Progress in clinical trials of boron neutron capture therapy of head and neck cancers / 中华放射医学与防护杂志

Boron neutron capture therapy(BNCT)is an advanced radiotherapy combined with targeted therapy and heavy ion therapy. BNCT is based on the nuclear reaction 10B (n, α) 7Li that occurs when boron-10 isotopes is irradiated with neutrons of the appropriate energy to produce high-energy recoiling 7Li nuclei and α particles. The released high linear energy transfer (LET) particles have path lengths of approximately one cell diameter (5-9 μm) and deposit most of their energy within the boron-containing tumor cells. BNCT has the advantages of precise tumor targeting, less damage to normal tissue and fewer irradiation fractionations (1-3 fractionations) than conventional radiotherapy (30 fractionation). The neutrons used in BNCT are produced by reactors or accelerators. The boron drugs used in clinical trials include BPA and BSH. In this paper, we review the clinical trial status and the significant progress of BNCT for head and neck tumors. The clinical data have approved the effectiveness of BNCT in the treatment of head and neck cancer. With the technical improvement of accelerator neutron source and the development of new boron drugs, BNCT will play a more important role in the field of clinical radiotherapy in the future.

Application of autosegmentation software in esophageal cancer / 中华放射医学与防护杂志

Objective To evaluate the geometric and dosimetric accuracy of autosegmentation software for contouring the organ-at-risk ( OAR) of esophageal cancer, and discuss its clinical feasibility. Methods A total of 10 patients were enrolled, and single and multi-template were adopted respectively to auto-delineate corresponding OARs on target CT images based on image registration. The geometric consistency including volume difference (ΔV) , dice similarity ( DSC) and position difference (Δx, Δy,Δz) between the two autosegmentation method and manual were compared using Wilcoxon signed-rank test. And the correlation between DSC and OAR volume was analyzed. In addition, to evaluate the clinical feasibility of autosegmentation, the dose distributions of all OARs were compared using Friedman test. Results The average DSC of all OARs obtained by single and multi-template were 0.82 ± 0.17 and 0.92 ± 0.54, respectively, with statistically significant difference (Z= -2.803- -2.497, P<0.05). A positive correlation between DSC of the autosegmentation and OAR volume was found by spearman analysis, and the single-template was not good enough for the spinal cord with smaller volume. The positional deviations of multi-template group were less than 0.5 cm in three directions, which were better than single-template group. The main dosimetric indexes of single-template and multiple-template were similar to manual coutours. V20 of whole lung were 23.2％, 22.4％ and 22.1％, Dmeanof whole lung were (11.3 ±4.0), (11.1 ±4.5) and (11.0 ±4.3) Gy, Dmaxof spinal cord were (40.3 ±4.8), (38.2 ±6.7) and (39.4 ± 5.3) Gy, respectively, and V30 of heart were 16.0％, 15.8％ and 15.5％, respectively. There was no statistical difference between the three methods (P>0.05), and all of the dosimetric indexes were in line with the requirements of clinical dose limits. Conclusions The autosegmentation software can achieve satisfactory precision for the OARs of the esophageal cancer patients, and the multi-template method is better than the single-template, which is more suitable for clinical application.

Comparison of three surgical modalities in treatment of lumbar spinal stenosis / 中华全科医师杂志

Objective To evaluate the clinical outcomes of lumbar spinal stenosis treated with three different surgical modalities.Methods One hundred and forty patients were treated with posterior lumbar interbody fusion (PLIF,n =50),transforaminal lumbar interbody fusion (TLIF,n =40) or modified method (n =50).The operation time and intraoperative blood loss were compared.The outcones were evaluated with Japanese Orthopedic Association (JOA) score and visual analogue scale (VAS),and the radiographic findings were also reviewed.Results The operation time was shorter and the intraoperative blood loss was less in modified group than those in other two groups (F =10.02,P ＜0.05).The excellent and good rate was 90％ (45/50) in PLIF group,92％ (37/40) in TLIF group and 90％ (45/50) in modified group.No complication happened in both TLIF group and modified group.Two patients had cerebrospinal fluid leakage in PLIF group.The JOA scores and VAS scores were significantly improved 3 and 6 months after surgery in three groups (F =10.66,9.68,11.03,all P ＜ 0.05).There were no significant differences in JOA scores and VAS scores among three groups before operation (P ＞ 0.05),also in JOA scores after operation among three groups.The VAS scores in TLIF group and modified group 3 and 6 months after operation were significantly lower than those in PLIF group (F =9.46,10.02,all P ＜ 0.05),but there was no significant difference between TLIF group and modified group.Interbody fusion was good in all three groups.Conclusions Three surgical methods have good clinical outcomes for lumbar spinal stenosis.But compared with PLIF and TLIF,the modified method has less blood loss,shorter operation time and less pain after operation.

Influence of matrix effect upon cyclosporine A test by fluorescence polarization immunoassay and enzyme-multiplied immunoassay technique methods / 中华检验医学杂志

Objective To explore the matrix effect on cyclosporine A (CsA) test by fluorescence polarization immunoassay (FPIA) and enzyme-multiplied immunoassay technique (EMIT), explain the discrepancy of external quality control results between these two methods and find the corrective action.Methods One hundred whole blood samples with various concentrations were adopted and CsA levels were detected by FPIA and EMIT.The results were compared with each other.Moreover, the influence of residual metal ions upon immunoreactions was assessed by adding Cu2+ and Zn2+.The effect of non-whole blood matrix on extraction efficiency for quality control materials and CsA calibrator was evaluated by adding identical volume of Hb-rich reagents followed with re-extraction.Results There is good correlation between results measured with FPIA(X) and EMIT(Y) methods ( Y=0.926 8X -8.115,R2 =0.996 9).Neither FPIA nor EMIT was affected by residual metal ions ( P ＞ 0.05 ). Non-whole blood matrix decreased the extraction efficiency of two methods, but it could be corrected by supplementation of the Hb-rich reagents (≥30 g/L).Conclusions Non-whole blood matrix may be the main reason for the inconsistent results measured by FPIA and EMIT methods.It could be corrected by using Hb-rich reagents.In addition,we should consider the influence of low lib on CsA test,espocially for organ transplant patients with lower Hb ( ＜30 g/L).

Smith-Peterson osteotomy for the treatment of degenerative lumbar scoliosis / 中国矫形外科杂志

[Objective]To investigate the feasibility and merits of the Smith-Peterson osteotomy for the treatment of degenerative lumbar scoliosis. [Methods]Twenty-five patients(11 males,14 females)with degenerative lumbar scoliosis malformations underwent operations from May 2004 to October 2007.The mean average age were 67 years (range,56~77 years).All the patients underwent more than three segments Smith-Peterson osteotomy and lumbar pedicle screw fixation to have the reconstruction of spinal coronal and sagittal plane balance.[Results]The mean duration of surgery were 200 mins(range,150~320 mins),and the average intraoperative blood loss were 1000 ml (range,600~2 000 ml).There were two cases of postoperative cerebrospinal fluid leakage,which were alleviated by pulling drainage tube and oppressing the wound.Postoperative pain and numbness in both lower extremities were aggravated in 2 cases,one of which was recovered completely 3 weeks later,and another 12 weeks later.The mean clinical follow-up were 36 months(range,24~60 months).JOA 29 score was recorded to evaluate the relief of the symptoms.The good-to-excellent rate was 88.2% and the poor rate was 0%.The coronal Cobb's angle was improved from the preoperative average of 23? (range,15?~ 40?) to the postoperative average of 12? (range,8?~ 20?).The sagittal Cobb's angle was improved from the preoperative average of 0 ?(range,-15?~ 15?) to the postoperative average of 33?(range,25?~ 40?).[Conclusion]Smith-Peterson osteotomy is an effective method for the decompression of lumbar spinal stenosis,and is helpful to correct the sagittal deformity of the degenerative lumbar scoliosis.It also has relatively small interference to nerve in the operation.