Objective To evaluate the changes of thyroid function during pregnancy in the second and third trimester in the regions with or without iodine deficiency. Methods The serum TSH, FT 3, FT 4 and TT 4 levels of 90 pregnant women (30 from iodine deficient area as study group, 60 from iodine sufficient area as control group) and 30 non pregnant women were assayed by high sensitive immunoradiometric assay (IRMA) or radioimmunoassay (RIA), and urine iodine level of pregnant women before delivery was also examined. Results (1) The serum TSH level in pregnant women in the second and third trimester was significantly higher than that of non pregnant women. The serum free thyroid hormone levels of pregnant women were significantly lower than that of non pregnant women, especially in the third trimester. (2) The serum TSH level of pregnant women from iodine deficient area in the second trimester and before delivery was significantly higher than that of pregnant women from iodine sufficient area (P

OBJECTIVETo observe the efficacy of Xiaoyan Zhixue Capsule (XYZXC) in treating uterus abnormal menorrhagia caused by intrauterine device (IUD) and to study its mechanism.

METHODSIUD users with menorrhagia were randomly divided into two groups, the XYZXC treated group and adrenosoem (AC-17) control group. Endometrial tissue of XYZXC treated group before and after treatment were taken out to observe its morphologic change with optic and electronic microscope. Animal experiment was done to observe the effect of XYZXC in eliminating inflammation of patierts, and the relevant parameters were monitored.

RESULTSClinical efficacy: (1) Total effective rate of the treated group was 90.3%, that of control group was 43.5%, comparison between them showed significant difference (P<0.01). (2) Morphological examination of endometrial tissue showed the inflammation in the treated group abated after treatment with the contractible function of helicine artery strengthened. Experimental study showed: (1) The auricular swelling of mice was inhibited by 40.5% in the treated group, the effect was equivalent to that of hydrocortisone (46.9%). (2) Compared with the control group, the plasma 6-keto-PGF1alpha and D-Dimer level in the treated group were markedly lower, and TXB2/6-keto-PGF1alpha ratio and plasma endothelin level were markedly higher (P<0.05 or P<0.01). ET contents in large dosage TCM group was significantly raised (P<0.05). (3) XYZXC could increase amplitude of contraction of the uterus smooth muscle as well as the uterus activity in rats in vivo.

CONCLUSIONXYZXC has obvious anti-inflammatory and hemostatic effects, it has marked effect in treating IUD caused pre- and post-menstruation menorrhagia, the possible mechanism may be: (1) Modulating the synthesis of prostaglandin; (2) Antagonizing the IUD caused fibrinolytic hyperfunction; (3) Promoting the synthesis of ET; (4) Increasing the contractility and activity of uterus smooth muscle.

Adult ; Animals ; Anti-Inflammatory Agents, Non-Steroidal ; therapeutic use ; Capsules ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Hemostatics ; therapeutic use ; Humans ; Intrauterine Devices ; adverse effects ; Menorrhagia ; drug therapy ; etiology ; Mice ; Phytotherapy ; Rats ; Rats, Sprague-Dawley ; Rats, Wistar ; Uterine Contraction ; drug effects

Objective:To explore the effect of cognitive-behavioral therapy on psychological stress and quality of life in patients with pulmonary tuberculosis.Methods:According to two-level cluster random design 461 patients with tuberculosis from 20 communities in Pizhou county of Jiangsu province were selected in the study from September 2018 to November 2018. The intervention group received cognitive-behavioral therapy for two months, while control group received routine follow-up. Anxiety, depression and quality of life were assessed by GAD-7, PHQ-9 and SF-36 scales, respectively. At the same time, the comparison between the two groups was conducted by independent sample t test, and the difference between the two groups before and after treatment was analyzed by paired sample ttest. Results:A total of 454 participants were finally included in this analysis; there were 230 cases in the intervention group and 224 cases in the control group. In the intervention group the scores of anxiety and depression after intervention were significantly lower than the baseline scores [(7.57±5.27) vs. (5.93±2.56), t=-4.245, P<0.01; (8.13±6.01) vs. (6.02±2.67); t=-4.866, P<0.01], and the quality of life score was significantly higher than the baseline score [(58.46±12.71) vs. (74.31±13.22); t=13.108, P<0.01]; while in the control group there were no significant differences in the scores of anxiety, depression and quality of life after intervention, compared with those at baseline [(7.62±5.41) vs.(7.65±5.38); (8.00±5.84) vs. (8.07±5.91); (59.11±13.25) vs. (60.51±13.76); t=0.059, t=0.126, t=1.104, all P>0.05]. However, only for patients with mild and moderate anxiety and depression symptoms in the intervention group, the anxiety and depression scores were decreased after intervention [(7.29±1.21) vs. (5.54±1.71), (11.99±1.31) vs. (9.17±1.55); (7.01±1.47) vs. (4.42±1.22), (11.88±1.12) vs. (8.39±2.33); t=8.056, t=10.020, t=13.558, t=8.852,all P<0.01]. Conclusion:Cognitive-behavioral therapy can relieve the psychological pressure and improve the quality of life in pulmonary tuberculosis patients with mild or moderate anxiety/depression symptoms.

Objective:To determine the effect of community management based on the Roy′s adaptation model (RAM) in patients with chronic obstructive pulmonary disease (COPD).Methods:This study was a cluster randomized controlled study, with the community as the cluster unit, and selected 805 COPD patients from 8 communities in Xuzhou City who had completed community registration before June 2019. A total of 735 patients actually completed follow-up and participated in intervention evaluation. They were randomly divided into control group (362 cases) and intervention group (373 cases) by random number table method. The control group received routine follow-up, while the intervention group received RAM intervention for 6 months. The forced expiratory volume in 1 second (FEV1)/forced volume vital capacity (FVC) ratio (FEV 1/FVC) and the modified British medical research council (mMRC) were used to assess the pulmonary function. The hospital anxiety and depression scales (HADS) were used to evaluate the mental health. The Chinese version of the Short Form Coping and Adaption Processing Scale (CAP-15) was used to assess the adaptive capacity. And the St. George′s Respiratory Questionnaire (SGRQ) was used to evaluate the quality of life in COPD patients. The t test or χ 2 test was used for pre-intervention comparisons between groups, and the repetitive measure analysis of variance (ANOVA) was used for post-intervention comparisons between groups. Results:After 6 months intervention, there were no significant differences in FEV 1/FVC radio between the two groups [(0.61±0.11) vs (0.62±0.12)] ( P=0.172). The scores of mMRC [(2.04±0.33) vs (2.77±0.31) points], HAD-A [(5.28±4.28) vs (6.99±4.41) points], HAD-D [(5.82±5.12) vs (7.27±4.93) points] and SGRQ [(40.17±9.30) vs (53.69±9.77) points] were all lower in the intervention group than those in the control group (all P<0.001). The CAPS-15 score was higher in the intervention group than that in the control group [(35.87±3.62) vs (26.1±3.47)] ( P<0.001). Conclusion:RAM could be used in community management of COPD patients, which could improve their dyspnea symptoms and psychological and physiological functions, also improve their adaptability and quality of life.

Objective To analyze the clinical value of postoperative radiotherapy for node-positive middle thoracic esophageal squamous cell carcinoma ( TESCC ) and to modify the target volume .Methods A total of 286 patients with node-positive middle TESCC underwent radical surgery in Cancer Hospital, Chinese Academy of Medical Sciences, from 2004 to 2009.In addition, 90 of these patients received postoperative intensity-modulated radiotherapy.The Kaplan-Meier method was used to calculate survival rates, and the log-rank test was used for survival difference analysis.The Cox model was used for multivariate prognostic analysis.The chi-square test was used for comparing the recurrence between patients receiving different treatment modalities.Results The 5-year overall survival ( OS) rates of the surgery alone ( S) group and surgery plus postoperative radiotherapy ( S+R) group were 22.9%and 37.8%, respectively, and the median OS times were 23.2 and 34.7 months, respectively ( P=0.003) .For patients with 1 or 2 lymph
node metastases (LNMs), the 5-year OS rates of the S group and S+R group were 27.3%and 44.8%, respectively ( P=0.017);for patients with more than 2 LNMs, the 5-year OS rates of the S group and S+R group were 16.7%and 25.0%, respectively (P=0.043).The peritoneal lymph node metastasis rates of N1 , N2 , and N3 patients in the S group were 2.9%, 10.9%, and 20.0%, respectively ( P=0.024) .The S+R group had a significantly lower mediastinal lymph node metastasis rate than the S group ( for patients with 1 or 2 LMNs:8.0%vs.35.3%, P=0.003;for patients with more than 2 LNMs, 10.0%vs.42.3%, P=0.001) , and had a prolonged recurrence time compared with the S group ( 25.1 vs.10.7 months, P=0.000) .However, for patients with more than 2 LNMs, the S+R group had a significantly higher hematogenous metastasis rate than the S group (46.7%vs.26.1%, P=0.039).Conclusions Patients with node-positive middle TESCC could benefit from postoperative radiotherapy.The target volume can be reduced for patients with 1 or 2 LNMs.Prospective studies are needed to examine whether it is more appropriate to reduce the radiotherapy dose than to reduce the target volume for patients with more than 2 LNMs.A high hematogenous metastasis rate warrants chemotherapy as an additional regimen.

[ Abstract] Objective To investigate the clinical efficacy of preoperative three-dimensional radiotherapy (3DRT) with or without concurrent chemotherapy for esophageal carcinoma.Methods We retrospectively analyzed 103 esophageal carcinoma patients who received preoperative 3DRT with or without concurrent chemotherapy from 2004 to 2014 in Cancer Hospital CAMS.The median radiation dose was 40 Gy, and the TP or PF regimen was adopted for concurrent chemotherapy if needed.The overall survival (OS) and disease-free survival ( DFS) were calculated by the Kaplan-Meier method, and the survival difference and univariate prognostic analyses were performed by the log-rank test.The Cox proportional hazards model was used for multivariate prognostic analysis.Results The number of patients followed at 3-years was 54.The 3-year OS and DFS rates were 61.1% and 54.9%, respectively, for all patients.There were no significant differences between the 3DRT and concurrent chemoradiotherapy (CCRT) groups as to OS (P=0.876) and DFS (P=0.521).The rates of complete, partial, and minimal pathologic responses of the primary tumor were 48.0%, 40.2%, and 11.8%, respectively.There were significant differences in OS and DFS between the complete, partial, and minimal pathologic response groups (P=0.037 and 0.003). No significant difference in pathologic response rate was found between the 3DRT and CCRT groups (P=0.953).The lymph node metastasis rate was 26.5%, and this rate for the complete, partial, and minimal pathologic response groups was 14%, 30%, and 67%, respectively, with a significant difference between the three groups (P=0.001).The OS and DFS were significantly higher in patients without lymph node metastasis than in those with lymph node metastasis (P=0.034 and 0.020).The surgery-related mortality was 7.8% in all patients.Compared with the 3DRT group, the CCRT group had significantly higher incidence rates of leukopenia (P=0.002), neutropenia (P=0.023), radiation esophagitis (P=0.008), and radiation esophagitis ( P=0.023).Pathologic response of the primary tumor and weight loss before treatment were independent prognostic factors for OS and DFS (P=0.030,0.024 and P=0.003,0.042). Conclusions Preoperative 3DRT alone or with concurrent chemotherapy can result in a relatively high complete pathologic response rate, hence increasing the survival rate.Further randomized clinical trials are needed to confirm whether preoperative CCRT is better than 3DRT in improving survival without increasing the incidence of adverse reactions.

Objective:To explore the effect of group cognitive behavior therapy (GCBT) on anxiety, depression and quality of life in patients with chronic obstructive pulmonary disease (COPD) in community.Methods:From August to November 2019, patients with moderate COPD in 18 communities in Xuzhou City were randomly divided into the intervention group ( n=240) and the control group ( n=223). The control group received routine management and the intervention group received group cognitive behavioral therapy intervention for 8 weeks on the basis of routine management.Before and after the intervention, FEV 1% predicted value and FEV 1/FVC were measured by pulmonary function tester.Hospital Anxiety and Depression Scale (HADS) was used to evaluate the anxiety and depression of patients.St.George's respiratory questionnaire (SGRQ), COPD assessment test (CAT) and modified medical research council dyspnea (mMRC) were used to evaluate the quality of life of patients.SPSS 20.0 software was used for analysis.The χ 2 test, independent sample t-test, paired sample t-test were used for statistical analysis. Results:After 8 weeks of intervention, the anxiety and depression scores of the intervention group were lower than those of the control group (anxiety: (8.23±4.02) vs (10.71±3.60); depression: (7.87±3.73) vs (10.20±3.72)( t=6.415, 6.185, both P<0.01). After the intervention, there was no significant difference in FEV 1%((51.7±12.3)% vs (52.0±12.6)%) predicted value and FEV 1/FVC((57.3±10.8)% vs (56.9±10.7)%) between the two groups( t=-0.259, 0.400, both P>0.05). The scores of CAT, mMRC and SGRQ in the intervention group were lower than those in the control group((17.35±5.78) vs (20.90±8.00), (1.55±0.82) vs (2.30±1.21), (41.78±21.56) vs (57.08±24.46))( t=-5.061, -7.227, -6.580, all P<0.01). Conclusion:Group cognitive behavioral therapy can relieve the anxiety and depression and improve the quality of life of patients with COPD.

Objective:To evaluate the clinical efficacy and failure patterns of prophylactic cranial irradiation (PCI) in patients with limited-stage small cell lung cancer (LS-SCLC) on the basis of modern chemoradiotherapy and diagnostic techniques.Methods:In this retrospective study, clinical data of 201 LS-SCLC patients treated with chemotherapy (EP/CE regimens, ≥4 cycles) and intensity-modulated radiotherapy (IMRT) in Cancer Hospital of Chinese Academy of Medical Sciences from 2006 to 2014 were reviewed. All patients were primarily managed with concurrent or sequential chemoradiotherapy and achieved complete response (CR) or partial response (PR). Ninety percent of patients were revaluated for brain metastasis (BM) by MRI and 10% by CT scan. Long-term survival and failure patterns were compared between the PCI ( n=91) and non-PCI groups ( n=110). Results:The median follow-up time was 77.3 months (95% CI 73.0-81.5 months). The median overall survival (OS), 2-and 5-year OS rates were 58.5 months, 72.5% and 47.7% in the PCI group, and 34.5 months, 61.7% and 35.8% in the non-PCI group ( P=0.075). The median progression-free survival (PFS), 2-and 5-year PFS rate were 22.0 months, 48.0% and 43.4% in the PCI group, significantly higher than 13.9 months, 34.4% and 26.7% in the non-PCI group ( P=0.002). The 2- and 5-year cumulative incidence of BM were 6.6% and 12.2% in the PCI group, and 30.0% , 31.0% in the non-PCI group ( P=0.001). The median time and rate of BM as an isolated first site of relapse were 11.9 months and 4.4% in the PCI group, and 8.7 months and 25.5% in the non-PCI group ( P<0.001). Multivariate analysis showed that response after chemoradiotherapy ( P<0.001) and PCI ( P=0.033) were the independent prognostic factors for PFS. Stratified analysis demonstrated that PCI significantly improved the 5-year PFS in patients who achieved CR (72.7% vs. 48.0%, P=0.013), while it did not improve the 5-year PFS in patients who obtained PR (26.1% vs. 20.2%, P=0.213). Conclusion:In the new era of standard chemoradiotherapy and more accurate diagnostic methods for BM, PCI was associated with improved PFS and lower incidence of BM in LS-SCLC patients.

Objective To investigate the clinical efficacy and prognosis of intensity-modulated radiotherapy(IMRT)combined with chemotherapy for limited-stage small cell lung cancer(LS-SCLC). Methods A retrospective analysis was performed on the clinical data of 484 LS-SCLC patients treated with chemoradiotherapy in our center from 2006 to 2014. The patients with partial or complete response to IMRT received prophylactic cranial irradiation(PCI). The Kaplan?Meier method was used to calculate survival rates, and the log-rank test and Cox regression were used for univariate and multivariate analyses, respectively. Results In all the patients, the follow-up rate was 93%;the median overall survival(OS) time was 23.8 months;the 2-,3-,and 5-year OS rates were 48.7%,39.8%,and 28.6%,respectively;the median progression-free survival(PFS)time was 14.1 months;the 2-, 3-, and 5-year PFS rates were 34.4%,30.5%, and 28.3%, respectively. The incidence rates of grade ≥3 bone marrow suppression, grade ≥2 radiation esophagitis, and grade ≥2 radiation pneumonitis were 26.9%, 24.8%, and 18.4%, respectively, in SCLC patients after IMRT. The objective response rate was 84.5%. The univariate analysis showed that age, smoking history, TNM stage, PCI, and the number of chemotherapy cycles before radiotherapy were prognostic factors for OS(P= 0.006, 0.001, 0.047, 0.000, and 0.046). The multivariate analysis showed that smoking history and PCI were independent prognostic factors(P=0.001 and 0.000).Conclusions IMRT combined with chemotherapy achieves satisfactory clinical outcomes in the treatment of LS-SCLC. Smoking history and PCI are independent prognostic factors for OS of LS-SCLC patients.

Objective To evaluate the dose distribution and clinical efficacy of hippocampal-sparing prophylactic cranial irradiation ( HS-PCI ) in patients with small cell lung cancer by using helical tomotherapy. Methods Clinical data of 49 patients with small cell lung cancer receiving HS-PCI using helical tomotherapy in Cancer Hospital between 2014 and 2017 were retrospectively analyzed. All patients received brain MRI to exclude the possibility of brain metastasis within 1 month after standard surgery or radio-and chemo-therapy. The prescription dose was 95% PTV,25 Gy in 10 fractions. The adverse reactions and cognitive functions of patients were observed before,6 months and 1 year after treatment,and the dose distribution in the hippocampal gyrus,survival rate and brain metastasis rate were analyzed. Results The median follow-up time was 16 months. The average dose in the hippocampal gyrus was 7. 23 Gy and 8. 46 Gy in the reduction region,which was reduced by 71. 88% and 66. 16% compared with the prescription dose. The maximum dose in the hippocampal gyrus was 10. 66 Gy and 15. 43 Gy in the reduction region. Among 49 patients,8 died,the 1-year survival rate was 85. 1% and the 2-year survival rate was 70. 3%.Nine patients (18. 3%) had brain metastases,and one of them with extensive multiple brain metastases (n＝13) presented with metastasis adjacent to the hippocampal gyrus. The main adverse reactions included mild headache, dizziness and brain edema,whereas no ≥ grade 2 adverse reactions occurred. At 6 months after treatment, the HVLT-R score was significantly decreased,and declined by 6. 78% at 12 months after treatment. The HVLT-R scores did not significantly differ in patients without brain metastasis before and 12 months after treatment ( P＞0. 05 ). Conclusion Application of HS-PCI using helical tomotherapy meets the dose requirement,effectively protects the cognitive function and yields slight adverse reactions.