ABSTRACT
Objective:To explore the influence of body mass index (BMI) changes on the doses to normal tissues and adverse reactions of the lower digestive system and urinary system in the brachytherapy for cervical cancer.Methods:Clinical data of 80 cervical cancer patients who received radical radiotherapy in our hospital from January 2020 to February 2021 were retrospectively analyzed. All patients received external beam radiation ± chemotherapy + brachytherapy. The delineation method of target areas and organs at risk (OAR) was determined based on the recommended scheme of GEC-ESTRO. The target areas included high risk (HR)-CTV and intermediate risk (IR)-CTV, and OAR consisted of rectum, sigmoid colon, bladder, and small intestine. The target area dose was evaluated by D 90% of the HR-CTV. The OAR volume dose was evaluated by using D2cm3. Correlation analysis was used to compare the dosimetric relationship between BMI and D2cm3, D1cm3 and D0.1cm3 in bladder, rectum, colon and small intestine. Logistic regression analysis was adopted to analyze the risk factors of acute and late adverse reactions in the lower gastrointestinal system and urinary system. Whether BMI was a risk factor was validated. Results:BMI was negatively correlated with the D2cm3, D1cm3 and D0.1cm3 of the small intestine ( P=0.034, 0.024, 0.034), and the correlation coefficients were -0.240, -0.255, and -0.241, respectively. Logistic regression analysis showed that BMI was not a risk factor for the occurrence of acute and late adverse reactions in the lower gastrointestinal system and urinary system. For every 1 Gy increase of D2cm3, D1cm3 and D0.1cm3 in the small intestine, the relative risk of acute adverse reactions in the lower gastrointestinal system was increased by 16.6%, 15.1%,and 12.7%, respectively. Conclusions:In brachytherapy for cervical cancer, there is a negative correlation between BMI and D2cm3, D1cm3 and D0.1cm3 of the small intestine. As the BMI of patients declines, the radiation dose to the small intestine shows an increasing trend, which may increase the risk of acute adverse reactions in the lower gastrointestinal system.
ABSTRACT
Objective:To measure the effect of applicator materials on absorbed dose in water from HDR afterloading 192Ir source by using three-dimensional printed holder (3DPH) and synthetic single-crystal diamond detector (SSCDD). Methods:SSCDD and plastic implants were fixed on the 3DPH in turn. The central axis of SSCDD was perpendicular to that of plastic implant needle on the same plane. The actual residence dwell position measured using source position simulator was 248 mm, which was consistent with the maximum response dwell position measured in a point by point way. The materials for measurement included 304 stainless steel, polyphenylene sulfone resins (PPSU), polymethyl methacrylate (PMMA) and 3-D printed polylactic acid (PLA), respectively. The attenuation of absorbed dose in water with different thickness or filling ratio was measured.Results:The linear fitting formula of relative dose varying with thickness (mm) for 304 stainless steel and PPSU materials were y=-0.029 7 x+ 1.000 3 and y=-0.002 3 x + 1.010 2, respectively. And the goodness-of-fits were 0.925 3 and 0.722 2, respectively. The effect on dose of PMMA materials within 10 mm was less than 1%. The linear fitting formula of relative dose varying with filling ratio (%) for PLA materials with 10 mm thickness was y=-0.000 4 x+ 1.024 6, with a goodness-of-fit of 0.854 5. Conclusions:The effect of applicator materials on the absorbed dose arising from afterloading 192Ir source should attract enough attention of both developers and clinical users, especially with regard to high-density materials like 304 stainless steel and new technology materials such as 3D printed polylactic acid.
ABSTRACT
Objective To investigate the clinical features, diagnosis, treatment and prognosis of myelodysplastic syndromes (MDS) with mature plasmacytoid dendritic cells (PDC) proliferation. Methods The clinical data of one case of MDS with excess blasts (EB)﹣1 with mature PDC proliferation in Air Force Medical Center was retrospectively analyzed, and the literature was reviewed. Results The patient′s physical examination revealed anemia and thrombocytopenia. Bone marrow smears showed 0.064 of myeloblasts and 0.152 of dendritic cells. Immunophenotyping showed two groups of abnormal proliferation cells, namely, myeloblasts and mature PDC. Decitabine treatment was given, and the red blood cells and platelets were infused intermittently. The condition of patient was basically stable. Conclusions MDS with mature PDC proliferation is extremely rare. No special clinical manifestations are found, and the diagnosis is based on bone marrow cytology and immunophenotyping. There is no standard regimen for treatment of MDS with mature PDC proliferation, and the prognosis depends on the progression of MDS.
ABSTRACT
In this article,the content of radiation physics in the ICRU report No.89 were interpreted in details,aiming to provide reference in the radiation physics for radiologists performing brachytherapy for cervical cancer patients.
ABSTRACT
Radiation oncology is a multidisciplinary clinical subject.It is necessary to focus on cultivating practical talents in the development of radiation oncology disciplines.The traditional teacheroriented teaching methods ignore the students' overall learning status and the ability of innovation and thinking.This paper explores improvement measures of training talents from multiple perspectives through an integrative system,which includes interdisciplinary collaborative teaching methods that are supplemented by group discussions,and an open examination way centering on the medical record.Meanwhile,its practical application has also been explored.
ABSTRACT
The role of three-dimensional brachytherapy (3D-BT) in the radical treatment of cervical cancer has been widely recognized. Obtaining the image information through simulated positioning is a key step of 3D-BT.Currently, MRI/CT positioning has been commonly applied in clinical practice, which has respective limitations when applied in radiosurgery. Consequently, it is of necessity to explore an accurate, highly efficient and convenient positioning approach. Besides MRI and CT, ultrasound is a novel positioning method in clinical settings. Through literature review, the application of ultrasound in 3D-BT was summarized, aiming to provide reliable reference for clinicians.
ABSTRACT
Precise implantation of applicator is the key step of brachytherapy in cervical cancer patients. The imaging guidance can guarantee the accuracy of applicator placement. At present, the imaging approaches used to guide the applicator placement mainly include ultrasound, CT and X-ray, and MRI and laparoscopy have been applied in certain institutions. There has been no consensus on the standard imaging technique. In this paper, nearly 50 articles and surveys were reviewed to demonstrate that ultrasound-guided placement is of clinical value and guiding significance. Therefore, the application of ultrasound-guided applicator placement in the brachytherapy for cervical cancer was summarized and reviewed.
ABSTRACT
The development of a treatment plan is one of the critical steps in the three-dimensional (3D) brachytherapy for cervical cancer.This article reviews more than 40 papers on the treatment plan design of high-dose-rate brachytherapy for cervical cancer and summarizes the principles and methods for developing a treatment plan of 3D brachytherapy.There are many difficult points in 3D brachytherapy.The doses delivered to tumor and normal tissues need to be balanced by considering many different factors under different conditions.In addition,there are still some uncertain factors for developing the treatment plan of 3D brachytherapy,which needs further exploration and research in the future.It can provide some references for colleagues in 3D brachytherapy for cervical cancer.
ABSTRACT
Objective To report a simple method for determination of dwell position offset of ring applicator using GafchromicTM EBT3 film and ImageJ software. Methods In the dummy plan, this study reconstructed the ring applicator point by point manually according to the MR line marker, the most distal reconstruction point was at the end of marker, set the offset to zero. The first, eleventh, and twenty-third dwell positions were activated with the step length of 2. 5 mm. A setup image was designed to immobilize the ring applicator. The setup image was composed of two perpendicular thin lines and a circular with a diameter of 16 mm. GafchromicTM EBT3 film was fixed behind the setup image by plastic tapes. After irradiation, a ruler was put on the bottom of the irradiated film as a plotting scale. Photos were taken with the help of a vertical camera using a tripod. The file was imported into ImageJ software and the coordinate values were obtained by semi-automatic recognition of the center of exposure area. The test was repeated five times at one week interval to evaluate the uncertainty. For every time, each dwell position was measured five times. Results The angle between the radius of the first dwell position and the x-axis was 43° in the dummy plan, and (46. 8 ± 0. 9)° for actual measurement. The offset was 0. 9 mm for the ring applicator combined with the MR according to calculation. The distances between the first,the eleventh and the twenty-third dwell positions and the center of the ring were ( 12. 9 ± 0. 1 ) mm, ( 12. 5 ± 0. 1 ) mm, (12. 4 ± 0. 1) mm, respectively. Conclusions Using GafchromicTM EBT3 film and the ImageJ software is a simplified method to validate the dwell position offset of the ring applicator.
ABSTRACT
Objective@#To evaluate the efficacy and safety of Xiaoaiping combined with chemotherapy in the treatment of advanced esophageal cancer.@*Methods@#This is a multi-center, randomized, open label and parallel controlled study. A total of 124 advanced esophageal cancer patients with Karnofsky Performance Status (KPS) score ≥60 and expected survival time≥3 months were enrolled. We adopted design and divided the patients into study and control group. The patients in study group received Xiaoaiping combined with S-1 and cisplatin. The control group received S-1 and cisplatin. Each group included 62 patients and 21 days as a treatment cycle. The efficacy and adverse events in patients of the two groups were observed and compared.@*Results@#57 patients in the study group and 55 in the control group were included in efficacy assessment. The response rate was 54.4% and 34.5% in the study group and control group, respectively(P<0.05). Disease control rates were 86.0% and 69.1%, respectively(P<0.05). The median progression-free survival (PFS) was 7.97 in the study group and 6.43 months in the control group(P<0.05). The median overall survival(OS) was 12.93 in the study group and 10.93 months in the control group(P<0.05). The most common adverse events in the two groups were nausea and vomiting, thrombocytopenia, anemia, neutropenia, liver damage, pigmentation, oral mucositis, renal impairment and diarrhea. The incidences of nausea, vomiting, thrombocytopenia, leukopenia, neutropenia and diarrhea in the study group were significantly higher than those in the control group(P<0.05).@*Conclusion@#Xiaoaiping combined with S-1 and cisplatin significantly increased response rate, and prolongedpatients′ survival in patients with advanced esophageal cancer.
ABSTRACT
Objective To investigate the correlation between ICRU reference point dose and dosevolume parameters of organs at risk (OARs) under different bladder and rectal filling status in threedimensional conformal brachytherapy for locally advanced cervical cancer.Methods A total of 31 patients who received magnetic resonance imaging-guided three-dimensional conformal brachytherapy for cervical cancer in 96 fractions were enrolled.The ICRU rectal and bladder reference points were determined in the treatment planning system,and the doses at these points were recorded and compared with the dose-volume parameters of the rectum and bladder.The paired t-test was used to analyze the differences between them.Results Bladder DICRU was lower than bladder D0.1cm3 and D1 cm3 (P=0.000 and 0.000),higher than bladder D5 cm3 and D10cm3 (P=0.000 and 0.000),and similar to bladder D2 cm3 (P=0.345).Under the bladder filling status,bladder DICRU was lower than D2cm3.Rectal DICRU was lower than rectal D0.1 cm3 and D1cm3 (P =0.000 and 0.002),higher than rectal D5 cm3 and D 10 cm3 (P =0.000 and 0.000),and similar to rectal D2cm3 (P=0.058).The ICRU bladder and rectal reference point doses were positively correlated with corresponding D2 cm3.In the case of bladder volume ≥ 200 cm3,the ICRU bladder reference point dose underestimated bladder D2 cm3.In the case of rectal volume ≥ 37 cm3,the ICRU rectal reference point dose overestimated rectal D2 cm3.Conclusions In three-dimensional conformal brachytherapy,it is generally safe to use D2 cm3 as an index to evaluate OARs,but when the bladder or rectum is in an empty status,the ICRU bladder or rectal reference point doses should be considered.
ABSTRACT
Objective This study aimed to establish a reliable primary culture protocol for preparing murine spleen-derived mesenchymal stem cells ( MSCs) by tissue explant culture.Methods Healthy mouse spleens were crushed by syringe handle to harvest spleen mesenchymal tissues.Then the tiny pieces of spleen tissue were digested by collagenase II before seeded into culture flasks.The morphological characteristics of spleen tissue-derived cells were observed under the inverted microscope.Further, the surface antigen profile of the cells was analyzed by flow cytometry (FACS).The cells were induced to differentiate into osteoblasts and adipocytes.Results The murine spleen-derived MSCs exhibited a spindle-shaped appearance.The FACS results showed that the spleen-derived MSCs highly expressed CD29, CD44, CD105 and Sca-1, but weakly expressed CD11b, CD34, CD45 and Ia. In addition, the spleen-derived MSCs steadily differentiated into osteoblasts and adipocytes in the induction medium.Conclusions A method of primary culture of murine spleen-derived MSCs by explant culture is successfully established.The harvested MSCs exhibit high purity and cell proliferation ability, and provide a reliable cell model for related researches.
ABSTRACT
To explore the clinic characters,treatments and prognosis of patients with primary bone lym-phoma( PLB ) .The clinical symptoms, signs, X -ray features, pathological morphology, immunophenotype and treatment of 7 patients with PLB were analyzed retrospectively and the pertinent literatures were reviewed.The re-sults showed that the main complains of 7 cases of PBL were local pain.The CT showed osteolytic bone destruc-tion and soft tissue swelling.There were 3 cases of diffuse large B cell lymphoma,1 case of Burkitt-type lympho-ma,1 case of periferal T-cell lymphoma,1 case of anaplastic large cell lymphoma,and 1 case of Hodgkins lym-phoma.2 patients presented with stageⅠ,4 with stageⅡ,and 1 with stage 3.The therapeutic procedure includes local radiotherapy combined with chemotherapy and targeted therapy.The clinical presentation of PLB is not spe-cial.The diagnosis and identification of histological type of PLB should be established by histopathological and im-munohistochemistry examinations.Early diagnosis and active therapy could improve the prognosis of PLB.Combi-nation therapy including radiotherapy and chemotherapy is the optimal treatment for PLB.
ABSTRACT
Objective To investigate the dosimetric differences between Utrecht applicator and ring applicator in three-dimensional (3D) conformal brachytherapy for locally advanced cervical cancer.Methods Twenty-five patients with locally advanced cervical cancer were treated with magnetic resonance imaging-guided 3D conformal brachytherapy.Utrecht applicator and ring applicator were used interchangeably for 96 cycles.Patients were divided into two groups according to the type of applicator.Each group received 48 cycles of treatment, in which ring applicator was first applied for 26 cycles and Utrecht applicator was first applied for 22 cycles.High-risk clinical target volume ( HR-CTV) , width, thickness, and D90 at the point A level, D2 cm3 of organs at risk (OARs), V7 Gy , W7 Gy,A, V7 Gy ,A, and W/T7 Gy were evaluated and analyzed using paired t-test.Results There were no significant differences in HR-CTV and the width, thickness, and D90 at the point A level between the Utrecht group and the ring group ( P=0.487;P=0.340;P=0.857;P=0.921);there were no significant differences in D2 cm3 values of bladder, rectum, sigmoid, and bowel between the two groups ( P=0.136;P=0.802;P=0.985;P=0.458);there were no significant differences in V7 Gy and T7 Gy,A between the two groups ( P=0.076;P=0.435) .The Utrecht group had a significantly larger W/T7 Gy,A than the ring group ( P=0.002 ) .Conclusions Utrecht applicator is appropriate for patients with relatively large width and width/thickness ratio of HR-CTV at the point A level.
ABSTRACT
<p><b>OBJECTIVE</b>To investigate the therapeutic effects of the conditioning regimen with busulfan plus cyclophosphamide (BU+CY) or total body irradiation plus cyclophosphamide (TBI+CY) on haploidentical stem cell transplantation (HSCT) in hematologic malignancy.</p><p><b>METHODS</b>The clinical outcomes of 77 HSCT recipients with hematologic malignancy from January 2001 to December 2010, including 21 AML, 33 ALL, 19 CML and 4 MDS were retrospectively evaluated. Among them, 65 patients obtained complete remission (CR) and 12 non-remission (NR) before transplantation; 39 patients received conditioning regimen with BU+CY, and 38 with TBI+CY.</p><p><b>RESULTS</b>There were no statistically significant differences in hematopoietic reconstitution, disease free survival (DFS), and transplant- related mortality (TRM) between two groups. The estimated 3- years overall survival (OS) was 56.4% for BU+CY and 31.6% for TBI + CY (P=0.0283). The overall relapse rate was similar between two groups (15.4% vs 34.2%; P=0.1538). However, the accumulative probability of relapse at 1-year was significantly lower in BU+CY than that in TBI+CY group (2.56% vs 26.67%; P=0.0116). The incidence of grade II-IV graft-versus-host disease (GVHD) was similar between two regimens (20.5% in BU+CY group and 18.4% in TBI+CY group; P=0.8168). The incidence of chronic GVHD (cGVHD) was higher in the TBI+CY group than that of BU+CY group (84.6% vs 41.1%; P=0.0007). The extensive GVHD obtained the similar outcome (30.8% vs 10.5%; P=0.0416).</p><p><b>CONCLUSION</b>Patients using BU+CY as conditioning regimen before transplant could obtain a better 3 year OS and lower short-term relapse rate. The TBI+CY conditioning regimen could significantly increase the incidence of cGVHD without increasing the acute GVHD. BU+CY conditioning regimen could be used for HSCT, but the attention should be paid to prevent the related hemorrhagic cystitis.</p>
Subject(s)
Adolescent , Adult , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Young Adult , Busulfan , Cyclophosphamide , Hematologic Neoplasms , Therapeutics , Hematopoietic Stem Cell Transplantation , Retrospective Studies , Transplantation Conditioning , Methods , Whole-Body IrradiationABSTRACT
BACKGROUND:Spinocerebel ar ataxia is a inherited neurodegenerative disease with progressive cerebel ar masonic movement disorders as the main clinical manifestation. So far, no drug is available to control the disease progression. OBJECTIVE:To observe the clinical effect of umbilical cord mesenchymal stem cells in treating spinocerebel ar ataxia by intrathecal injection. METHODS:Thirty-eight cases of spinocerebel ar ataxia were given umbilical cord mesenchymal stem cells by intrathecal injection, 1×106/kg once a week, four times as a course. These 38 cases received 52 courses. Among them, 27 cases received 1 course, 8 cases received 2 courses and 3 cases received 3 courses. International Cooperative Ataxia Rating Scale (ICARS) and Activity of Daily Living Scale (ADL) were used to evaluate patients’ neural functions (the greater scores, the more severe damage) and ability of daily living (the lower score, the stronger the ability of daily living). After treatment, al patients were subjected to fol ow-up visit. RESULTS AND CONCLUSION:The total effective rate of 52 courses of treatment was 84.62%. ICARS and ADL scores were significantly decreased at 1 month after treatment (P<0.01). In most of effective patients, unstable walking and standing, slow movement, upper limb fine motor disorder, writing difficulties, dysarthria, eye movement disorders were improved. After treatment, common adverse effects were dizziness (1 case), low back pain (2 cases), headache (1 case), and fever (2 cases). Al these symptoms disappeared within 1-3 days. No treatment-related adverse events happened in the median fol ow-up of 39 months (11-59 months). The il ness of effective patients had been stable for 1-19 months, average (5.95±4.84) months. Intrathecal injection of umbilical cord mesenchymal stem cells is safe to ameliorate clinical symptoms to some extent within a certain time. It may delay the progression of spinocerebel ar ataxia. Multiple courses of treatment can help to further improve neurological function in most patients.
ABSTRACT
Dexmedetomidine and midazolam have been widely used in clinical anesthesia and intensive care unit sedation. These two drugs differ in sedative mechanism. We hypothesized that the neurotoxicity of repeated exposure to dexmedetomidine or midazolam for neonatal mice might be different. Twenty four mice of postnatal day 8 were randomly divided into control (n=8), dexmedetomidine (n=8) and midazolam group (n=8) respectively. In the three groups, saline(10mL/kg), dexmedetomidine(10microg/kg) or midazolam(40mg/kg) was injected intraperitoneally once a day, in the next five days, respectively. Then the brains of the mice in the three qroups were removed and cryosectioned. Apoptotic neural cell in hippocampus region was detected with terminal deoxynucleotydyl transferase -mediated dUTP nick end labeling(TUNEL). Bcl2 and Bax protein expression level in the hippocampus were determined by immunofluorescent staining. In the present study, the number of TUNEL-positive cells from midazolam group ((20 +/-3) /mm2) was larger than that from dexmedetomidine group ((15+/-2) /mm2, P<0. 05) and control group((13+/-3) /mm2, P<0. 05); Bcl-2 protein quantity in hippocampus from control group((790+/-103)/mm2)was significantly lower than that in midazolam group((1187+/- 162)/mm2, P<0.05)and dexmedetomidine group((890+/-125)/mm2, P<0. 05). Bax protein level in control group((942+/-104)/mm2) was also significantly lower than that in midazolam group((1839+/-160)/mm2, P<0. 05)and dexmedetomidine group((1143+/-125)/mm2, P<0. 05); Bax/Bcl-2 ratio in midazolam group(0. 64+/-0. 13) was significantly lower than that in dexmedetomidine group(0. 78 +/-0. 14, P<0. 05) and control group(0. 84+/-0. 15, P<0. 05). Our results suggest that dexmedetomidine has lower neurotoxicity than midazolam for neonatal mice.
Subject(s)
Animals , Mice , Animals, Newborn , Apoptosis , Dexmedetomidine , Toxicity , Hippocampus , Pathology , Mice, Inbred C57BL , Midazolam , Toxicity , Neurons , Pathology , Neurotoxicity Syndromes , Proto-Oncogene Proteins c-bcl-2 , Metabolism , bcl-2-Associated X Protein , MetabolismABSTRACT
Objective To evaluate the efficacy of rituximab-containing regimens on post-transplantation lymphoproliferative disorder (PTLD) following haploidentical hematopoietic stem cell transplantation (HSCT). Methods The clinical data of 3 cases of PTLD after haploidentical HSCT were analyzed retrospectively. Time to development of PTLD ranged from 57 to 164 days after HSCT.The main symptoms included fever, superficial lymph node enlargement. Epstein-Bart virus (EBV)-positive B-cell PTLD was diagnosed by biopsy of lymph node. Management of 3 patients consisted of withdraw of immunosuppressive treatment, anti-viral therapy, rituximab (375 rng/m2 , per week for four weeks) monotherapy or chemotherapy plus rituximab. Results All the patients had complete remission after treatment. Conclusion PTLD is a serious complication of HSCT especially haploidentical HSCT. Rituximab-containing regimens are potentially effective, well-tolerated with mild toxicity and improve the prognosis of PTLD following haploidentical HSCT.
ABSTRACT
Objective To approach the alleviating effect of medicative diet for food therapy on hepatic function of patients with gastric cancer and adjuvant chemotherapy after operation and supply references for effective treatment and nursing. Methods We divided 123 patients with gastric cancer after operation into the test group (65 cases) and the control group (58 cases).The control group adopted routine treatment project while the test group received medieative diet for food therapy based on routine treatment project. The changes in hepatic functions were compared between the two groups. Results The changes in hepatic functions of the test group were better than those of the control group (P<0.01 ). Conclusion Medicative diet for food therapy could significantly restore the seriously damaged hepatic function after chemotherapy.
ABSTRACT
BACKGROUND:Heterogeneous deproteinized bone because of wide source and its special biological characteristics maybe a good bone tissue engineering scaffold.Its immunogenicity and mechanical properties are different by different interventions.OBJECTIVE:To proof the preparation technology,immunological and mechanical properties of heterogeneous deproteinized bone.DESIGN,TIME AND SETTING:A control observational experiment was performed in the Heilongjiang Key Laboratory of Anti-fibrosis Biotherapy from February to October 2008.MATERIALS:Fresh femoral cancellous bones extracted from adult pigs,which were not including cartilages and cortical bones,were prepared into size of 3 cm?0.5 cm?0.5 cm.Their long axis direction was the same with orientation of trabeculae.The apparent pore densities of the used bones were almost same.METHODS:The bones were soaked in chloroform-carbinol(1:1) 24 hours for degrease.They were shaken and washed by distilled water at 50 ℃,and then put into 20% H2O2 for 24 hours.The procedure repeated three times.The bones were soaked in distilled water at room temperature for 24 hours,and then dryed.MAIN OUTCOME MEASURES:The gross morphological and histological features of the deproteinized cancellous bones were observed.The contents of amino acid and their biomechanical properties were measured.RESULTS:The three-dimensional space structures of the deproteinized cancellous bones were not damage greatly,and they had a natural pore network system which composited of hydroxyapatite and collagen.The contents of collagen amino acids in the deproteinized cancellous bones had no obvious difference from fresh cancellous bones,but the wave crests of aromatic amino acids such as tyrosine and methionine were disappear.The elastic moduli of deproteinized cancellous bones were significantly higher than those of fresh cancellous bones(P