Abstract Background With the end of 35 years of the one-child policy in China, the second-child policy presents a challenge for maternity hospitals. We aimed to inform configuration of medical ...resources by investigating willingness to have a second child in women with risk factors for adverse pregnancy outcomes. Methods We did a cross-sectional study in two hospitals in Zhejiang province, China. We surveyed women aged 30–45 years with gynecological disease (6000 in a university hospital and 6000 in a county hospital) by questionnaire, between January and April, 2016. The survey included questions about age, location, educational degree, occupation, physical health, family economic situation, current marital status, composition of women's parents' family, influence of second child on family and work, and childbearing history. Patients with malignant gynecological disease were excluded. Written informed consent was obtained, and the study was approved by the hospitals' institutional review boards. Findings For university hospital patients, willingness to have a second child was more closely associated with age (OR 1·005, 95% CI 0·105–3·843, p=0·005) and location (1·041, 0·077–10·37, p=0·043) than in county hospital patients. University hospital patients, with mean age 33·93 years (SD 3·77), were more likely to have two children than county hospital patients, with mean age 34·57 years (SD 4·20; OR 5·85, 95% CI 1·20–28·51, p=0·014). Patients living in rural areas were more likely to be willing to have two children than those living in cities (57·61%, 1060 of 1840 vs 45·91%, 1910 of 4160; OR 1·028, 95% CI 0·51–4·38, p=0·008). For county hospital patients, willingness to have a second child was more closely associated with parents' family composition (OR 1·082, 95% CI 0·02–7·05, p=0·05) than for university hospital patients. In the university hospital, women from families in which both husband and wife were only children, or in which the woman was an only child, were more likely to have two children than from families in which both husband and wife were not only children (64·57%, 1270 of 1966 vs 35·43%, 1670 of 4714, OR 1·02, 95% CI 0·04–10·22, p=0·017. Interpretation Risk factors for adverse pregnancy outcomes are not associated with a reduced willingness to have a second child. In addition to strengthening the capacity and quality of maternal health delivered by hospitals, the Chinese government should increase training and financial support for hospitals to cope with adverse pregnancy outcomes. Funding None.
Cellular therapy has emerged as a potentially novel treatment for severe ischemic heart disease, and there is increasing evidence that stem cell transplantation may improve the perfusion and ...contractile function of ischemic myocardium. However, the problem of poor donor cell engraftment and survival in ischemic myocardium limits the successful use of cellular therapy for treating ischemic heart disease. This review discusses the state-of-the-art understanding of the low level of cell engraftment and cell survival after transplantation into the ischemic heart, with a focus on the approaches that have been investigated for supporting and improving the survival and engraftment of transplanted cells in this setting.
To analyze patterns of local-regional failure (LRF) for completely resected stage IIIA(N2) non-small cell lung cancer (NSCLC) patients treated in our hospital and to propose a clinical target volume ...(CTV) for postoperative radiation therapy (PORT) in these patients.
From 2005 to 2011, consecutive patients with pT1-3N2 NSCLC who underwent complete resection in our hospital but who did not receive PORT were identified. The patterns of first LRF were assessed and evaluated as to whether these areas would be encompassed by our proposed PORT CTV.
With a median follow-up of 24 months, 173 of 250 patients (69.2%) experienced disease recurrence. Of the 54 patients with LRF as the first event, 48 (89%) had recurrence within the proposed PORT CTV, and 6 (11%) had failures occurring both within and outside the proposed CTV (all of which occurred in patients with right-lung cancer). Ninety-three percent of failure sites (104 of 112) would have been contained within the proposed PORT CTV. For left-sided lung cancer, the most common lymph node station failure site was 4R, followed by 7, 4L, 6, 10L, and 5. For right-sided lung cancer, the most common site was station 2R, followed by 10R, 4R, and 7.
LRF following complete surgery was an important and potentially preventable pattern of failure in stage IIIA(N2) patients. Ipsilateral superior mediastinal recurrences dominated for right-sided tumors, whereas left-sided tumors frequently involved the bilateral superior mediastinum. Most of the LRF sites would have been covered by the proposed PORT CTV. A prospective investigation of patterns of failure after PORT (following our proposed CTV delineation guideline) is presently underway and will be reported in a separate analysis.
Abstract Background Intrathoracic esophagogastric anastomotic leak is a critical complication after esophagectomy. Recently, novel complex diagnostic and therapeutic managements for intrathoracic ...esophagogastric anastomotic leak have been performed at our institution. Materials and methods Sixty-seven consecutive patients with intrathoracic esophagogastric anastomotic leak after esophagectomy from January 2009 to May 2015 at our institution were reviewed. Thirty-nine patients received conventional managements (conventional group), in which they were diagnosed via contrast swallow when there was a suspicion of anastomotic leak and were subsequently treated with a metallic stent. Twenty-eight patients received complex managements (complex group), in which they were diagnosed using digital subtraction angiography, an intraluminal drainage tube was placed, and clips were subsequently performed under an endoscope. The outcomes of the two groups were retrospectively analyzed. Results There were no significant differences ( P > 0.05) between the two groups in the preoperative general clinical data, whereas the postoperative data exhibited some differences. Compared with the conventional group, the confirmation time and recovery time are significantly decreased in the complex group ( P < 0.01 and P < 0.01, respectively), and the incidence of severe complications is also lower ( P < 0.01); however, there were no significant differences in the mortality rate between the two groups ( P > 0.05). Conclusions Complex managements may represent a useful therapeutic option for postoperative esophagogastric anastomotic leak.
To prospectively investigate the efficacy and toxicity of accelerated hypofractionated thoracic radiation therapy (HypoTRT) combined with concurrent chemotherapy in the treatment of limited-stage ...small-cell lung cancer (LS-SCLC), with the hypothesis that both high radiation dose and short radiation time are important in this setting.
Patients with previously untreated LS-SCLC, Eastern Cooperative Oncology Group performance status of 0 to 2, and adequate organ function were eligible. HypoTRT of 55 Gy at 2.5 Gy per fraction over 30 days was given on the first day of the second or third cycle of chemotherapy. An etoposide/cisplatin regimen was given to 4 to 6 cycles. Patients who had a good response to initial treatment were offered prophylactic cranial irradiation. The primary endpoint was the 2-year progression-free survival rate.
Fifty-nine patients were enrolled from July 2007 through February 2012 (median age, 58 years; 86% male). The 2-year progression-free survival rate was 49.0% (95% confidence interval CI 35.3%-62.7%). Median survival time was 28.5 months (95% CI 9.0-48.0 months); the 2-year overall survival rate was 58.2% (95% CI 44.5%-71.9%). The 2-year local control rate was 76.4% (95% CI 63.7%-89.1%). The severe hematologic toxicities (grade 3 or 4) were leukopenia (32%), neutropenia (25%), and thrombocytopenia (15%). Acute esophagitis and pneumonitis of grade ≥3 occurred in 25% and 10% of the patients, respectively. Thirty-eight patients (64%) received prophylactic cranial irradiation.
Our study showed that HypoTRT of 55 Gy at 2.5 Gy per fraction daily concurrently with etoposide/cisplatin chemotherapy has favorable survival and acceptable toxicity. This radiation schedule deserves further investigation in LS-SCLC.
Allergic rhinitis (AR) is a common allergic airway disorder that is often poorly managed. There is an urgent need to enhance medication adherence in order to improve treatment outcomes in patients ...with AR. The efficacy of wearable smart watches in improving medication adherence is currently unclear.
This study aimed to evaluate the efficacy of a novel smart watch in improving medication adherence and symptom control in patients with AR. The reliability of self-reported medication use was also investigated.
This randomized, open-label, parallel controlled, pilot study enrolled adult patients with AR caused by cypress pollen. Patients were randomized in a 1:2 ratio to an intervention group and control group. Smart watches were only distributed to patients in the intervention group. During the cypress pollen season, all patients were required to take oral antihistamines daily and use nasal corticosteroids and antihistamine eye drops as needed. Daily AR symptom scores and medication usage were recorded in both groups. The smart watch was able to identify medication-taking behaviors of patients via artificial intelligence (AI) and relay this information to physicians, who sent short message service reminders to patients who forgot to take oral antihistamines for more than 2 days.
During the pollen season, the adherence rate to oral antihistamines in the intervention group (n = 17) was significantly higher than that in the control group (n = 38) (63.3% ± 28.5% versus 43.2% ± 30.2%, P = 0.02). The daily symptom score of the intervention group was lower than that of the control group (2.4 ± 1.1 versus 3.9 ± 1.0, P < 0.001). There was no significant difference in the on-demand medication score between the 2 groups (1.3 ± 0.4 versus 1.5 ± 0.5, P = 0.13). The consistency rate between self-reported nasal corticosteroid usage and the gold standard (ie, human observation of medication usage in the videos recorded by the smart watch) was 20.0% (0%, 53.7%), and the consistency rate between self-reported antihistamine eye drop usage and the gold standard was 24.3% (2.1%, 67.1%).
This pilot study showed that the application of smart watches in patients with AR was associated with improved medication adherence and symptom control. Furthermore, the reliability of self-reported medication usage was limited.
The purpose of this study was to assess the associations between 3-dimensional echocardiography (3DE)-derived changes in right ventricular (RV) volumes and strains with subsequent RV cardiotoxicity ...in patients treated with anthracyclines.
Although early detection and prediction of left ventricular (LV) dysfunction has been widely studied in patients receiving anthracyclines, little is known about the early changes in RV size and function in this population.
A total of 74 patients with diffuse large B-cell lymphoma who received 6 cycles of anthracycline-based treatment were enrolled. Echocardiography was performed at baseline or before chemotherapy (pre-chemotherapy) (T0); after 2 cycles (T1); after 4 cycles (T2); and at the end of 6 cycles of chemotherapy (T3). Right ventricular end-diastolic volume (RVEDV), end-systolic volume (RVESV), ejection fraction (RVEF), longitudinal free wall strain (RVLFS), and longitudinal septal strain (RVLSS) were quantified by 3DE. RV cardiotoxicity was defined as a relative reduction of >10% in 3D RVEF or a relative reduction of >5% to a value of <45%. Volume status was assessed by inferior vena cava diameter (IVCD) and the estimated right atrial pressure (RAP).
Twenty-seven patients developed cardiotoxicity after 6 cycles of chemotherapy (T3). Compared to baseline, increases in 3D RVEDV (58.5 ± 7.7 ml vs. 64.2 ± 7.0 ml; p < 0.001) and RVESV (27.8 ± 4.2 ml vs. 31.3 ± 4.2 ml; p < 0.001) were observed by the end of the fourth cycle of chemotherapy (T2). 3D RVLFS (−27.3 ± 3.1% vs. −24.2 ± 2.6%; p < 0.001) was also decreased at T2 compared to baseline. Statistically significant declines in 3D RVLSS (−26.1 ± 2.5% vs. −22.9 ± 2.7%; p < 0.001) and RVEF (54.0 ± 2.8% vs. 49.8 ± 2.4%; p < 0.001) were only observed at T3. A relative decrease in RVLFS of >12.4% (sensitivity, 78.6%; specificity, 82.6%; area under the curve (AUC), 0.80; p ＜ 0.001); and a relative increase in RVESV of >13.2% (sensitivity, 71.4%; specificity, 71.7%; AUC, 0.76; p ＜0.001) from baseline to T2 predicted subsequent RV cardiotoxicity at T3. IVCD and RAP did not change significantly over time.
3DE-derived measurements of RV strain and volume were associated with subsequent changes in RVEF. With further study, RVLFS and RVESV could potentially be used to predict subsequent declines in RVEF with anthracyclines.
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Abstract Introduction Spinal teratomas are extremely rare; they constitute <0.5% of all spinal cord tumors. These rare tumors have nonspecific manifestations but in most cases are accompanied by ...neurological deficits. Rupture of a mature teratoma can cause chemical meningitis. Patient Description A 7-year-old boy presented with paroxysmal abdominal pain and a history of recurrent aseptic meningitis. Kernig and Brudzinski signs were present. Lumber puncture revealed pleocytosis with no evidence of bacteria growth. Imaging of the spine revealed a cystic lesion in spinal cord at thoracic level 9-11. Endoscopic excision of the cyst was successfully performed. Surgical and histopathological findings confirmed extramedullary matured teratoma. Conclusions As the symptomatic attacks of spontaneous rupture of spinal teratoma resemble presentations of Mollaret meningitis, spinal teratoma should be considered in the differential diagnosis of Mollaret meningitis. We describe a rare example of spinal teratoma causing recurrent meningitis. Spine imaging should be considered in individuals with recurrent aseptic meningitis as this promotes earlier diagnosis, more appropriate treatment, and improved neurological outcome.
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