Objective To investigate the efficacy of postoperative concurrent chemoradiotherapy for early-stage cervical adenosquamous carcinoma and adenocarcinoma.Methods A total of 62 patients with cervical adenosquamous carcinoma,149 patients with cervical adenocarcinoma,and 2687 patients with cervical squamous cell carcinoma,all of whom were in stage Ⅰ B-Ⅱ A and were treated from 2006 to 2012,were enrolled,and some of them received postoperative pelvic radiotherapy ± para-aortic extended field radiation ±afterloading radiotherapy.The chemotherapy regimen consisting of DDP,TP,and FP was given to these patients.The chi-square test was used for comparison of general clinical data,the Kaplan-Meier method was used for calculating survival rates,and the log-rank test was used for survival difference analysis.Results Cervical adenosquamous carcinoma and adenocarcinoma had no significant differences in clinicopathological features (P=0.107-0.639).The high-risk patients with adenocarcinoma had a higher recurrence rate than their low-risk counterparts even after adjuvant radiotherapy or chemoradiotherapy (P=0.000).In the patients treated with surgery and radiotherapy,those with adenosquamous carcinoma had the shortest median survival time,followed by those with adenocarcinoma and squamous cell carcinoma (P =0.134,0.787);in the patients treated with surgery and concurrent chemoradiotherapy,those with adenocarcinoma had the shortest median survival time,followed by those with adenosquamous carcinoma and squamous cell carcinoma (P=0.131,0.643),and the median survival time showed a significant difference between the patients with adenocarcinoma and those with squamous cell carcinoma (P =0.000).In the patients with adenosquamous carcinoma and adenocarcinoma,the patients treated with postoperative concurrent chemoradiotherapy had higher incidence rates of short-term adverse reactions than those treated with postoperative radiotherapy (P=0.037,0.003),but the incidence rates of long-term adverse reactions showed no difference between the two groups of patients (P=0.861,0.655).In the patients with adenosquamous carcinoma,the patients treated with postoperative concurrent chemoradiotherapy had a lower rate of distant metastasis (P =0.003) and prolonged median overall survival and disease-free survival (both increased by 17 months) (P=0.811,0.799),as compared with those treated with postoperative radiotherapy,while in the patients with adenocarcinoma,the median overall survival and disease-free survival were reduced by 11 and 9 months,respectively (P=0.330,0.115).Conclusions Compared with postoperative radiotherapy,postoperative concurrent chemoradiotherapy for early-stage high-risk cervical adenosquamous carcinoma can reduce the rate of distance metastasis.Compared with radiotherapy,postoperative concurrent chemoradiotherapy for adenosquamous carcinoma and adenocarcinoma cannot improve survival time.

Objective To investigate the effects of numerous re-planning strategies on the anatomic and dosimetric outcomes of target volume and organs at risk (OARs) in patients with head and neck cancer receiving fractionated radiotherapy.Methods From 2015 to 2016,28 patients with head and neck cancer were enrolled in this study with Shandong Cancer Hospital,consisting of 19 patients with nasopharyngeal carcinoma, 4 patients with laryngocarcinoma, and 5 patients with carcinoma of the maxillary sinus.All of them received conventionally fractionated radiotherapy.Each patient had six weekly cone-beam CT (CBCT) scans, which were performed on the first day of every week, to obtain reference images.A virtual CT image was generated by registration of planning CT and each weekly CBCT image.The four re-planning strategies were used for the reconstruction of re-planned dose, while the initial planning was used as a reference.The weekly doses calculated using virtual CT were summed together to obtain the actual dose.The actual and initial planned doses were evaluated.The nonparametric Friedman test was used to evaluate the differences between multiple groups, and the differences between any two groups were analyzed by paired t test.Results The sizes of planning target volume, clinical target volume, and left/right parotid glands (PGs) changed significantly within the six weeks (P=0.041, 0.046, 0.024, and 0.017, respectively).For these four re-planning strategies, there were significant differences between the actual dose and the initial planned dose to the PGs (all P<0.05), with average values decreased by 5.02%, 11.17%, 12.08%, and 13.19%, respectively, compared with that in the reference strategy.Conclusions Re-planning during treatment course could ensure the sparing of OARs and allow for sufficient dose to the target volume.The higher the number of re-planning strategies, the more the actual dose is close to the initial planed dose;the efficiency of two re-planning strategies is the highest.

Objective To study the difference between intensity-modulated radiation therapy (IMRT) and three dimensional conformal radiation therapy (3D-CRT) for pelvic radiation of post-operative treatment with gynecologic malignant tumor. Methods A prospective investigation study was conducted on 183 patients of post-operative patients with whole pelvic radiation therapy of cervical cancer or endometrial cancer in Zhejiang Cancer Hospital [IMRT group (n=85) and 3D-CRT group (n=98)] from Oct. 2015 to Oct. 2016. The two groups received same dose (45 Gy in 25 fractions). Comparison of two groups with radiation dosimetry:the score according to the Radiation Therapy Oncology Group (RTOG) acute radiation injury grading standards before and after radiotherapy reaction, the score from functional assessment of cancer therapy scale-cervix (FACT-Cx) scale and expanded prostate cancer index composite for clinical practice (EPIC-CP) scale were also analyzed. Results (1) There were no significant effect with age, culture level, family economic condition and ratio of radiochemotherapy between two groups (all P>0.05). (2) Dosimetric comparison for IMRT vs 3D-CRT:the average dose of planning target volume (PTV) decreased(46.1 ± 0.4) vs(46.4 ± 0.5)Gy, V45 dose percentage increased(95.2 ± 1.0)%vs (93.3 ± 2.0)%, intestinal bag dose of V40 decreased(24.4 ± 6.8)%vs (36.5 ± 15.9)%, rectal V40 dose percentage decreased(73.9 ± 12.3)%vs (85.4 ± 8.4)%, and lower rectal V45 dose percentage(32.8 ± 13.4)%vs (71.5 ± 13.7)%, bladder V40 dose percentage decreased(55.5 ± 13.0)% vs (84.4 ± 13.0)%. Bone marrow V20 lower:(67.9 ± 5.4)% vs (79.5 ± 6.6)%, V10 lower:(82.1 ± 6.0)% vs (86.3 ± 6.6)%; there were significant differences (all P<0.05). There was no significant difference between the dose of V45 in the intestinal pouch and bladder (P>0.05). (3) Acute radiation injury classification for IMRT vs 3D-CRT:big or small intestine:Ⅱ-Ⅲreaction [13%(11/85) vs 24% (24/98); χ2=3.925, P=0.048], there was significant difference. Bladder: Ⅲ reaction [19% (16/85) vs 26% (25/98); χ2=1.171, P=0.279], there was no significant difference. Radiochemotherapy of bone marrow suppression:Ⅲ-Ⅳreaction (14/20), the incidence rate [26%(14/54) vs 31%(20/65);χ2=0.339, P=0.562], the difference was not statistically significant. (4) Quality of life scale by FACT-Cx scale in IMRT vs 3D-CRT:there were no significant difference before radiotherapy (82 ± 16 vs 85 ± 16;t=1.279, P=0.203), while there was significant difference after radiotherapy (76 ± 14 vs 71 ± 18;t=-2.160, P=0.032). EPIC-CP scale score:before radiotherapy they were (16±7 vs 15±6;t=-0.174, P=0.862) ,but after radiotherapy (18±7 vs 22± 7; t=3.158, P=0.002), there was significant difference between them. Before and after radiotherapy, the increased EPIC-CP scale of the IMRT group vs 3D-CRT group were 3 ± 4 and 6 ± 4, the 3D-CRT group was significantly higher, the difference was statistically significant (t=5.500, P=0.000). Conclusion IMRT has shown that there are a significant benefit for the post-operative patients with cervical cancer and endometrial cancer compared to 3D-CRT.

Objective To explore the clinical significance of serum squamous cell carcinoma antigen (SCC?Ag) in early cervical squamous cell carcinoma. Methods The clinicopathological data and follow?up information of 1435 patients with stageⅠA2?ⅡA cervical squamous cell carcinoma were collected. The correlation between serum SCC?Ag level and clinicopathological feature and prognosis were analyzed.The best cut?off of serum SCC?Ag for predicting pelvic lymph node metastasis and survival of cervical squamous cell carcinoma patients were also identified. Results The result of univariate analysis showed that The International Federation of Gynecology and Obstetrics (FIGO) staging, tumor size, depth of cervical stromal invasion, lymphovascular space involvement, pelvic lymph node metastasis, common iliac lymph node metastasis and para?aortic lymph node metastasis were significantly related with serum SCC?Ag level (all P＜0.05). The result of multivariate logistic regression analysis showed that tumor size, depth of cervical stromal invasion, pelvic lymph node metastasis and common iliac lymph node metastasis were the independent risk factors of preoperative serum SCC?Ag＞2.65 ng／ml ( all P＜0.001). Multivariate Cox regression analysis showed that lymphovascular space involvement, SCC?Ag＞3.15 ng／ml, common iliac lymph node metastasis and tumor size ＞4 cm were the independent prognostic risk factors ( all P＜0.05). The univariate analysis showed that, the tumor size, FIGO stage, depth of cervical stromal invasion and SCC?Ag level were significantly related with the recurrence of 1 096 patients without postoperative high risk factors ( all P＜0.05). Multivariate logistic regression analysis showed that FIGO stage (OR＝1.671) and SCC?Ag＞2.65 ng／ml (OR＝4.490) were the independent risk factors for recurrence (both P＜0.05). The best cut off of SCC?Ag for predicting early postoperative cervical lymph node metastasis of cervical squamous cell carcinoma was 2.65 ng／ml, the sensitivity was 60.8%,the specificity was 71.8%. The best cut off of SCC?Ag for predicting prognosis of cervical squamous cell carcinoma was 3.15 ng／ml, the sensitivity was 53.5%, the specificity was 71.1%.Conclusions Preoperative serum squamous cell carcinoma antigen is an independent prognostic risk factor of survival of patients with early cervical squamous cell carcinoma, and is significantly related with recurrence of patients without postoperative high?risk factors. It can be used as a reference factor for postoperative adjuvant radiotherapy.

Objective? To investigate the occurrence and influencing factors of falls in elderly patients with knee osteoarthritis (KOA), and provide scientific reference for the prevention of falls in elderly patients with KOA. Methods? Using convenience sampling method, 104 elderly patients diagnosed as KOA in orthopaedic wards of four ClassⅢ Grade A hospitals in Hangzhou from November 2017 to August 2018 were selected as subjects. General Information Questionnaire, Morse Fall Scale(MFS)and the Barthel Index(BI)for Activities of Daily Living (ADL) were applied in the investigation. Single factor analysis and multiple factor Logistic regression were used to analyze the influencing factors of falls in elderly KOA patients. Results? A total of 104 questionnaires were sent out in this study, and 95 valid questionnaires were recovered, yielding an effective recovery rate of 91.35%. The incidence of falls in elderly KOA patients was 45.26% (43/95), of which 62.79% (27/43) had fallen twice or more. There were significant differences in knee injury history, staircase climbing and falls among elderly KOA patients (P＜ 0.05). There were significant differences in the risk of falls between elderly KOA patients in "whether taking drugs", "whether using walking aids", "status of self-care ability", and "age" (P＜ 0.05). Logistic regression analysis showed that history of knee injury, frequent staircase climbing and use of walking aids were the influencing factors of falls in elderly KOA patients (OR=4.028, 25.569, 3.191; P＜ 0.05). Conclusions? In view of the influencing factors of falls in elderly KOA patients, individualized nursing measures should be taken to strengthen falls risk assessment, carry out fall prevention related education and improve patients' social support, which will help to reduce the incidence of falls and further improve patients' quality of life.

Objective To explore the clinical significance of serum squamous cell carcinoma antigen (SCC?Ag) in early cervical squamous cell carcinoma. Methods The clinicopathological data and follow?up information of 1435 patients with stageⅠA2?ⅡA cervical squamous cell carcinoma were collected. The correlation between serum SCC?Ag level and clinicopathological feature and prognosis were analyzed.The best cut?off of serum SCC?Ag for predicting pelvic lymph node metastasis and survival of cervical squamous cell carcinoma patients were also identified. Results The result of univariate analysis showed that The International Federation of Gynecology and Obstetrics (FIGO) staging, tumor size, depth of cervical stromal invasion, lymphovascular space involvement, pelvic lymph node metastasis, common iliac lymph node metastasis and para?aortic lymph node metastasis were significantly related with serum SCC?Ag level (all P＜0.05). The result of multivariate logistic regression analysis showed that tumor size, depth of cervical stromal invasion, pelvic lymph node metastasis and common iliac lymph node metastasis were the independent risk factors of preoperative serum SCC?Ag＞2.65 ng／ml ( all P＜0.001). Multivariate Cox regression analysis showed that lymphovascular space involvement, SCC?Ag＞3.15 ng／ml, common iliac lymph node metastasis and tumor size ＞4 cm were the independent prognostic risk factors ( all P＜0.05). The univariate analysis showed that, the tumor size, FIGO stage, depth of cervical stromal invasion and SCC?Ag level were significantly related with the recurrence of 1 096 patients without postoperative high risk factors ( all P＜0.05). Multivariate logistic regression analysis showed that FIGO stage (OR＝1.671) and SCC?Ag＞2.65 ng／ml (OR＝4.490) were the independent risk factors for recurrence (both P＜0.05). The best cut off of SCC?Ag for predicting early postoperative cervical lymph node metastasis of cervical squamous cell carcinoma was 2.65 ng／ml, the sensitivity was 60.8%,the specificity was 71.8%. The best cut off of SCC?Ag for predicting prognosis of cervical squamous cell carcinoma was 3.15 ng／ml, the sensitivity was 53.5%, the specificity was 71.1%.Conclusions Preoperative serum squamous cell carcinoma antigen is an independent prognostic risk factor of survival of patients with early cervical squamous cell carcinoma, and is significantly related with recurrence of patients without postoperative high?risk factors. It can be used as a reference factor for postoperative adjuvant radiotherapy.

ObjectiveTo investigate the immediate effect of wearing a soft ankle brace on dynamic and static balance function and biomechanics of affected lower limbs during walking in chronic ankle instability (CAI) patients. MethodsFrom January to August, 2021, 40 CAI patients from Musculoskeletal Rehabilitation Center, Beijing Rehabilitation Hospital, Capital Medical University were measured dynamic and static balance indexes with Zebris FDM-System and Y balance test, before and after wearing a soft ankle brace; while the kinetics indexes and surface electromyography of the affected lower extremities during walking were collected with Zebris FDM-System and a surface electromyography telemeter simultaneously. ResultsThe velocity and area of center of pressure reduced in both open and closed eye modes (|t| > 2.876, P < 0.01), the Y-balance scores increased in all the directions (|t| > 21.212, P < 0.001) after wearing brace; while the peak pressures and impulses increased in the midfoot and medial forefoot regions (|t| > 2.057, P < 0.05), and decreased in the lateral heel, lateral forefoot and toe regions (|t| > 2.464, P < 0.05), and the root mean square of surface electromyography increased in the tibialis anterior and lateral gastrocnemius (|t| > 2.159, P < 0.05) during walking. ConclusionWearing soft brace can immediately improve dynamic and static balance of CAI patients, and optimize plantar kinetic distribution and enhance activation of the anterior tibial and the lateral head of gastrocnemius of the affected limb during walking, to improve motor control of CAI patients.

Objective: To explore the clinical significance of serum squamous cell carcinoma antigen (SCC-Ag) in early cervical squamous cell carcinoma. Methods: The clinicopathological data and follow-up information of 1435 patients with stage ⅠA2-ⅡA cervical squamous cell carcinoma were collected. The correlation between serum SCC-Ag level and clinicopathological feature and prognosis were analyzed. The best cut-off of serum SCC-Ag for predicting pelvic lymph node metastasis and survival of cervical squamous cell carcinoma patients were also identified. Results: The result of univariate analysis showed that The International Federation of Gynecology and Obstetrics (FIGO) staging, tumor size, depth of cervical stromal invasion, lymphovascular space involvement, pelvic lymph node metastasis, common iliac lymph node metastasis and para-aortic lymph node metastasis were significantly related with serum SCC-Ag level (all P<0.05). The result of multivariate logistic regression analysis showed that tumor size, depth of cervical stromal invasion, pelvic lymph node metastasis and common iliac lymph node metastasis were the independent risk factors of preoperative serum SCC-Ag>2.65 ng/ml (all P<0.001). Multivariate Cox regression analysis showed that lymphovascular space involvement, SCC-Ag>3.15 ng/ml, common iliac lymph node metastasis and tumor size >4 cm were the independent prognostic risk factors (all P<0.05). The univariate analysis showed that, the tumor size, FIGO stage, depth of cervical stromal invasion and SCC-Ag level were significantly related with the recurrence of 1 096 patients without postoperative high risk factors (all P<0.05). Multivariate logistic regression analysis showed that FIGO stage (OR=1.671) and SCC-Ag>2.65 ng/ml (OR=4.490) were the independent risk factors for recurrence (both P<0.05). The best cut off of SCC-Ag for predicting early postoperative cervical lymph node metastasis of cervical squamous cell carcinoma was 2.65 ng/ml, the sensitivity was 60.8%, the specificity was 71.8%. The best cut off of SCC-Ag for predicting prognosis of cervical squamous cell carcinoma was 3.15 ng/ml, the sensitivity was 53.5%, the specificity was 71.1%. Conclusions Preoperative serum squamous cell carcinoma antigen is an independent prognostic risk factor of survival of patients with early cervical squamous cell carcinoma, and is significantly related with recurrence of patients without postoperative high-risk factors. It can be used as a reference factor for postoperative adjuvant radiotherapy.

Objective:To evaluate the prognostic factors and the value of definitive pelvic radiotherapy in patients with stage Ⅳ B hematogenous metastatic cervical squamous cell carcinoma. Methods:Clinical data of 80 patients with Ⅳ B stage squamous cell carcinoma admitted to Zhejiang Cancer Hospital from 2006 to 2016 were retrospectively analyzed. The survival analysis was conducted by Kaplan- Meier method. Prognostic factors were analyzed by Cox models. Results:The 1-, 2-and 5-year overall survival (OS) and progression-free survival (PFS) rates were 52.5%, 26.3%, 16.8% and 25%, 13.8%, 8.8%, with a median OS of 13.8 months and a median PFS of 5.6 months, respectively. The most common site of metastasis was bone (51.3%), followed by lung (36.3%) and liver (26.3%). Univariate analysis revealed that chemotherapy combined with definitive pelvic radiotherapy and ≥6 cycles of chemotherapy were positively correlated with OS and PFS, whereas ECOG performance status score of 3-4 and liver metastasis were negatively correlated with OS and PFS. In multivariate analysis, liver metastasis ( HR=2.23, 95% CI: 1.01-4.91, P=0.048) and ECOG performance status score of 3-4( HR=2.01, 95% CI: 1.03-3.91, P=0 0.040) were significantly correlated with poor OS. Subgroup multivariate analysis showed that compared with chemotherapy±palliative radiotherapy, systemic chemotherapy combined with definitive pelvic radiotherapy significantly improved OS ( HR=0.39, 95% CI: 0.18-0.84, P=0.016). Compared with double drugs combined with<4 cycles of chemotherapy, double drugs in combination with ≥4 cycles of chemotherapy significantly improved OS ( HR=0.32, 95% CI: 0.15-0.68, P=0.003). Conclusions:Patients with low ECOG performance status score or liver metastasis obtain poor prognosis. Definitive pelvic radiotherapy combined with chemotherapy can enhance clinical prognosis of patients with Ⅳ B stage hematogenous metastatic cervical squamous cell carcinoma.