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Objective:To compare the dosimetric difference between volumetric modulated arc therapy (VMAT) plans with flattening filter (FF) and flattening filter-free (FFF) for whole-breast radiation therapy after breast conserving surgery for left breast cancer.Methods:Twenty patients with left breast cancer who underwent breast conserving surgery in Xuzhou Central Hospital from August 2017 to August 2018 were selected by random number table method, and the CT data were obtained. Both FF-VMAT plan and FFF-VMAT plan were designed with ECLIPSE 10.0.4 treatment planning system (TPS) of American Varian company. The prescription dose of the planned target volume (PTV) was 50 Gy (2 Gy/time), and the local tumor bed was irradiated with 10 Gy/5 times. The dosimetric parameters of the two plans were compared.Results:The two plans of all patients met the prescription dose requirements. Compared with FF-VMAT plan, FFF-VMAT plan had better conformity (conformal index: 0.87±0.04 vs. 0.77±0.05) and homogeneity (homogeneity index: 7.36±0.88 vs. 10.89±3.00) (both P < 0.01); FFF-VMAT plan had lower average dose of heart [(7.73±1.44) Gy vs. (9.16±4.24) Gy] and contralateral lung [(3.61±0.74) Gy vs. (8.42±0.45) Gy] (both P < 0.01), FFF-VMAT plan had higher average dose of contralateral breast [(3.92±1.08) Gy vs. (2.02±1.42) Gy] ( P < 0.01), and V 2 Gy in the heart [(79.27±1.18)% vs. (58.94±21.25)%] and V 5 Gy in the ipsilateral lung [(44.89±2.17)% vs.(37.86±8.33)%] (all P < 0.01). The monitor unit of the FF-VMAT plan was (973±89) MU, which was lower than that of the FFF-VMAT plan [(1 356±201) MU] ( P < 0.01). Conclusion:FFF-VMAT plan can effectively reduce the cardiac dose after breast conserving surgery for left breast cancer, but it increases the risk of organ damage at low dose area.
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Objective To analyze the changes of susceptibility in acute cerebral ischemia (ACI) using quantitative susceptibility mapping (QSM).Methods Twenty-three patients with ACI who met the criteria underwent conventional brain MR and QSM scan,and the susceptibility maps were obtained with QSM post-processing software in image processing workstation.According to DWI images,ROIs were manually drawn on lesions of ACI to obtain magnetic susceptibility on susceptibility map,including cortical gray matter (CGM),subcortical white matter (SWM),caudate (CA),globus pallidus (GP),putamen (PU),thalamus (TH),substantia nigra (SN),dentate nucleus (DN) and pons (PO).Then magnetic susceptibility of contralateral position was obtained.According to whether cerebral microbleeds (CMBs) were observed,the ACI patients were divided into CMBs group and non-CMBs group.The magnetic susceptibility of groups and different ROIs of ACI and the contralateral area were compared statistically.Results There was significant difference in magnetic susceptibility between CMBs group [(79.04 ± 52.25) × 10-9 ppd] and non-CMBs group ([-4.01 ± 44.57] × 10 9 ppd;Z=-3.297,P =0.001).The difference of magnetic susceptibility between the lesion side and the contralateral side ([-12.10±16.75]× 10-9 ppd) was statistically significant in CMBs group (Z=-3.296,P=0.001),but not in non-CMBs group (contralateral side [1.61 ±32.77] × 10-9 ppd;Z=-0.157,P=0.875).According to the location of ROIs,magnetic susceptibility had statistical differences only in PO,CGM and contralateral side (Z=-2.023,--3.130,P=0.043,0.002).Conclusion QSM can be used to quantitatively analyze magnetic susceptibility of ACI lesions and find CMBs,therefore is helpful to guiding treatment.
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Objective@#To investigate the impact of allergic airway diseases on the risk of attention deficit hyperactivity disorder (ADHD) in school-age children.@*Method@#Used stratified cluster sampling method, school-age children in first to sixth grade in primary schools in 9 randomly selected cities including Shanghai, Guangzhou, Xi′an, and Wuhan were enrolled in the study. Interview of parents with questionnaires, which included school-age individual and family social environment questionnaire (including history of diagnosed ADHD, allergic rhinitis, and bronchial asthma) and Children′s Sleep Habits Questionnaire (CSHQ), were finished and collected during November to December in 2005.Diagnosed allergic rhinitis and asthma by specialist were independent variables and divided into following three categories as no allergic diseases (neither allergic rhinitis nor asthma), single allergic disease (allergic rhinitis or asthma), and combined allergic diseases (allergic rhinitis and asthma). Diagnosed ADHD as dependent variable, binary logistic regress model was used to analyze the risks of ADHD in school-age children.@*Result@#Totally 23 791 questionnaires were handed out, while 22 018 were collected. The children had an average age of (8.8±1.8) years, within which 10 869 were male, and 11 021 were female. The risk ratios of ADHD were 2.197 (95%CI: 1.823-2.648) and 3.150 (95%CI: 2.082-4.760) in children with single allergic disease and combined allergic diseases separately. There was no significant difference after adjusting for the factor of sleep habits, as the risk ratios were 2.055 (95%CI: 1.683-2.508) and 3.140 (95%CI: 2.061-4.784) in children with single and combined allergic airway disease separately.@*Conclusion@#Allergic rhinitis and bronchial asthma increased the risk of ADHD, not depending on sleep habits. Hence, allergic airway diseases could be independent risk factors of ADHD.
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Objective To explore the changes of susceptibility of different sides and gender in healthy young adults with quantitative susceptibility mapping (QSM).Methods Totally 41 healthy young right-handed adults underwent conventional brain MRI and QSM scan,and the susceptibility maps were obtained by the image post-processing software.Then the ROI of the bilateral frontal grey matter (FGM),frontal white matter (FWM),caudate (CA),globus pallidus (GP),putamen (PU),thalamus (TH),substantia nigra (SN),red nucleus (RN),dentate nucleus (DN),pons (PO),corpus callosum (CC) were manually drawn to obtain magnetic susceptibility on the susceptibility map.The magnetic susceptibility of each ROI was compare between both sides,as well as gender by Mann-Whitney test.Results The magnetic susceptibility of the bilateral ROI of GP was the highest,and SN was followed,FWM was minimum.The susceptibility of bilateral FGM,FWM,CA,GP,PU,TH,SN,RN,DN,PO,CC had no statistically significant differences (all P＞0.05).The magnetic susceptibility in CA of different gender had statistically significant difference (P＜0.05).Conclusion The brain magnetic susceptibility.can be measured by QSM,and it can assess brain iron content quantitatively.
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Objective To explore the value of terminal ileum suspension in the treatment of low rectal cancer.Methods 80 patients with low rectal cancer who underwent laparoscopic operation in our hospital from June 2015 to February 2017,were randomly divided into two groups:the control group (group C) and the test group (group T),40 cases in each group.In group C,laparoscopic radical resection of rectal cancer (Dixon) was performed and in group T Dixon was combined with terminal ileum suspension.Peripheral blood nutritional indicators (total plasma protein,albumin,pre-albumin,transferrin) and major electrolytes of two groups were observed 1 day before operation and 1,3 and 7 days after operation.The two groups were compared in terms of first exhaust time,postoperative hospital stay,total costs for hospitalization,postoperative discomforts and complications.Results There were no statistical differences in the levels of nutrition indicators and electrolytes between them (P ＞ 0.05) and neither it was with first exhaust time,hospital stay,total costs of hospitalization,incidence of postoperative discomforts and complications (P ＞ 0.05).The re-operation rate of group T with anastomotic leak was significantly lower than group C (P ＜ 0.05).Conclusion Terminal ileal suspension does not affect patients' postoperative recovery without increasing the patient's suffering and economic burden,and can effectively reduce the reoperation rate caused by anastomotic leak.It is easy to operate.
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Objective To explore the clinical,CT and MRI features of ovarian adenofibroma(OAF)and improve the diagnostic level. Methods Ninety-two cases of OAFs were analyzed retrospectively and summarized the features including clinical manifestations ,CT and MRI images. Results The probability of unilateral ,serous and benign OAFs were 91.3%,89.1%and 97.8%. OAFs associated with uterine or/and ovarian lesions was 40.2%. The clinical manifestations of OAF was not typical. These OAFs were divided into 2 groups according to whether or not accompanied with uterus or/ and ovarian lesions. The clinical manifestations and laboratory indexes were only found abnormal menstruation rate(P<0.05),but there were no significant difference between other indexes. The performance of CT plain scan and CT/MRI enhanced scan had not characteristic.The percentage of the"black sponge"on T2WI image and hyperintensity on DWI image of OAFs were 40.0% and 65.0%. Conclusion The"black sponge"on T2WI image and hyperintensity on DWI image may be helpful to diagnose OAF.
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Objective To explore the clinical,CT and MRI features of ovarian adenofibroma(OAF)and improve the diagnostic level. Methods Ninety-two cases of OAFs were analyzed retrospectively and summarized the features including clinical manifestations ,CT and MRI images. Results The probability of unilateral ,serous and benign OAFs were 91.3%,89.1%and 97.8%. OAFs associated with uterine or/and ovarian lesions was 40.2%. The clinical manifestations of OAF was not typical. These OAFs were divided into 2 groups according to whether or not accompanied with uterus or/ and ovarian lesions. The clinical manifestations and laboratory indexes were only found abnormal menstruation rate(P<0.05),but there were no significant difference between other indexes. The performance of CT plain scan and CT/MRI enhanced scan had not characteristic.The percentage of the"black sponge"on T2WI image and hyperintensity on DWI image of OAFs were 40.0% and 65.0%. Conclusion The"black sponge"on T2WI image and hyperintensity on DWI image may be helpful to diagnose OAF.
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One hundred and twenty patients with senile primary osteoporosis were enrolled in the study from January 2012 to April 2013,including 41 males and 79 females.Patients were randomly assigned to two groups:60 patients in study group were treated with salmon calcitonin combined with zoledronic acid (salmon calcitonin 50 IU i.m,q.d for 7 d,then 100 IU q.i.d for 7 d,followed by zoledronic acid 5 mg i.v gtt/y);60 cases in control group were treated with alendronate (70 mg p.o/wk).Both groups received the same doses of calcium.Visual analogue scale (VAS) scores were assessed before,and 1,6 and 12 months after treatment,12-Item Short-Form Health Survey (SF-12) and bone mineral density (BMD) were assessed before and 12 months after treatment.There were no significant differences in all baseline parameters between two groups (P ＞ 0.05).After 1 month of treatment,the VAS scores of study group was lower than that of the control group (2.1 ± 3.0 vs.4.2 ± 3.1,P ＜ 0.05),however,both groups had similar improvements in VAS scores in 6 and 12 months after the treatment (P ＞0.05).Compared to those before treatment,physical component summary and mental component summary of SF-12 scores after 1 year of treatment were improved significantly in both groups (P ＜ 0.05).Also,BMD was significantly improved after 1 year of treatment in both groups (P ＜ 0.05).The incidence of side effect in study group was lower than that in control group (16％ vs.20％,P ＜0.05).The results indicate that salmon calcitonin combined with zoledronic acid is an effective,safe,reliable and well tolerated therapy for senile primary osteoporosis.The long-term outcomes remain to be determined.
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Parkinson's disease (PD) is a complicated disease, commonly diagnosed among the elderly, which leads to degeneration of the central nervous system. It presently lacks an effective therapy for its complex pathogenesis. Adverse effects from Western drug-based medical intervention prevent long-term adherence to these therapies in many patients. Traditional Chinese medicine (TCM) has long been used to improve the treatment of PD by alleviating the toxic and adverse effects of Western drug-based intervention. Therefore, the aim of this study is to evaluate the efficacy and safety of Xifeng Dingchan Pill (XFDCP), a compound traditional Chinese herbal medicine, taken in conjunction with Western medicine in the treatment of PD patients at different stages in the progression of the disease.
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Shanghai healthcare system reform is proceeded in the system engineering theory adopting the methods of making the overall plans, the combination of scientific design whole and part, the combination of microcosm and macrocosm, the combination of innovation and standard, the combination of qualitative analysis and quantitative analysis, the combination of structural optimization and improvement so as to promote the development of Shanghai healthcare system and provide successful experiences for our national healthcare system reform.
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Objective To evaluate clinical outcome in postoperative patients with advanced gastric cancer treated with concurrent chemotherapy and dendritic cells (DCs) vaccine as well as alteration of immune function. Methods Sixty-four postoperative patients with advance gastric cancer were divided into control group and DC vaccine group, In control group, 38 patients were treated with LCH regimen consisted of 5-fluorouracil 0.75 g/d_(1-5) and oxaliplatin 0.2 g/d_1. In DC vaccine group,blood sample was obtained from 26 patients who were followed by LCH regimen treatment next day.One week after the chemotherapy, patients were immunized with DC vaccine for 2 times at interval of one week. The second cycle was performed after 28 days. The percentages of T lymphocytes and natural killer (NK) cells and cytokine levels before and after treatment were compared between two groups. The therapeutic effects (including no remote metastasis and enlarged lymph nodes in cavity and/or tumor reduced in volume) were also evaluated. Results The concentrations of T lymphocytes (CD3~+ and CD4~+ ), NK cells, interleukin (IL)-2, IL-12 and interferon-γ in DC vaccine group were significantly increased after vaccination compared with those before vaccination (P＜0.05), and even higher than those in control group (P＜0.05). The effective rate was higher in DC vaccine group (80. 76%) than that in control group (68.42%) with significant difference (P＜0. 05). The side effects of chemotherapy such as the decreased peripheral white blood ceils and immune cells were less serious in DC vaccine group compared with control group (P＜ 0.05), while the uncomfortable incidence of gastrointestinal tract and peripheral neuritis showed no significant difference between two groups (P＞0.05). Conclusions Application of concurrent chemotherapy and DC vaccine in patients with advanced gastric cancer after surgical treatment may achieve a short-term efficacy, meanwhile it can reduce the side effects induced by chemotherapy.
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Objective To explore the association between 1425G/A single nucleotide polymorphism(SNP)of protein kinase Cη gene(PRKCH)and cerebral infarction in Jiangsu Han population.Methods 255 patients with cerebral infarction and 225 controls were recruited in our case-control study.The 1425G/A in PRKCH gene was detected by direct sequencing of PCR products.Data were coded and entered in SPSS Windows(version 13.0).Results The frequencies of the GA+AA genotypes(56.86%)and A allele (36.27%)in cerebral infarct group were significantly higher than those in control group(44.44%and24.67%.χ2=7.377,P=0.007 and χ2=15.104,P<0.01).Further analysis indicated that the genotypes(63.09%)and alleles(40.27%)frequencies were statistically different between lacunar infarction subtype and controls(44.44%and 24.67%;χ2=11.744,P=0.Ol and χ2=20.445,P<0.01).Logistic regression analysis revealed that hypertension,diabetes mellitus.hyperlipidemia and the A allele of 1425G/A polymorphism were independent risky factors for lacunar infarction.Conclusions The SNP 1425G/A in PRKCH is closely associated with cerebral infarction.particularly with lacunar infarction.
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Objective To study the effectiveness of EEG bio-feedback in ameliorating the attention of children with attention deficit/hyperactivity disorder (ADHD) compared to a control group receiving methylphenidate treatment; and to explore the effectiveness of EEG bio-feedback in treating ADHD children refractory to methylphenidate. Methods Forty-four ADHD children were randomly assigned to an EEG bio-feedback group or a methylphenidate group. An additional twenty ADHD children refractory to methylphenidate were referred to as EEG bio-feedback group B. The two EEG bio-feedback groups received training in enhancing their beta activity and suppressing their theta activity. The methylphenidate group were treated with methylphenidate for 3 months. The subjects′ attention stability was measured using a number cancellation test. Their attention allocation and attention shift were tested using a neuropsychological behavioral test instrument, including trail-making test. All groups received re-tests during treatment, post-treatment and during a 6 month follow-up. Results During treatment, the cancellation speed of children in the EEG bio-feedback group A was slower than that of children in the MPH group. At the end of the treatment, there were no significant differences in speed between the two groups. Six months to one year after treatment the cancellation speed of the EEG bio-feedback group A was significantly faster than that of the MPH group. The EEG bio-feedback group B demonstrated significant increases in their cancellation speeds after 20 treatments and during a 1 year follow-up. During treatment and post-treatment, Q scores were significantly lower in EEG bio-feedback group A than in the methylphenidate group. Six months to one year after treatment the Q scores were significantly higher in EEG bio-feedback group A than in the methylphenidate group. There was no significant increase in the Q scores in EEG bio-feedback group B during treatment, but they increased significantly post-treatment. There was no significant difference in the trail-making time between EEG bio-feedback group A and the methylphenidate group during the treatment. Six months to one year after treatment, the trailmaking times in EEG bio-feedback group A were significantly less than in the MPH group. EEG bio-feedback group B showed significant decreases in trailmaking time post-treatment and during follow-up. Conclusions EEG bio-feedback may produce significant and long-term improvements in attention stability, attention allocation and attention shift. EEG bio-feedback may be useful for children with ADHD when methylphenidate is ineffective.
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<p><b>OBJECTIVE</b>To describe trends of changes in blood lead levels in children aged 1 - 6 years during the time period before and after introducing lead free gasoline in Shanghai 1997 and 1999.</p><p><b>METHODS</b>Blood lead levels of 1 969 children aged 1 - 6 years were determined by a sampling survey in five districts of Shanghai in August and September, 1997. Blood lead levels of the same population were re-determined by the same method from April to June in 1998 and from August to September in 1999. Filter paper blood lead test was carried out monthly using the filter paper blood lead proficiency testing program of Centers for Disease Control in the United States. The results from blood lead samples were under acceptable ranges during the study.</p><p><b>RESULTS</b>The geometric means of blood lead levels were 83 microgram/L in 1997, 80 microgram/L in 1998 and 76 microgram/L in 1999, respectively. The prevalence rates of childhood lead poisoning (blood lead level was equal or more than 100 microgram/L) were 37.8% in 1997, 25.7% in 1998 and 24.8% in 1999. The amounts of decrease on average blood lead levels in the five districts between 1997 and 1999 were 10 microgram/L, 11 microgram/L, 6 microgram/L, 4 microgram/L and 2 microgram/L, respectively.</p><p><b>CONCLUSION</b>Lead poisoning is a preventable disease. The average levels of lead in young children in Shanghai decreased significantly after the introduction of lead free gasoline to Shanghai. Lead emissions from vehicles running on leaded gasoline was one of the important contributors to increase the children's blood lead levels in Shanghai. Lead poisoning is not evenly distributed among children in Shanghai, resulting in the different levels of decline.</p>
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Child, Preschool , Humans , China , Environmental Monitoring , Methods , Reference Standards , Environmental Pollutants , Blood , Gasoline , Reference Standards , Lead , Blood , Time FactorsABSTRACT
The general clinical abilities of attending doctors are closely linked with the overall quality of patient care in a hospital. A set of quality standards for ward rounds by attending doctors were formulated in the author's hospital and an intensive evaluation was conducted by the experts team of the results of inspection and assessment. It is suggested that the hospital should tighten the quality control of ward rounds by attending doctors and pay serious attention to various problems that may occur. In particular, the hospital should set strict assessment standards for post qualification for attending doctors and strive to cultivate their clinical abilities after their post assumption. In addition, it should bring their talent into full play on the basis of vigorous management and assessment and discover and correct their shortcomings in ward rounds in a timely manner.
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12 kinds of histochemical methods were adopted to evaluate the effects of gossypol optical isomers on the reproductive system of Wistar rats, following the administration of (?) and (+)-gossypol at a dosage of 30mg/kg daily, and(-)-gossypol at a dosage of 15 mg/kg daily, respectively for 2 or 3 weeks. (+)-gossypol has no an tifertility activity. (?) and (-)-gossypol caused kinetic disorder of spermatogemsis, and inhibited turnover of nuclear basic protein of the late, elongated spermatids in the testis. No changes in G6PDH and 30-HSDH histochmical reaction in Leydig cells, and ALP in the basement membrane of epididymis were observable reflecting that gossypol has no effect on synthesis and secretion of testosterone. Spermatozoa in the epididymis of rats treated with (?) and (-)-gossypol exhibited head and tail separation. The formazan deposits of reaction of LDH, LDH-X, MDH and ICDH located in sperm mitochondria appeared to become coarse and to reduce in quantity after (?) and (-)-gossypol treatment.
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Objective: To study the effect of zinc deficiency(ZD)on the gene expression of vitamin D receptor(VDR)and CaBP in duodenal mucosa of rats. Methods: Thirty weaning male rats were randomly divided into three groups:ZD,paired-fed(PF),zinc adaquate(ZA). After 15 d feeding, took the duodenal mucosa to extract RNA,and measured the levels of VDR mRNA and CaBP mRNA in duodenal mucosa by real time fluorescent quantity PCR. Results: The VDR gene expression of ZD group was downregulated 88.89% as that of PF group,and 50.00% as that of ZA group. CaBP gene expression of ZD group was downregulated 80.16% as that of the PF group,and 88.50% as that of ZA group. Conclusion: Zinc deficiency, by changing the activity of VDR and the mRNA expression of VDR,affects the transcription of the target gene CaBP,and then the absorption of calcium that causes allo-osteogenesis.