Study on the angle between the long axis of lacrimal sac and bony nasolacrimal duct in patients with chronic dacryocystitis / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To analyze the difference of the angle between the long axis of lacrimal sac and bony nasolacrimal duct(BNLD)in patients with chronic dacryocystitis and normal eyes, and discuss the relationship between the angle and chronic dacryocystitis.<p>METHODS:A total of 218 patients(248 diseased eyes)from Sichuan Province who visited the ophthalmology department of our hospital from January 2016 to March 2019 were collected retrospectively. All patients underwent computed tomography dacryocystography(CT-DCG)immediately after bilateral lacrimal duct irrigation, and three-dimensional reconstruction of the nasolacrimal duct structure was performed. The structures of the nasolacrimal duct, lacrimal sac and its surrounding tissues were observed in the coronal position, and the lacrimal sac-BNLD angles of the diseased eyes and the normal eyes were measured respectively.<p>RESULTS:The lacrimal sac-BNLD angle of the diseased eyes \〖23.55°(17.30°, 29.90°)\〗 was higher than that of the normal eyes \〖20.05°(15.40°, 28.35°)\〗(<i>P</i><0.05). Among them, the angle of the diseased eyes in female patients \〖24.60°(17.75°, 31.00°)\〗 was significantly higher than that in normal eyes \〖21.15°(15.10°, 27.35°)\〗(<i>P</i><0.05), while there was no significant difference in the angle between the diseased eyes and normal eyes in male patients(<i>P</i>>0.05). In addition, the angle of the diseased eyes in the age group of 41-60 a \〖25.20°(17.90°, 33.00°)\〗 was significantly higher than that in normal eyes \〖21.60°(15.25°, 29.05°)\〗(<i>P</i><0.05).<p>CONCLUSION: The angle between the long axis of lacrimal sac and bony nasolacrimal duct increased in patients with chronic dacryocystitis, which may be one of the factors causing the onset of chronic dacryocystitis in middle-aged and elderly women.

Comparison of the displacements of peripheral lung cancer based on 4D CT scan and 3D CT scan assisted with active breathing control / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To compare the position, displacement, degree of inclusion (DI) and matching index (MI) of the gross tumor volume (GTV) for peripheral lung cancer based on 4-dimensional CT (4D CT) and 3-dimensional CT (3D CT) assisted with active breathing control (ABC).</p><p><b>METHODS</b>Eighteen patients with peripheral lung cancer underwent 4D CT simulation scan during free breathing and 3D CT simulation scans in end-inspiratory hold (CTEIH) and end-expiratory hold (CTEEH) in turn. The 4D CT images from each respiratory cycle were sorted into 10 phases. phase 0 was defined as end-inspiratory phase (CT0), and phase 50 was defined as end-expiratory phase (CT50). The GTVs were delineated separately on CT0, CT50, CTEIH and CTEEH images, and then GTV0, GTV50, GTVEIH and GTVEEH were constructed, respectively.</p><p><b>RESULTS</b>The median distances between the centroids of GTV0 and GTVEIH, GTV50 and GTVEEH were 3.9 mm and 3.4 mm in all patients, 3.2 mm and 3.1 mm in the upper lobe group, and 5.0 mm and 4.7 mm in the lower lobe group, respectively. In the upper lobe group, the GTV0 and GTVEIH were 65.9% and 63.1%, and the median mutual DIs of GTV50 and GTVEEH were 67.5%, 63.1%, respectively. In the lower lobe group, the GTV0 and GTVEIH were 35.3% and 21.4%, and the median mutual DIs of GTV50 and GTVEEH were 27.8% and 24.8%, respectively. In the upper lobe group, the median MI of GTV0 and GTVEIH was 0.5, and the median MI of GTV50 and GTVEEH was 0.6. In the lower lobe group, the median MI of GTV0 and GTVEIH was 0.2, and the median MI of GTV50 and GTVEEH was 0.3. Whether in the upper or lower lobe groups, all the differences between displacements of centroid positions of GTVEIH and GTVEEH (ABC displacement) and GTV0 and GTV50 (4D displacement ) were <1 mm in three dimensional directions (all P>0.05).</p><p><b>CONCLUSIONS</b>The target displacement of tumors based on 3D CT scanning in end-inspiratory hold and end-expiration hold can be used to construct internal target volume instead of that based on 4D CT scanning in extreme phase for peripheral lung cancers, but spatital mismatches of GTVs are obvious between extreme phases in 4D CT and corresponding phases in 3D CT assisted with ABC, especially for tumors of smaller volume and with larger motion amplitude.</p>

Outcome evaluation of hepatocellular carcinoma patients after balancing the covariates between groups through propensity score / 第二军医大学学报

Objective To balance the covariatesby propensity score matching for better evaluating the efficiencies of surgery resection (SR) and transcatheter arterial chemoembolization (TACE) for treatment of early-stage hepatocellular carcinoma (HCC) patients. Methods A total of 350 early-stage HCC patients treated by SR(192 cases) or TACE (158 cases) were collected from Shandong Tumor Hospital (2003 to 2011). Propensity score caliper matching was used to balance the covariance between the two groups. And then the matched data were subjected to survival analysis and the survival rates were comparedbetween the two groups. Results The covariates were imbalanced before matching; the1-, 2-, 3-, and 4-year survival rates and the median survival time of SR group were 80. 92%, 49. 44%, 33. 73%, 19. 72%, and 2. 00 years, respectively; those of TACE group were 80. 02%, 53. 92%, 31. 21%, 13. 42%, and 2. 40 years, respectively; and log-rank test showed no significant differences in the survival rates between the two treatment groups (P = 0. 710 8). The covariates were balanced after matching; the 1-, 2-, 3-, and 4-year survival rates and the median survival time of SR group were 84. 22%, 57. 68%, 36. 80%, 24. 09%, and 2. 50 years, respectively; those of TACE group were 73. 84%, 47. 26%, 28. 31%, 10. 69%, and 2. 00 years, respectively; and log-rank test showed significant difference in the survival rates between the two groups (P = 0. 018 2). The survival rate of SR group was higher than that of TACE group. Conclusion After reducing the confounding bias by Propensity score matching method, SR showes a better efficiency for early HCC patients compared with TACE.

Measurement of intrafraction displacement of the mediastinal metastatic lymph nodes of non-small cell lung cancer based on four-dimensional computed tomography (4D-CT) / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To measure the intrafraction displacement of the mediastinal metastatic lymph nodes of non-small cell lung cancer (NSCLC) based on four-dimensional computed tomography (4D-CT), and to provide the basis for the internal margin of metastatic mediastinal lymph nodes.</p><p><b>METHODS</b>Twenty-four NSCLC patients with mediastinal metastatic lymph nodes confirmed by contrast enhanced CT (short axis diameter ≥ 1 cm) were included in this study. 4D-CT simulation was carried out during free breathing and 10 image sets were acquired. The mediastinal metastatic lymph nodes and the dome of ipsilateral diaphragma were separately delineated on the CT images of 10 phases of breath cycle, and the lymph nodes were grouped as the upper, middle and lower mediastinal groups depending on the mediastinal station. Then the displacements of the lymph nodes in the left-right, anterior-posterior, superior-inferior directions and the 3-dimensional vector were measured. The differences of displacement in three directions for the same group of metastatic lymph nodes and in the same direction for different groups of metastatic lymph nodes were compared. The correlation between the displacement of ipsilateral diaphragma and mediastinal lymph nodes was analyzed in superior-inferior direction.</p><p><b>RESULTS</b>The displacements in left-right, anterior-posterior and superior-inferior directions were (2.24 ± 1.55) mm, (1.87 ± 0.92) mm and (3.28 ± 2.59) mm for the total (53) mediastinal lymph nodes, respectively. The vectors were (4.70 ± 2.66) mm, (3.87 ± 2.45) mm, (4.97 ± 2.75) mm and (5.23 ± 2.67) mm for the total, upper, middle and lower mediastinal lymph nodes, respectively. For the upper mediastinal lymph nodes, the displacements in left-right, anterior-posterior and superior-inferior directions showed no significant difference between each other (P > 0.05). For the middle mediastinal lymph nodes, the displacements merely in anterior-posterior and superior-inferior directions showed significant difference (P = 0.005), while the displacements were not significantly different in the left-right and anterior-posterior, left-right and superior-inferior directions (P > 0.05). The displacements of the total and the lower mediastinal lymph nodes in left-right and superior-inferior, or anterior-posterior and superior-inferior directions were significantly different (P < 0.05), but was not significantly different in left-right and anterior-posterior directions (P > 0.05). The displacements of different group of mediastinal lymph nodes in a single direction or vector showed no significant difference (P > 0.05). In the superior-inferior direction, the correlation between the displacements of ipsilateral diaphragma and mediastinal lymph nodes were not statistically significant (P > 0.05).</p><p><b>CONCLUSIONS</b>During free breathing, the differences between the intrafractional displacement of mediastinal metastatic lymph nodes in the same direction and its station were not statistically significant. The displacements of the total mediastinal metastatic lymph nodes in the superior-inferior direction were greater than that in the left-right and anterior-posterior directions, especially for the middle and lower mediastinal metastatic lymph nodes. There was no significant correlation between the displacements of ipsilateral diaphragma and the mediastinal metastatic lymph nodes in the superior-inferior direction, so it was unreasonable to estimate and predict the displacement of mediastinal metastatic lymph nodes by the displacement of ipsilateral diaphragma.</p>

Displacement of the silver clips in surgical cavity based on four-dimensional CT images for patients undertaking external-beam partial breast irradiation after breast-conserving surgery / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To explore the displacement of the selected clips and the center of the geometry consisted of all the clips in the surgical cavity measured on the basis of four-dimensional computed tomography (4D-CT) simulation images.</p><p><b>METHODS</b>Fourteen breast cancer patients after breast-conserving surgery were recruited for external beam partial-breast irradiation (EB-PBI), and received large aperture CT simulation. The 4D-CT image data sets were collected when the patient was in the free breathing state. Using the Varian Eclipse treatment planning system, the selected four clips in the cavity were separately delineated on the CT images from 10 phases of the breath cycle, and all of the clips in the cavity were marked to obtain the geometry. Then the displacement of the four selected clips and the center of the geometry in the left-right (LR), anterior-posterior (AP), and superior-inferior (SI) directions were measured. The differences of the displacement were compared.</p><p><b>RESULTS</b>The displacements in the AP and SI directions were always greater than the displacement in LR direction for the same selected clip. The difference of the displacements in the same direction of the different selected clips was not statistically significant (P>0.05). The displacements of the geometry center consisted of all of the clips in the LR, AP, SI directions were (1.34±0.39) mm, (2.01±1.02) mm and (1.89±1.03) mm, respectively, and the difference of the displacements between LR and AP, LR and SI were all statistically significant (P<0.05). In the same directions (LR, AP and SI), the displacement of geometry center was always greater than the displacement of the selected clips, and the difference except SI direction was all statistically significant (P<0.05). In the SI direction, the association between the displacement of geometry center and the upper clip, geometry center and the lower clip was statistically significant (P<0.05).</p><p><b>CONCLUSION</b>When the target for EB-PBI is defined on the basis of 4D-CT simulation images, the displacement of the selected clips at the border of the surgical cavity is not qualified to substitute the displacement of the target defined basing on all of the clips in the surgical cavity.</p>

Outcome evaluation of hepatocellular carcinoma patients after balancing the covariates between groups through propensity score / 第二军医大学学报

Objective To balance the covariatesby propensity score matching for better evaluating the efficiencies of surgery resection (SR) and transcatheter arterial chemoembolization (TACE) for treatment of early-stage hepatocellular carcinoma (HCC) patients. Methods A total of 350 early-stage HCC patients treated by SR(192 cases) or TACE (158 cases) were collected from Shandong Tumor Hospital (2003 to 2011). Propensity score caliper matching was used to balance the covariance between the two groups. And then the matched data were subjected to survival analysis and the survival rates were comparedbetween the two groups. Results The covariates were imbalanced before matching; the1-, 2-, 3-, and 4-year survival rates and the median survival time of SR group were 80. 92%, 49. 44%, 33. 73%, 19. 72%, and 2. 00 years, respectively; those of TACE group were 80. 02%, 53. 92%, 31. 21%, 13. 42%, and 2. 40 years, respectively; and log-rank test showed no significant differences in the survival rates between the two treatment groups (P = 0. 710 8). The covariates were balanced after matching; the 1-, 2-, 3-, and 4-year survival rates and the median survival time of SR group were 84. 22%, 57. 68%, 36. 80%, 24. 09%, and 2. 50 years, respectively; those of TACE group were 73. 84%, 47. 26%, 28. 31%, 10. 69%, and 2. 00 years, respectively; and log-rank test showed significant difference in the survival rates between the two groups (P = 0. 018 2). The survival rate of SR group was higher than that of TACE group. Conclusion After reducing the confounding bias by Propensity score matching method, SR showes a better efficiency for early HCC patients compared with TACE.

The relationship between Ridit analysis and rank sum test for one-way ordinal contingency table in medical research / 中华预防医学杂志

<p><b>OBJECTIVE</b>To explore several numerical methods of ordinal variable in one-way ordinal contingency table and their interrelationship, and to compare corresponding statistical analysis methods such as Ridit analysis and rank sum test.</p><p><b>METHODS</b>Formula deduction was based on five simplified grading approaches including rank_r(i), ridit_r(i), ridit_r(ci), ridit_r(mi), and table scores. Practical data set was verified by SAS8.2 in clinical practice (to test the effect of Shiwei solution in treatment for chronic tracheitis).</p><p><b>RESULTS</b>Because of the linear relationship of rank_r(i) = N ridit_r(i) + 1/2 = N ridit_r(ci) = (N + 1) ridit_r(mi), the exact chi2 values in Ridit analysis based on ridit_r(i), ridit_r(ci), and ridit_r(mi), were completely the same, and they were equivalent to the Kruskal-Wallis H test. Traditional Ridit analysis was based on ridit_r(i), and its corresponding chi2 value calculated with an approximate variance (1/12) was conservative. The exact chi2 test of Ridit analysis should be used when comparing multiple groups in the clinical researches because of its special merits such as distribution of mean ridit value on (0,1) and clear graph expression. The exact chi2 test of Ridit analysis can be output directly by proc freq of SAS8.2 with ridit and modridit option (SCORES =).</p><p><b>CONCLUSION</b>The exact chi2 test of Ridit analysis is equivalent to the Kruskal-Wallis H test, and should be used when comparing multiple groups in the clinical researches.</p>