ABSTRACT
A 46-year-old male sustained severe pe- netrating injury by a sharp instrument to his right upper sternoclavicular junction. The wound tract was from suprasternal notch to mediastinum. Exploratory operation via median sternotomy under general anesthesia found a large mediastinal septum hematoncus, as well as brachiocephalic trunk and left brachiocephalic vein injuries. The perforating vascular wounds were repaired with 5-0 prolene suture. He was recovered uneventfully and discharged 9 days after operation. There was no sequel found during 7 years follow-up.
Subject(s)
Humans , Male , Middle Aged , Brachiocephalic Trunk , Wounds and Injuries , General Surgery , Brachiocephalic Veins , Wounds and Injuries , General Surgery , Sternoclavicular Joint , Wounds and Injuries , General Surgery , Wounds, Penetrating , General SurgeryABSTRACT
Objective To evaluate the effect of home-made immobilization device with KV-CBCT in lung-SBRT and investigate its clinical use value.Methods Choosing 10 lung tumor patients (half centre type tumor;half peripheral type) random analysis the interfractional and intrafractional setup errors in the SBRT process by this fixed device with KV-CBCT.The concrete method is using Varian's KV-CBCT scans the patients before and after the SBRT each time,then make the registration between the reconstructed 3 d image and the planned CT image (both based on bone landmark),we then obtain the average setup errors in LR,AP and SI directions.Simultaneously,this research make contrastive analysis of setup errors among this fixed device and other fixed devices such as vacuum pad,phantom in body IMRT.All data make one-factor analysis of variance by SSPS 17.0.Results All the setup errors data was gaussian distribution,the centre type interfraction was at (0.01 ±0.32) cm (LR),(-0.08 ±0.38) cm (AP),(0.14 ±0.36) cm (SI) of the cross section,peripheral type interfraction was at (0.01 ± 0.32) cm (LR),(-0.08 ± 0.38) cm (AP),(0.14 ± 0.36) cm (SI) of the cross section (P =0.001).We found out that the average of lung tumor's setup error at all three directions have no significant difference-the largest was the AP directions (P =0.003),the second was the SI direction (P =0.003) and the smallest was the LR direction (P =0.001).The central type has no significant difference at three directions.Compare to the other fixed device,the average setup errors of our device are (0.09 ± 0.33) cm (LR),(-0.10 ± 0.44) cm (SI),(0.17 ±0.35) cm (AP) better than the report at present paper.As the interfraction setup error was small enough by using this fixed device while it has beyond the system algorithm,the registration software of system shows (0.0 ± 0.0 cm).Conclusions The range of lung tumor motion can be cut down obviously and enhance each placement accuracy,repeatability,on SBRT with home-made immobilization device.
ABSTRACT
<p><b>OBJECTIVE</b>To identify predictors of treatment retention problems at the two initial methadone maintenance treatment (MMT) clinics in Guangdong province, and to provide reference in reducing the rate of drop-outs.</p><p><b>METHODS</b>All of the patients were investigated at baseline and followed during the treatment period. Kaplan-Meier method on Survival Analysis was used to analyze retention related factors and predictors.</p><p><b>RESULTS</b>509 subjects were recruited in this study with median of retention time as 108 days (95%CI: 74 - 142 days). The retention rate at 1-, 3-, 6-, 12-months were 75.9%, 52.7%, 41.6%, 30.1%, respectively. Data from Multivariate Cox Proportional Hazard Model analysis showed predictors of retention would involve factors as HIV infection state at baseline (HR = 1.241, P = 0.047), daily methadone dose (HR = 0.633, P = 0.004) and secretly using drugs during treatment period (HR = 5.345, P = 0.000).</p><p><b>CONCLUSION</b>The retention rates at the two initial MMT clinics in Guangdong province were low. Patients who were HIV negative at baseline but still secretly using heroine during treatment or accepted low daily average dosage of methadone, had the tendency to drop out. The results implied that retention time could be prolonged by increasing daily methadone dosage.</p>