Bone tunnel positions in anterior cruciate ligament reconstruction evaluated by three-dimensional CT reconstruction based on Mimics software:modified transtibial versus anteromedial portal technique / 中国骨伤

OBJECTIVE@#To compare the femoral and tibial tunnel positions of anterior cruciate ligament reconstruction using the modified transtibial (MTT) technique and anteromedial (AM) portal technique.@*METHODS@#Between January 2017 and September 2020, 78 patients with anterior cruciate ligament rupture underwent single-bundle reconstruction with the modified transtibial technique in 39 cases (group MTT) and through anteromedial approach in 39 cases (group AM). There were 25 males and 14 females in group MTT, with an average age of (37.0±2.3) years old; 27 males and 12 females in group AM, with an average age of (37.5±2.2) years old. CT scan of the affected knee was conducted one week after the surgery to measure and compare the femoral tunnels positioning (Fx, Fy), tibial tunnels positioning in the frontal plane(Tx1), tibial tunnels positioning in the sagittal plane (Ty1), and tibial tunnels positioning in the axial plane (Tx2, Ty2) in patients undergoing anterior cruciate ligament reconstruction through Mimics software.@*RESULTS@#Three-dimensional CT reconstruction after the surgery showed that the average Fx and Fy were(25.2±2.1)% and (34.9±3.0)% respectively and the Tx1 and Ty1 were (45.5±3.3)% and (44.7± 3.0)% respectively, while the Tx2 and Ty2 were (47.0±3.0)% and (39.9±4.2)% respectively in group MTT. In group AM, the average Fx and Fy were (26.0±2.0)% and (36.1±3.9)% respectively and the Tx1 and Ty1 were (46.5±3.1)% and (45.6± 3.1)% respectively, while the Tx2 and Ty2 were (47.4±2.5)% and (39.6±3.9)% respectively. There were no statistically significant differences in the femoral and tibial tunnels between the two groups (@*CONCLUSION@#Both the MTT and AM technique can achieve good anatomical positioning of the femoral and tibial tunnels, without significant differences in the positioning of the bone tunnels.

Classification of glioma and solitary brain metastasis using magnetic resonance imaging radiomics feature / 解剖学报

Objective To analyze the difference of radiomics features between solitary brain metastasis and glioma using routine 3T TI, T2 and fluid attenuation inversion recovery (FLAIR) magnetic resonance imaging, to explore the significance of texture features constructed in different directions and angles in tumor regions in distinguishing the two kinds of tumors, and to explore a feasible method for high-precision classification of solitary brain metastases and gliomas. Methods Given the multimodal images of 43 patients with glioma and 45 age- and sex- matched patients with solitary brain metastasis, the gray level co-occurrence matrices of different angles of each slice were constructed from the transverse, coronal and sagittal directions of the tumor regions of these images, and the texture spatial relationship features (including contrast, correlation, energy and homogeneity) were calculated. Wilcoxon rank sum test was used to eliminate redundant features and select features with strong distinguishing ability. Finally, SVM linear kernel classifier was used to classify the selected features to achieve the identification of the two kinds of tumors. Results When classifying glioma and solitary brain metastasis, the precision, recall, Fl score and accuracy of multimodal and multidirectional combination features were 0.8857, 0.9114, 0.8944 and 0.8922, respectively. The area under the receiver operating characteristic curve obtained by linear kernel SVM classifier was 0. 9602. Totally 40 of the 45 patients with solitary brain metastases were correctly classified, and 39 of the 43 gliomas were correctly classified. Conclusion The multimodal and multi-directional combination features of tumor areas can be classified by linear kernel SVM classifier to distinguish gliomas from solitary brain metastases, which can be used as a second opinion to effectively assist doctors in making diagnosis.

Effect of Zhuangyao Jianshen Wan (ZYJCW) on P2X1 and P2X3 mRNA expressions in rats with diuresis caused by kidney deficiency / 中国中药杂志

To investigate the urination-reducing effect and mechanism of Zhuangyao Jianshen Wan (ZYJCW). In this study, SI rats were subcutaneously injected with 150 mg · kg(-1) dose of D-galactose to prepare the sub-acute aging model and randomly divided into the model group, the Suoquan Wan group (1.17 g · kg(-1) · d(-1)), and ZYJCW high, medium and low dose groups (2.39, 1.20, 0.60 g · kg(-1) · d(-1)) , with normal rats in the blank group. They were continuously administered with drugs for eight weeks. The metabolic cage method was adopted to measure the 24 h urine volume and 5 h water load urine volume in rats. The automatic biochemistry analyzer was adopted to detect urine concentrations of Na+, Cl-, K+. The ELISA method was used to determine serum aldosterone (ALD) and antidiuretic hormone (ADH). The changes in P2X1 and P2X3 mRNA expressions in bladder tissues of rats were detected by RT-PCR. According to the results, both ZYJCW high and medium dose groups showed significant down-regulations in 24 h urine volume and 5 h water load urine volume in (P <0.05, P <0.01), declines in Na+ and Cl- concentrations in urine (P <0.01), notable rises in plasma ALD and ADH contents (P <0.05, P <0.01) and remarkable down-regulations in the P2X1 and P2X3 mRNA expressions in bladder tissues (P <0.01). The ZYJCW low dose group revealed obvious reductions in Na+ and Cl- concentrations in urine (P <0.01). The results indicated that ZYJCW may show the urination-reducing effect by down-regulating the P2X1 and P2X3 mRNA expressions in bladder tissues of rats with diuresis caused by kidney deficiency.

Modified partially wide tangents technique in post-mastectomy radiotherapy for patients with left-sided breast cancer / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The role of internal mammary nodes (IMN) irradiation for breast cancer patients after mastectomy remains controversial. This study aimed to compare different techniques for radiation of the chest wall (CW) and IMN post-mastectomy for left-breast cancer patients in terms of dose homogeneity within planning target volume (PTV) and dose to critical structures.</p><p><b>METHODS</b>Thirty patients underwent CT simulation, while CW, IMN, left lung, heart and contralateral breast were contoured. Three three-dimensional conformal radiotherapy (3D-CRT) techniques, namely, standard tangents, partially wide tangents (PWT), and modified PWT techniques plus intensity modulated radiotherapy (IMRT) technique have been used to radiate CW and IMN. In addition to the target coverage and dose homogeneity, we also evaluated the dose to the critical structures including heart, left lung and contralateral breast.</p><p><b>RESULTS</b>All three 3D-CRT techniques provided satisfactory coverage regarding total PTV. The PWT and the modified PWT gave better coverage of IMN PTV with V(47.5) of (96.83 ± 4.56)% and (95.19 ± 3.90)% compared to standard tangents ((88.16 ± 7.77)%), P < 0.05. The standard tangents also contributed the biggest IMN V(D105%), V(D110%), V(D115%) and V(D120%). The lowest mean dose of the heart was achieved by the modified PWT ((8.47 ± 2.30) Gy), compared with PWT ((11.97 ± 3.54) Gy) and standard tangents ((11.18 ± 2.53) Gy). The mean dose of lung and contralateral breast with the modified PWT was significantly lower than those with PWT. Comparing IMRT with the modified PWT, both techniques provided satisfactory coverage. The conformity indexes (CI) with IMRT (CI1: 0.71 ± 0.02; CI2: 0.64 ± 0.02) were better than those with the modified PWT (CI1: 0.50 ± 0.02; CI2: 0.45 ± 0.02). The mean dose, V(5), V(10) and V(5-10) of heart and left lung with the modified PWT were significantly lower than those with the IMRT. The mean dose and V(D2%) of contralateral breast with the modified PWT were not significantly different from the IMRT (P = 0.868 and P = 0.212).</p><p><b>CONCLUSIONS</b>No single technique provides both the best CW and IMN coverage with minimum lung and heart dose. The modified PWT technique can be used as a clinical tool for the treatment of the left-sided post-mastectomy breast cancer patients to provide homogeneous target coverage while maintaining low doses to normal tissue.</p>

Dosimetrical optimization study of intensity modulated radiotherapy for intact breast / 中国癌症杂志

Background and purpose:Intensity-modulated radiotherapy(IMRT) can significantly improve the dosimetric distribution of both the target and organs at risk compared to tangential irradiation for whole breast. However,its optimized methods remain different and conflicting for many radiotherapy institutions.In order to achieve the optimized planning of IMRT for the irradiation of intact breast,we investigated different optimizing methods in three dimensional radiotherapy planning system.Methods:Ten patients with early-stage breast cancer after breast conserving surgery were eligible for the study.Two kinds of plans were performed on each patient in three-dimensional treatment planning system,inverse planning IMRT and forward planning IMRT which included 3 different optimizing methods as manual optimizing(MO),multiple points optimizing(PO) and automated inverse optimizing(AO).Various parameters were used to evaluate the efficacy of different IMRT plans.All plans were compared using dose volume histograms(DVH) for the planning target volume(PTV) and organs at risk(OARs).Results:For MO,PO,AO forward plans and inverse plans,median number of segments were 5,5.5,5 and 20 respectively,and mean total MU were 225.8, 228.4,226.4 and 345.8 MU,respectively.Comparing the different forward planning optimizations,the best target coverage and dose homogeneity of PTV was observed in AO plans(P(?)0.01),and PO and AO plans showed a better reduction of OARs exposure compared with MO plans(P(?)0.05).A further improvement of dose homogeneity in the PTV and better sparing of OARs was achieved using inverse planning(P(?)0.05).Conclusion:Forward planning IMRT with AO optimization for intact breast irradiation could provide both efficacy and dosimetric advantages better than others.The inverse IMRT plan showed more potential in improving the dosimetric outcomes.However,further studies are required for inverse optimizing plans.

Factors influencing target volume motion in tangential whole breast irradiation for breast cancer / 中华放射肿瘤学杂志

Objective To evaluate the impact of breathing motion on target volume and the factors influencing the set-up errors during tangential whole breast irradiation.Methods From Jan 2003 to Dec 2003,patients with early-stage breast cancer after breast conserving surgery,were selected to be eligible for the study.All patients were immobilized in treatment position by breast beard of Med-Tec 250.The motion of the breast treatment volume was observed on a fluoroscope in different directions under free breathing in 16 patients.The set-up errors in different dimensions during irradiation were measured by weekly portal films (PF) in comparison with digital reconstructed radiographs (DRR) in 11 patients.Results The central lung distance (CLD) variation during free breathing was (2.1?1.2) mm which is greater than the motion to- wards the other directions.By comparing the PF and DRR,the systemic error,random error and overall er- ror in the outer,inner and cranio-caudal directions was 1.9,1.6,2.5 and 2.4,1.7,3.1 and 2.6,2.3, 3.5 mm,respectively.In addition,the discrepancy of the treatment position in cranio-caudal direction and breast volume was most obvious at the beginning 2 weeks with the peak of breast volume at the second week. It decreased gradually during the following 3 weeks.Conclusions This study suggests that the mean value of the motion of the breast target volume during one breathing cycle is less than 2 mm.The set-up errors dur- ing irradiation is the greatest in cranio-caudal direction,suggesting that the fixing precision of the breast board should be further improved.The set-up error during irradiation are most obvious at the beginning two weeks,with the peak of the breast volume in the second week.

Value of postmastectomy radiotherapy in T1 or T2 breast cancer patients with 1-3 positive axillary lymph nodes / 中华放射肿瘤学杂志

Objective To analyze the incidence and risk factors for regional nodal failure(RNF) and chest wall recurrence(CWR) in T1 or T2 breast cancer patients(median age 44 year-range 26-72) with 1-3 positive axillary nodes treated with postmastectomy radiotherapy limited to the regional nodes.Methods From 1990 to 1999,320 patients were treated with postmastectomy(radical or modified radical) radiother- apy confined to the supraclavicular and internal mammary nodes with a median dose of 50 Gy in 25 fractions over 5 weeks.The median number of nodes examined was 8 (range 1-24).The median lymph nods rate (LNR) was 25% (range 5%-100%).Results The 5-year overall survival rate and disease free survival rate was 89.7% and 83.4%,respectively.The 5-year RNF and CWR was 7.9% and 5.7%,respectively. The 5-year RNF in patients with LNR＜30% and≥30% was 4.4% and 14.0% (P=0.002).The 5-year CWR in the subgroups with LNR＜30% and≥30% was 3.5% and 9.6% (P=0.018).In age≤35 year eld patients with LNR≥30%,the 5-year RNF and CWR was 40.0% and 20.0%.In T2 patients with LNR≥30%,the 5-year RNF and CWR was 15.8% and 12.2%.Age and LNR were independent prognostic factors for RNF+CWR,LNR was the only independent prognostic factor for CWR by multivariate analysis. Conclusions In T1 or T2 breast cancer patients with 1-3 positive axiliary nodes treated with radical or modified radical mastectomy,a relatively high incidence of chest wall recurrence is observed in the subgroup of patients with lymph nods rate of 30% or greater accompanied by a T2 primary tumor or age≤35 years old. Lymph nodes rate is the only significant prognostic factor of chest wall recurrence.For these patients,post- operative lymphatic drainage area and chest wall irradiation should be considered.