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Objective: To explore the independent risk factors of internal mammary lymph nodes (IMN) metastasis and the risk assessment method of IMN metastasis preoperatively in breast cancer patients with negative IMN in imaging examination, and guide the radiotherapy of IMN in patients with different risk stratification of IMN metastasis. Methods: The clinical and pathological data of 301 breast cancer patients who underwent internal mammary sentinel node biopsy(IM-SLNB) and/or IMN dissection in Shandong Cancer Hospital with negative IMN on CT and/or MRI from January 2010 to October 2019 were analyzed retrospectively. The independent risk factors were analyzed by univariate and multivariate logistic regression, and the independent risk factors of IMN metastasis were used to risk stratification. Results: Among the 301 patients, 43 patients had IMN metastasis, and the rate of IMN metastasis was 14.3%. Univariate analysis showed that vascular tumor thrombus, progesterone receptor (PR) expression, T stage and N stage were associated with IMN metastasis. Multivariate logistic regression analysis showed that tumor located in medial quadrant, positive PR and axillary lymph node metastasis were independent risk factors for IMN metastasis. The risk of IMN metastasis was assessed according to the independent risk factors of the patients: low-risk group is including 0 risk factor, medium-risk group is including 1 risk factor, and high-risk group is including 2-3 risk factors. According to this evaluation criteria, 301 patients with breast cancer were divided into low-risk group (with 0 risk factors), medium-risk group (with 1 risk factor) and high-risk group (with 2-3 risk factors). The IMN metastasis rates were 0 (0/34), 4.3% (6/140) and 29.1% (37/127), respectively. Conclusions: The risk stratification of IMN metastasis according to three independent risk factors of IMN metastasis including tumor located in medial quadrant, positive PR and axillary lymph node metastasis in breast cancer patients can guide the radiotherapy of IMN in newly diagnosed breast cancer patients. For N1 patients, radiotherapy of IMN is strongly recommended when the primary tumor is located in the medial quadrant and/or PR positive.
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Female , Humans , Breast Neoplasms/pathology , Lymph Nodes/pathology , Lymphatic Metastasis/pathology , Neoplasms, Second Primary/pathology , Retrospective Studies , Risk Assessment , Sentinel Lymph Node Biopsy/methodsABSTRACT
Objective:To investigate the clinical value of echocardiography in the diagnosis of fetal arrhythmia.Methods:1 500 pregnant women who underwent a regular prenatal examination in Cangnan Hospital Affiliated to Wenzhou Medical University from March 2018 to March 2020 were included in this study. These pregnant women underwent fetal echocardiography in the second trimester of pregnancy (24-26 weeks). We evaluated the condition of, and calculated the incidence of, fetal arrhythmia complicated by fetal cardiac structure abnormality . The diameters of the descending aorta, umbilical artery, and middle cerebral artery were compared between normal fetuses and arrhythmia fetuses.Results:Fetal arrhythmia was found in 131 pregnant women who were in the second trimester of pregnancy, with an incidence of fetal arrhythmia of 8.73%. Fetal arrhythmia and cardiac structure abnormality were detected in 19 pregnant women, with an incidence of fetal arrhythmia and cardiac structure abnormality of 1.27%. Fetal arrhythmia was detected in 131 (8.73%) pregnant women who were in the second trimester of pregnancy and it was detected in 32 (2.13%) pregnant women who were in the third trimester of pregnancy. Arrhythmia was detected in 18 (1.2%) newborns. Only 5 (0.33%) fetuses died during the perinatal period. Four (0.27%) fetuses had arrhythmia complicated by cardiac structure abnormality. One (0.07%) fetus was normal. The diameters of the descending aorta and middle cerebral artery were greater in normal fetuses than in arrhythmia fetuses in pregnant women who were in the second trimester of pregnancy, and the diameter of the umbilical artery was significantly smaller in normal fetuses than in arrhythmia fetuses ( t = -8.27-19.62, all P < 0.001). Conclusion:Echocardiography can effectively help diagnose fetal arrhythmia and observe abnormal cardiac structure. The imaging technique is of great clinical value in improving the diagnosis and treatment of fetal arrhythmia.
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Objective:To analyze the genetic etiology of idiopathic short stature(ISS) children, and to investigate the clinical characteristics of Noonan syndrome caused by PTPN11 gene mutation, and the response to recombinant human growth hormone(rhGH) as well.Methods:Genomic DNA was extracted from the peripheral blood of 232 ISS patients, and the genome was detected by whole exon sequencing. The gene variation was analyzed according to the guideline of American College of Medical Genetics and Genomics(ACMG), and clinical baseline data and follow-up data of rhGH treatment were collected from PTPN11 gene pathogenic patients.Results:Among 232 ISS patients, 6 were found to have PTPN11 pathogenic gene variants(c.1507G>C, c. 317A>G, c. 923A>G, c. 922A>G, c. 236A>G, c. 922A>G), diagnosed as Noonan syndrome. Together with 3 cases of Noonan syndrome patients(all PTPN11 gene variation C. 1510A>G) previously diagnosed in our hospital, the clinical characteristics of patients were analyzed. Among the 9 Noonan syndrome patients, 7 were boys and 2 were girls. The average age was 10.2(4.5, 14.7) years old, and their height standard deviation score was -3.06 SD(95% CI -2.29 SD--3.94 SD). Among them, 4 patients received rhGH treatment with an average treatment duration of 2.25(1.5, 3.5) years. After treatment, their height increased by 14.3(8.6, 23.9) cm, and the change in height standard deviation score improved by 0.21 SD(95% CI 0.12 SD-0.27 SD). Conclusion:Noonan syndrome has a wide range of clinical phenotypes. For children with short stature, heart defects and cryptorchidism, the possibility of Noonan syndrome should be considered. PTPN11 is the common pathogenic gene for Noonan syndrome, and genetic testing facilitates the early diagnosis, treatment, and follow-up prognosis of Noonan syndrome patients.
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Objective:To investigate the effectiveness of abdominal compression in tumor motion and the target volume, and analyze the suitable margins of planning target volume (PTV) for patients treated with lung-SBRT based on 4DCT.Methods:Patients diagnosed with peripheral pulmonary tumor were enrolled. The patients were divided into the whole group, upper-middle-lobe group (group A) and the lower-lobe group (group B). Each patient underwent 3DCT, 4DCT with abdominal compression (4DCT com) and 4DCT with free breath (4DCT free) scans. The GTVs were delineated and IGTVs on these images. PTV MIP 5 mm, PTV MIP 4 mm, PTV MIP 3 mm were constructed with a 5, 4, 3 mm margin in left-right (LR), anterior-posterior (AP) directions and cranial-caudal (CC) directions. Results:The median motion vector with compression reduced by 30.92% in whole group, increased by 3.42% in group A and reduced by 18.80% in group B, respectively. And there were no significant differences of TMA LR, TMA AP, TMA CC and motion vector by the Wilcoxon test ( P>0.05). The median sizes of IGTV MIP com , IGTV MIP free and IGTV10 com, IGTV10 free were 4.01, 5.36 cm 3and 6.59, 7.65 cm 3, with statistically significant difference ( Z=-3.45, -3.14, P<0.01). The median ratio of DI of IGTV CBCT com in PTV MIP 5 mm, PTV MIP 4 mm and PTV MIP 3 mm≥95% was 100%, 100% and 83.33%, respectively. Conclusions:The patients′ respiratory pattern changed with abdominal compression and abdominal compression is useful in reducing the size of IGTV MIP and IGTV10, which could reduce the target volume and protect the normal tissue. Adding a 4 mm margin to IGTV MIP com based on 4DCT account for respiration in SBRT is a tendency for precise radiotherapy.
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Subject To compare the irradiation-induced injury and clinical efficacy between SIB-IMRT and LB-IMRT for early-stage breast cancer after breast-conserving surgery.Methods:From November 2002 to February 2012, 353 early breast cancer patients who underwent IMRT after breast-preserving surgery at Shandong Cancer Hospital were selected, of whom 218 patients receiving SIB-IMRT and 135 patients receiving LB-IMRT.The prescription dose of the SIB-IMRT group was the ipsilateral breast (PTV b ) 1.8-1.9 Gy, 27-28 times, and concurrent tumor bed (PTV t) 2.15-2.3 Gy, 27-28 times. In the LB-IMRT group, the prescription dose was PTV b 2.0 Gy, 25 times, followed by PTV t boost 2.0 Gy, 5-8 times. Results:The median follow-up time was 92 months. The excellent, good, fair, and poor cosmetic results in the SIB-IMRT and LB-IMRT groups were 10.1% and 12.6%, 85.8% and 80.7%, 3.7% and 5.2%, 0.5%, and 0.7%, respectively ( P=0.731). The 5-year locoregional recurrence rates (LRRs) in the SIB-IMRT and LB-IMRT groups were 3.21% and 5.93% and the 10-year LRRs were 4.13% and 6.67%, respectively ( P=0.209, 0.280). The 3-, 5-, 8-, and 10-year overall survival rate in the SIB-IMRT and LB-IMRT groups were 97.7% and 97.8%, 96.3% and 95.2%, 94.9% and 92.0%, 93.6% and 90.3%, respectively ( P=0.288). The 3-, 5-, 8-, and 10-year disease-free survival in the SIB-IMRT and LB-IMRT groups were 95.4% and 93.8%, 91.8% and 87.7%, 89.9% and 84.1%, 89.0% and 82.1%, respectively ( P=0.160). Conclusion:There is no significant difference in the cosmetic effect, local control rate, and survival rate between SIB-IMRT and LB-IMRT after breast-preserving surgery in patients with early-stage breast cancer. SIB-IMRT is a safe and feasible treatment.
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Objective:To investigate the application value of 18F-FDG PET-CT combined with MRI in the radiotherapy for esophageal carcinoma by comparing the differences in the gross target volume (GTV), position length delineated on the end expiratory (EE) phase of 4DCT, PET-CT and T 2-weighted MRI (T 2W-MRI). Methods:Twenty-six patients with thoracic esophageal cancer scheduled to receive concurrent chemoradiotherapy sequentially underwent 3DCT, 4DCT, PET-CT and enhanced MRI for thoracic localization. All images were fused with the 3DCT images by deformable registration. GTV CT, GTV 50% GTV PET2.5, GTV MRI and GTV DWI were delineated on 3DCT, the EE phase of 4DCT images, PET-CT with the thresholds of SUV≥2.5, T 2W-MRI and diffusion-weighted images, respectively. Results:GTV PET2.5 was significantly larger than GTV 50% and GTV MRI ( P<0.001 and P=0.008), whereas the volume of GTV MRI was similar to that of GTV 50%( P=0.439). Significant differences were observed between the CI of GTV MRI to GTV 50% and GTV PET2.5 to GTV 50%( P=0.004). The conformity indexes (CIs) of GTV MRI to GTV CT and GTV PET2.5 to GTV CT were statistically significant ( P=0.004 and P=0.039). The CI of GTV MRI to GTV PET2.5 was significantly smaller than that of GTV MRI to GTV 50%, GTV MRI to GTV CT, GTV PET2.5 to GTV 50% and GTV PET2.5 to GTV CT ( P=0.000-0.021). The length of gastroscopy was similar to those of GTV PET2.5 and GTV DWI (both P>0.05), and there was no significant difference in the length between GTV PET2.5 and GTV DWI ( P=0.072). Conclusion:GTV MRI yields significantly different volume and poor spatial matching compared with GTV PET2.5. The application of PET-CT combined with MRI under respiratory gating system in the delineation of GTV should be used with caution in thoracic squamous esophageal cancer. MRI-DWI can replace PET-CT to help determine the upper and lower boundaries of GTV based on CT images.
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To explore whether paeonol can play an anti-atherosclerotic role by regulating the expression of aortic caveolin-1 and affecting NF-κB pathway, so as to inhibit the inflammatory response of vascular endothelium in atherosclerotic rats. The atherosclerotic model of rats was induced by high-fat diet and vitamin D_2. The primary culture of vascular endothelial cells(VECs) was carried out by tissue block pre-digestion and adherent method. The injury model of VECs was induced by lipopolysaccharide(LPS), and filipin, a small concave protein inhibitor, was added for control. HE staining was used to observe pathological changes of aorta. TNF-α, IL-6 and VCAM-1 were detected by ELISA. Western blot assay was used to detect the protein expression levels of caveolin-1 and p65 in aorta and VECs. The results showed that as compared with model group, paeonol significantly reduced aortic plaque area and lesion degree in rats, decreased the level of serum TNF-α, IL-6 and VCAM-1 in the rats and enhanced the relative expression level of caveolin-1, decreased p65 expression conversely(P<0.05 or P<0.01). In vitro, as compared to model group, paeonol obviously improved cell morphology, decreased the secretion of TNF-α, IL-6 and VCAM-1 in VECs, increased caveolin-1 expression, and decreased p65 protein expression(P<0.05 or P<0.01). Furthermore, filipin could reverse the effect of paeonol on expression of inflammatory factors and proteins(P<0.05 or P<0.01). According to the results, it was found that paeonol could play the role of anti-atherosclerosis by up-regulating the expression of caveolin-1 and inhibiting the activation of NF-κB pathway to reduce vascular inflammation in atherosclerotic rats.
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Animals , Rats , Acetophenones , Caveolin 1 , Endothelial Cells , Endothelium, Vascular , Inflammation , NF-kappa B , Signal Transduction , Tumor Necrosis Factor-alpha , Up-RegulationABSTRACT
Objective:To assess the feasibility of delayed-enhancement MRI in contouring the lumpectomy cavity (LC) for patients with invisible seroma or a low cavity visualization score (CVS≤2) in the excision cavity after breast-conserving surgery (BCS).Methods:Twenty-six patients with stage T 1-2N 0M 0 who underwent prone radiotherapy after BCS were recruited. The LC delineated on CT simulation images was denoted as LC CT. The LCs delineated on T 2WI, as well as on different delayed phases (2-, 5-and 10-minute) of delayed-enhancement T 1WI were defined as LC T2, LC 2T1, LC 5T1 and LC 10T1, respectively. Subsequently, the volumes and locations of the LCs were compared between CT simulation images and different sequences of MR simulation images using deformable image registration. Results:The volumes of LC T2, LC 2T1, LC 5T1 and LC 10T1 were all larger than that of LC CT. A statistical significance was found between the volume of LC CT and those of LC 2T1 or LC 5T1, respectively (both P<0.05). The conformal index (CI), degree of inclusion (DI), dice similarity coefficient (DSC) and the distance between the center of mass of the targets (COM) of LC CT-LC 10T1 were better than those of LC CT-LC T2, LC CT-LC 2T1 and LC CT-LC 5T1, however, there was no statistical difference among them (all P>0.05). Conclusions:It is feasible to delineate the LC based on prone delayed-enhancement MR simulation images in patients with low CVS after BCS. Meanwhile, the LCs derived from prone delayed-enhancement T 1WI of 10-minute are the most similar with those derived from prone CT simulation scans using titanium clips, regardless of the volumes and locations of LCs.
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Objective To investigate the independent association of the body mass index(BMI) with serum uric acid among shorter children and adolescent. Methods A cross-sectional study was conducted to collect general clinical data of 922 subjects with shorter statures. In each case, their information about height, weight, insulin-like growth factor-Ⅰ(IGF-Ⅰ), growth hormone peak, uric acid, and blood lipids were collected, and their BMI and BMI standard deviations score( SDS) were calculated. Smooth curve fitting and multiple piecewise linear regression were used to analyze the relationship between BMI SDS and uric acid. Results Univariate analysis found that serum uric acid was positively correlated with age, height standard deviation score, body weight standard deviation score, BMI SDS, IGF-Ⅰ standard deviation score, growth hormone peak, triglyceride, and creatinine ( P＜0. 05 ), while negatively correlated with high-density lipoprotein-cholesterol( P＜0.01). Female had significantly lower serum uric acid levels than male(P=0.003). The serum uric acid level was significantly increased after puberty(P＜0.01). After adjusting for potential confounders, the smooth curve fitting revealed a U-shaped relationship between BMI SDS and uric acid, with a BMI SDS inflection point of-0.7. In the population of BMI SDS＜-0.7, for every unit increase of BMI SDS, serum uric acid decreased by 11. 78 μmol/L( P=0. 030). In the population of BMI SDS≥-0. 7, uric acid increased by 11.79 μmol/L(P＜0.01) for every unit increase of BMI SDS. Conclusion Serum uric acid levels seem to be affected by BMI, and increased in population with thin or obesity. We should pay attention to the measurement of serum uric acid in both thin and obese children.
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AIM:To investigate the effect of interleukin-6 (IL-6) on epithelial-mesenchymal transition (EMT) , migration and invasion of papillary thyroid carcinoma TPC-1 cells by inducing the expression of long noncoding RNA lnc TCF7.METHODS:The effects of IL-6 on the expression of lnc TCF7 in the TPC-1 cells were detected by RT-q PCR after the TPC-1 cells were treated with IL-6 at 0, 5, 10, 20 and 50μg/L for 24 h or with IL-6 at 50μg/L for 0, 6, 12 and 24 h.After the TPC-1 cells were treated with IL-6 at 50μg/L for 24 h, the effect of IL-6 on the protein expression of E-cadherin and vimentin in the TPC-1 cells was detected by Western blot.The TPC-1 cell line with lnc TCF7 over-expression was established, and the effects of lnc TCF7 over-expression on EMT, migration and invasion of the TPC-1 cells were measured by Western blot and Transwell assay.After knockdown of lnc TCF7 expression and exposure to IL-6 at 50μg/L, the effects of lnc TCF7 on EMT, migration and invasion of TPC-1 cells treated with IL-6 were observed.RESULTS:The expression of lnc TCF7 in the TPC-1 cells was induced by IL-6 in a dose-and time-dependent manner.The expression of E-cadherin was down-regulated, the expression of vimentin was up-regulated, and the migration and invasion abilities of the TPC-1 cells were enhanced by lnc TCF7 over-expression (P<0.05).The expression of E-cadherin was decreased, the expression of vimentin, Snail and Slug was increased, and the migration and invasion abilities of the TPC-1 cells and intercellular space were enhanced by IL-6.The above changes induced by IL-6 were significantly inhibited by knockdown of lnc TCF7expression.CONCLUSION:IL-6 promotes the EMT, migration and invasion of papillary thyroid carcinoma TPC-1 cells by inducing the expression of lnc TCF7.
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Objective To explore the dosimetric variance in incidental irradiation to the internal mammary nodes among inverse intensity-modulated radiotherapy (I-IMRT), forward intensity-modulated radiotherapy (F-IMRT),and three-dimensional conformal radiotherapy (3DCRT) after breast-conserving surgery,and to provide a basis for deciding whether to spare the internal mammary nodes in clinical treatment. Methods A total of 84 patients undergoing breast-conserving surgery were enrolled as subjects. The internal mammary nodes in the first three intercostal spaces were contoured. Three radiotherapy plans were designed for each patient. The internal mammary nodes were not included in the planning target volume. Comparison was made among the three plans. The results were compared using Wilcoxon signed rank test. Results The I-IMRT, F-IMRT,and 3DCRT plans had similar median Dmeanvalues for the internal mammary nodes,which were 2 740.2,2973.9,and 2951.4 cGy,respectively. The analyses of the three individual intercostal spaces showed that there was no difference in Dmeanfor the first intercostal space or the second intercostal space between the three plans;For the third intercostal space,however,I-IMRT had a significantly higher Dmeanthan 3DCRT and F-IMRT. The analyses of the three individual plans showed that for each plan,the Dmeanwas the highest in the third intercostal space,followed by the second intercostal space and the first intercostal space. Conclusions All the three plans fail to attain an adequate prescribed dose to cure subclinical disease,and there is no significant difference among the three plans. Therefore,it is risky to exclude the internal mammary nodes using any one of the three radiotherapy techniques for patients with clinical indications for internal mammary nodes radiation. In the combination therapy including chemotherapy,endocrine therapy,and targeted therapy,however,further follow-up is needed to determine whether the incidental irradiation dose to the internal mammary nodes could meet clinical requirement.
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Objective: To comprehensively compare and evaluate the yield and quality of Chuanmingshen violaceum and provide a basis for breeding and high-yield cultivation. Methods: The principal component analysis of eight main agronomic characters and two quality characters from 25 cultivated populations of C. violaceum came from different origins in Sichuan Province were analyzed, and the comprehensive evaluation and cluster analysis were carried out. Results: The results showed that fresh and dry weight of stem and leaf, fresh and dry weight of root and polysaccharide content had greater coefficients of variation among species, while plant height, length, and diameter of taproot had smaller coefficients of variation. Principal component analysis showed that the 10 main traits might be represented by four principal components, and the cumulative contribution rate was 87.304%, and induced that high yield factor, quality factor, plant type factor, and plant height factor respectively. The comprehensive score of sample 1 was the highest, which was the low-height, high-yield, and good-quality material, and the comprehensive score of sample 13 was the lowest, which was the high-height and high-quality and low-yield material. The test materials could be divided into five types by cluster analysis, namely, long-term and high-yield and high-quality material, heavy-root and poor-quality material, low-yield and poor-quality material, high-height and low-yield and good-quality material, and dwarf and high-yield and good-quality material. Conclusion: The comprehensive evaluation method is reliable by the principal component analysis and cluster analysis. The resource of C. violaceum in Sichuan is rich. We can choose some high quality resources among them to provide the basis for the selection of new varieties of Sichuan Province.
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Objective The best combination of nitrogen, phosphorus and potassium and application amount of fertilizer were studied to provide technical support and theoretical basis for rational fertilization in the production of Chuanmingshen violaceum. Methods The effects of N, P and K application on yield and main effective components of C. violaceum were studied by L9(34) orthogonal experiment design. Results Reasonable N, P, and K application could significantly increase the yield of C. violaceum, and was beneficial to the accumulation of total polysaccharides and the content of imperatorin. Among them, the yield of 75.22 kg/hm2 under the combination of N2P1K2 was the highest, the increase rate was 60.67%, the total polysaccharide content was 25.46%, and the content of imperatorin was 0.489 mg/g. The yield of 44.82 kg/hm under the combination of N3P2K2 was the lowest, the total polysaccharide content was 2.40%, and the content of imperatorin was 0.379 mg/g. The effects sequence of N, P, and K fertilizers on the yield of C. violaceum were N > P > K. The nitrogen fertilizer had the most obvious effect on the yield of C. violaceum, followed by phosphate fertilizer, and potassium fertilizer had the worst effect. Conclusion Under the conditions of this experiment, the best combination of fertilization was N2P1K2 or N2P3K1. The optimum amount of fertilization of N, P2O5, and K2O were 1.08, 0.73, and 0.83 kg/hm2, respectively; or 1.08, 1.10, and 0.50 kg/hm2, respectively.
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Objective@#To investigate the influencing factors of the dose coverage of unplanned internal mammary lymph node (IMN) irradiation in patients receiving chemotherapy after mastectomy.@*Methods@#Clinical data of 138 patients receiving radiotherapy in the upper and lower lymph node drainage area of the thoracic wall and clavicle [three-dimensional conformal radiotherapy (3DCRT), field-in-field forward intensity-modulated radiotherapy (F-IMRT) or inverse IMRT (I-IMRT)] were retrospectively analyzed. The IMN was delineated according to the Radiation Therapy Oncology Group (RTOG) criteria. The unplanned irradiation dose of the IMN was obtained. The correlation between the IMN irradiation dose, clinical characteristics and specific parameters of radiotherapy during the unplanned irradiation was statistically analysed.@*Results@#The mean dose of unplanned IMN irradiation was 32.85 Gy (range: 2.76-50.93 Gy). In total, 7.3% of breast cancer patients obtained the therapeutic dose of≥ 45 Gy. Body weight, body mass index (BMI), body surface area (BSA) and thoracic transverse diameter (DT) were lower, whereas the planning target volume of IMN (VIMN) included in the chest wall PTV (IMNin) and the ratio of IMNin to VIMN were higher compared with those of their counterparts with insufficient therapeutic dose. Multivariate regression analysis demonstrated that body weight, thoracic anteroposterior diameter (DAP), DT, RIMNin and PTV volume were the influencing factors of the dose coverage of unplanned IMN irradiation (P=0.000, 0.000, 0.001, 0.000 and 0.034).@*Conclusions@#For patients receiving chemotherapy after mastectomy, the dose coverage significantly varies when the IMN is the unplanned target. Partial patients achieve the therapeutic dose. The dose coverage of unplanned IMN irradiation is influenced by physical characteristics, anatomical features and technical parameters of radiotherapy, which should be emphasized during the study design and result analysis.
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Objective@#To explore the differences and correlation between the target volumes based on deformation registration (DIR) using preoperative prone diagnostic magnetic resonance (MR) imaging and postoperative prone computed tomography (CT) simulation imaging for patients undergoing breast-conserving surgery (BCS).@*Methods@#Eighteen breast cancer patients suitable for external-beam partial breast irradiation (EB-PBI) after BCS were enrolled. Preoperative prone diagnostic MR and postoperative prone CT scan sets were acquired during free breathing for all patients. The gross tumor volume (GTV) delineated on the preoperative diagnostic MR images was defined as GTVMRI, the clinical target volumes (CTVMRI+ 1 and CTVMRI+ 2)were defined as 10 and 20 mm margins around the GTVMRI, and the planning target volume (PTVMRI+ 1 and PTVMRI+ 2) were defined as 15 and 25 mm margins around the GTVMRI, respectively. Tumor bed (TB) delineated on the postoperative prone CT simulation images acquired during free breathing was defined as GTVTB, CTV and PTV were defined as 10 and 15 mm margins around the GTVTB, respectively. The target volume of the whole breast contoured on the MR and CT images were defined as CTVBreast-MRI and CTVBreast-CI, respectively. The MR and CT images were registered deformably in MIM software system.@*Results@#The GTVTB, CTVTB and PTVTB were significantly greater than GTVMRI, GTVMRI+ 1 and PTVMRI+ 1, respectively (Z=-3.593, -3.593, -2.983, P<0.05). Meanwhile, the CTVTB and PTVTB were significantly less than the CTVMRI+ 2 and PTVMRI+ 2, respectively(Z=-2.722, -2.853, P<0.05). The conformal index (CI) and degree of inclusion (DI) of GTVTB-GTVMRI, GTVTB-CTVMRI+ 1, CTVTB-GTVMRI and CTVTB-GTVMRI+ 1 based on center-coincidence of the compared targets were better than those based on DIR of the thorax(Z=-3.724、-3.724、-2.591、-3.593, P<0.05; Z=-3.724、-3.724、-3.201、-3.724, P<0.05).@*Conclusions@#For the patients enrolled for prone EB-PBI, target volumes delineated on the preoperative prone MR images were significantly smaller compared to that on the postoperative prone CT images, but a statistically significant positive correlation was found between the MR and CT target volumes. There were still relatively poor spatial overlap whether for the whole breast or the targets between the preoperative prone diagnostic MR images and the postoperative prone simulation CT images based on DIR. Therefore, it is infeasible to guide postoperative EB-PBI target delineation using the preoperative prone diagnostic MR images.
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Objective@#To evaluated the unplanned coverage dose to the internal mammary chain (IMC) in patient treated with postmastectomy radiotherapy (PMRT).@*Methods@#One hundred and thirty eight patients with breast cancer receiving radiotherapy (RT) in our hospital were retrospectively analyzed. Patients were divided into three groups: three-dimensional conformal radiotherapy (3D-CRT) group, forward intensity-modulated radiotherapy (F-IMRT) group and inverse IMRT (I-IMRT) group. The IMC were contoured according to Radiation Therapy Oncology Group (RTOG) consensus, and were not include into the planning target volume (PTV). The incidental irradiation dose to IMC among the three groups and the first three intercostal spaces IMC (ICS-IMC 1-3) were all compared, and explored the relationship between the mean doses (Dmean) of IMC and the OARs (ipsilateral lung and heart).@*Results@#The dose delivered to IMC showed no difference in CRT, F-IMRT and I-IMRT(33.80 Gy, 29.65 Gy and 32.95 Gy). And 10.42%, 2.04%, and 9.76% patients achieved ≥45 Gy when treated with CRT, F-IMRT and I-IMRT. For the IMC dose in the first three intercostal spaces (ICS1-3), there was no difference to the three treatment plannings. The Dmean, V20, V30, V40 and V50 of the ICS-IMC2 and ICS-IMC3 were all obviously superior than ICS-IMC1 for all these three plannings. Moderate positive correlation was founded between Dmean for IMC and Dmean for heart for left breast cancer patients underwent CRT (r=0.338, P=0.01). Whereas for F-IMRT and I-IMRT groups, positive correlation were founded between Dmean for IMC and Dmean and V20 for ipsilateral lung for all patients (F-IMRT: r=0.366, P=0.010; r=0.318, P=0.026; I-IMRT: r=0.427, P=0.005; r=0.411, P=0.008).@*Conclusions@#In 3D-CRT, F-IMRT and I-IMRT planning methods, partial patients get IMC irradiated doses that could achieve therapeutic doses. Compared with 3D-CRT, F-IMRT and I-IMRT further reduced the dose of irradiated organs. However, there is no difference in the dose coverage of IMC for the three planned approaches when the IMC made an unplanned target.
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Objective To detect the changes of heart volume during concurrent chemoradiotherapy for esophageal cancer based on repeated enhanced 4DCT.Methods Patients with squamous cell esophageal cancer underwent repeated enhanced 4DCT and 3DCT scans before and after 10,20 and 30 fractions of radiotherapy,respectively.The heart was contoured on 3DCT,end expiratory (EE) and maximum intensity projection (MIP) of 4DCTimages.The changes in theheart volume,blood pressure.and heart rate were statistically compared at different time points.Results A total of forty-six patients completed 4 fractions of 3DCT and enhanced 4DCT scans.Compared with the initial values,the heart volume was significantly decreased by 3.27％,4.45％ and 4.52％ after 10 fractions of radiotherapy,and reduced by 6.05％,5.64％ and 4.51％ following 20 fractions of radiotherapy on 3DCT,EE and MIP,respectively (P=0.000-0.027).The heart volume after 30 fractions of radiotherapy did not significantly differ from the initial volume (P＞ 0.05).After radiotherapy,there was a significant decrease inboth systolic and diastolic blood pressure (P =0.000 and P =0.009) and a significant ‖ increase in the heart rate (P=0.0 0 1) compared with those measured before radiotherapy.Conclusions Enhanced 4DCT scan can clearly reflect the changes of heart volume throughout concurrent chemoradiotherapy.The heart volume starts to shrink during the early stage of radiotherapy and continue to decrease until the middleand late-stage,whereas it restores to the initial volume after radiotherapy.Simultaneously,blood pressure declines and heart rate is accelerated during radiotherapy.
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Objective To investigate the difference of target volumes and dosimetric parameters between supine and prone positions for external-beam partial breast irradiation (EB-PBI) after breastconserving surgery (BCS).Methods Thirty breast cancer patients with T1N0M0 stage who underwent three-dimensional conformal radiation therapy (3D-CRT) EB-PBI after BCS were enrolled from July 2016 to April 2017.Supine and prone scan sets were acquired during free breathing for all patients.Target volumes and organs at risk (OARs) including heart,ipsilateral lung and bilateral breast were contoured by the same radiation oncologist.The tumor bed (TB) was determined based on surgical clips.The clinical target volume (CTV) consisted of the TB plus 1.0 cm margin and the planning target volume (PTV) was CTV plus 0.5 cm.Dosimetric parameters for target volumes and OARs were compared between supine and prone positions.Results The median volumes of the TB,the CTV and the PTV in supine were 14.40 cm3,57.35 cm3,108.85 cm3 and 14.10 cm3,62.60 cm3,113.70 cm3 for prone positions,respectively.The CTV and PTV in prone position were significantly greater than those in supine position,respectively (Z=-3.01,-2.87,P ＜0.05),but the TBs were not statistically different (P ＞0.05).The median homogeneity indexs (HI) in supine position was less than those in prone position (Z =-3.137,P ＜0.05),while the mean conformal indexs (CI) was increased with prone positioning (t =9.034,P ＜ 0.05).The mean dose (D) to the heart in the supine position was significantly lower than that in prone (0.34 and 1.19 Gy,Z =-4.12,P ＜0.05).The D to the ipsilateral lung in the prone position was significantly lower than that in supine (1.59 and 1.72 Gy,Z =-2.18,P ＜ 0.05).There was not significantly statistical difference for the D to the ipsilateral breast between two positionings (10.01 and 10.40 Gy,P ＞0.05).Conclusions It was feasible to carry out 3D-CRT EB-PBI in prone position in free breathing for Chinese breast cancer patient,with primary advantages of better CI and the significantly lower radiation dose to the ipsilateral lung.
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A new method for detection of Escherichia coli exist in licorice decoction was developed by using DNA-based electrochemical biosensor. The thiolated capture probe was immobilized on a gold electrode at first. Then the aptamer for Escherichia coli was combined with the capture probe by hybridization. Due to the stronger interaction between the aptamer and the E. coli, the aptamer can dissociate from the capture probe in the presence of E. coli in licorice decoction. The biotinylated detection probe was hybridized with the single-strand capture probe. As a result, the electrochemical response to Escherichia coli can be measured by using differential pulse voltammetric in the presence of α-naphthyl phosphate. The plot of peak current vs. the logarithm of concentration in the range from 2.7×10² to 2.7×10⁸ CFU·mL⁻¹ displayed a linear relationship with a detection limit of 50 CFU·mL⁻¹. The relative standard deviation of 3 successive scans was 2.5%，2.1%，4.6% for 2×10²，2×10⁴，2×106：⁶ CFU·mL⁻¹ E. coli, respectively. The proposed procedure showed better specificity to E. coli in comparison to Pseudomonas aeruginosa, Staphylococcus aureus and Bacillus subtilis. In the detection of the real extractum glycyrrhizae, the results between the proposed strategy and the GB assay showed high degree of agreement, demonstrating the designed biosensor could be utilized as a powerful tool for microbial examination for traditional Chinese medicine.
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Objective To compare the geometric differences of gross tumor volumes(GTV)and displacements of selected clips propagated by rigid image registration(RIR)and deformable image registration (DIR)at end-inhale phase(CT0)and end-exhale phase(CT50)based on four-dimensional computed tomography(4DCT)of the whole breast after breast-conserving surgery(BCS). Methods Forty-four patients who underwent 4DCT simulation scans after BCS were selected. The GTV and displacements of selected metal clips at CT0and CT50were manually delineated by the same radiotherapy physician. Subsequently,the GTV and displacements of selected clips from CT0images were transformed and propagated to CT50images using RIR and DIR.The geometric differences of GTV and displacements of surgical clips from DIR were compared with those from RIR based on the dice similarity coefficient(DSC)and the displacements of the center of mass(COM)in the three-dimensional(3D)directions. Results The mean DSC was 0.86± 0.04 for RIR and 0.87± 0.04 for DIR(P=0.000).The displacements of COM in 3D directions from RIR were significantly greater than those from DIR(1.22 mm vs. 1.10 mm,P=0.000).In the anterior-posterior direction,the displacements from RIR were significantly greater than those from DIR for both GTV and selected clips(P=0.000).However,in the left-right and superior-inferior directions,there were no significant differences in displacements between RIR and DIR for both GTV and the selected clips(all P>0.05). Conclusions DIR can improve the overlap for GTV registration from 4DCT scans at CT0and CT50.Furthermore,DIR is superior to RIR in reflecting GTV and the displacements of selected clips in anterior-posterior direction induced by respiratory movement.