Objective To study the clinical efficacy of both acupuncture combined with flames and simple acupuncture and moxibustion treatment of nerve root cervical spondylosis,so as to provide appropriate basis for the improvement of nerve root cervical spondylosis treatment. Methods A total of 60 cases of nerve root cervical spondylosis were enrolled for the study and randomly divided into two groups with the treatment of acupuncture combined with dragon moxibustion group(treatment group,n=30)and simple acupuncture group(control group,n=30). The clinical symptoms before and after treatment,and signs changes between the two groups were compared. Results Patients of both two groups showed significant im?provement after treatments(P<0.05);CSR simplify McGill Pain Scale scores inquiry(P<0.05). The total effective rate of the treatment group was 96.67%,which was 90.0%in the control group,with statistically significant difference(P<0.05). It indicated that the combined use of acupuncture and moxibustion therapy had better efficacy than simple acupuncture treatment. Conclusion The combined use of acupuncture and moxibustion therapy with flames in nerve root cervical spondylosis showed better clinical effect,which can be used as a preferred method of clinical treatment pro?grams.

Objective To observe the curative effect of pricking bloodletting combined with acupuncture on patients with piriformis injury syndrome.Methods A prospective randomized controlled clinical trial was conducted, 84 patients with piriformis injury syndrome admitted to the Department of Acupuncture and Massage in the First Affiliated Hospital of Xinjiang Medical University from May 2011 to May 2014 were enrolled, and they were divided into observation group and control group by random number table, each group being 42 cases. The patients in the observation group were treated with bloodletting once a week (after bloodletting no other treatment was given), and then once a day of acupuncture was performed for 4 days in a week, completing one therapeutic course; while in the control group, the patient was treated with routine acupuncture once a day for 5 days in a week, finishing one therapeutic course. The interval between two therapeutic courses was 2 days, two courses were carried out, and afterwards the clinical therapeutic effects were evaluated in the two groups. The changes of visual analogue scale (VAS) of two groups before and after treatment and the therapeutic effects were observed.Results The VAS score of the two groups after treatment was lower than that before treatment, and the degree of decrease of VAS score in the observation group was significantly lower than that of thecontrol group (1.50±1.35 vs. 2.69±1.68,P < 0.01); the total effective rate in the observation group was obviously higher than that in the control group [100.00% (42/42) vs. 69.05% (29/42),P < 0.01].Conclusion Pricking bloodletting combined with acupuncture therapy for treatment of piriformis injury syndrome can shorten the course of treatment.

Objective To observe the clinical efficacy of acupuncture combined with acupoint injection for treatment of patients with intractable hiccups and to seek its standard therapeutic regimen. Methods A prospective study was conducted. Eighty-six patients with intractable hiccups in various clinical departments in the First Affiliated Hospital of Xinjiang Medical University met the inclusion criteria of this study were selected,and according to the different treatment options they were divided into observation group and control group with 43 cases in each group. In the observation group,on the basis of treatment for their primary diseases,the rules of soothing the chest oppression and regulating the flow of qi(Kuanxiong Liqi)and regulating the stomach and sending down abnormally ascending qi(Hewei Jiangni)were followed in treatment,and acupuncture was carried out at Danzhong,Neiguan(double=bilateral acupoints),Zusanli(double),Sanyinjiao(double),Taichong(double)with the needle staying for 20 minutes each time,1 mL metoclopramide injection was injected at each of the bilateral Zusanli acupoints,once a day. In the control group,the patients received intramuscular injection of 10 mg metoclopramide once a day. Both groups were treated for consecutive 7 days. After treatment for 3 days and 5 days,the clinical efficacy was observed,and before treatment and after treatment for 3,5,7 days,the changes of hiccups frequency and persistent duration were investigated. Results Compared with the control group,the total effective rates in observation group on the 3rd and 5th day after treatment were significantly increased〔3 days:88.4%(38/43)vs. 51.2%(22/43),5 days:95.3%(41/43)vs. 62.8%(27/43),both P<0.01〕. With the prolongation of therapy,the hiccups frequency was gradually decreased and the persistent duration of hiccup was gradually shortened,reaching the lowest degree on the 7th day after treatment,and the changes were more significant in the observation group〔hiccups frequency(times/day):0.57±0.08 vs. 2.04±1.78,hiccup duration time(minutes/time):1.07±0.68 vs. 9.23±5.69,both P<0.05〕. Conclusion The therapeutic effects of acupuncture combined with acupoint injection for treatment of patients with intractable hiccups are superior to signal western medicine therapy.

Objective To explore the effect of puncture the left or right branch of portal vein on the incidence of postoperative hepatic encephalopathy in transjugular intrahepatic portosystemic shunt (TIPS). Methods A literature search was conducted through investigating PubMed, Cochrane Library, CNKI digital library and Wanfang databases. Randomized controlled trials and cohort studies related to the effect of puncture the left or right branch of portal vein on the incidence of postoperative hepatic encephalopathy in TIPS were included in this review. According to the methods for Cochrane systematic review, the data were extracted, the quality of the literatures was evaluated, statistical analysis was conducted and the data were analyzed with RevMan 5.0. Results One randomized controlled trial and four cohort studies, including 552 patients with liver cirrhosis received TIPS, were finally included in this review. Random-effects model meta-analysis showed that puncture of the left branch of portal vein in TIPS caused lower incidence of postoperative hepatic encephalopathy than puncture of the right branch of portal vein (RR=0.51, 95%CI was 0.39 to 0.66, P<0.01). Conclusion Puncture of the left branch of portal vein in TIPS can significantly reduce the incidence of postoperative hepatic encephalopathy in comparison with puncture of the right branch of portal vein.

Objective To investigate the consensus and controversies on delineation of radiotherapy target volume for patients with non-small cell lung cancer(NSCLC). Methods Study questionnaires were designed by radiation oncologists in Peking University School of Oncology. The forms were sent through email to radiation oncologists in 10 radiation departments in China and 2 departments in US in November,2007. The brief introduction and PET/CT digital data of one patient with NSCLC were sent to radiation oncologists in 10 departments in Beijing. On Jan. 12,2008,the case discussion was held by more than 300 radiation oncologists from Beijing,Tianjin, Hebei, Liaoning Province and Inner Mongolia Autonomous Region. Results All receivers of the questionnaire responded . The set up error was 5-7 mm . For patients with locally advanced NSCLC treated with radiotherapy concurrently with near full dose chemotherapy,ll out ot 12 responding departments defined planning target volume(PTV) of primary tumor as gross tumor volume(GTV) plus 6-8 nun plus set-up error and respiratory movements ,and only one defined PTV as GTV plus set-up error and respiratory movements. For PTV of the mediastinal lymph nodes in the same patient,9 out of 12 responding departments defined PTV as GTV plus 6-8 mm plus set-up error and respiratory movements,and 3( of China) out of 12 defined PTV as GTV plus set-up error and respiratory movements. Stereotactic body .radiotherapy with high fraction dose was used in 11 out of 12 responding departments with fraction dose varying from 6 to 20 Gy,including 6 of which defined PTV of primary tumor as GTV plus 6-8 mm plus respiratory movements and set-up error, and 5 defined PTV of early stage lung cancer as GTV plus respiratory movements and set-up error. The consensus on delineation of primary tumor of the case discussion was that the appropriate window width and window level were 1600 Houasfield Units(HU) and -600 HU for lung window,and 400 HU and 20 HU for mediastinal window. The controversies was focused on whether the CTV for metastatic lymph nodes should be restricted as GTV plus 6-8 mm or enlarged to enclose all the involved lymph node region. Conclusions PIT of primary tumor and mediastinal metastatic lymph nodes should be GTV plus 6-8 mm plus respiratory movements plus set-up error. The basic controversies of target delineation are focused on the fraction dose and PIT range for early stage NSCLC, and on the possibility of defining the PIT as GTV plus respiratory movements and set-up error when treated with concurrent radiotherapy and full dose chemotherapy for locally advanced NSCLC.

Objective:To investigate the clinical efficacy and prognosis of transjugular intrahepatic portosystemic shunt (TIPS) and drug combined with endoscopic treatment in patients with liver cirrhosis and esophagogastric variceal bleeding (EGVB).Methods:From January 2012 to December 2013, at the First Affiliated Hospital of Xi′an Jiaotong University, the data of 147 patients with liver cirrhosis and EGVB undergoing TIPS or drug combined with endoscopic treatment were retrospectively collected, with 87 cases in TIPS treatment group and 60 in drug combined with endoscopic treatment group.The 5 years follow-up data were analyzed, and the overall survival rates, rebleeding-free survival rates and hepatic encephalopathy-free survival rates at 6 weeks, 1 year, 2 years and 5 years after treatment of two groups were compared. Independent sample t test, Mann-Whitney U test, chi-square test, Fisher exact test, Z test, log-rank test and trend test were used for statistical analysis. Results:There were no significant differences in age, gender, etiology, Child-Pugh classification, initial liver function, coagulation function, liver ascites, previous history of hepatic encephalopathy, blood pressure and preoperative blood transfusion history between the TIPS treatment group and combination of drugs and endoscopy treatment group (all P>0.05). Forty-one patients died within 5 years, of which 20 (48.8%) died of rebleeding and 6 (14.6%) died of hepatic encephalopathy. There were no significant differences in 6-week, 1-year and 2-year overall survival rates between the TIPS group and drug combined with endoscopic treatment group (all P>0.05), however the 5-year overall survival rate of the TIPS treatment group was higher than that of the drug combined with endoscopic treatment group (78.4% vs. 63.2%), and the difference was statistically significant ( Z=2.06, P=0.048). The 6-week, 1-year, 2-year, 5-year rebleeding-free survival rates of the TIPS group were 97.7%, 96.5%, 88.9% and 70.9%, respectively, which were all higher than those of the drug combined with endoscopic treatment group (86.7%, 53.3%, 43.3% and 27.1%), and the differences were statistically significant ( Z=2.35, 6.39, 6.26 and 4.80, all P<0.05). There were no significant differences in hepatic encephalopathy-free survival rates at 6 weeks, 1 year and 2 years after treatment between the TIPS group and drug combined with endoscopic treatment group (all P>0.05), however the 5-year hepatic encephalopathy-free survival rate of the TIPS treatment group was lower than that of the drug combined with endoscopic treatment group (67.7% vs. 86.7%), and the difference was statistically significant ( Z=2.28, P=0.030). The lower the Child-Pugh classification, the higher the cumulative 5-year survival rate ( χ2=6.75, P<0.01). There was no statistically significant difference in the 5-year overall survival rate in patients with the same Child-Pugh classification between the TIPS group and the drug combined with endoscopic treatment group (all P>0.05). Conclusions:The efficacy of TIPS is better than that of the drug combined with endoscopic treatment in treating EGVB. Even the long-term risk of hepatic encephalopathy of TIPS is higher, the short-term, middle-term and long-term rebleeding rate are decreased. Patients with Child-Pugh grade C do not need to avoid TIPS when choosing the treatment, the earlier the TIPS used, the better survival benefit will be obtained.

Objective To compare the effects of different stent configurations on shunt failure,hepatic encephalopathy,and hepatic myelopathy after transjugular intrahepatic portosystemic shunt (TIPS).Methods From March 2014 to June 2015,the clinical data of 73 hospitalized,patients who met the inclusion and exclusion criteria,and underwent TIPS for upper gastrointestinal hemorrhage caused by cirrhotic portal hypertension were retrospectively analyzed.According to the stent configuration during operation,patients were divided into simple coated stent group (hepatic vein,portal vein and hepatic parenchyma coated stent,23 cases),simulated Viatorr stent group (hepatic vein and hepatic parenchyma coated stent plus portal vein bare stent,27 cases) and combined stent group (hepatic vein and portal vein hare stent plus hepatic parenchyma coated stent,23 cases).Patients were followed up for one year,the incidences of shunt failure,hepatic encephalopathy and hepatic myelopathy within one year after TIPS of three groups were compared.Chi-square test,Fisher exact probability method and variance analysis were performed for comparison among groups.Cox regression analysis was used for difference analysis in imbalance of variables and incidence of outcome events among the three groups.Results The portal vein pressure gradient of simple coated stent group,simulated Viatorr stent group and combined stent group decreased from (22.15±4.52),(23.01±5.48) and (21.13±4.49) mmHg (1 mmHg=0.133 kPa) to (9.15±2.94),(11.20±3.27) and (8.75+4.06) mmHg after operation,respectively.Before and after operation,the differences in portal venous pressure gradient were statistically significant of three groups (t=10.488,7.188 and 7.850,all P＜0.05).The shunt failure rates of simple coated stent group,simulated Viatorr stent group and combined stent group were 13.0％ (3/23),18.5％ (5/27) and 30.4％ (7/23),respectively.The results of Cox regression analysis indicated that there was no statistically significant difference in shunt failure rates among different stent configurations after TIPS (P=0.339).The incidences of hepatic encephalopathy of simple coated stent group,simulated Viatorr stent group and combined stent group postoperative were 69.6％ (16/23),33.3％ (9/27) and 30.4％ (7/23),respectively,the difference was not statistically significant among the three groups (P＞ 0.05).The results of Cox regression analysis showed that the relative ratio values (95％ confidence interval) of incidence of postoperative hepatic encephalopathy of simple coated stent group compared with simulated Viatorr stent group and combined stent group were 2.901 (1.279 to 6.584) and 2.735 (1.123 to 6.658),and the differences were statistically significant (both P＜0.05).The incidences of hepatic myelopathy of simple coated stent group,simulated Viatorr stent group and combined stent group were 8.7％ (2/23),3.7％ (1/27) and 4.3％ (1/23),respectively,and there was no statistically significant difference in the incidence of hepatic myelopathy among three groups after operation (P＞0.05).During one-year follow-up,among 73 patients,two patients died,one in simple coated stent group and the other in combined stent group.The one-year survival rate after TIPS was 97.3％.Conclusions One year after operation,the incidences of shunt failure are similar between simple coated stent group,simulated Viatorr stent group and combined stent group.One year after operation,the incidence of hepatic encephalopathy is similar between simulated Viatorr stent group and combined stent group which are both lower than that of simple coated stent.The incidence of hepatic myelopathy is low,and its association with TIPS remains to be further investigated.

OBJECTIVE: To compare patient survival outcomes between completion hysterectomy and conventional surveillance in locally advanced adenocarcinoma of the cervix after concurrent chemoradiotherapy (CCRT). METHODS: Patients with adenocarcinoma of the cervix after CCRT were identified in a tertiary academic center database from 2004 to 2018. Patients received completion hysterectomy or surveillance after CCRT. We compared the progression-free survival (PFS) and overall survival (OS) between the patients with or without adjuvant hysterectomy. Surgery features, operative complications, and pathologic characteristics were documented. Patient outcomes were also analyzed according to clinicopathologic factors. RESULTS: A total of 78 patients were assigned to completion surgery and 97 to surveillance after CCRT. The PFS was better in the surgery group compared to the CCRT only group, at 3 years the PFS rates were 68.1% and 45.2%, respectively (hazard ratio [HR]=0.46; 95% confidence interval [CI]=0.282–0.749; p=0.002). Adjuvant surgery was also associated with a higher rate of OS (HR=0.361; 95% CI=0.189–0.689; p=0.002), at 3 years, 87.9% and 67%, respectively. Tumor stage, size, lymph-vascular space invasion (LVSI), lymphadenopathy were associated with PFS but not with OS. Hysterectomy specimens revealed 64.1% (50/78) of the patients had pathologic residual tumor. Patients age less than 60, tumor size over 4 cm, stage IIB and persistent residual disease after CCRT were most likely to benefit from hysterectomy. Hysterectomy was associated with a lower rate of locoregional recurrence but did not reach statistical significance (5.13% vs. 13.5%, p=0.067). CONCLUSION Completion hysterectomy after CCRT was associated with better survival outcome compared with the current standard of care.

OBJECTIVE: To compare patient survival outcomes between completion hysterectomy and conventional surveillance in locally advanced adenocarcinoma of the cervix after concurrent chemoradiotherapy (CCRT).METHODS: Patients with adenocarcinoma of the cervix after CCRT were identified in a tertiary academic center database from 2004 to 2018. Patients received completion hysterectomy or surveillance after CCRT. We compared the progression-free survival (PFS) and overall survival (OS) between the patients with or without adjuvant hysterectomy. Surgery features, operative complications, and pathologic characteristics were documented. Patient outcomes were also analyzed according to clinicopathologic factors.RESULTS: A total of 78 patients were assigned to completion surgery and 97 to surveillance after CCRT. The PFS was better in the surgery group compared to the CCRT only group, at 3 years the PFS rates were 68.1% and 45.2%, respectively (hazard ratio [HR]=0.46; 95% confidence interval [CI]=0.282–0.749; p=0.002). Adjuvant surgery was also associated with a higher rate of OS (HR=0.361; 95% CI=0.189–0.689; p=0.002), at 3 years, 87.9% and 67%, respectively. Tumor stage, size, lymph-vascular space invasion (LVSI), lymphadenopathy were associated with PFS but not with OS. Hysterectomy specimens revealed 64.1% (50/78) of the patients had pathologic residual tumor. Patients age less than 60, tumor size over 4 cm, stage IIB and persistent residual disease after CCRT were most likely to benefit from hysterectomy. Hysterectomy was associated with a lower rate of locoregional recurrence but did not reach statistical significance (5.13% vs. 13.5%, p=0.067).CONCLUSION: Completion hysterectomy after CCRT was associated with better survival outcome compared with the current standard of care.
Adenocarcinoma ; Cervix Uteri ; Chemoradiotherapy ; Disease-Free Survival ; Female ; Humans ; Hysterectomy ; Lymphatic Diseases ; Neoplasm, Residual ; Recurrence ; Standard of Care ; Uterine Cervical Neoplasms

Objective To investigate the quality of life, sexual quality of life and its influencing factors in cervical cancer patients undergoing radiotherapy. Methods Pre-menopausal patients of 87 cases were diagnosed with cervical cancer treated with radiotherapy at Peking Union Medical College Hospital from December 2013 to December 2018 were recruited in this study. The functional assessment of cancer therapy-cervix ( FACT-Cx V4. 0) and the female sexual function index ( FSFI) were evaluated. Demographic and treatment data were collected. The influencing factors were analyzed by multiple linear regression analysis. Results The total score of quality of life was 114( 100-126) , 19( 16-21) for physiology, 21( 18-24) for social/family, 19( 17-21 ) for emotion, 19 ( 14-22 ) for function and 39 ( 34-43 ) for additional attention, respectively. The end time of radiotherapy was the influencing factor of the total score ( P= 0.034 ) , physiology ( P=0) and function ( P=0.008) . Family was the influencing factor of social family dimension ( P=0.010) . The total score of FSFI was 8.0( 5.0-20.5) , 1.8( 1.2-3.0) for sexual desire, 1.5( 0-2.7) for sexual arousal, 0.3( 0-3.6) for vaginal lubrication, 0( 0-3.6) for orgasm, 3.2( 2-4) for satisfaction and 0( 0-3.6) for sexual pain, respectively. The total score was less than 27 in 97%( 84/87) of the patients and had sexual dysfunction. Age was the influencing factor of sexual arousal ( P=0.005) and vaginal lubrication ( P=0.039) . Occupation was the influencing factor of sexual pain ( P=0.004) . Conclusions The quality of life of premenopausal patients with cervical cancer is affected by multiple factors. Radiotherapy-related complications should be actively treated to improve the quality of life and sexual life of patients.