model in patients with recurrent/refractory Hodgkin lymphoma receiving involved-field radiotherapy after autologous stem cell transplantation.Material and methodsThe study consisted in the retrospective analysis of 30 consecutive patients with recurrent/refractory Hodgkin lymphoma who received involved-field radiotherapy after autologous stem cell transplantation. Our policy was of adding involved-field radiotherapy for patients with positive PET scan before autologous stem cell transplantation (23 out of 30 patients, 77%), and/or irradiating sites of bulky disease at relapse (11 out of 30 patients, 37%). Patients were stratified into four risk groups according to the presence of the five clinical risk factors identified by the GHSG; (1) stage IV disease; (2) time to relapse ≤ 3 months; (3) ECOG-PS ≥ 1; (4) bulk ≥ 5 cm; and (5) inadequate response to salvage chemotherapy.ResultsThe median interval from autologous stem cell transplantation to involved-field radiotherapy was 3 months (range, 1–7 months), and the median involved-field radiotherapy dose was 35 Gy (range, 12–40 Gy). At a median follow-up of 35 months (range, 1–132 months), the 2-year progression-free survival in the entire series was 60%. When examining the four different GHSG risk groups, the progression-free survival rate at 2 years was 86%, 83%, 50%, and 36% for patients with score = 0, score = 1, score = 2, and score = 3 to 5, respectively (P = 0,01). Among the 12 patients having at least three risk factors who underwent thoracic involved-field radiotherapy, three (25%) developed pneumonitis.ConclusionThe adoption of the GHSG risk model at the time of recurrence/progression is a useful prognostic tool to select patients with Hodgkin lymphoma for consolidative involved-field radiotherapy after autologous stem cell transplantation.     

五禽戏锻炼联合耳穴压豆在肩周炎患者中的应用观察

目的:观察五禽戏锻炼联合耳穴压豆在肩周炎患者中的应用疗效。方法:选取我院肩周炎患者60例(2017年6月-2018年12月),治疗方案不同分组。耳穴压豆组(30例)接受耳穴压豆治疗,联合组(30例)接受五禽戏锻炼联合耳穴压豆治疗。对比两组疗效、治疗前后肩关节功能[日常生活活动能力量表(Activity of Daily Living Scale,ADL)、关节活动度(Range of Motion,ROM)、徒手肌力量表(Manual Muscle Test,MMT)、疼痛]改善、中医症状积分、视觉模拟评分法(Visual Analog Scale,VAS)。结果:联合组总有效率高于耳穴压豆组(P<0.05);联合组治疗1个疗程后疼痛、ADL、ROM及MMT评分较耳穴压豆组高(P<0.05);联合组治疗1个疗程后肩部刺痛、抬举受限、局部肿胀评分较耳穴压豆组低(P<0.05);联合组治疗1个疗程后VAS评分较耳穴压豆组低(P<0.05)。结论:五禽戏锻炼联合耳穴压豆治疗肩周炎,能显著提高治疗效果,减轻肩部疼痛,改善肩关节功能。     

Management and supportive treatment of frail patients with metastatic pancreatic cancer

Data regarding management of frail patients with pancreatic ductal adenocarcinoma practice is currently very scarce. Randomized clinical trials usually exclude these subgroup of patients and the majority of the publications only consider chronological age and ECOG performance status for their classification. Therefore, the current available data do not reflect daily clinical practice. Only data from a phase two study (FRAGANCE study), designed to select a tolerable dose-schedule of nab-placitaxel + gemcitabine (Phase one) and to evaluate the efficacy of the selected regimen (Phase two) in patients with ECOG-2 and previously untreated advanced PDAC, are currently available. Management of these particular patients is exceedingly complex and requires collaboration of multidisciplinary teams and intensive support treatment. This article reviews the literature available regarding the management of the so-called frail patients and provide guidance for chemotherapy as well as supportive care treatments.     

Surgical complexity score and role of laparoscopy in women with advanced ovarian cancer treated with neoadjuvant chemotherapy

ObjectivesTo evaluate surgical complexity scores (SCS) and minimally invasive surgery (MIS) at interval debulking surgery (IDS) in advanced epithelial ovarian cancer (EOC) patients receiving neoadjuvant chemotherapy (NACT).MethodsA multi-institutional study of NACT with IDS for advanced EOC was conducted. Demographic data were abstracted and SCS assigned based on IDS findings. Disease-specific overall survival (DSS) was defined as the time from completion of adjuvant chemotherapy to death due to disease. Cox proportional hazards regression models were used for univariate and multivariate survival analyses.Results282 patients were identified; 80.5% had high-grade serous histology and 54.6% were <75 (median 63.9; range 34.1–84.8). Approximately 84% were optimally cytoreduced (61% R0; 23% <1 cm). In multivariate analyses, age 75+ (p ≤ 0.001), residual disease (>1 cm; p = 0.03), and SCS ≥ 3 (p = 0.04) were significantly predictive of worse DSS when morbidity and ASA score were also in the model. When optimally debulked was defined as R0, only age 75+ (<0.001) was significantly associated with decreased DSS. In the R0 cohort, SCS did not significantly predict DSS. However, subset analysis defining optimal ≤1 cm, revealed higher SCS was associated with a 1.6-fold increased risk of death (p = 0.02).Fifty-one patients underwent laparoscopic IDS. Twenty-four (47%) were converted to laparotomy to achieve optimal debulking in 21 patients (87.5%); while 25 had laparoscopic optimal cytoreduction (19/25 [76%] R0).ConclusionsIn women with advanced EOC treated with NACT, older age, SCS ≥ 3, and residual disease >1 cm at IDS were predictors of worse survival. MIS appears safe and feasible with acceptable optimal cytoreduction rates.     

Intracerebral Hemorrhage in a Young Urban Population: Etiologies and Outcomes in Patients 50 and Younger

Goal: There is limited research on intracerebral hemorrhage in young urban populations. There is reduced access to healthcare and a high prevalence of multiple comorbidities in this vulnerable population. We studied the etiologies and outcomes of spontaneous intracerebral hemorrhage in an urban North Philadelphia cohort aged 50 years old and younger. Materials and methods: A retrospective chart review of subjects 50 years old and younger who presented with spontaneous intracerebral hemorrhage at Temple University Hospital was conducted. A novel scoring system was used to classify the cause of each intracerebral hemorrhage. This system was used to assign a degree of likelihood that hypertension, amyloid angiopathy, tumor, oral anticoagulants, vascular malformations, infrequent causes, or cryptogenic etiologies were present. Aneurysmal subarachnoid hemorrhage was excluded. The prevalence of each risk factor and outcomes were analyzed. Findings: Of the 110 patients in the study, the most common etiology was hypertension (82.7%). There was no statistically significant difference in mortality between patients with multiple possible etiologies for their hemorrhage. Vascular malformations and cavernomas were rare (5.5%). Conclusions: Hypertension was the most common cause of intracerebral hemorrhage in a young urban population. The presence of multiple possible etiologies does not correlate with a worse prognosis of mortality. There is a need for further research into hemorrhagic stroke in young populations.