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Objective:To analyze the predictive factors for prognosis of adult patients with acute traumatic shock.Methods:A retrospective cohort study was used to analyze the clinical data of 122 adult patients with acute traumatic shock treated in ICU of Second People′s Hospital of Liaocheng from July 2013 to September 2021. There were 90 males and 32 females with the age range of 18-83 years [(49.8±16.9)years]. Injury severity score (ISS) was 14-50 points [(28.6±6.3)points]. According to the prognosis, the patients were divided into good prognosis group ( n=48) and poor prognosis group ( n=74). The gender, age, and leukocyte count, neutrophil count, lymphocyte count, platelet count, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), D-dimer, lactic acid, ISS and shock index (SI) on emergency admission were compared between the two groups. Univariate stepwise regression analysis and multivariate Logistic regression analysis were used to screen the indicators affecting the prognosis of patients with acute traumatic shock. Predictive value of the indicators affecting patients′ prognosis were analyzed by receiver operating characteristic (ROC) curve, and the area under the curve (AUC), sensitivity, specificity and optimal cut-off value were calculated. The indicators affecting the prognosis were analyzed by stratification analysis. Results:There was no significant difference between the two groups in gender, platelet count, D-dimer, ISS and SI (all P>0.05). The age, lymphocyte count and lactate level in poor prognosis group were higher than those in good prognosis group, while the leukocyte count, neutrophil count, NLR and PLR in poor prognosis group were lower than those in good prognosis group (all P<0.01). Univariate stepwise regression analysis showed that age and NLR were related to the prognosis of patients with acute traumatic shock (all P<0.01). While the gender, leukocyte count, neutrophil count, platelet count, PLR, D-dimer, lactic acid, ISS and SI had no correlation with the prognosis (all P>0.05). Multivariate Logistic regression analysis showed that age ( OR=0.96, 95% CI 0.93-0.98) and NLR ( OR=1.19, 95% CI 1.10-1.29) were the affecting factors for prognosis of patients with acute traumatic shock. ROC analysis showed the AUC of age for 0.32 (95% CI 0.22-0.41) together with the optimal cut-off value predicting prognosis for 48.5 years (sensitivity 68.9%, specificity 64.6%), the AUC of NLR for 0.79 (95% CI 0.71-0.90) together with the optimal cut-off value predicting prognosis for 6.51 (sensitivity 77.1%, specificity 71.6%). Stratified analysis showed that the proportion of patients in poor prognosis group was increased gradually with the increase of age ( P<0.01), while that was decreased significantly with the increase of NLR level ( P<0.01). Conclusions:Age and level of NLR on emergency admission can predict the prognosis of adult patients with acute traumatic shock, with the best cut-off value of 48.5 years and 0.79. Moreover, advanced age and lower level of NLR indicate much poorer prognosis.
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Objective:To develop a deep learning-based approach for predicting the dose distribution of intensity-modulated radiotherapy (IMRT) for breast cancer patients, and evaluate the feasibility of applying the predicted dose distribution in the automatic treatment planning.Methods:A total of 240 patients with left breast cancer admitted to Fudan University Shanghai Cancer Center were enrolled in this study: 200 cases in the training dataset, 20 cases in the validation dataset and 20 cases in the testing dataset. A modified deep residual neural network was trained to establish the relationship between CT image, the contouring images of target area and organs at risk (OARs) and the dose distribution, aiming to predict the dose distribution. The predicted dose distribution was utilized as the optimization objective function to optimize and generate a high-quality plan.Results:Compared with the dose distribution of clinical treatment plan, the predicted dose distribution for target areas and OARs showed no statistical significance except for a simultaneous boost target PTV 48Gy. And the treatment plan generated based on the predicted dose distribution was basically consistent with the predicted outcomes. Conclusion:Our results demonstrate that the deep learning-based approach for predicting the dose distribution of IMRT for breast cancer contributes to further achieving the goal of automatic treatment planning.
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Objective To develop an automatic algorithm to predict the dose-volume histogram (DVH) and implement it in clinical practice.Methods Based on the prior information in the existing plan,such as dosimetric results of organs at risk (OARs) and OAR-target spatial relationship,a two-dimensional kernel density estimation was implemented to predict the DVH of OARs.The predicted DVH curves were converted into objective functions that would be implemented in the Pinnacle treatment planning system.Comparisons between predicted and actual values and between Auto-plan and manual planning were made by paired t test.Results We applied this algorithm to 10 rectal cancer patients,10 breast cancer patients,and 10 nasopharyngeal carcinoma patients.The predicted DVH of OARs showed that the deviation between the actual and predicted values at important clinical dose points were within 5%(P>0.05).The re-planning for the 10 breast cancer patients using Auto-plan showed that the heart dose was significantly reduced and the target coverage was increased,which was consistent with the predicted results.Conclusions The method proposed in this study allows for accurat DVH prediction,and,combined with Auto-plan,can be used to generate clinically accepted treatment plans.
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Objective To retrospectively review the history and development of radiotherapy quality assurance ( QA) in the Affiliated Cancer Hospital of Fudan University, and to report the primary experience and evolvement of an entire QA workflow management. Methods The multidisciplinary QA team has implemented an entire QA workflow management process in the Radiotherapy Center using the failure modes and effects analysis ( FMEA) and plan?do?check?act ( PDCA) tool since April 2015. Treatment data of approximately 6000 patients before and after implementation were compared. Results The error rate was reduced from 17% to 09% after using the entire QA workflow management. Conclusions Entire QA workflow management effectively improves the accuracy and safety of radiotherapy.
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@#Objective To explore the protective effects of proanthocyanidins pretreatment on intestinal function after cerebral ischemia-reperfusion injury. Methods 24 Sprague-Dawley rats were randomly divided into sham group (group A, n=8), ischemia-reperfusion group (group B, n=8) and proanthocyanidins pretreatment group (group C, n=8). The model of cerebral ischemia-reperfusion injury in rats was established according to Longa's method. Group C was intraperitoneally injected with proanthocyanidins 10 mg/(kg ⋅ d), group A and group B were injected with normal saline for 5 consecutive days. 1 and 3 days after cerebral ischemia-reperfusion, ileum myoelectric slow wave and smooth muscle contractility, the activity of superoxide dismutase (SOD) and content of malondialdehyde (MDA) were measured, the content of the serum TNF-α was tested with ELISA kit, ileum tissues were tested with hematoxylin eosin (HE) staining and used for measuring the moisture content. Results Compared with group B 1 and 3 days after cerebral ischemia-reperfusion, the intestinal mucosa injury relieved, the intestinal mucosa score decreased (P<0.05) and the number of infiltrated inflammatory cell decreased in group C; the frequency of slow wave and contraction trended to increase (P>0.05), and the amplitude increased (P<0.05) in group C; the serum SOD activity increased (P<0.05), and the content of MDA and TNF-α decreased (P<0.01) in group C; the intestinal moisture content reduced (P<0.01) in group C. Conclusion Proanthocyanidins pretreatment can protect intestinal function from injury after cerebral ischemia-reperfusion.
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Objective To explore the protective effects of proanthocyanidins pretreatment on intestinal function after cerebral isch-emia-reperfusion injury. Methods 24 Sprague-Dawley rats were randomly divided into sham group (group A, n=8), ischemia-reperfusion group (group B, n=8) and proanthocyanidins pretreatment group (group C, n=8). The model of cerebral ischemia-reperfusion injury in rats was established according to Longa's method. Group C was intraperitoneally injected with proanthocyanidins 10 mg/(kg?d), group A and group B were injected with normal saline for 5 consecutive days. 1 and 3 days after cerebral ischemia-reperfusion, ileum myoelectric slow wave and smooth muscle contractility, the activity of superoxide dismutase (SOD) and content of malondialdehyde (MDA) were measured, the content of the serum TNF-αwas tested with ELISA kit, ileum tissues were tested with hematoxylin eosin (HE) staining and used for mea-suring the moisture content. Results Compared with group B 1 and 3 days after cerebral ischemia-reperfusion, the intestinal mucosa injury relieved, the intestinal mucosa score decreased (P0.05), and the amplitude increased (P<0.05) in group C;the serum SOD activity in-creased (P<0.05), and the content of MDA and TNF-αdecreased (P<0.01) in group C;the intestinal moisture content reduced (P<0.01) in group C. Conclusion Proanthocyanidins pretreatment can protect intestinal function from injury after cerebral ischemia-reperfusion.