A randomized trial of diet and physical activity in women treated for stage II–IV ovarian cancer: Rationale and design of the Lifestyle Intervention for Ovarian Cancer Enhanced Survival (LIVES): An NRG Oncology/Gynecologic Oncology Group (GOG-225) Study

Ovarian cancer is the most common cause of gynecological cancer death in United States women. Efforts to improve progression free survival (PFS) and quality of life (QoL) after treatment for ovarian cancer are necessary. Observational studies suggest that lifestyle behaviors, including diet and physical activity, are associated with lower mortality in this population. The Lifestyle Intervention for Ovarian Cancer Enhanced Survival (LIVES) NRG 0225 study is a randomized, controlled trial designed to test the hypothesis that a 24 month lifestyle intervention will significantly increase PFS after oncological therapy for stage II-IV ovarian cancer. Women are randomized 1:1 to a high vegetable and fiber, low-fat diet with daily physical activity goals or an attention control group. Secondary outcomes to be evaluated include QoL and gastrointestinal health. Moreover an a priori lifestyle adherence score will be used to evaluate relationships between adoption of the diet and activity goals and PFS. Blood specimens are collected at baseline, 6, 12 and 24 months for analysis of dietary adherence (carotenoids) in addition to mechanistic biomarkers (lipids, insulin, telomere length). Women are enrolled at NRG clinic sites nationally and the telephone based lifestyle intervention is delivered from The University of Arizona call center by trained health coaches. A study specific multi-modal telephone, email, and SMS behavior change software platform is utilized for information delivery, coaching and data capture. When completed, LIVES will be the largest behavior-based lifestyle intervention trial conducted among ovarian cancer survivors.     

乳腺癌去势照射卵巢定位的临床研究

目的 探讨乳腺癌去势照射卵巢定位的临床研究。方法 收集1982年10月～2003年10月136例乳腺癌患者在B超引导下卵巢定位的临床资料。结果 甲组68例，照射结束后，2～6个月复查全部停经；乙组68例，于照射后，1个月复查，月经停止21例，2～6个月复查停经28例，仍有19例有月经。结论 每次放射之前必须充盈膀胱，以确保卵巢放置在首次B超定位时画定的投影范围内。     

Fatigue and Its Associated Factors in Ambulatory Cancer Patients: A Preliminary Study

Although fatigue is considered to be one of the major causes of distress among cancer patients, little is known about its association with other factors, such as demographic, medical, and psychosocial factors. A total of 455 ambulatory cancer patients completed the Profile of Mood States (POMS) scale, which includes a fatigue subscale. Other information was obtained in an interview. The results of a multiple regression analysis suggested that sex, education, employment status, the size of the household, the performance status, and depressive mood were associated with fatigue. Our findings reveal that the fatigue experienced by cancer patients may be determined by multiple factors, including demographic, physical, and psychological factors.     

妇科恶性肿瘤术后化疗患者生存质量及心理健康状况的纵向调查

目的纵向调查妇科恶性肿瘤术后化疗患者不同时间点的生存质量、心理健康状况变化及其影响因素。方法采用便利抽样法,选取2013年5-11月山东省某三级甲等医院妇科恶性肿瘤术后化疗患者35例,分别于术后1周及术后1、3、6个月利用欧洲生存质量量表(EuroQol-5Dquestionnaire,EQ-5D)与凯斯勒心理疾患量表(Kessler 10)对其身心健康状况进行纵向评价。结果妇科恶性肿瘤术后化疗患者不同时间点的心理健康状况(F=2.90,P0.05)及自评健康状况(F=6.88,P0.01)差异均有统计学意义;多因素分析显示,教育程度、职业类型及自评健康得分是妇科恶性肿瘤术后化疗患者心理健康状况的独立影响因素,而术后时间、婚姻状况及Kessler 10得分是患者生存质量的独立影响因素。结论妇科恶性肿瘤术后化疗患者的生存质量和心理健康状况呈动态变化,且受多种因素的影响;医护人员在临床治疗及出院后延续护理中应针对风险因素,并根据患者所处的心理阶段采取积极有效的干预措施,使患者处于最佳身心状态,提高治愈率和生存质量。     

10年间卵巢上皮性癌的治疗及预后因素分析

目的：探讨本院90年代卵巢上皮性癌的治疗与预后影响因素。方法：对1990年1月至1999年12月在我院治疗的294例卵巢上皮性癌进行回顾性分析。全部手术切除标本经病理诊断并按FIGO分期标准分期。294例全部经手术治疗。其中58例经2－4次手术。结果：3年，5年及10年的生存率分别为I期92．1％，86．8％及82．1：II期79．9％，65．4％及52．3％，III期54．8％，37．2％，及20．8％（P＜0．005），3例未化疗者均在术后2年内死亡。COX回归模型单，多因素分析发现，上皮性癌的预后与年龄，病理类型的关系不大（P＞0．05），而与临床分期，细胞分级，术后残留癌灶大小有关（P＜0．005），化疗疗程≥6次与不足6次相比，相对风险率为0．7456，死亡风险概率降低0．25，残留癌灶小于等于2厘米与＞2厘米者相比，相对风险度为0．3261，死亡风险概率降低0．67，结论：临床分期、细胞分级、术后残留癌灶大小及化疗疗程是否≥6疗程是影响卵巢癌预后的主要因素。晚期卵巢上皮性癌的预后近10年有所改善，初次手术时要尽量切净，使残留癌灶＜2厘米，术后尽早正规，足量，足疗程化疗，可提高生存率，对复化转移者，只要能切除者尽量切除，术后再次化疗或加放疗等综合治疗仍可提高生存率。     

保留卵巢功能的卵巢肿瘤手术的临床研究

目的探讨对卵巢肿瘤患者行保留卵巢功能手术的可行性及其意义.方法回顾分析我院接受保留卵巢功能手术的71例卵巢肿瘤患者的临床资料.对双侧良性肿瘤行剜除术,肿瘤较大者行全肿瘤切除,保留卵巢皮质部分健康组织;对恶性肿瘤根据患者年龄、生育要求、肿瘤临床分期、病理类型及随访条件等确定选择保留卵巢功能手术,术后均加用化疗.结果术后90%患者按月行经,72%患者妊娠分娩,97%的良性肿瘤临床完全治愈,90%的恶性肿瘤临床完全缓解.结论对于卵巢肿瘤施行保留卵巢功能的手术是可行,且有效,但要严格掌握手术指征.     

A Comparison of Quality-of-Life in Patients with Dual Chamber Pacemakers and Individually Programmed Atrioventricular Delays

Dual chamber pacemakers are increasingly implanted to achieve optimal hemodynamics by AV synchrony, but the effect of AV delay programming on the patient's quality-of-life has been less well studied. The influence of an individually programmed AV delay between 100 and 250 ms on quality-of-life was investigated in a randomized, double-blind crossover study of 13 patients (69 ± 10 years of age) with dual chamber pacemakers implanted because of high degree AV block. During radionuclide ventriculography at rest, the "optimal AV delay" with the maximal left ventricular ejection fraction and the "most unfavorable AV delay" with the least ejection fraction were determined. The ejection fraction at rest with the "optimal AV delay" was 51%± 10%, and with the "most unfavorable AV delay," 44%± 11% (P < 0.0001). The optimal AV delay determined by radionuclide ventriculography correlated well with the optimal AV delay determined by Doppler echocardiography using flow velocity integrals (r = 0.78, P < 0.0016). Each patient was assigned in random order to either AV delay during a 2-week period and then the pacing mode was switched for another 2-week period. At the end of each period, patients were assessed by a functional status questionnaire to assess physical capability and two further questionnaires to quantify cardiovascular symptoms or self-perceived health. There were no differences in the two AV delays regarding the patient's perceived physical capability and specific symptoms. The patient's total judgment was identical to the optimal AV delay (score 36%± 19%) and the most unfavorable AV delay (33%± 21%). Thus, in patients with a dual chamber pacemaker, an individually programmed AV delay affects left ventricular function at rest, but has no influence on quality-of-life. The determination of the flow velocity integral by Doppler echocardiography is a simple and reliable method to optimize the AV delay if necessary.     

60例妇科癌症患者疼痛的护理体会

目的:探讨妇科癌症患者疼痛的护理措施。方法:60例妇科癌症患者随机分为常规护理、特殊护理,观察疼痛治疗效果。结果:特殊护理患者疼痛缓解明显。结论:护理干预能改善患者疼痛。     

卵巢癌患者外周血细胞粘附分子水平测定的临床意义

目的：探讨卵巢癌患者外周血可溶性细胞粘附分子CD29和CD44变化及其意义。方法：采用流式细胞仪技术检测40例卵巢癌患者外周血可溶性细胞粘附分子CD29和CD44表达。结果：卵巢癌患者外周血可溶性细胞粘附分子CD29和CD44表达显著增加。结论：卵巢癌患者外周血可溶性细胞粘附分子CD29和CD44的水平对卵巢癌的临床分期具有一定的临床价值。     

Nutritional Aspect of Cancer Care in Medical Oncology Patients

PurposeAwareness of advances in the nutritional aspects of cancer care and translation of this information into clinical practice are important for oncology practitioners to effectively couple oncologic and nutritional approaches throughout the cancer journey. The goal of this consensus statement by a panel of medical oncologists was to provide practical and implementable guidance addressing nutritional aspects of cancer care from the perspective of the medical oncologist.MethodsA panel of medical oncologists agreed on a series of statements supported by scientific evidence and expert clinical opinion.FindingsParticipating experts emphasized that both poor nutritional intake and metabolic alterations underlie cancer-related malnutrition. The use of liquid and high energy-dense oral nutritional supplements may enable better patient compliance, whereas higher efficacy is more likely with the use of pharmaconutrient-enriched oral nutritional supplements in terms of improved weight, lean body mass, functional status, and quality of life, as well as better tolerance to antineoplastic treatment. A multimodal approach is currently believed to be the best option to counteract the catabolism leading to cancer-related malnutrition; this treatment is scheduled in parallel with anticancer therapies and includes nutritional interventions, multitarget drug therapies, and exercise and rehabilitation programs. Participating experts emphasized the role of the oncologist as a reference professional figure in the coordination of nutritional care for patients with cancer within the context of complex and different clinical scenarios, particularly for permissive-adjunctive nutritional support.ImplicationsThis review article provides practical guidance addressing major nutritional aspects of cancer care from the medical oncologist's perspective. Thus, this document is expected to assist oncology practitioners in terms of awareness of advances in the nutritional aspects of cancer care and translation of this information into their clinical practice to effectively couple oncologic and nutritional approaches as part of the continuum of care for patients with cancer.     

卵巢癌患者复发恐惧影响因素及干预措施研究进展

卵巢癌在我国的发病率持续升高,患者复发恐惧处于较高水平.本文归纳了卵巢癌患者复发恐惧的影响因素,包括人口社会学因素、临床特征、治疗手段、应对方式、社会支持,总结了认知-存在团体疗法和支持性团队表达疗法两种护理干预措施的研究现状,旨在为帮助卵巢癌患者降低复发恐惧水平、提高护理质量提供参考依据.     

年轻宫颈癌患者保留卵巢功能的研究进展

宫颈癌是最常见的妇科恶性肿瘤之一，发病率在近几年明显上升，发病年龄日趋年轻化。目前国内早期宫颈癌的治疗选择主要是手术和放疗，放疗对宫颈癌疗效好，但放射线辐射损伤卵巢和宫颈癌根治术时切除双侧卵巢常导致卵巢功能衰竭或丧失。现代妇科肿瘤治疗强调以人为本、合理治疗，在延长患者生存时间、提高生活质量的同时，应尽可能保留其女性生理功能。因此，保留年轻宫颈癌患者的卵巢功能，提高术后生活质量一直是学者们关注的热点。现综述如下。     

初诊妇科恶性肿瘤患者支持性照顾需求现状及影响因素

目的探讨初诊妇科恶性肿瘤患者支持性照顾需求现状及其影响因素。方法 2014年6-11月采取便利抽样法选择重庆市3所三级甲等医院的初诊妇科恶性肿瘤患者100例,进行癌症患者支持性照顾需求问卷调查。结果初诊妇科恶性肿瘤患者总体支持性照顾需求得分为(107.78±26.45)分,条目均分为(1.82±0.45)分,其中健康信息需求程度最高;多元线性回归分析提示,治疗阶段、年龄、文化程度和经济收入是初诊妇科恶性肿瘤患者支持性照顾需求的独立影响因素(R2=0.485)。结论初诊妇科恶性肿瘤患者支持性照顾需求水平较高,且受患者年龄、文化程度、经济收入及治疗阶段等的影响,医务人员应予以重视并为其提供针对性帮助。     

肿瘤患者PICC置管相关静脉血栓形成危险因素Meta分析

目的 通过Meta分析明确肿瘤患者PICC置管相关静脉血栓形成的危险因素,为预防及降低肿瘤患者PICC置管相关静脉血栓形成提供参考依据。方法 在中国期刊全文数据库（CNKI）、中国生物医学文献数据库（CBM）、万方数据库、维普数据库、百度文库、PubMed、EMbase、Web of Science、Medline、Cochrane中进行文献检索,检索时间为开始收录时间起到2018年11月并进行文献质量评价,应用Stata 13.0对国内外有关肿瘤患者PICC置管相关静脉血栓形成危险因素的病例对照研究及队列研究进行Meta分析,用 Egger线性回归法判定发表偏倚。结果 共纳入18篇文献,总病例6 425例,病例组/暴露组825例,对照组/非病例组5 600例。危险因素合并OR 值分别为：年龄≥60岁2.560（95%CI：1.653~3.967）、超重或肥胖3.552（95%CI：2.103~5.998）、合并高血压2.041（95%CI：1.302~3.200）、合并糖尿病2.021（95%CI：1.695~2.409）、PICC置管史2.188（95%CI：1.204~3.976）、置管期间放疗4.308（95%CI：1.901~9.763）、活动量少4.559（95%CI：1.035~20.085）、感染2.748（95%CI：1.397~5.408）、肿瘤分期为Ⅲ~Ⅳ期2.746（95%CI：1.643~4.589）、肿瘤转移4.023（95%CI：1.895~8.544）。Egger线性回归法分析显示,活动量少、肿瘤转移、置管期间放疗存在一定发表偏倚。结论 年龄≥60岁、超重或肥胖、合并高血压、合并糖尿病、PICC置管史、感染、肿瘤分期为Ⅲ~Ⅳ期为肿瘤患者PICC置管相关静脉血栓形成的危险因素,活动量少、肿瘤转移、置管期间放疗作为肿瘤患者PICC置管相关静脉血栓的危险因素的证据尚不充分。应对肿瘤患者中存在的可改变危险因素进行早期干预,加强监测不可改变危险因素。     

卵巢癌患者组织中miR-135b的表达及临床意义

目的 探讨miR-135b在卵巢癌组织中的表达及意义。方法 选取2015年1月～2017年12月在解放军第一七四医院和南方医科大学深圳医院接受手术的卵巢病变患者的卵巢组织,包括28例卵巢癌组织和10例卵巢良性肿瘤组织,所有的组织均经过病理确认。运用荧光定量PCR(RT-PCR)的方法检测28例卵巢癌及10例卵巢良性肿瘤组织中miR-135b的表达水平,并分析其与卵巢癌患者年龄、组织学类型、分化程度、临床分期及淋巴结转移的关系。结果 ①28例卵巢癌组织中miR-135b 的表达量(1.90± 0.53)与10例卵巢良性肿瘤组织中miR-135b表达量(1.45±0.45)比较,差异有统计学意义(t=2.03,P<0.05); ②19例≥50岁卵巢癌患者组织中miR-135b的表达量(1.97±0.51)和20例浆液性囊腺癌组织中miR-135b的表达量(1.96±0.50)分别与9例<50岁卵巢癌患者组织中miR-135b的表达量(1.77±0.57)和8例黏液性腺癌组织中miR-135b的表达量(1.77±0.61)比较,差异均无统计学意义(t=0.743～0.846,均P<0.05)。20例中低分化组织中miR-135b的表达量(2.05±0.54),17例临床分期Ⅲ～Ⅳ期组织中miR-135b的表达量(2.10±0.46)和15例有淋巴结转移的组织中miR-135b的表达量(2.10±0.53)均分别高于8例高分化组织中miR-135b的表达量(1.55±0.25),11例临床分期I～II组织中miR-135b的表达量(1.60±0.49)和13例无淋巴结转移的组织中miR-135b的表达量(1.68±0.44)比较,差异均有统计学意义(t=5.036～7.517,均P<0.05)。结论 miR-135b在卵巢癌组织中高表达,miR-135b 的表达水平与卵巢癌的分化程度、临床分期和淋巴结转移有关。