Arm ; Asian Continental Ancestry Group ; Bias (Epidemiology) ; Carboplatin ; Disease-Free Survival ; Doxorubicin ; Drug Therapy ; Follow-Up Studies ; Humans ; Maintenance Chemotherapy ; Ovarian Neoplasms ; Prognosis ; Quality of Life ; Recombination, Genetic ; Sample Size

Objectives: An Asian Gynecologic Oncology Group phase III randomized trial was conducted to determine whether maintenance chemotherapy could improve progression-free survival (PFS) in stages III/IV ovarian cancer. Methods: Between 2007 and 2014, 45 newly-diagnosed ovarian cancer patients were enrolled after complete remission and randomized (1:1) to arm A (4-weekly carboplatin area under the curve 4 and pegylated liposomal doxorubicin [PLD] 30 mg/m2, n=24) for 6 cycles or arm B (observation, n=21). The primary end-point was PFS. A post hoc translational study was conducted to deep sequence BRCA/homologous recombination deficiency (HRD) genes, because BRCA/HRD mutations (BRCA/HRDm) are known to be associated with better prognosis. Results: Enrollment was slow, accrual was closed when 7+ years had passed. With a medianfollow-up of 88.9 months, the median PFS was significantly better in arm A (55.5 months) than arm B (9.2 months) (hazard ratio [HR]=0.40; 95% confidence interval [CI]=0.19–0.87; p=0.020), yet the median overall survival was not significantly different in arm A (not reached) than arm B (95.1 months) (p=0.148). Overall grade 3/4 adverse events were more frequent in arm A than arm B (60.9% vs 0.0%) (p<0.001). Quality of life was generally not significantly different. Distribution of BRCA1/2m or BRCA/HRDm was not significantly biased between the two arms. Wild-type BRCAon-HRD subgroup seemed to fare better with maintenance therapy (HR=0.35; 95% CI=0.11–1.18; p=0.091). Conclusions Despite limitations in small sample size, it suggests that maintenance carboplatin-PLD chemotherapy could improve PFS in advanced ovarian cancer.

Objective To observe the clinical efficacy and safety of levosimendan combined with terbutaline sulfate in the treatment of chronic obstructive pulmonary disease with cardiac insufficiency.Methods A total of 88 patients were randomly divided into control group and treatment group,with 44 cases in each group.Patients in both groups were given conventional treatment and symptomatic treatment.Patients in control group were given inhalation budesonide suspension liquid 1 mg + terbutaline sulfate atomized liquid 5 mg in jet atomizer,oxygen driven atomization inhalation,twice a day.Patients in treatment group were given levosimendan 0.1 μg · kg-1 · min-1 infusion,continue medication 24 h on the basis of control group.All patients were treated for 7 d.The clinical efficacy,troponin T,myocardial enzyme spectrum,cardio-pulmonary function and adverse drug reactions in two groups were observed.Results After treatment,the total effective rates in treatment group and control group were 88.64％ (39/44 cases),70.45％ (31/44 cases),with significant difference (P ＜ 0.05).The levels of troponin T,creatine kinase,creatine kinase isoenzyme,lactate dehydrogenase,left ventricular end diastolic diameter,forced expiratory volume in one second,forced expiratory volume in one second/ forced vital capacity (FEV1/FVC),left ventricular ejection fraction,maximum walking distance within 6 min in control group were (0.48 ±0.06) μg · L-1,(189.29 ±21.30) U · L-1,(11.34 ± 1.71)U·L-1,(159.29±17.11) U L-1,(50.29 ± 5.79) mm,(1.35 ± 0.19) L,(60.93 ± 7.09)％,(42.39 ±4.58)％,(260.39 ± 29.21)m,had significant difference with those in treatment group,which were (0.18 ±0.03)μg · L-1,(130.27 ± 16.11)U · L-1,(8.87 ± 1.09) U · L-1,(138.70 ± 14.51) U · L-1,(47.01 ±5.01)mm,(1.70±0.23) L,(76.94±8.58)％,(51.29±5.71)％,(324.29 ±35.16)m (P＜0.05).The adverse drug reactions in treatment group were palpitations,headache,dizziness,total incide nce rate of adverse drug reactions was 6.82％ (3/44 cases).The adverse drug reactions in control group were orthostatic hypotension,hyponatremia,arrhythmia,thirst,total incidence rate was 11.36％ (5/44 cases),with no significant difference (P ＞0.05).Conclusion Levosimendan combined with terbutaline sulfate in the treatment of chronic obstructive pulmonary disease with cardiac insufficiency has a higher clinical efficacy,with high safety.

Background:The Food and Drug Administration recently announced that the use of morcellation may cause fibroids or pelvic dissemination and metastasis of uterine sarcoma;therefore,the use of morcellation is limited in the USA.A large sample study is necessary to assess the proportion of uterine malignant tumors found in patients with laparoscopic myomectomy.Methods:A national multicenter study was performed in China.From 2002 to 2014,33,723 cases were retrospectively selected.We calculated the prevalence and recorded the clinical characteristics of the patients with malignancy after morcellation application.A total of 62 cases were finally pathologically confirmed as malignant postoperatively.Additionally,the medical records of the 62 patients were analyzed in details.Results:The proportion of postoperative malignancy after morcellation application was 0.18％ (62/33,723) for patients who underwent laparoscopic myomectomy.Nearly 62.9％ (39/62) of patients had demonstrated blood flow signals in the uterine fibroids before surgery.And,23 (37.1％) patients showed rapid growth at the final preoperative ultrasound.With respect to the pathological types,38 (61.3％) patients had detectable endometrial stromal sarcoma,13 (21.0％) had detectable uterine leiomyosarcoma,only 3 (3.2％) had detectable carcinosarcoma,and 5 (8.1％) patients with leiomyoma had an undetermined malignant potential.Conclusions:The proportion of malignancy is low after using morcellation in patients who undergo laparoscopic myomectomy.Patients with fast-growing uterine fibroids and abnormal ultrasonic tumor blood flow should be considered for malignant potential,and morcellation should be avoided.

OBJECTIVETo investigate the interactive effect of job task and psychosocial factors on the outcomes of musculoskeletal disorders.

METHODS653 workers from different type of manufacturing industries and administration office recruited in a cross-sectional epidemiological survey. The Quick Exposure Check (QEC) was applied to assess the ergonomic load of job task, Job Content Questionnaire (JCQ) for identifying psychological characteristics, and Nordic Standardized Questionnaire for investigating outcomes of WMSDs.

RESULTSThe prevalence of WMSD in shoulder, upper back, lower back and hand/wrist were significantly different under a variety of combined job task and psychosocial characteristics (P < 0.05 or P < 0.01). The more physical and psychological loads, the higher prevalence of WMSDs were revealed. By using multivariate analyses, a potential interactive effect was found in terms of the WMSDs symptoms in hand/wrist, shoulder, upper back and lower back after adjusted by work year, age, and gender.

CONCLUSIONSHigher physical load and greater psychosocial risk are more frequent self-reported symptoms of WMSDs than those of lower exposures. Ergonomic intervention strategies aimed at reducing the incidence of WMSDs should not only be focused on control of physical work factors but also psychosocial risks of relevance.

Adolescent ; Adult ; Female ; Humans ; Male ; Middle Aged ; Musculoskeletal Diseases ; etiology ; psychology ; Occupational Diseases ; etiology ; psychology ; Stress, Psychological ; Surveys and Questionnaires ; Task Performance and Analysis ; Young Adult

OBJECTIVETo identify predictive markers of the long-term outcome for neo-adjuvant chemotherapy (NC) in locally advanced breast cancer (LABC) treated with intravenous vinorelbine (V) and epirubicin (E) combination regimen.

METHODSOne hundred and nineteen patients with LABC were treated from September 2001 to May 2006. All patients were diagnosed as invasive breast cancer by 14G core needle biopsy and treated with three cycles of VE regimen before the operation. The patients were subjected to surgery and subsequently were given other three cycles of VE or cyclophosphamide+epirubicin+fluorouracil (CEF) regimen according to the clinical responses. Local-regional radiotherapy was applied to all patients after the chemotherapy and followed by hormone-therapy according to hormone receptor status. The impact of clinical, pathological, and immunohistochemical features on disease free survival (DFS) and overall survival (OS) was evaluated.

RESULTSAll patients were evaluable for responses: clinical complete response was documented in 27 patients (22.7%), 78 patients (65.5%) obtained partial clinical response. The pathological complete response was found in 22 cases (18.5%). Of the patients, 115 cases (96.6%) were followed-up for a median time of 63.4 months (range, 9-76 months), the 5-year DFS rate and OS rate was 58.7% and 71.3%, respectively. On multivariate analysis, high pre-Ki-67 (P=0.012) and post-Ki-67 expression (P=0.045), no pathological complete response after NC (P=0.034) were associated with the higher risk of disease relapse; high pre-Ki-67 (P=0.017) and post-Ki-67 expression (P=0.001), negative pre-ER (P=0.002) and no pathological complete response after NC (P=0.034) were associated with a shorter survival.

CONCLUSIONPathological response in primary tumor, pre-Ki-67 and post-Ki-67 expression, pre-ER expression are important predictors of long-term outcome for LABC patients with three cycles of VE regimen before operation.

Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Breast Neoplasms ; drug therapy ; pathology ; surgery ; Chemotherapy, Adjuvant ; Epirubicin ; administration & dosage ; Female ; Follow-Up Studies ; Humans ; Lymphatic Metastasis ; Middle Aged ; Prognosis ; Retrospective Studies ; Treatment Outcome ; Vinblastine ; administration & dosage ; analogs & derivatives

Objective To evaluate the effect of cigarette smoking on obesity in middle-aged and elderly Chinese men.Methods From 2002 to 2006,a population-based cohort study of 61,491 Chinese men aged from 40 to 74 in urban Shanghai were conducted by the Shanghai Men's Health Study(SMHS).Information on smoking status and body weight change was collected using a structured questionnaire by face-to-face interview.Measurements of body weight,height and circumferences of waist and hip were taken by medical professionals.Multiple regression models were used to evaluate the associations of smoking habit with body mass index(BMI),waist-to-hip ratio(WHR)and adult body weight gain after adjusting for potential confounding factors.Results The current smokers had a lower BMI(23.4±3.1)and body weight gain in adulthood(11.6±9.7)kg than non-smokers[24.0±2.9 and(12.7±8.9)kg,respectively].The adjusted differences between these two groups were 0.60(95%CI:-0.67--0.54)for BMI and 1.46 kg (95%CI:-1.65--1.27)for body weight gain,respectively.Smokers,both former and current,showed a higher WHR than non-smokers with an adjusted average difference of 0.006 08(95%CI:0.005 08-0.007 09).Among current smokers,the WHR increased with the early age starting smoking,number of cigarettes smoked per day,years of smoking and pack-years of smoking in a dose-response manner.Further analysis showed that,although the ex-smokers showed a higher body weight and weigh gain than non-smokers in succedent several years of smoking cessation,they were comparable to non-smokers in body size after 5 years of quitting smoking.Conclusion Cigarette smoking may be inversely associated with body weight and weight gain but positively related to central fat deposition which is more detrimental to health than general obesity.The initial wain in weight after smoking cessation is temporary.

Objective To evaluate the effect of cigarette smoking on obesity in middle-aged and elderly Chinese men.Methods From 2002 to 2006,a population-based cohort study of 61,491 Chinese men aged from 40 to 74 in urban Shanghai were conducted by the Shanghai Men's Health Study(SMHS).Information on smoking status and body weight change was collected using a structured questionnaire by face-to-face interview.Measurements of body weight,height and circumferences of waist and hip were taken by medical professionals.Multiple regression models were used to evaluate the associations of smoking habit with body mass index(BMI),waist-to-hip ratio(WHR)and adult body weight gain after adjusting for potential confounding factors.Results The current smokers had a lower BMI(23.4±3.1)and body weight gain in adulthood(11.6±9.7)kg than non-smokers[24.0±2.9 and(12.7±8.9)kg,respectively].The adjusted differences between these two groups were 0.60(95%CI:-0.67--0.54)for BMI and 1.46 kg (95%CI:-1.65--1.27)for body weight gain,respectively.Smokers,both former and current,showed a higher WHR than non-smokers with an adjusted average difference of 0.006 08(95%CI:0.005 08-0.007 09).Among current smokers,the WHR increased with the early age starting smoking,number of cigarettes smoked per day,years of smoking and pack-years of smoking in a dose-response manner.Further analysis showed that,although the ex-smokers showed a higher body weight and weigh gain than non-smokers in succedent several years of smoking cessation,they were comparable to non-smokers in body size after 5 years of quitting smoking.Conclusion Cigarette smoking may be inversely associated with body weight and weight gain but positively related to central fat deposition which is more detrimental to health than general obesity.The initial wain in weight after smoking cessation is temporary.