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Objective@#To retrospectively analyze the efficacy and prognostic factors of postoperative intensity modulated radiotherapy for grade Ⅱ gliomas.@*Methods@#Retrospective analysis was conducted on patients with postoperative grade Ⅱ glioma in our hospital from Jan. 2010 to Dec. 2018. The primary endpoint was progression-free survival, and the secondary endpoint was overall survival. Correlative analyses of prognosis by age, gender, initial resection status, the maximum diameter of the lesions, bi-hemisphere, astrocytoma, chemoradiation, adjuvant chemotherapy were conducted.@*Results@#A total of 109 cases with grade Ⅱ glioma were enrolled. The follow-up rate was 91.75%, including 10 cases dead and 27 relapsed. There were 24 cases (88.9%) of in-field failure, and 3 cases (11.1%) of out-field failure. 14 cases of recurrence occurred in 81 cases of total resection group, accounting for 17.3%, and 13 in 28 cases of subtotal resection group, accounting for 46.4%. The recurrence rate in the subtotal resection group was significantly higher than that in the total resection group (χ 2=9.484, P<0.05). The 1-, 2-, 3-, 4- and 5-year progression-free survival rates were 92.5%, 86.0%, 80.6%, 77.5% and 66.8%, respectively. The 2-, 3-, 4- and 5-year overall survival rates were 97.2%, 90.8%, 87.7% and 84.5%, respectively. Multivariate analysis showed that patients with subtotal resection(HR=3.608, P<0.05) and bi-hemisphere(HR=3.183, P<0.05)were significantly correlated with the progression free survival.@*Conclusions@#Postoperative intensity modulated radiotherapy for grade Ⅱ gliomas can achieve a better PFS. Recurrence in the radiation field is the main failure mode. Initial resection status and bi-hemisphere of tumor are important influential factors for PFS of grade Ⅱ gliomas patients.
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Objective To retrospectively analyze the efficacy and prognostic factors of postoperative intensity modulated radiotherapy for grade Ⅱ gliomas.Methods Retrospective analysis was conducted on patients with postoperative grade Ⅱ glioma in our hospital from Jan.2010 to Dec.2018.The primary endpoint was progression-free survival,and the secondary endpoint was overall survival.Correlative analyses of prognosis by age,gender,initial resection status,the maximum diameter of the lesions,bihemisphere,astrocytoma,chemoradiation,adjuvant chemotherapy were conducted.Results A total of 109 cases with grade Ⅱ glioma were enrolled.The follow-up rate was 91.75％,including 10 cases dead and 27 relapsed.There were 24 cases (88.9％) of in-field failure,and 3 cases (11.1％) of out-field failure.14 cases of recurrence occurred in 81 cases of total resection group,accounting for 17.3％,and 13 in 28 cases of subtotal resection group,accounting for 46.4％.The recurrence rate in the subtotal resection group was significantly higher than that in the total resection group (x2 =9.484,P＜0.05).The 1-,2-,3-,4-and 5-year progression-free survival rates were 92.5％,86.0％,80.6％,77.5％ and 66.8％,respectively.The 2-,3-,4-and 5-year overall survival rates were 97.2％,90.8％,87.7％ and 84.5％,respectively.Multivariate analysis showed that patients with subtotal resection (HR =3.608,P＜ 0.05)and bi-hemisphere (HR =3.183,P＜ 0.05) were significantly correlated with the progression free survival.Conclusions Postoperative intensity modulated radiotherapy for grade Ⅱ gliomas can achieve a better PFS.Recurrence in the radiation field is the main failure mode.Initial resection status and bihemisphere of tumor are important influential factors for PFS of grade Ⅱ gliomas patients.
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Objective@#To evaluate the effect of tumor shape and location on pulmonary dose-volume parameters by intensity-modulated radiation therapy (IMRT) in patients with non-small cell lung cancer (NSCLC), aiming to provide a reference basis for establishing limits of the pulmonary dose-volume parameters during IMRT.@*Methods@#Clinical data of 208 NSCLC patients undergoing radical IMRT from June 2009 to June 2016 were retrospectively analyzed. According to the tumor shape and location, 208 cases were divided into the vertical bar group (n=127) and the horizontal bar group (n=81), the superior lung group (n=103) and the inferior lung group (n=105). Regression model curve was used to evaluate the effect of tumor shape and location upon the common pulmonary dose-volume parameters(V5, V20, MLD, AVS5 and AVS20).@*Results@#In all groups, the fitting curves of V5, V20 and MLD were manifested in the quadratic equation pattern, and AVS5 and AVS20 in the logarithmic equation manner. In the vertical bar group, the V5(P=0.015), V20(P=0.047) and MLD (P=0.012) were significantly higher, whereas the AVS5(P=0.044) was significantly lower compared with those in the horizontal bar group. No statistical significance was observed in AVS20 between two groups (P=0.490). The tumor location exerted significant effect upon V5 alone (P=0.009).@*Conclusions@#When the tumors presents in the vertical bar shape, the limits of the common lung dose-volume parameters are likely to exceed those of tumors in the vertical bar shape. Lung tumors located in the inferior lobe exerts a more significant effect upon the low-dose region volume compared with the tumors in the superior lobe.
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Objective:To explore the effectof tumor volume on pulmonary dose-volume parameters by intensity-modulated radiation therapy (IMRT) in non-small cell lung cancer (NSCLC),and to provide a basis for pulmonary dose parameters in IMRT treatment.Methods:A total of 204 patients with NSCLC received IMRT were retrospectively analyzed from June,2009 to October,2013.The prescribed dose of planning target volume (PTV) for primary tumor was 60-66Gy (2.00-2.25 Gy,27-33 times in all).The fractional volume percent of the lung received a dose ＞5 or 20 Gy (V5,V20),and absolute volume of lung received a dose ＜5 Gy (AVS5).The mean lung dose (MLD) in normal tissues were analyzed.Regression model curve was used to analyze them along with the change of primary tumor volume.Results:With the increase in lung tumor volume,the V5,V20 and MLD presented quadratic equation curve,and AVS5 presented logarithmic equation.When the tumor volume,less than a certain value (294.6,283.2,304.9 cm3,respectively),the V5,V20 and MLD increased with tumor size and presented an increased quadratic curve;when the tumor volume was higher than a certain value (294.6,283.2,304.9 cm3 respectively),the V5,V20 and MLD was declined.The AVS5 was declined in a logarithmic curve along with the increase of tumor volume.Conclusion:With the increase in lung tumor volume,the change in rule ofV5,V20,MLD and AVS5 is not completely equivalent.When the tumor volume exceeds a certain boundary value (about 300 cubic centimeter),the corresponding tumor diameter is about 7-8 cm.In addition to the focus on pulmonary V5,V20 and MLD,we should also pay more attention to AVS5 restrictions in establishment ofIMRT in NSCLC.
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Objective@#To calculate out the Hausdorff distance based on the scripting in RayStation treatment planning system, which was then applied in measuring the deformation error of brain stem during image automatic registration between CT and MR.@*Methods@#Scripting was edited in RayStation system (version 4.7) by using IronPython. The set of point coordinates on the contour of any two region of interest (ROI) had been found firstly, then the Hausdorff distance between the two point sets was calculated out. A graphical user interface (GUI) was designed by using XAML to acquire the visualized output of Hausdorff distance. GUI appeared when the script was run, where two ROIs was selected, then the corresponding Hausdorff distance and the running time were displayed by pressing the "Calculate" button.@*Results@#The mean Hausdorff distance of brain stem in 20 patients with head and neck neoplasms was 1.20 cm while the mean elapsed time was 11.01s.@*Conclusions@#Hausdorff distance of any two ROIs can be calculated out by using the developed method. GUI is designed to realize the visual interaction with RayStation system. Therefore, the RayStation system satisfies the demands of Hausdorff distance calculation in both clinical and research work.
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Objective To analyze the efficacy and prognostic factors of postoperative radiotherapy for high grade gliomas based on MRI guided target delineation. Methods Retrospective analysis was conducted on 111 patients with high-grade gliomas from October 2010 to December 2015. The patients were treated with IMRT in combination with temozolomide guided by MRI-CT fusion technique after target delineation at preoperation, postoperation ( < 72 h ) and before radiotherapy. The survival rate was calculated by K-M method. The analyses of single factor and multiple factor, ranging from the patients′age, gender, pathological grade, number of lesions, multiple lobes, tumour crossing the midline,epilepsy, the maximum diameter of the lesions, adjuvant chemotherapy and other factors on prognosis were conducted with Log-Rank test and COX regression analysis. Results A total of 111 patients met the criteria for admission, and the overall follow-up rate was 94. 6%. The survival rates of 1-, 2-, 3-, 4-, 5- year were 81. 6%, 54. 2%, 39. 1%, 25. 4%, 15. 5%, respectively. The median survival time was 38 months. The single factor analysis showed that pathological grading (χ2 =5. 549, P<0. 05), age (χ2 =6. 393, P<0. 05), preoperative tumor maximum diameter (χ2 =4. 555, P<0. 05) and adjuvant chemotherapy (χ2 =4. 965, P <0. 05 ) were correlated with on the survival rate, while multivariate analysis showed that pathological grade Ⅲ, younger age, preoperative tumor with size smaller contributed to the good prognosis (Wald=4. 784, 4. 560, 5. 859, P<0. 05). Conclusions High grade gliomas after operation by MRI-CT fusion technique in preoperative and postoperative 72 h and MRI before radiotherapy guided by radiotherapy, for intensity-modulated radiotherapy combined with temozolomide chemotherapy, can obtain better efficacy. The grade Ⅲ of glioma, <50 years old, the maximum diameter of the tumor <6 cm, the adjuvant chemotherapy may have the better prognosis.
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Objective To analyze the efficacy and prognostic factors of postoperative radiotherapy for high grade gliomas based on MRI guided target delineation. Methods Retrospective analysis was conducted on 111 patients with high-grade gliomas from October 2010 to December 2015. The patients were treated with IMRT in combination with temozolomide guided by MRI-CT fusion technique after target delineation at preoperation, postoperation ( < 72 h ) and before radiotherapy. The survival rate was calculated by K-M method. The analyses of single factor and multiple factor, ranging from the patients′age, gender, pathological grade, number of lesions, multiple lobes, tumour crossing the midline,epilepsy, the maximum diameter of the lesions, adjuvant chemotherapy and other factors on prognosis were conducted with Log-Rank test and COX regression analysis. Results A total of 111 patients met the criteria for admission, and the overall follow-up rate was 94. 6%. The survival rates of 1-, 2-, 3-, 4-, 5- year were 81. 6%, 54. 2%, 39. 1%, 25. 4%, 15. 5%, respectively. The median survival time was 38 months. The single factor analysis showed that pathological grading (χ2 =5. 549, P<0. 05), age (χ2 =6. 393, P<0. 05), preoperative tumor maximum diameter (χ2 =4. 555, P<0. 05) and adjuvant chemotherapy (χ2 =4. 965, P <0. 05 ) were correlated with on the survival rate, while multivariate analysis showed that pathological grade Ⅲ, younger age, preoperative tumor with size smaller contributed to the good prognosis (Wald=4. 784, 4. 560, 5. 859, P<0. 05). Conclusions High grade gliomas after operation by MRI-CT fusion technique in preoperative and postoperative 72 h and MRI before radiotherapy guided by radiotherapy, for intensity-modulated radiotherapy combined with temozolomide chemotherapy, can obtain better efficacy. The grade Ⅲ of glioma, <50 years old, the maximum diameter of the tumor <6 cm, the adjuvant chemotherapy may have the better prognosis.
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Objective To compare the survival conditions of patients with insulinoma after enucleation of insulinoma or partial resection of pancreas.Methods The clinical data of 99 patients with insulinoma,treated with surgery from May.2003 to Aug.2015 were retrospectively analyzed.Of the 99 patients,38 received enucleation of insulinoma alone and 61 received partial resection of pancreas.The overall data were analyzed by SPSS 21.0 software.Results Average survival of patients after enucleation of insulinoma (103.3 months) was longer than that of patients after partial resection of pancreas (77.5 months),and the difference had statistical significance (P=0.006).The difference of the incidence of most chronic or temporary complications had no statistical significance between the two groups (P＞0.05),except for new-onset diabetes (P=0.004).Conclusion Enucleation of insulinoma should be firstly recommended for patients with insulinoma in suitable size,which can provide patients with better survival condition.
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Objective:To explore the regular variation pattern of tumor volumes of the patients with non-small cell lung cancer (NSCLC) before and after targeting treatment of epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI),and to clarify its clinical value.Methods:The materials of 39 NSCLC patients with EGFR-TKI targeting treatment were retrospectively analyzed. The tumor volumes were detected by volume measurement software of TPS and Image J image processing software,then the absolute and relative tumor volume changes of the NSCLC patients before and after targeting treatment were analyzed by paired sample comparison symbol Wilcoxon rank test. Results:The absolute tumor volumes (mm3 )of the patients with NSCLC before and 1 month after targeting treatment were 14 822.11 (7 524.73,54 999.41)and 7 954.42 (3 499.73,29 396.83),respectively, and there was statistically significant difference (Z=-3.257,P=0.001);the absolute tumor volumes of the patients with NSCLC 1 and 2 months after targeting treatment were 8 358.47 (4 394.36,24 430.05)and 7 028.76 (3 634.98,21 056.71),respectively,and there also was statisticaliy significant difference (Z=-2.213,P=0.027).When the original tumor volume before targeting treatment was regarded as 1,the relative tumor volume of 1 month after targeting theatment was 0.612 6 (0.313 8,0.853 7),and there was significant difference (Z=-3.855,P0.05);the changes of tumor relative volume presented platform stage after 3 months.The tumor relative volumes of 7-9 months after EGFR-TKI treatment reached the bottom.Conclusion:The average primary tumor volume of the NSCLC patients is obviously reduced 1 and 2 months after TKI targeting treatment. It may be optimal to carry out radiotherapy in 3-9 months after EGFR-TKI targeting treatment.
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Objective To compare the clinical effectiveness among disposable circumcisionsuture device and Shang Ring in treating redundant prepuce and phimosis.Methods The clinical data of 224 cases of circumcisions done by disposable circumcision suture device(n =112)and Shang Ring(n =112)were retrospective1y analyzed. Operation time,intra -operational bleeding and postoperative complications among two techniques were compared. Results Disposable circumcision suture operation and Shang ring circumcision without significant difference in the operation time and intra -operational bleeding.There result was (6.1 ±0.8)min vs (6.5 ±1.7)min and (2.0 ±0.0)mL vs (1.8 ±0.0)mL(P >0.05).The incidence of postoperative complications with incision pain rate was 21.43% vs 50.89%,infection rate was 14.29% vs 6.25%,frenum area incision edema rate was 8.04% vs 25.89%,and the postoperative hematoma and healing time was (8.0 ±1.7)d vs (14.0 ±1.2)d,the differences were statistically significant(P <0.05).Conclusion Each of two techniques has its own advantages and disadvantages.The treatment decision making should be a detailed description to the patients,we propose that school -age children should choose Shang Ring built -in method and the others should use disposable circumcision suture device depending on the situation.
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Objective To evaluate extended vs standard left lateral lobectomy for left lateral lobe hepatolithiasis.Methods A retrospective study was conducted on the clinical data of 110 patients who underwent hepatectomy for hepatolithiasis limited to left lateral lobe of the liver.Results 42 patients received left lateral lobectomy, 68 patients did left hemihepatectomy.There were no marked difference between the two groups in the operation time, introperation or postoperation blood loss, bile leak and bleeding on the hepatic cut surface, liver function and the postoperative hospital stay.The incidence of residual and recurrent stones was 14.3％ and 11.9％ in left lateral lobectimy group and 0％, 0％ in left hemihepatectomy group.Conclusion Left hemihepatectomy for left lateral lobe hepatolithiasis is a safe and effective procedure.
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Objective To evaluate the efficacy and safety of acarbose tablets combined with protamine zinc recombinant lai pulp mixing insulin injection in the treatment of elderly patients with type 2 diabetes.Methods 170 elderly patients with type 2 diabetes were randomly divided into the observation group and the control group.85 cases in the observation group were given acarbose tablets combined with protamine zinc recombinant lai pulp mixing insulin injection,85 cases in the control group received aspart 30.The patients were followed up for 12 weeks,the blood glu cose levels,blood glucose fluctuation,glycosylated hemoglobin (HbAlc),the incidence of hypoglycemia and insulin dosage were observed.Results' The level of fasting plasma glucose (FPG) (t =9.92,P ＜ 0.05),2h postprandial blood glucose(2hPG) (t =18.18,P ＜0.05),the mean blood glucose within 4h(t =13.62,P ＜0.05),days of average blood glucose fluctuations (t =14.56,P ＜ 0.05) of observation group dropped significantly compared with that before treatment;HbAlc achieved rate(6.5％)of the observation group and control group were 35.29％,28.23％,re spectively,HbAlc achieved rate (7.0％) of observation group and control group were 57.64％,52.94％,the differences were not statistically significant(all P ＞ 0.05).The dose of insulin was significantly lower in the observation group(20.11 ±3.36) u/d than(35.78 ±4.68) u/d in the control group(t =25.08,P ＜0.01).There were 2 cases of hypoglycemic events and 3 cases in the control group.Conclusion Protamine zinc recombinant insulin lispro injection combined with acarbose has reliable clinical efficacy and safety.
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ObjectiveTo evaluate the association between Cyclin D1 G870A polymmphism and risk of colorectal cancer.MethodsExtensive searches of relevant studies on datebase like PubMed,EMCC and CNKI were performed.Case control studies involving unrelated subjects and genotype frequencies in control group consistent with Hardy-Weinberg equilibrium were included for the meta-analysis.Twenty-three case-control studies with 6 344 cases and 9 018 controls were analyzed by the fixed-effect or random-effect meta-analysis method.The metaanalysis was applied with RevMan 5.0 software for heterogeneity test.AA and GA were compared with those with GG genotype.Pooled OR value and 95％ confidence interval (CI) were calculated.ResultsThere were statistical differences between AA & GA and GG.The pooled OR value was 1.10 (95％CI:1.01-1.19,P =0.02).The values were analyzed hierarchically according to different populations.The pooled OR value of Asian was 1.11 (95％ CI:0.98-1.26,P=0.11).The pooled OR value of American was 1.13(95％CI:0.97-1.32,P=0.12).The pooled OR value of European was 1.06(95％CI:0.89-1.25,P =0.52).The pooled OR value of Oceanian was 1.05(95％ CI:0.80-1.38,P=0.73).The values were analyzed hierarchically according to the comparison basis.The pooled OR value of hospital-based was 1.07 (95％ CI:0.95-1.20,P =0.28).The pooled OR value of population-based was 1.13 (95％CI:1.01-1.26,P=0.04).ConclusionThe Cyclin D1 G870A polymorphism is correlated with the susceptibility of colorectal cancer risk at the aggregate level analysis.Analysis by different methods:according to different populations,every group don't support the correlation.According to comparison basis,there has no correlation in hospital-based group,but there has correlation in population-based group.
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Objective To explore the application value of neoadjuvant chemotherapy (NACT) in treating cervical carcinoma. Methods Seventy-one cervical carcinoma patients who were divided into three groups:PF group (cisplatin and fluorouracil,23 cases) or CBP group (carboplatin,bleomycetin and cyclophosphamide, 24 cases) or TP group (paclitaxel and cisplatin, 24 cases); operation was made 14 - 21 days afterwards. The therapeutic effect, chemotherapy side-effect and the effect on operation and pathology for these three groups were analyzed and compared. Results The effective rate was 93.8%(30/32),88.6% (31/35),82.4%(28/34) in TP group,CBP group,PF group,respectively. However, the therapeutic effect had no statistics significance with age, preoperative tumor grade, pathologic type for all the three groups, the therapeutic effect had statistical significance with clinical stage. The rate which pathological examination showed no residual cancer was biggest in CBP group [CBP group was 28.6%(6/21), TP group was 4.3% (1/23), PF group was 11.8%(2/17), P < 0.05 ]. Conclusions Three NACT projects are safe and effective treatment for cervical cancer. However,each project has advantages. The NACT projects can be elected for different patient according to his illness and economy.
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Objective To study the setup errors in three-dimensional conformal radiotherapy (3DCRT) for thoracic esophageal carcinoma using electronic portal imaging device(EPID) and calculate the margins from CTV to PTV. Methods Forty-one patients with thoracic esophageal carcinoma who received 3DCRT were continuously enrolled into this study. The anterior and lateral electronic portal images (EPI) were aquired by EPID once a week. The setup errors were obtained through comparing the difference between EPI and digitally reconstructed radiographs(DRR). Then the setup margins from CTV to PTV were calculat-ed. By using self paired design,22 patients received definitive radiotherapy with different margins. Group A: the margins were 10 mm in all the three axes;Group B: the margins were aquired in this study. The differ-ence were compared by Paired t-test or Wilcoxon signed-rank test. Results The margins from CTV to PTV in x,y and z axes were 8.72 mm, 10.50 mm and 5.62 mm, respectively. Between the group A and group B, the difference of the maximum dose of the spinal cord was significant(4638.7 cGy±1449.6 cGy vs. 4310.2 cGy±1528.7 cGy; t=5.48, P=0.000), and the difference of NTCP for the spinal cord was also significant (4.82%±5.99% vs. 3.64%±4.70%;Z=-2.70,P=0.007). Conclusions For patients with tho-racic esophageal carcinoma who receive 3DCRT in author's department,the margins from CTV to PTV in x, y and z axes were 8.72 mm, 10.50 mm and 5.62 mm, respectively. The spinal cord could be better protected by using these setup margins than using 10 mm in each axis.
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The authors compared the purpose,and the main content of three international standards in medical education developed by the Institute for International Medical Education (IIME), World Health Organization Western Pacific Regional Office (WHO/WPRO), and World Federation for Medical Education (WFME) respectively. The IIME's standard is deferent from the others. The IIME's standard contains seven broad educational outcome domains and 60 items in the domains. The purpose of IIME's standard is to improve the common core competency of individual medical graduates of each medical school in the world, and the standard focuses the outcome of medical education and belongs to summative individual evaluation. The WHO/WPRO's and WFME's standards are quite similar. They define the standards across nine broad areas of medical schooling divided into 38 sub-areas. The ultimate goal of the WHO/WPRO's standard is to encourage national governments to adopt a quality assurance process in medical education. The aim of the two standards is to promote the quality assurance of medical schools. Both of the two standards focus the whole process of medical schooling and medical schools, and belong to formative evaluation.
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The article gives a brief account of the application of clinical observation to the evaluation of medical students' core competence. It expounds the key points in the assessment about their professional values,attitudes and behavior, emphasizing the application scope, working principle and advantages and disadvantages in the rank evaluation as well as the methods to enhance the effectiveness of evaluation.
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Objective To define the correlation between mutation of DNA-LigaseⅣ gene and radiosensitivity.Methods Nasopharyngeal squamous carcinoma cell line (CNE), lung adenocarcinoma cell line (SPC-A1) and breast adenocarcinoma cell line(MCF-7) after irradiation were assessed with specific biological parameters. Polymerase chain reaction, cloning and sequencing techniques were used to determine the sequence of DNA-LigaseⅣ gene in these three cell lines. Then the impact of homologous change and mutation on hydrophicity-hydrophobicity of genic products was analyzed.Results The surviving fractions derived from irradiation were different with more radiosensitivity in the CNE cell line than in the others. In three cell lines, the homology of LigaseⅣ gene were: 99.95%,99.99%,99.98%, respectively. Some mutations including transversion and transition were detected and led to alterations in the hydrophicity-hydrophobicity function of products. Higher radiosensitivity of CNE was associated with amino-acid substitutions: 313aa His→Arg,538aa Gly→Arg,579aa Lys→Arg and 585aa Asn→Ser.Conclusion These results suggest that LigaseⅣp play an important role in the ligation of DNA double strand breaks and certain mutations bring about changes in radiosensitivity.