The effect of bulk electron density on the dose accuracy of treatment planning for postoperative cervical cancer / 中华放射医学与防护杂志

Objective:To study the impact on dose accuracy for the treatment planning by manually assigning accurate electron density for CT image-based tumor tissues and organs at risk.Methods:Twenty cases of retrospective postoperative cervical cancer radiotherapy plans were selected. The body electron density of the corresponding organs was derived from the ICRU 46 report and assigned in the treatment planning system (Monaco5.11, Sweden), including the bladder, rectum, intestine, kidney, spinal cord, femoral head, and ilium. The original plans were double-arc volumetric modulated arc therapy plan (360° VMAT), using Monte Carlo algorithm, the calculation grid was 0.3 cm × 0.3 cm × 0.3 cm, and the minimum subfield width was 0.6 cm. Keep the original plan fluence unchanged and recalculate the dose to generate a new plan. The two-dimensional dose distribution and dose-volume histogram (DVH) were used to compare the differences between the two plans. The difference was compared between the two group plans by using the dosimetry parameters and DVH two dimension curve.Results:For the planning of assigning bulk electron density (Plan RED), the deviation of the patient′s target dose parameters and the original plan (Plan ref) was <2%, and the average deviation of all target regions D2, D98, Dmean was < 0.7%, only 2 of the 180 data were between 2% and 3%. The average deviation of V20, V30, D1 cm 3, Dmean of the bladder, rectum, and small intestine, the original Plan ref was less than 0.6%, and 4 out of 240 data had values > 2%. Plan RED′s average hop count was 0.9% higher than Plan ref, and the total number of subfields remains unchanged. The planned dose generated by manually assigning the electron density in Plan RED was higher than that in Plan ref, but met the clinical requirements. The two-dimensional curves of the DVH diagram for targets and OARs almost completely overlapped, and there was no obvious difference in the dose distribution diagram of the same cross section. The statistical result of all parameters showed that the difference in planned dose parameters between the two groups was not statistically significant( P>0.05). Conclusions:The overall deviation of dose accuracy between Plan RED and Plan ref is <2%, which meets the clinical requirements and provides a reference for realizing MRI-only treatment planning.

A study on a method for restricting dwell time variation in brachytherapy plan optimization / 中华放射医学与防护杂志

Objective:To report an implementation method and result of an inverse dose optimization algorithm (GBPO) that can control the dwell time variation in three-dimensional brachytherapy.Methods:The GBPO used a quadratic objective function. A dwell time modulation item was added to the objective function to restrict the dwell time variation, and a DTMF (dwell time modulation factor) was used to adjust the dwell time variation. A retrospective study was made of 15 cervical cancer patients treated using the Fletcher applicator. The relationship between the DTMF and dwell time deviation was analyzed. Dose-volume histogram (DVH) parameters of HR-CTV ( D100%, V150%) and organs at risk (OARs) ( D0.1 cm 3, D1 cm 3, D2 cm 3) were used to evaluate the difference between the GBPO plans and the commercial treatment plan system (using the IPSA algorithm) plans. Results:When the DTMF was less than 20, the dwell time deviation decreased quickly. However, after the DTMF increased to 100, and the dwell time deviation had no remarkable change. The D100% of GBPO plan was higher than that of IPSA plan (3.63±0.36 vs. 3.53±0.34, t=2.45, P<0.05), and the difference in other dosimetric parameters between the GBPO plans and the IPSA plans was not statistically significant ( P>0.05). Conclusions:The method reported in this study to control the dwell time variation was feasible. The GBPO plans have a comparable quality as the IPSA plans for the studied cervical cancer cases. The GBPO algorithm could be integrated into a three-dimensional brachytherapy treatment planning system.

Effects of mesenteric lymph duct ligation on sepsis-induced lung and intestinal injuries in rats / 西安交通大学学报(医学版)

Objective To study the effect of mesenteric lymph duct ligation(MLDL)on sepsis-induced lung and intestinal injuries in rats.Methods Sepsis was induced by cecal ligation and puncture(CLP)in male rats.The rats were randomly divided into sham control group in which rats received sham operation,sepsis group(CLP group)in which rats received saline after CLP operation,and CLP+MLDL group in which rats received mesenteric lymph duct ligation(MLDL)after CLP operation.The rats were sacrificed at 24 h after CLP modeling. Bronchoalveolar lavage fluid,arterial blood,and intestine and lung tissues were collected to determine organ injuries.Results The lung tissue histopathology and blood gas analysis revealed that MLDL markedly alleviated the lung injury(ALI score:6.14 ± 0.51 vs.8.12 ± 0.63,P=0.029 9),improved oxygen partial pressure[(78.67 ± 4.51)mmHg vs.(64.83 ± 2.90)mmHg,P=0.0273],decreased lung W/D ratio(6.12 ± 0.25 vs.7.63 ± 0.49,P=0.021 2),decreased BALF cytokines levels[TNF-α:(828.17 ± 81.89)pg/mL vs.(1 118.17 ± 79.22)pg/mL,P=0.029 1;IL-6:(39.33 ± 5.50)ng/mL vs.(68.67 ± 5.24)ng/mL,P=0.003 4],alveolar permeability[protein levels:2.117 ± 0.289 2 vs.3.033 ± 0.164 7,P=0.020 3,and cell levels:(30.00 ± 3.587)×106/L vs.(43.83 ± 2.358)×106/L,P=0.009 1].However,according to the results of HE and biochemical detection,MLDL had no protective effect on sepsis-induced intestinal injury.Moreover,MLDL could significantly reduce the bacterial loads of the blood and lung,but do not change the bacterial level in the intestines.Conclusion MLDL has a significant protective effect on sepsis-induced lung injury mainly by decreasing bacterial translocation,but had no effect on intestinal injury.This difference may be related to that MLDL inhibits the bacteria spreading from abdominal cavity to other organs in sepsis but it causes their accumulation in the intestines.

Detection of proinflammatory cytokines in serum samples from patients with primary major depres-sive disorder / 中华微生物学和免疫学杂志

Objective To provide supportive evidences for the diagnosis of primary major depres-sive disorder (MDD) by analyzing the alterations of proinflammatory cytokines such as IL-1α, IL-6, IL-18, TNF-αas well as the total complement activity (CH50) in serum samples.Methods Hamilton Depression Rating Scale ( HAMD) was used to rate the severity of depression with the patients who were diagnosed as primary MDD.Enzyme-linked immunosorbent assay (ELISA) was used to detect the levels of IL-1α, IL-6, IL-18 and TNF-αand the CH50 in serum samples from 49 patients and 40 healthy subjects .Results Pa-tients with MDD showed significantly different levels of IL-6, IL-18, TNF-αand CH50 in serum samples as compared with that in healthy subjects (P0.05).There were significant gender differ-ences with levels of IL-1αamong the patients with MDD (P0.05). Conclusion The changes of CH50 and certain proinflammatory cytokines such as IL-6, IL-18 and TNF-αmight be involved in the progression of MDD , suggesting the possibility of using them as indicators for the di-agnosis of MDD.

Clinical efficacy of daily low-dose tadalafil on erectile dysfunction-no sexual life / 中华男科学杂志

<p><b>OBJECTIVE</b>Erectile dysfunction-no sexual life (ED-NS) is defined as the inability to have enough penile erection hardness and duration so as to have enough confidence in attempting sexual intercourse for more than six months. This study was to investigate the effect of daily low-dose tadalafil on ED-NS.</p><p><b>METHODS</b>We treated 35 ED-NS patients aged 17-35 (25.9 +/- 3.9) years with oral tadalafil at 5 mg qd for 3 months and followed them up for another 3 months after drug withdrawal. We obtained the scores of the patients on Self-estimation Index of Erectile Function-No Sexual Life (SIEF-NS) and compared them before and after medication and at 3 months after drug withdrawal.</p><p><b>RESULTS</b>The patients' SIEF-NS scores were 43.2 +/- 7.1 after medication and 42.1 +/- 7.4 at 3 months after drug withdrawal, both significantly higher than 21.2 +/- 5.9 before treatment (P < 0.05), though there was no significant difference between the former two scores (P > 0.05).</p><p><b>CONCLUSION</b>Daily medication of low-dose tadalafil can significantly improve the erectile function of the patients with ED-NS.</p>

Study on multiple aldosterone-producing adenomas / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the experience on diagnosis and treatment of multiple adrenal aldosterone-producing adenomas (APA).</p><p><b>METHODS</b>Eighteen cases of multiple adrenal APA were analyzed retrospectively, which were admitted from October 1992 to April 2006.</p><p><b>RESULTS</b>Adrenalectomy was performed for 4 cases of unilateral synchronous multiple APA, which were discovered with three adenomas by 3D-CT; bilateral tumor resection was performed for 6 cases of bilateral synchronous multiple APA. There were 8 cases of bilateral metachronous multiple APA, including 2 cases of ipsilateral recurrent adrenal APA after adrenal tumor removal, which underwent tumor resection. Another 6 cases were contralateral APA following adrenalectomy due to adrenal APA, and underwent tumor resection. After operation, the adrenal function seemed to be normal, and no recurrence had been found on follow-up.</p><p><b>CONCLUSIONS</b>Unilateral multiple synchronous APA require adrenalectomy. Tumor resection should be performed for bilateral or asynchronous APA, and it is very important to preserve healthy adrenal tissue as much as possible. 3D-CT has much value on diagnosis of small APA, unilateral multiple synchronous APA and ipsilateral recurrent adrenal APA.</p>

Mechanism of reversal of multidrug resistance in human renal carcinoma cells by protein kinase C inhibitor / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To explore the mechanism of reversal of multidrug resistance in renal carcinoma cells by protein kinase C inhibitor.</p><p><b>METHODS</b>RT-PCR, Western blot and inverted fluorescent microscopy were used to determine the expression of PKCalpha and MDR related gene MDR1, MRP1, LRP in RCC cells transferred by PKCalpha cDNA. Also effects of activator and inhibitor of PKC in combination with adriamycin on multidrug resistance in RCC cells were evaluated by MTT.</p><p><b>RESULTS</b>The results of semi-quantitative RT-PCR analysis showed that the expression level of MDR1 was higher in RCC cells transferred by PKCalpha cDNA than in RCC cells, the reversal effectiveness of PKC inhibitors in combination with adriamycin (ADM) was apparently favorable. IC(50) of ADM in 786 - 0 cells was 7.8015e(-7) (5.7046e(-7) to 1.0669e(-6)); IC(50) of ADM in PKCalpha/786 - 0 cells was 1.6588e(-6) (1.1621e(-6) to 2.3677e(-6)); IC(50) of ADM in combination with PMA in PKCalpha/786 - 0 cells was 2.6794e(-6) (2.0521e(-6) to 3.4983e(-6)); IC(50) of ADM in combination with calphostin C in PKCalpha/786 - 0 cells was 9.2506e(-8) (5.9337e(-8) to 1.4422e(-7)).</p><p><b>CONCLUSION</b>PKC inhibitors can reverse multidrug resistance in renal carcinoma cells in vitro via changes of expression of MDR1.</p>

Parapelvic cyst of kidney / 中华外科杂志

<p><b>OBJECTIVE</b>To study the clinical features, treatment and diagnosis of parapelvic cyst.</p><p><b>METHODS</b>Twenty-three patients of parapelvic cyst of the kidney were reviewed retrospectively. Fourteen cases (61%) complained of lumbar pain or discomfort, and 4 patients (17%) accompany hematuria and hypertension.</p><p><b>RESULTS</b>In 15 patients receiving surgery, 2 were treated by nephrectomy, one by radical nephrectomy for misdiagnosis. Postoperative diagnosis confirmed a cyst. Eight patients were treated conservatively for cyst being small and without clinical symptoms. Nineteen cases were followed up for 0.5 - 12.0 years.</p><p><b>CONCLUSIONS</b>Ultrasonography and CT scan are the main diagnostic methods. Enhanced CT is extremely helpful in differential diagnosis of hydronephrosis. Surgical management is suitable for big cysts, lumbar pain, hematuria, hypertension and other complications.</p>

Strategy for the diagnosis and treatment of bilateral testicular tumor / 中华泌尿外科杂志

Objective To evaluate the clinical features and the strategy for the diagnosis and treat- ment of bilateral testicular tumor.Methods The clinical data (including the signs and symptoms,imaging studies,tumor markers,treatment modalities and histopatbologic diagnoses) of 10 cases of bilateral testicular tumor from January 1980 to December 2004 were reviewed.Their age ranged from 19 to 58 years(mean,34 years).Of the 10 cases,8 with metachronous and 2 with synchronous testicular tumors were identified.The clinical stages at the primary and secondary tumor diagnosis were:5 cases of stageⅠ,3 of stageⅡ;and 6 cases of stageⅠ,1 of stageⅡ,and 1 of stageⅢ,respectively,in 8 metachronous tumor patients.Two syn- chronous tumor patients were both identified as stageⅠdisease.Histological examination showed the primary tumor (seminoma) in 4 cases and the secondary contralateral tumor (seminoma) in 3.Results Two syn- chronous tumor patients underwent bilateral radical orchiectomy simultaneously,and 8 underwent orchiectomy successively.Retroperitoneal lymph node dissection was performed in 3 cases.Postoperatively,hypogonadism occurred in 10 patients,and 7 of them received androgen replacement therapy.Follow-up ranged from 9 month to 23 years with a mean of 10.5 years.Two patients died of the disease;2 had metastasis (1 of them was alive with metastasis);2 had recurrences and underwent local resection.Conclusions Metachronous bilateral testicular cancers are more common than synchronous bilateral testicular cancers.Seminoma was the most common histopathologic type.Testis-sparing surgery can be performed in selected cases.