Study on the sensitivity of a volumetric modulated arc therapy plan verification equipment on multi-leaf collimator opening and closing errors and its gamma pass rate limit / 生物医学工程学杂志

To investigate the γ pass rate limit of plan verification equipment for volumetric modulated arc therapy (VMAT) plan verification and its sensitivity on the opening and closing errors of multi-leaf collimator (MLC), 50 cases of nasopharyngeal carcinoma VMAT plan with clockwise and counterclockwise full arcs were randomly selected. Eight kinds of MLC opening and closing errors were introduced in 10 cases of them, and 80 plans with errors were generated. Firstly, the plan verification was conducted in the form of field-by-field measurement and true composite measurement. The γ analysis with the criteria of 3% dose difference, distance to agreement of 2 mm, 10% dose threshold, and absolute dose global normalized conditions were performed for these fields. Then gradient analysis was used to investigate the sensitivity of field-by-field measurement and true composite measurement on MLC opening and closing errors, and the receiver operating characteristic curve (ROC) was used to investigate the optimal threshold of γ pass rate for identifying errors. Tolerance limits and action limits for γ pass rates were calculated using statistical process control (SPC) method for another 40 cases. The error identification ability using the tolerance limit calculated by SPC method and the universal tolerance limit (95%) were compared with using the optimal threshold of ROC. The results show that for the true composite measurement, the clockwise arc and the counterclockwise arc, the descent gradients of the γ passing rate with per millimeter MLC opening error are 10.61%, 7.62% and 6.66%, respectively, and the descent gradients with per millimeter MLC closing error are 9.75%, 7.36% and 6.37%, respectively. The optimal thresholds obtained by the ROC method are 99.35%, 97.95% and 98.25%, respectively, and the tolerance limits obtained by the SPC method are 98.98%, 97.74% and 98.62%, respectively. The tolerance limit calculated by SPC method is close to the optimal threshold of ROC, both of which could identify all errors of ±2 mm, while the universal tolerance limit can only partially identify them, indicating that the universal tolerance limit is not sensitive on some large errors. Therefore, considering the factors such as ease of use and accuracy, it is suggested to use the true composite measurement in clinical practice, and to formulate tolerance limits and action limits suitable for the actual process of the institution based on the SPC method. In conclusion, it is expected that the results of this study can provide some references for institutions to optimize the radiotherapy plan verification process, set appropriate pass rate limit, and promote the standardization of plan verification.

Application of artificial neural network in evaluation of IVF embryo / 中华检验医学杂志

Artificial neural network (ANN) is a network framework that drives artificial intelligence (AI). Classical convolutional neural networks (CNN) are mainly used for cell count and image recognition at fixed time in embryo evaluation. Fully connected deep neural networks (DNN), with increased accuracy of image recognition, are suitable for the units equipped with high configuration hardware and need comprehensive prediction according to the integrated clinical information. Residual networks improve the accuracy by increasing layers and solving the gradient disappearance problem through jump connection to realize dynamic embryo assessment. Bayesian networks (BN) and multi-layer perceptron (MLP) are two machine learning methods. The former is especially used for comprehensive prediction combined with complex clinical information in case of lack of conditions. The latter has gradient disappearance and explosion problem, and is easy to lose some spatial features of images, so it is used for small sample volumes. ANN has advantages in the prediction of implantation rate and aneuploidy and reducing invasive detection in quality assessment of embryos, which is an important research direction of human-assisted reproductive technology (ART).

Design and Validation of Remote Radiotherapy System / 中国医疗器械杂志

Telemedicine technology is a means of deploying medical resources with low cost and high efficiency. A set of remote radiotherapy system based on Citrix was designed in this paper, so that the senior radiation therapists from the developed areas can provide medical services effectively for the patients in the rural areas. This paper focused on the design ideas and the detail of the technical implementation of how to design a remote radiotherapy system based on the existing equipment in the primary hospital. And the technical reliability and security of the remote radiotherapy system were verified by the scientific test method with pairwise comparison. The early practical experience shows that through the remote radiotherapy system the primary radiotherapy personnel and the radiotherapy experts from thirdgrade class-A hospital can form effective alliance in radiotherapy techniques to allow patients in rural areas to receive more professional radiation therapy.

Factors influencing the postoperative resolution of varicocele-associated scrotal pain / 中华男科学杂志

Objective@#To investigate the factors influencing the postoperative resolution of varicocele-associated scrotal pain.@*METHODS@#Using the keywords "varicocele", "testicular pain", "scrotal pain", "painful varicocele", "ligation", and "varicocelectomy", we searched the PubMed, Embase, Cochrane Collaboration's Database, CNKI, Wanfang, and VIP Database up to October 2016 for the studies relating to surgical treatment of varicocele-associated scrotal pain. We assessed the quality of the cohort studies included using the Newcastle-Ottawa Scale and that of the randomized controlled trials included with the Cochrane Collaboration's tool. We conducted a meta-analysis using the RevMan software.@*RESULTS@#Finally 14 studies were included in this meta-analysis, of which, 2 involved the history of disease, 8 involved the nature of pain, 2 involved the intensity of pain, 9 involved the grade of varicocele, 3 involved the side of varicocele, 9 involved surgical approaches, 3 involved surgical techniques, and 4 involved postoperative recurrence. The pain resolution rate was significantly higher after subinguinal ligation than after high or inguinal ligation (RR = 0.82, 95% CI: 0.76－0.89, P <0.01; RR = 0.92, 95% CI: 0.86－0.99, P = 0.02), and so was it after microsurgery than after laparoscopic varicocelectomy (RR = 0.77, 95% CI: 0.60－0.99, P = 0.04).@*CONCLUSIONS@#Subinguinal varicocelectomy and microsurgery are more effective options than laparoscopic and high or trans-inguinal ligation of the spermatic vein for resolution of varicocele-associated scrotal pain, while the history of disease, the nature and intensity of pain, the grade and side of varicocele, or postoperative recurrence cannot be regarded as the influencing factors.

Development of a Software for Automatically Generated Contours in Eclipse TPS / 中国医疗器械杂志

<p><b>OBJECTIVE</b>The automatic generation of planning targets and auxiliary contours have achieved in Eclipse TPS 11.0.</p><p><b>METHODS</b>The scripting language autohotkey was used to develop a software for automatically generated contours in Eclipse TPS. This software is named Contour Auto Margin (CAM), which is composed of operational functions of contours, script generated visualization and script file operations. RESULTS Ten cases in different cancers have separately selected, in Eclipse TPS 11.0 scripts generated by the software could not only automatically generate contours but also do contour post-processing. For different cancers, there was no difference between automatically generated contours and manually created contours.</p><p><b>CONCLUSION</b>The CAM is a user-friendly and powerful software, and can automatically generated contours fast in Eclipse TPS 11.0. With the help of CAM, it greatly save plan preparation time and improve working efficiency of radiation therapy physicists.</p>

Development of a software for 3D virtual phantom design / 生物医学工程学杂志

In this paper, we present a 3D virtual phantom design software, which was developed based on object-oriented programming methodology and dedicated to medical physics research. This software was named Magical Phan tom (MPhantom), which is composed of 3D visual builder module and virtual CT scanner. The users can conveniently construct any complex 3D phantom, and then export the phantom as DICOM 3.0 CT images. MPhantom is a user-friendly and powerful software for 3D phantom configuration, and has passed the real scene's application test. MPhantom will accelerate the Monte Carlo simulation for dose calculation in radiation therapy and X ray imaging reconstruction algorithm research.

A comparative study of clinical effects of 2-micron laser vaporization resection of prostate versus transurethral resection of prostate for treatment of benign prostatic hyperplasia / 中国综合临床

Objective To investigate and compare the clinical effects of 2-micron laser vaporization resection of prostate (2-micron laser) and versus transurethral resection of prostate (TURP) for treatment of benign prostatic hyperplasia(BPH) in this prospective random control study.Methods Sixty patients of BPH were randomly divided into two groups including the 2-micron laser group (n =30) and the TURP group (n =30).The perioperative markers and therapeutic results including duration of surgery,blood lose during surgery,improvement of symptoms after treatment,postoperative bladder washing time,the mean bladder irrigating time,hospital stay time,and recent complications were recorded and analyzed.Results The international prostate symptom score((6.6 ± 1.8) vs.(33.2 ±2.2),(5.7 ± 1.3) vs.(33.4 ±2.3) respectively),maximal urinary flow((20.6 ± 1.5) ml/s vs.(7.8 ± 4.3) m/s,(19.5 ± 1.7) ml/s vs.(8.3 ± 4.5) ml/s respectively),residual urine volume((22.3 ±4.7) ml vs.(57.2 ± 10.5) ml,(26.3 ±7.2) ml vs.(60.2 ± 14.5) ml respectively) were significantly improved in both groups after operation (P =0.005,0.008,0.036,0.001,0.005,0.013 respectively),but the differences between these two groups were not significant (P =0.16,0.49,0.97 respectively).The volume of hemorrhage ((20.9 ± 12.1) ml vs.(55.3 ± 27.8) ml),the mean bladder irrigating time ((1.0 ±0.5) d vs.(3.5 ±0.7) d),cathererization time ((3.2 ± 1.3) d vs.(6.0 ± 1.5) d),hospital stay time ((6.8 ±0.7) d vs.(10.6 ±0.6) d) were significantly less or shorter in the 2-micron laser group than in the TURP group (P =0.009,0.005,0.035,0.03 respectively).There was no significant difference in rates of complications between the two groups (P ＞ 0.05).Conclusion The therapy of 2-micron laser is safer and more efficacious than TURP for BPH patients,with advantages of short surgery duration,little blood loss,and quick recovery.

Effect of robotic-assisted laparoscopic radical cystectomy and urinary diversion / 中国综合临床

Objective To assess the safety and effectiveness of robotic-assisted laparoscopic radical cystcctomy and urinary diversion in the treatment of bladder cancer.Methods We collected the clinical data of one patient with bladder cancer who underwent RCRA with ileal neobladder from the Second Artillery General Hospital in Beijing on March,2010.Literature on this topic was analyzed.Results ( 1 ) Tbc operation duration of this procedure was 540 mins.The intra-operative blood loss was 200 ml,and no blood transfusion was needed.Postoperative pathologic examination indicated low-grade infiltrative urothelial carcinoma.The patient exhausted on the 3th post-operative day,had off-bed activities on the 4th post-operative day,and was discharged on the 28th post-operative day.(2) There were more than 400 patients underwent RARC worldwide.The RARC group had marginally lower complications rate (31％ vs.28％ ) and numbers of lymph node dissection ( 18.2 vs.13.0) than the LCR group.There were significant differences in the duration of operation (285.7 mins vs.372.0 mins),intraoperatie blood loss ( 286 ml vs.556.0 ml) and mean days of hospitalization ( 8.6 d vs.13.0 d) between the RARCA and the LCR groups.Conclusion RARC is a novel and effective procedure for the treatment of bladder cancer.As there is only a relatively small sample around the world and little experience on this procedure can be referred,more clinical practice with RARC and high quality research with long-term follow-up are needed to update the database and evaluate its effectiveness and safety.

Vitrification technology in whole embryo freezing / 中南大学学报(医学版)

Objective To investigate the clinical outcome of patients who underwent whole embryo vitrification freezing and thawed frozen embryo transplantation, and to compare it with the patients at the same period in the fresh cycle to explore the value of vitrification technology in the whole embryo freezing combined with recovery transplantation. Methods The whole embryo freezing group included 40 untransplanted cases of in-vitro fertilization (IVF), while another 300 patients in the fresh cycle with in vitro fertilization and embryo transfer (IVF-ET) at the same period served as the fresh cycle group. The average number of transferred embryos, high-quality embryos, endometrial thickness, estradiol (E2) level, and clinical pregnancy rate were compared.Results The average number of transferred embryos, high-quality embryos, difference in endometrial thickness were not significant between the 2 groups (P>0.05); the E2 level of the fresh cylcle group was significantly higher than that of the whole embryo freezing group (P<0.05), and the clinical pregnancy rate in the fresh cylcle group was significantly lower than that of the whole embryo freezing group (P<0.05). Conclusion Vitrification technology is a simple, reliable, and efficient embryo freezing technology. For patients who meet the requirements, whole embryo vitrfication freezing and thawed frozen embryo transplantation is feasible. It is worth for further clinical research.

Study on the relationship between HBV infection and polymorphism of CⅡTA G-944C gene among Jinuo,Dai and Aini minority populations in Yunnan province / 中华流行病学杂志

Objective To explore the relationship between HBV infection and the genotypes and allele frequencies of CⅡTA G-944C gene polymorphism in three minority populations(Jinuo,Dai and Aini population)in Xishuangbanna district,Yunnan province.Methods Polymerase chain reaction and sequencing method were used to study the genotypes and allele frequencies distributions of CⅡTA G-944C gene polymorphism in those three populations.Relationship between the genotypes distribution and HBV infection results were also analyzed.Results The rates on HBV infection and HBsAg carrier status in Aini minority population were 89.2% and 16.3%,which were significantly higher than in Jinuo(27.9% and 3.9%,χ~2=135.196 and 10.361,P=0.000 and 0.001)and Dai population(44.9% and 6.6% χ~2=96.783 and 8.748,P=0.000 and 0.003)while among Aini population it was significantly different with the other two minority populations.The CC genotype and C allele frequencies were more distributed in Aini population than in the other two minority populations.In contrast,the GG genotype and G allele frequencies were lower than the other two minority populations,with χ~2 rates between Aini and Jinuo population were 11.841 and 12.208 and the P as 0.003 and 0.000 respectively while the χ~2 rates between Ami and Dai population were 23.902 and 20.220 with P value as 0.000 and 0.000.The genotypes frequencies of CⅡTA G-944C was significantly different in the infected individuals(IF)group and health control(HC)group in Jinuo population(χ~2=6.150 and 4.911,P=0.046 and 0.027).When compared with HBsAg+ group and HBsAg~- group,the genotypes and allele frequencies were different in Aini population and the total three minority populations(χ~2 rates in Jinuo minority were 8.650 and 5.034 with P values as 0.013 and 0.025).However,the χ~2 rates in the whole population were 13.047 and 9.416 with P values as 0.001 and 0.002,respectively.The distribution of CC genotype and C allele gene in HBsAg~+ group was increasing.Data from non-condition logistic regression analysis and adjusting for confounding factors,the HBsAg~+ group had a significantly increase of HBsAg~- group under the C allele Recessive Model(P=0.000;OR=2.964;95% CI:1.609-5.460).Conclusion The genotypes and allele frequencies distribution of CⅡTA G-944C were different in the three ethnic populations.Polymorphism of this gene was closely associated with HBsAg carrier.The CC genotype patients were more easily to become HBsAg carrier.

Preparation of recombinant polypeptide of N-terminal heparin-binding domain of fibronectin and its effect on disseminated intravascular coagulation in rats / 中国实验血液学杂志

This study was aimed to prepare the polypeptide of N-terminal heparin-binding domain of fibronectin(rhFNHN-29 polypeptide) with pichia expression system, to detect biological activity of recombinant polypeptide and investigate its effect on disseminated intravascular coagulation (DIC) in rats. The sequence of N-terminal heparin-binding domain of fibronectin was amplified from FNcDNA by PCR. The aim gene was cloned into T vector for selection. Then it was cloned into pAo815SM and pPIC9K vectors.Lined pPIC9K vectors were transformed into GS115 Pichia cells so as to express the aim polypeptide in Pichia expression system. The fermentation liquid were precipitated by 80% ammonium sulfate, and the further dissolved sediment were purified using S-100 column and SP column. Its activity of binding with heparin were detected by Western-blot. The established DIC rats (40 rats) were randomly divided into two groups. One group was treated with rhFNHN-29 polypeptide, and the other was treated with normal saline. The rats in the former group were injected with rhFNHN-29 polypeptide (10 mg/kg) through tail vein at 0.5 hour before, 2 hours and 4 hours after injection of LPS respectively. The rats in latter group were injected with equal volume saline. In addition, 20 normal rats injected with normal saline were as normal controls. 500 microl blood was taken from the rat vein, at 6 hours after the injection of LPS. White blood cell (WBC), hemoglobin (Hb) and platelets were tested from 50 microl blood. The rest 450 microl blood was used to isolate plasma for detecting TNFa level and coagulogram. The rats were killed at 24 hours after injection with LPS. Their livers, lungs, hearts, kidneys, and brain tissues were taken for histopathologic examination. The results showed that the aim polypeptide was successfully expressed in Pichia expression system. The expression level reached approximately 30 mg/L. The polypeptide had activity of binding with heparin antibody. In the experiment study of polypeptide effect on DIC in rats, the plasma TNFa level in polypeptide-treated group was lower than that in saline control group, the hemogram, coagulogram and histopathology were more obviously improved in polypeptide-treated group as compared with saline control group. It is concluded that the rhFNHN-29 polypeptide is successfully prepared, this polypeptide can antagonize DIC induced by endotoxin in rats.

Behaviors study of image registration algorithms in image guided radiation therapy / 中华放射肿瘤学杂志

Objective Study the behaviors of image registration algorithms, and analyze the elements which influence the performance of image registrations. Methods Pre-known corresponding coordinates were appointed for reference image and moving image, and then the influence of region of interest (ROI) selection, transformation function initial parameters and coupled parameter spaces on registration results were studied with a software platform developed in home. Results Region of interest selection had a manifest influence on registration performance. An improperly chosen ROI resulted in a bad registration. Transformation function initial parameters selection based on pre-known information could improve the accuracy of image registration. Coupled parameter spaces would enhance the dependence of image registration algorithm on ROI selection. Conclusions It is necessary for clinic IGRT to obtain a ROI selection strategy (depending on specific commercial software) correlated to tumor sites. Three suggestions for image registration technique developers are automatic selection of the initial parameters of transformation function based on pre-known information, developing specific image registration algorithm for specific image feature, and assembling real-time image registration algorithms according to tumor sites selected by software user.

Small interfering RNA inhibits the expression of connexin43 in the human corpus cavernosum penis smooth muscle cells / 中华男科学杂志

<p><b>OBJECTIVE</b>To inhibit the expression of connexin43 (Cx43) in the human corpus cavernosum penis smooth muscle cells by small interfering RNA (siRNA) and detect the gap junction intercellular communication (GJIC), and to investigate the application of siRNA technology in the gap junction of corpus cavernosum penis smooth muscle cells and its role in the penile erection process.</p><p><b>METHODS</b>With the help of the software of Ambion Corporation, the specific recombinant plasmids with siRNA targeting human Cx43 gene were constructed. The recombinant plasmids having been stably transferred into human corpus cavernosum penis smooth muscle cells for 48 hours, semi-quantitive reverse transcription polymerase chain reaction (RT-PCR) and Western blotting techniques were used to examine the inhibitory effects of siRNA on the expressions of the Cx43 gene and protein, in comparison with the siRNA negative control and the blank control group, respectively. The GJIC was detected by scrape-loading and fluorescence dye transfer experiments through the fluorescence microscope.</p><p><b>RESULTS</b>The results of enzyme digestion analysis and DNA sequencing showed that the recombinant plasmid pSilencer 1.0-U6-siRNA-Cx43 was successfully constructed. The relative levels of Cx43 mRNA and protein expression in the smooth muscle cells were (0.45 +/- 0.08)% and (0.56 +/- 0.06)% after successful transfer of the recombinant plasmid. However, the expression levels of mRNA and protein were (0.72 +/- 0.04)% and (0.80 +/- 0.08)% in the negative siRNA transfer group, and (0.74 +/- 0.09)% and (0.77 +/- 0.11)% in the blank control, respectively, with a significant difference (P < 0.05). The GJIC also decreased significantly.</p><p><b>CONCLUSION</b>siRNA can significantly inhibit the expression of Cx43 and block the GJIC in the human corpus cavernosum penis smooth muscle cells. siRNA technology plays an important role in penile erection and flaccidity.</p>

Cytogenetics and Polygenic Factor Analysis of 364 Female Children with Short Stature / 实用儿科临床杂志

Objective To explore the effect of chromosomal abnormality and polygenic inheritance factor in female children with short stature.Methods 1.Chromosome analysis:peripheral blood was drawn for 1 mL and cultured 72 h to analyze chromosome karyotype (Giemsa Banding ) of peripheral lymphocytes.2.Polygenic factor analysis:the children′s final height were estimated based on their parents average height,and analyzed the distribution characteristics of children′s final height and compared the estimate final height with the actual height.Results Eighty-three cases out of the 364 female children with short stature were chromosomal abnormality(22.80%).Among the 83 cases,the 45,XO and 46,X,i(Xq) occupied 70%.The distribution of children target height shifted left,and the target height of 76 cases was lower than 2 standard deviation (-2 s)and the consistency of target height and actual height reached 20.88%.The target height of 7 cases was lower than 2 standard deviation in those whose chromosome turned out to be abnormal,and the consistency of target height and actual height was 8.43%.Conclusions Chromosomal abnormality is one of the most important etiologic agents causing short stature in female children, and polygenic inheritance is another important etiologic agent.