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Objective:To explore the clinical application value of Bodyfix fixation device in stereotactic body radiotherapy (SBRT) for elderly patients with lung cancer.Methods:The clinical data of 63 elderly patients with lung cancer who received SBRT in Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from January to October 2021 were retrospectively analyzed. According to different fixation methods, the patients were divided into Bodyfix combined with vacuum bag fixation device group (Bodyfix group, 20 cases) and 4D respiratory gating technology combined with vacuum bag fixation device group (vacuum bag group, 43 cases). Cone beam CT (CBCT) was used for position verification before each treatment, linear and rotational errors in the horizontal (X), head-to-foot (Y), front-to-back (Z) directions were recorded.Results:The linear errors of Bodyfix group in the X, Y and Z directions were 1.7 mm (1.3 mm, 3.0 mm), 4.6 mm (4.3 mm, 5.3 mm) and 1.3 mm (0.8 mm, 2.8 mm), and the rotational errors were (0.46±0.04)°, (-0.48±0.05)° and 0.64°(0.38°, 1.07°); the linear errors of vacuum bag group in the X, Y and Z directions were 2.1 mm (1.6 mm, 3.3 mm), 2.8 mm (1.8 mm, 3.7 mm) and 3.0 mm (2.3 mm, 3.8 mm), and the rotational errors were (0.69±0.04)°, (-0.70±0.04)° and 0.64° (0.42°, 0.86°). The differences in linear errors in the Y and Z directions and rotational errors in the X and Y directions between the two groups were statistically significant ( P values were <0.001, <0.001, 0.003 and 0.007). Conclusions:Compared with the 4D respiratory gating technology, the Bodyfix fixation device has smaller rotational errors in the X and Y directions and linear errors in the Z direction. It can be used as an effective method of postural fixation for SBRT in elderly patients with lung cancer.
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AIM: To investigate the PI3K/AKT/GSK-3β signaling pathway involved in the protective effect and mechanism of propofol on the cerebral ischemia-reperfusion injury in rats. METHODS: There were 72 healthy male SD rats. All rats established a model of focal cerebral ischemia-reperfusion injury according to the Zea Longa method and were randomly divided into six groups (n=12), A-sham operation group, B-model group (MCAO), C-Propofol group, D-Propofol+adenosine A1R antagonist group (DPCPX), E-Propofol group+PI3K specific inhibitor (LY294002), F-Propofol+GSK3β inhibitor group (SB216763). The neurological scores of rats 24 h after operation, LDF monitors changes in cerebral blood flow before and after embolization were observed. The TTC staining method was used to detect the cerebral infarction volume of rats in each group; HE staining method was used to observe the morphological changes of the rat brain tissue; Immunohistochemical method was used to detect Bcl-2 positive cells expression; TUNEL was used to detect cerebral cortex ischemia in each group. The percentage of neuronal apoptotic cells. RESULTS: Compared with group A, the behaviors, cerebral infarction volume, apoptosis rate, and Bcl-2 protein expression of rats in groups B, C, D, E, and F all increased (P<0.05); compared with group C, the behavioral scores, cerebral infarction volume and apoptosis rate of rats in groups B, D and E all increased significantly, and the expression of Bcl-2 protein was decreased significantly (P<0.01), but the expression of Bcl-2 protein in group F was increased, cell apoptosis rate decreased (P<0.05), behavior score and infarcts decreased (P<0.05). CONCLUSION: The neuroprotective effect of propofol mediated by adenosine A1R on ischemia-reperfusion injury in rats may be related to the PI3K/AKT/GSK-3β signal transduction pathway.
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Objective To investigate the accuracy and application value of optical surface monitoring system in intensity modulated radiotherapy for thoracic tumors patients.Methods Twenty-eight patients with thoracic tumors were included.During each treatment fraction,the patients were immobilized with body surface markers and laser lamps.The surface images obtained by the optical surface monitoring system were registered with the reference images and recorded during the CBCT scan.The translation and rotation errors of x (left-right),y (craniocaudal) and z (anterior-posterior) axes were recorded.After scanning,the CBCT images were registered with the planned CT images and the translation and rotation errors of x,y and z axes were recorded.The setup errors of these two image systems were analyzed and corrected before each treatment.The correlation between the two sets of setup errors were analyzed with Pearson test,and systematic error (∑) and random error (σy) were also calculated.The consistency of the two image systems was evaluated with the Bland-Altman method and the 95％ limits of agreement were calculated.Results There was a good correlation between these two groups,and the correlation coefficients were 0.79,0.62,and 0.53 in x,y and z axes,respectively.The ∑/σr of the optical surface monitoring system were 0.7 mm/1.5 mm,0.9 mm/1.8 mm and 0.9 mm/1.5 mm in x,y and z axes,respectively.The ∑/σ of CBCT were 0.8 mm/1.6 mm,1.3 mm/1.9 mm and 0.7 mm/1.5 mm in x,y and z axes,respectively.The 95％ limits of agreement of translations direction were (-2.0-2.3),(-3.4-3.6) and (-3.3-2.4) mm,and the 95％ limits of agreement of rotation direction were (-2.0 to 1.6)°,(-2.0 to 1.4)° and (-1.6 to 1.6)° inx,y and z axes,respectively.Conclusions The optical surface monitoring system is an effective image guide tool,which can quickly and accurately verify the patient's position and improve the position accuracy.It can be applied for positioning in the intensity modulated radiation treatments for the thoracic tumor patients.
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Objective To analyze the setup errors by cone-beam computed tomography (CBCT) for breast cancer patients who were immobilized with neck and breast thermoplastic mask and received intensity modulated radiation therapy (IMRT), and to calculate the external margins from the clinical target volume (CTV) to the planning target volume (PTV) (MPTV) of tumors. Methods Twenty-five breast cancer patients who were immobilized with neck and breast thermoplastic mask and received IMRT in the Oncology Department of Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from November 2016 to June 2017 were enrolled. The position of the patients were verified by CBCT before treatment . The linear and rotation errors of the X, Y and Z axes were analyzed by online bone registration. The systematic errors (Σ) and random errors (σ) of the patients were also calculated, and then the margins from CTV to PTV margins were calculated based on MPTV=2.5Σ+0.7σ. 25 patients'height, weight, body mass index (BMI) and the maximum diameters of CTV in the lateral, longitudinal and vertical directions were recorded, and the relation between the setup errors and the above mentioned was analyzed by using Spearman method. Results A total of 174 CBCT scans for 25 breast cancer patients were completed. The group Σ were 1.40 mm, 1.50 mm and 1.20 mm, and rotation errors were 0.9°, 0.7° and 0.8° at the X, Y and Z axes, respectively. The group σ were 2.20 mm, 3.00 mm and 1.40 mm, and rotation errors were 0.7°, 0.6° and 0.7° at the X, Y and Z axes, respectively. MPTVwas recommended as 4.90 mm, 6.00 mm and 3.90 mm at the X, Y and Z axes, respectively. There was no correlation between the height, weight, BMI of the patients and the setup errors (all P ＞ 0.05). However, there was a significant correlation between the maximum lateral, longitudinal diameters of the CTV and the setup errors (rs= 0.406, P= 0.044; rs= 0.512, P= 0.009). Conclusions The neck and breast thermoplastic mask can improve the diagnostic accuracy of radiotherapy in breast cancer patients. The data of setup errors verified by CBCT can provide meaningful references for the setting of MPTV.
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Objective To investigate the effects of hemodynamic,prognostic effect and myocardial protection of Salvia injection on patients with acute organophosphorus pesticide poisoning. Methods 68 cases of patients with acute organophosphate were divided into observation group(n=34)and control group(n=34) from January 2012 to December 2013.The control group were given with atropine detoxification (dose:5-10mg), Tiopronin (0.2 g/d, 1 times/d) liver treatment, Pioneer will(2 g/second,1/d).The observed group received the foundation treatment and Salvia injection(30ml, 1/d), 7d course of treatment. The myocardial enzymes and hemodynamic parameters of two groups were observed before and after treatment. Results The survival rate and died rate of observation group were 94.12%(32 cases ), 5.88%(2 cases ). The survival rate and died rate of control group were 79.41%(27cases )and 20.59%(7cases). The survival rate and died rate of two groups were significant difference (χ2=5.123, P<0.05). The myocardial enzymes (AST, CK, CK-MB, LDH, HBDH) of observation groupafter 2d each index[were(58.6±22.7)U/L, (412.6±156.9)U/L, (78.6± 35.2)U/L, (489.3 ± 112.3)U/L, (412.8 ± 259.6)U/L] and blood rheology (ESR, FIB, LBV, HBV)each index[were(14.36±4.19) mm/h before , (259.3±23.14)g/L, (7.17±1.12)mPa?s, (4.12±0.81)mPa?s]were lower than in the same group therapy [myocardial enzymes indexes were (131.3±32.5)U/L, (1324.5± 345.2)U/L, (187.5 ± 72.2)U/L, (914.5 ± 312.2)U/L, (812.3 ± 312.2)U/L; hemorheology indexes were (23.29±3.49)mm/h, (389.57±34.24) g/L, (10.4±1.3)mPa?s, (6.3±1.2)mPa?s]. 5 d after treatment control group myocardial enzymes(AST, CK, CK-MB, LDH, HBDH)each index[were(85.3±22.8)U/L, (486.3± 78.9)U/L, (67.8±11.2)U/L, (542.3±78.6)U/L, (225.9±112.4)U/L]and hemorheology indexes[were(17.7± 4.6)mm/h, (289.4±32.5)g/L, (8.9±1.2)mPa?s, (5.6±1.3)mPa?s] was significantly lower than in the same group before treatment[myocardial enzymes indexes were(128.3±29.3)U/L, (1298.6±329.4)U/L, (182.6± 70.6)U/L, (902.3±286.3)U/L, (803.6±293.6)U/L;hemorheology indexes were (23.9±3.5)mm/h, (382.6± 32.5)g/L, (10.3±1.1)mPa?s, (6.2±1.1)mPa?s, P<0.05]. Conclusion Salvia injection can effectively improve the hemodynamic indicators of acute organophosphorus pesticide poisoning patients , reduce myocardial damage, promote patient prognosis.