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 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 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 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 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 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 evaluate the clinical efficacy of concurrent chemoradiotherapy for cervical adenocarcinoma, and to analyze the treatment and evaluate the prognosis of patients with residual lesions after definitive radiotherapy.Methods:Clinical data of 109 patients with locally advanced cervical adenocarcinoma treated from January 2005 to February 2016 were analyzed retrospectively. The prescription dose of external irradiation was 50.4 Gy, 28 fractions, and the point A dose of brachytherapy was 30-36 Gy, 5-7 fractions. Cisplatin or paclitaxel was used as concurrent chemotherapy regimen. Clinical efficacy was evaluated after concurrent chemoradiotherapy. Patients with clinical partial remission (PR) after treatment might receive salvage surgery and/or chemotherapy and/or radiotherapy. The survival analysis was performed with Kaplan Meier method.Results:The median follow-up period was 48 months, and the 3-year and 5-year overall survival rates were 74.1% and 58.5%, respectively. After concurrent chemoradiotherapy, 72 patients (66.1%) achieved clinical complete remission, and 31 patients (28.4%) obtained PR. After receiving salvage treatment, the 3-year overall survival rate and progression-free survival rate of PR patients were 53.1% and 40.5%, respectively. Only 4 patients (3.7%) and 2 patients (1.8%) had grade 3 or greater urinary and gastrointestinal toxicity after definitive treatment.Conclusion:For patients with cervical adenocarcinoma who have clinical residual lesions after primary treatment, salvage treatment should be actively taken in order to improve survival outcomes.

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 determine the regional boundary of para-aortic lymph node (PAN) metastasis in cervical cancer, and to explore the clinical target volume (CTV) margin.Methods:Eight-six patients with cervical cancer metastasis to PAN below and above left renal vein (LRV) were retrospectively included in this study. The anatomical relationship of the metastatic PANs and surrounding structures were analyzed according tocontrast-enhanced computed tomography (CT) and three dimensional reconstruction images.Results:Eight-six patients had metastatic PANs belowLRV: metastatic nodes were located onthe medial side of ovarian vessels and ureters, behind the renal veins, duodenum, mesenteric vessels, in front of the anterior border of lumbar vertebra and psoas. The inferior mesenteric vein was close to the left anterior side of PANs. Where the duodenum appeared, no node was presenton the anterolateral side of the inferior vena cava (IVC).Above the LRV, 27 patients had retrocrural node involvement along the azygos and hemiazgos vein, and 25/27 cases were located below the junction level of cardia and oesophagus, and 5/27 patients had metastatic lymph nodes between IVC and the right crura of diaphragm, all below the level of coeliac trunk artery.Conclusions:CTV margin delineation of PAN below and above LRV is recommended:superiorly, the junction level of cardia and oesophagus; laterally, crura and the medial side of ovarian vessels and ureters and inferior mesenteric vein; anteriorly, the posterior side of the coeliac trunk artery and renal veins and duodenum, mesenteric vessels; posteriorly, the anterior border of lumbar vertebra and psoas.