Abnormal sensation during total body irradiation: a prospective observational study

Light flash and odor during radiotherapy are well-known phenomena. Two prospective observational studies have indicated that 55% of patients observed a light flash during irradiation of the retina and 27% of patients sensed an odor during radiotherapy for the nasal cavity. A prospective observational study was performed in all patients at our hospital who received total body irradiation (TBI) between January 2019 to October 2021. Light flash and odor during TBI were examined using the same method as that used in previous studies. A total of 32 patients received TBI during the study period. The patients had a median age of 41 (18–60) years, and included 20 males and 12 females. A survey checklist showed that 14 patients (44%) sensed light and 14 patients (44%) sensed odor during TBI,. The color of the light during irradiation was yellow in six cases, white in four cases, and blue in four cases. The intensity of the light was 2–5 (median 3, 1 is very weak, 5 is very strong) and the time over which the light flash was felt was 4–60 s (median 10 s). Two patients each sensed smells of plastic, ozone and bleach, and others sensed one smell each. The intensity of the odor was 1–4 (median 3, 1 is very weak, 5 is very strong) and the time over which the odor was sensed was 1–25 s (median 3 s). We conclude that light flashes and odors are each sensed by 44% of patients during TBI. Various types of light flashes and odors were reported in this study.     

全身照射技术的临床应用（之一）——白血病等病症患者在造血干细胞移植前的全身放射治疗

全身放疗（TBI）是白血病等病症患者在造血干细胞移植前的预处理,而造血干细胞移植又是治愈白血病等病症的首选方案。本文结合笔者26年来收治的近600例TBI患者,较为详尽地介绍了TBI治疗的设备与器材、适应症与并发症、照射方式与治疗方案、吸收剂量的测量与处方剂量的计算、剂量率对放射性肺炎与总处方剂量的影响、肺组织和眼晶体的剂量估算及治疗过程中的实时剂量监控等有关内容,希望对同道有所裨益。     

腹腔镜卵巢打孔术联合未成熟卵泡穿刺术治疗难治性多囊卵巢综合征效果评价

目的 探讨腹腔镜卵巢打孔术联合经阴道未成熟卵泡穿刺术(IMFA)对难治性多囊卵巢综合征患者生育储备功能的影响.方法 选取2018年3月-2019年6月本院收治的难治性多囊卵巢综合征患者96例,采取随机数字表法将其分为对照组和实验组,各48例.对照组患者给予腹腔镜卵巢打孔术进行治疗,实验组患者在对照组基础上联合使用IMF...     

Relation between oxidative damage and dietary protein: marginal protein level which modulates oxidative damage in mice with total body irradiation

Mice were fed different levels of dietary protein (8%, 11%, 14%, 17% or 20%) and then gave total body irradiation (TBI) with X-rays. The levels of lipid peroxides and protein carbonyls in the liver and chromosomal damage in bone marrow did not differ among the groups, which were not received TBI. However, the oxidative damage of lipid and protein in the liver increased due to TBI only in the 8% or 11% protein group. The chromosomal damage in bone marrow due to TBI was higher in the 8% or 11% protein group than those in the 14%, 17% or 20% protein group. Concentrations of antioxidants (vitamins C, E and GSH) in the liver were lower, and the concentrations of non-heme iron in the liver were higher in the 8% or 11% protein group than those in the 14%, 17% or 20% protein group.     

Estimation of total body water from foot-to-foot bioelectrical impedance analysis in patients with cancer cachexia – agreement between three prediction methods and deuterium oxide dilution

INTRODUCTION: Bioelectrical impedance analysis (BIA) is a useful bedside measure to estimate total body water (TBW). The aim of this study was to determine the agreement between three equations for the prediction of TBW using BIA against the criterion method, deuterium oxide dilution, in patients with cancer cachexia. METHODS: Eighteen measurements of TBW using foot-to-foot BIA in seven outpatients with cancer cachexia (five male and two female, age 56.4 +/- 6.7 years) at an Australian hospital. Three prediction formulae were used to estimate TBW - TBW(ca-radiotherapy) developed in patients with cancer undergoing radiotherapy, TBW(ca-underweight) and TBW(ca-normal weight) developed in underweight and normal weight patients with cachexia. TBW was measured using the deuterium oxide dilution technique as the gold standard. RESULTS: Mean measured TBW was 39.5 +/- 6.0 L. There was no significant difference in measured TBW and estimates from prediction equations TBW(ca-underweight) and TBW(ca-radiotherapy). There was a significant difference in measured TBW and TBW(ca-normal weight). All prediction equations overestimated TBW in comparison with measured TBW. The smallest bias was observed with TBW(ca-underweight) (0.38 L). The limits of agreement are wide (>7.4 L) for each of the prediction equations compared with measured TBW. CONCLUSIONS: At a group level, TBW(ca-underweight) is the best predictor of measured TBW in patients with cancer cachexia. For an individual however, the limits of agreement are wide for all prediction equations and are unsuitable for use. Practitioners need to be aware of the limitations of using TBW prediction equations for individuals.     

腹腔镜与开腹手术对早期卵巢癌临床疗效评价的随机对照分析

目的 探讨腹腔镜与开腹手术对早期卵巢癌临床疗效的比较.方法 选取2014年6月至2015年6月榆林市第一医院妇科接诊的44例早期卵巢癌患者,根据随机数字表法分为实验组和对照组,实验组给予腹腔镜手术治疗,对照组给予开腹手术治疗,评价两组的临床疗效差异.结果 腹腔镜组和开腹组的手术时间无明显差异(279.23±74.24:268.66±76.13min,P＞0.05),但是腹腔镜组的术中出血量(159.44±92.66:381.25±73.16mL,P=0.002)、术中输血率(0.00％:13.64％,P=0.005)和子宫切除率明显低于开腹组(50.00％:63.64％,P=0.024),差异有统计学意义.腹腔镜组的术后胃肠道恢复时间(1.64±0.76:2.69±0.92天,P=0.002)和住院时间均早于开腹组(10.35±5.11:13.21±6.62天,P=0.001)[子宫切除比例(50.00％:63.64％,P=0.024)也低于开腹组,差异有统计学意义].两组患者术后化疗率(90.91％:86.36％,P=1.365)和复发率无明显差异(4.55％:9.09％,P=0.784).术后评价性生活质量和植物神经功能失调症状,2组患者无明显差异(P＞0.05).结论 腹腔镜手术具有损伤小、子宫切除率低、术后恢复快、并发症少等优势,在患者术后生活质量的保留上与开腹手术相同,对于早期卵巢癌患者可作为首选治疗.     

Estimation of total body water from bioelectrical impedance spectroscopy in oncology outpatients receiving radiotherapy and agreement with three prediction equations

Background: Bioelectrical impedance spectroscopy (BIS) may be more accurate in determining total body water (TBW) than bioelectrical impedance analysis (BIA). The present study compared the agreement between three TBW prediction equations developed using BIA and BIS‐derived TBW in oncology outpatients. Methods: A cross‐sectional, observational study was conducted in 37 outpatients receiving radiotherapy (27 males/10 females, aged 68.3 ± 10.2 years). TBW was estimated by BIS (TBW_BIS) and three BIA TBW prediction equations (TBW_ca‐u: underweight cancer patients; TBW_ca‐n: normal‐weight cancer patients; and TBW_rad: patients receiving radiotherapy). Bland–Altman analyses determined agreement between methods. BIS‐derived TBW using new resistivity constants was calculated. Results: The mean ± SD of TBW estimated by BIS was 39.8 ± 8.3 L, which was significantly different from the prediction equations; TBW_rad 35.1 ± 7.9 L, TBW_ca‐u 33.1 ± 7.5 L and TBW_ca‐n 32.3 ± 7.3 L, (P < 0.001). Using new resistivity constants, TBW was 36.2 ± 8.1 L but this still differed from the equations (P < 0.001). Bias between TBW_BIS and that predicted by the equations was in the range 4.7–7.4 L or 1.1–3.9 L using new resistivity constants. Conclusions: TBW estimated by BIS cannot be directly compared with oncology‐specific BIA equations, suggesting that BIS cannot be used at the group level in outpatients receiving radiotherapy. There was a reduced bias with BIS using new resistivity constants; however, further research should determine any advantage of BIS over BIA in this population.     

拮抗剂方案与其他方案在卵巢低反应患者中的临床疗效比较

目的 比较拮抗剂方案与短方案、微刺激方案在卵巢低反应患者体外受精-胚胎移植治疗中的临床疗效.方法 对南京医科大学附属南京妇幼保健院生殖中心2014年1月至2015年9月接受体外受精-胚胎移植治疗的卵巢低反应患者临床资料进行回顾性分析,比较拮抗剂方案与短方案、微刺激方案的临床疗效.结果 拮抗剂组与短方案组相比临床疗效相当,但平均促性腺激素释放激素激动剂(Gn)时间更短、Gn用量更少(t值分别为8.72、6.98,均P<0.05).拮抗剂组与微刺激方案组相比,Gn时间、Gn用量高于后者(t值分别为2.90、12.80,均P<0.05),HCG日内膜厚度明显高于后者(t=15.94,P<0.05),获卵数、可移植胚胎数、优质胚胎数均高于后者(t值分别为9.94、19.01、7.04,均P<0.05),且临床妊娠率、累计妊娠率均高于后者(χ2值分别为1.82、11.29,均P<0.05),周期取消率低于后者(χ2=11.74,P<0.05),而两组流产率无明显差异(χ2=0.19,P>0.05).结论 对于卵巢低反应患者,拮抗剂方案可以获得相对满意的临床妊娠率,同时具有经济性较高、治疗周期短、周期取消率较低等优点,值得临床推广.     

多囊卵巢综合征子宫内膜生存素和Ki67的表达及临床特征研究

目的:检测多囊卵巢综合征(PCOS)患者子宫内膜生存素(survivin)和K i67的表达,研究其与性激素、血脂、胰岛素抵抗指数(HOMA)、体重指数(BM I)等临床特征的关系。方法:选取PCOS患者31例作为实验组,输卵管性不孕患者20例作为对照组,采用免疫组化法检测两组患者子宫内膜survivin和K i67的表达,采用免疫法测定血中性激素及血脂水平,并进行糖耐量葡萄糖试验(OGTT)和胰岛素释放试验(INS)。结果:PCOS组survivin和K i67表达均高于对照组。胰岛素抵抗组K i67表达高于非胰岛素抵抗组,相关性分析发现K i67表达与BM I、HOMA呈正相关。结论:PCOS患者子宫内膜细胞抗凋亡和增殖活跃,肥胖和胰岛素抵抗增加了子宫内膜K i67的表达。     

Body dysmorphic disorder in patients with anorexia nervosa: prevalence,clinical features,and delusionality of body image

OBJECTIVE: The prevalence of body dysmorphic disorder in patients with anorexia nervosa is unknown. We hypothesized that body dysmorphic disorder would be underdiagnosed in patients with anorexia nervosa and that comorbidity with body dysmorphic disorder would result in greater overall dysfunction. METHOD: Forty-one patients with DSM-IV anorexia nervosa completed the Body Dysmorphic Disorder Questionnaire, a self-report screen for body dysmorphic disorder. A follow-up interview was conducted using a reliable clinician-administered semistructured diagnostic instrument for DSM-IV body dysmorphic disorder. Delusionality about appearance was assessed using a validated semistructured interview. Comorbid DSM-IV diagnoses, number of hospitalizations and suicide attempts were obtained by means of a detailed diagnostic interview. RESULTS: Sixteen (39%) of the 41 patients with anorexia nervosa were diagnosed with comorbid body dysmorphic disorder unrelated to weight concerns. The anorexia nervosa patients with body dysmorphic disorder had significantly lower overall functioning and higher levels of delusionality than the anorexic patients without body dysmorphic disorder. DISCUSSION: These preliminary results suggest that body dysmorphic disorder may be relatively common among patients with anorexia nervosa. The presence of comorbid body dysmorphic disorder may indicate a more severe form of illness.     

腹腔镜子宫(阴道)骶骨固定术与改良全盆底重建术治疗盆腔脏器脱垂的临床疗效观察

目的探讨经腹腔镜子宫(阴道)骶骨固定术及改良全盆底重建术用于治疗中盆腔缺陷为主的盆腔脏器脱垂(POP)患者的临床疗效。方法纳入2012年3月-2015年3月住院的中盆腔脏器脱垂达到POP-Q分期Ⅱ~Ⅲ期的患者169例,根据手术方式分为改良全盆底重建组81例和腹腔镜下骶骨固定术组88例。按照规范化标准为患者实施手术,手术中对合并盆底功能障碍进行对应处理。围手术期记录患者相应情况,检测手术主客观满意度。所有患者纳入随访,填写盆底功能障碍及性生活质量评估量表。结果骶骨固定术组平均年龄比较[(43.78±7.63)岁vs.(53.01±10.50)岁],两组绝经概率比较(33.0%vs.60.5%),术前压力性尿失禁(SUI)概率比较(46.1%vs.65.4%)显著低于改良全盆底重建组,差异有统计学意义(P<0.05)。与改良全盆底重建组相比,骶骨固定组手术出血量[(60.32±30.27)mlvs.(98.35±40.28)ml]、尿管留置时间[(1.90±0.90)dvs.(2.50±1.10)d]及子宫切除比例(30.7%vs.60.5%)更低,差异有统计学意义(P<0.05)。两组患者手术后12个月时PFIQ-7及PFQI-20评分均较手术前显著下降(P<0.05)。术后12个月时,骶骨固定组的PISQ-12评分显著高于手术前(P<0.05)。结论骶骨固定术及改良全盆底重建术治疗POP患者均具有较好的疗效及安全性,远期预后良好。骶骨固定术改善POP患者性生活质量更为显著。     

育龄期未生育PCOS患者子宫体体积与临床标志物的相关性分析

目的 分析育龄期未生育多囊卵巢综合征(PCOS)患者子宫体体积与代谢、内分泌、出凝血等指标及子宫动脉血流的相关性,为PCOS患者临床治疗和预后预测提供参考.方法 选取2015年10月至2016年9月在上海交通大学医学院附属仁济医院就诊的育龄期未生育PCOS患者353例及正常未生育女性102例,超声检测子宫体大小及子宫动脉血流相关指数.PCOS患者按照子宫体大小的四分位间距分为子宫体体积偏小组、中间组及偏大组.检测PCOS患者的体质指数(BMI)、性激素、血糖及胰岛素等代谢及内分泌指标并进行相关性分析.结果 育龄期未生育PCOS患者子宫体体积较正常女性偏小(Z=2.572,P<0.05),子宫动脉阻力指数(RI)、收缩期峰值速度/舒张末期血流速度(S/D)偏高(左:t值分别为2.961、3.531,均P<0.05;右:t值分别为2.413、2.804,均P<0.05).子宫体体积偏小组、中间组及偏大组的患者年龄、黄体生成素、黄体生成素/卵泡刺激素(LH/FSH)比值、总胆固醇水平及子宫动脉血流阻力比较差异均有统计学意义(F值分别为6.898、6.483、7.228、4.742、3.054、5.142、4.454、4.542,均P<0.05).结论 子宫体体积偏小是育龄期未生育PCOS患者的主要临床表现之一,且与生殖内分泌紊乱程度、脂代谢异常及子宫动脉血流阻力升高相关.     

Higher amounts of body fat are associated with inadequate intakes of calcium and vitamin D in African American women

Calcium and vitamin D are associated with obesity. We hypothesized that African American women with higher calcium and vitamin D intakes would have lower body fat compared with women with lower calcium and vitamin D intakes. This cross-sectional study included 100 premenopausal African American women aged 18 to 40 years with a spectrum of body mass indices (17.3-46.7 kg/m²). Dietary information was obtained using 24-h recalls. Total body fat was determined by dual-energy x-ray absorptiometry and reported as percentage body fat (%BF). Subjects' data were divided into 2 groups (n = 50 per group) based on the median quartile of %BF, and differences were determined using independent t tests. Women with at least 37.9%BF had mean calcium (mg per day ± SD) and vitamin D intakes (µg per day ± SD) of 528.6 ± 146.0 and 3.8 ± .9, respectively. In comparison, women with lower %BF (<37.9%) had higher (P < .001) calcium and vitamin D intakes of 911.5 ± 208.3 and 5.0 ± 0.8, respectively. Partial correlation coefficients (controlling for the confounding variables of fat, carbohydrate, and protein intakes) indicated significant (P < 0.001) inverse associations between calcium intake and %BF (r = −.666), and vitamin D and %BF (r = −.460) in the 100 women. In conclusion, women with lower intakes of calcium and vitamin D were more likely to exhibit excessive adiposity compared with women with higher intakes.     

低体重和肥胖儿童身体成分特点及脂肪肌肉含量与骨密度相关性研究

目的 探讨低体重和肥胖儿童身体成分特点及其脂肪肌肉含量与骨密度的相关性.方法 选择2015年6月至2016年6月于眉山市妇幼保健院儿保门诊体检的5~7岁儿童为研究对象,按体质量指数(BMI)分为低体重组、肥胖组和对照组,测量身体成分各项指标,包括体脂比、全身脂肪含量、肌肉含量及局部和全身骨密度,并对结果进行分析.结果 同性别儿童低体重组的体脂比、全身脂肪含量、肌肉含量及局部和全身骨密度均分别明显低于对照组,二者之间差异均具有统计学意义(t=3.076~3.326,均P<0.05);同性别儿童对照组的体脂比、全身脂肪含量、肌肉含量及局部和全身骨密度均分别明显低于肥胖组,二者之间差异均具有统计学意义(t=2.998~3.427,均P<0.05).经Logistic回归分析:低体重组儿童的肌肉含量与不同部位骨密度均呈正相关性(r=0.779~0.889,均P<0.05);肥胖组男性儿童的肌肉含量与下肢骨密度、体脂比和全身脂肪含量与躯干骨密度均呈正相关性(r=0.779~0.882,均P<0.05),肥胖组女性儿童肌肉含量与上肢骨密度,以及体脂比、全身脂肪含量和肌肉含量与下肢骨密度均呈正相关性(r=0.781~0.901,均P<0.05);对照组儿童的肌肉含量与不同部位骨密度均呈正相关性(r=0.779~0.912,均P<0.05),对照组女性儿童的体脂比、全身脂肪含量和肌肉含量均与下肢骨密度和全身骨密度均呈正相关性(r=0.805~0.912,均P<0.05).结论 与正常儿童相比,低体重和肥胖儿童身体成分构成,各指标与骨密度的相关关系明显不同于正常儿童.在对儿保门诊儿童管理中,体重、体脂比、全身脂肪含量、肌肉含量的变化均是需要关注的重要指标,从而促进其骨骼健康发育.     

多囊卵巢综合征子宫内膜胰岛素受体和胰岛素样生长因子-Ⅰ的表达与临床特征研究

目的:检测多囊卵巢综合征(PCOS)患者子宫内膜胰岛素受体(IR)、胰岛素样生长因子-Ⅰ(IGF-Ⅰ)的表达,研究其与PCOS患者性激素、血脂、胰岛素抵抗指数(HOMA)、体重指数(BM I)等临床特征的关系。方法:选取P-COS患者31例作为实验组,输卵管性不孕患者20例作为对照组。采用免疫组化方法检测子宫内膜IR、IGF-Ⅰ表达。用免疫法测定血清性激素、血脂、糖耐量葡萄糖试验(OGTT)、胰岛素释放试验(INS)。结果:实验组子宫内膜IR表达低于对照组,IGF-Ⅰ表达高于对照组。PCOS肥胖组IR低于非肥胖组,肥胖组IGF-Ⅰ表达高于非肥胖组;胰岛素抵抗组IGF-Ⅰ表达高于非胰岛素抵抗组。相关性分析发现IGF-Ⅰ表达与BM I、HOMA呈正相关。结论:PCOS患者子宫内膜IR表达低于正常妇女,但IGF-Ⅰ表达却增高。肥胖及胰岛素抵抗增加了IGF-Ⅰ在子宫内膜的表达。     

血清胸苷激酶1、血管内皮生长因子、糖类抗原19-9、可溶性间皮素相关肽在上皮性卵巢癌患者中的表达及临床意义分析

目的 探讨血清TK1、VEGF、CA19-9及SMRP在上皮性卵巢癌患者中的表达及临床意义.方法 选择2017年3月-2018年12月本院收治的80例上皮性卵巢癌患者作为研究A组,另将同期本院收治的86例卵巢良性肿瘤患者作为研究B组,同期选择70例健康女性纳入对照组.通过酶联免疫吸附试验测定3组血清TK1、VEGF及S...     

妊娠期糖尿病合并多囊卵巢综合征患者的不良临床结局分析

目的对妊娠期糖尿病(gestational diabetes mellitus,GDM)合并多囊卵巢综合征(polycystic ovary syndrome,PCOS)患者在妊娠过程中的临床不良结局进行分析,有助于对此类患者进行相关筛查、诊断及干预,减少不良并发症的发生。方法选取2014年1月至2016年1月在延安大学附属医院进行产前检查确诊为GDM的199例孕妇,其中102例PCOS患者纳入PCOS组,97例非PCOS患者为对照组。观察比较两组患者的妊娠结局(妊娠期高血压、子痫前期、早产、羊水过多及羊水过少、剖宫产率)和新生儿结局(新生儿体重、巨大胎儿、新生儿Apgar评分、新生儿黄疸、呼吸窘迫综合征及低血糖),并将两组患者中有统计学差异的指标进行Logistic回归分析。结果两组患者早产、羊水过多、羊水过少、剖宫产、新生儿体重、巨大胎儿、新生儿Apgar评分、新生儿黄疸及呼吸窘迫综合征的发生率比较,差异均无统计学意义(P0.05)。将有统计学差异的指标纳入Logistic回归分析发现:PCOS组中妊娠期高血压、子痫前期和新生儿低血糖的发生风险显著增高(P0.05)。结论PCOS增加GDM孕妇的妊娠期高血压、子痫前期和新生儿低血糖患病风险。