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Objective:To create AAPM TG 119 test plans for intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) in order to evaluate the accuracy of the United Imaging Healthcare′s URT treatment planning system (URT-TPS). The plans were delivered to the phantom using the United Imaging Healthcare′s URT-Linac 506C.Methods:The overall accuracy of IMRT and VMAT planning, measurement, and analysis were evaluated for four test geometries provided by American Association of Physicists in Medicine (AAPM) Task Group Report 119(TG-119) on multi-target, prostate, head and neck and C-shape (easy). The dose distributions were measured in the coronal plane. The point measurements were measured by a Farmer type ion chamber and fluence measurements were completed with film and Delta4 phantom, respectively. Measured planar dose distributions were analyzed using gamma index with criteria 3%/3 mm.Results:For IMRT and VMAT plans, the planning results matched the TG-119 planning results. Measured point doses of IMRT and VMAT were within 2.62% and 3.90% of the planned doses, respectively. Measured film dosimetry gamma values of IMRT and VMAT were> 97.50% and> 93.27%, respectively.Conclusion:Based on these analyses which were performed in line with the TG119 recommendations, it is evident that the URT treatment planning system and URT-Linac 506C have commissioned IMRT and VMAT techniques with adequate accuracy.
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Objective To investigate the dosimetry differences of target and OARs of an integrated design of fields in IMRT and the mainstream IMRT technique for post-radical mastectomy.Methods A total of 41 patients with post-radical mastectomy who received IMRT were eligible,the conventional fixing two-degrade collimator and the integrated IMRT fields were designed respectively.The dosimetry parameters of target and OARs,monitor units and delivery time of both plans were compared.Results The dose distribution for targets and OARs of both plans met clinical requirements.The dosimetry parameters of target of both plans showed no statistically significant difference (P＞0.05).Compared with the conventional technique,the integrated IMRT plans showed significant advantages,the ipsilateral lung V5 decreased by9.7％ (t=2.407,P＜0.05),V10 11.2％ (t=2.160,P＜0.05),V20 17.3％ (t=2.465,P＜0.05),V30 13.4％ (t=2.119,P＜0.05),D 13.8％ (t=2.258,P＜0.05).And the heart V30 decreased by 28.4％ (t =2.589,P＜0.05),D 23.2％ (t=2.409,P＜0.05).The dosimetric differences of other OARS were not statistically significant (P＞0.05).Conclusions The new method can effectively reduce exposed volume and exposed dose of ipsilateral lung and heart without affecting the target dose coverage.The method has universal applicability to patients with post-radical mastectomy who received IMRT,with important clinical significance.
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Objective@#To investigate the dosimetry differences of target and OARs of an integrated design of fields in IMRT and the mainstream IMRT technique for post-radical mastectomy.@*Methods@#A total of 41 patients with post-radical mastectomy who received IMRT were eligible, the conventional fixing two-degrade collimator and the integrated IMRT fields were designed respectively. The dosimetry parameters of target and OARs, monitor units and delivery time of both plans were compared.@*Results@#The dose distribution for targets and OARs of both plans met clinical requirements. The dosimetry parameters of target of both plans showed no statistically significant difference (P>0.05). Compared with the conventional technique, the integrated IMRT plans showed significant advantages, the ipsilateral lung V5 decreased by 9.7%(t=2.407, P<0.05), V10 11.2%(t=2.160, P<0.05), V20 17.3%(t=2.465, P<0.05), V30 13.4%(t=2.119, P<0.05), Dmean 13.8%(t=2.258, P<0.05). And the heart V30 decreased by 28.4%(t=2.589, P<0.05), Dmean 23.2%(t=2.409, P<0.05). The dosimetric differences of other OARS were not statistically significant(P>0.05).@*Conclusions@#The new method can effectively reduce exposed volume and exposed dose of ipsilateral lung and heart without affecting the target dose coverage. The method has universal applicability to patients with post-radical mastectomy who received IMRT, with important clinical significance.
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Objective To compare the dosimetric differences of the targets and the OARs in rectal cancer patients between Auto-planning and intensity-modulated radiotherapy (IMRT),and explore the advantages of Auto-planning (AP).Methods A total of 10 postoperative radiotherapy rectal cancer patients were selected,whose CT images were used to create AP plan and IMRT plan respectively using Pinnacle3 9.i0 treatment planning system.Through comparing the dose-volume histograms of the two plan types,the differences of the homogeneity index,conformity index and the doses to organs at risk (OARs) were analyzed.Results The AP plans were significantly better (t=-1.36,-3.03,0.37,P＜0.05) in terms of higher D Dmin and lower Dmax.But the differences in D2,Dg5,D98 were insignificant (P＞ 0.05).In the AP plan,the HI values of the target area were significantly reduced,and the CI values were significantly increased (t =1.24,0.10,P＜ 0.05).Significant superior results were found in V40,V50 of bladder,V30,V45,V50 of small intestine,V30,V40 of left and right femoral head (t=-3.21-1.02,P＜ 0.05).AP plans achieved insignificantly lower V30,V45 in bladder,V4o in small intestine and V45 in left and right femoral head than IMRT plan (P＞0.05).Conclusions Compare with IMRT plans,the AP plans for rectal cancer can achieve better homogeneity index,effectively reduce the maximum dose,increase the minimum dose,reduce hot and cold volumes in the target area.Meanwhile,AP plans can also protect the normal tissues better by reducing the dose to the OARs.
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Objective To evaluate the clinical application value of a novel immobilization system in total marrow irradiation ( TMI) with MVCT image. Methods From 2016 to 2017, a retrospective analysis of the setup errors of 22 patients receiving TMI in two groups ( twelve patients were immobilized with the novel immobilization system in group 1, ten patients were immobilized with the combinatorial immobilization devices in group 2) was performed in this study on Zhongnan Hospital of Wuhan University. Two-sample t-test was used to analyze the differences of setup errors and the consistency of setup between two groups. Results In group 1, the setup errors on left-right, superior-inferior, anterior-posterior and rotation directions were ( 1.06±0.79) , ( 1.34±0.66) , ( 2.45±1.48) mm and ( 0.63°±0.65°) for the head and neck position, ( 1.58±1.13) , ( 2.38±1.99) , ( 2.05± 1.68) mm and ( 0.31°± 0.32°) for the chest position, ( 1.67± 1.24) , ( 3.88±2.20) , ( 1.96± 1.32) mm and ( 0.48°± 0.53°) for the pelvis position, and ( 0.95± 0.73) , ( 1.99± 1.35) , ( 3.66±2.13) mm and ( 0.24°±0.31°) for the lower limb, respectively. In group 2, the setup errors were ( 2.59±2.58) , ( 3.28±1.85) , ( 3.71±2.43) mm and ( 1.15°±1.18°) for the head and neck position, ( 4.38±3.69) , ( 5.64±3.78) , ( 2.72± 1.91) mm and ( 1.55°± 0.86°) for the chest position, ( 4.14± 2.97) , ( 6.97±3.68) , ( 2.21±2.26) mm and ( 1.23°±0.74°) for the pelvis position, ( 2.28± 1.15) , ( 5.97± 3.00) , ( 3.44±1.93) mm and ( 1.09°±0.94°) for the lower limb, respectively. The setup errors significantly differed between two groups on the left-right, superior-inferior and rotation directions for all positions ( all P<0.05) . The setup consistency significantly differed between two groups on the left-right, superior-inferior and rotation directions for the chest and pelvis positions ( all P<0.05) . Conclusion The novel immobilization system can significantly improve the setup accuracy and setup consistency, and enhance the precision of treatment for patients.
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Objective To evaluate the clinical efficacy and prognostic factors of stereotactic body radiotherapy(SBRT)for pulmonary oligometastases,and to further explore the patients most suitable for SBRT. Methods From 2012 to 2105,51 patients with 76 oligometastatic lung tumors were treated with SBRT.In those patients,27 had primary lung tumors and the others had extrapulmonary tumors. Seven patients had squamous cell carcinoma,thirty-five had adenocarcinoma, and the rest had other types of cancer. The patients received radiotherapy at a dose of 50 Gy in five fractions or 60 Gy in three fractions. Survival analysis was made by the Kaplan-Meier method. A multivariate analysis was made by the Cox model. Results The 1-and 2-year local control rates were 86%(65/76)and 80%(61/76),respectively. The 1-and 2-year overall survival(OS)rates were 80%(41/51)and 55%(28/51),respectively. The median survival time was 30(2-57)months,while the median progression-free survival time was 8(1-32)months. Twenty-one patients had grade 1 radiation pneumonitis(RP),while one patient had grade 2 RP. The multivariate analysis revealed that no more than 2 oligometastatic lung tumors,progression-free interval(PFI), and a performance score(PS)no higher than 1 were independent factors for OS(all P<0.05). Conclusions SBRT is effective and safe for treating pulmonary oligometastases. The number of oligometastatic lung tumors,PFI,and PS are independent prognostic factors for OS. Suitable patients and the appropriate timing of treatment are key to the efficacy of SBRT.
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Objective The objective of this study was to provide a way to assess the nutritional status of patients and to afford targeted nutritional supports during the radiotherapy on the basis of the laboratory parameters related to nutrition and chest muscle size in lung cancer patients at the different time.Methods The laboratory parameters were obtained in a cohort of 160 lung cancer patients who received thoracic radiotherapy in our department from March 2012 to November 2015.Fourteen patients who had complete chest CT scan images during radiotherapy were selected to evaluate chest muscles volume.The Chest muscles and its volume were delineated and calculated by CT scan images.Results The levels of(Hemoglobin)HGB,lymphocyte,total protein and albumin were decreased in different degrees during and after radiotherapy,which had the positive correlation with the number and doses of radiotherapy(P0.05).Conclusion Cancer patients were prone to suffer from malnutrition during radiotherapy.The intake of energy and protein was less than the requirements.We should always take the nutritional status of patients into account and provide targeted nutritional support to improve treatment tolerance and quality of life of patients during radiotherapy.
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BACKGROUND:Hidden blood loss is one of most important complications after total knee arthroplasty, but the mechanism and influential factors are not yet clear. OBJECTIVE:To analyze the relative influential factors for hidden blood loss in primary unilateral total knee arthroplasty. METHODS:Data of 235 patients who had undergone primary unilateral total knee arthroplasty from April to September 2014 were retrospectively studied. There were 38 males and 197 females aged from 48 to 82 years old with a mean age of 66 years. The Gross formula was used to calculate the amount of hidden blood loss. The effects of gender, age, height, body weight, body mass index, anesthesia method, administration of tranexamic acid, postoperative anticoagulation method, typeof prosthesis, tourniquet time and pre-operative coagulation function on the postoperative hidden blood loss and total blood loss after total knee arthroplasty were analyzed. RESULTS AND CONCLUSION:(1) Significant differences in hidden blood loss and total blood loss after total knee arthroplasty were detected between male and female patients (P< 0.01). Significant differences in hidden blood loss and total blood loss were found between tranexamic acid and non-tranexamic acid groups (P< 0.05,P< 0.01).(2) Multivariate linear regression analysis showed that preoperative hemoglobin level and heightwere important factors influencing the blood loss after arthroplasty. Hidden blood loss and total blood loss were not correlated with age, body mass index, anesthesia method, postoperative anticoagulation method, type of prosthesis, tourniquet time and preoperative coagulation function. (3) Results indicate that gender and administration of tranexamic acid affect hidden blood loss and total blood loss after total knee arthroplasty. However, age, body mass index, anesthesia method, postoperative anticoagulation method, type of prosthesis, tourniquet time and preoperative coagulation function do not greatly affect hidden blood loss.
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Information department in hospitals shoulders the tasks of construction,operation,maintenance and super-vision of hospital information system ( HIS) . The work load increases with the update of HIS. The key issues con-cerned by the chief of HIS include the over planning of resources,optimizing the allocation of techniques,enforcing the means of management, improving the level of service and the efficiency of support. The principles for the design of performance appraisal program and the specific appraisal indicators in Information Department of Chinese PLA Second Artillery Forces were thus described in this paper in an attempt to provide reference for the information management in other hospitals.
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Objective To explore the effect of mediastinal drainage on the treatment for intra -thoracic anastomotic leak in esophageal cancer patients after esophagectomy .Methods One hundred and thirty -four e-sophageal cancer patients underwent esophagectomy and a mediastinal drainage tube was routinely placed intro -operatively ( observation group ) .Other 150 esophageal cancer patients underwent esophagectomy without mediasti -nal drainage were retrospectively set as control group .The following factors in the two groups were compared:in-cidence of anastomotic leak,and mortality rate,incidence of respiratory failure,incisional infection,rate and dura-tion of moderate or high fever ( T≥38℃) , duration of antibiotic use , duration of anastomotic leak healing and length of hospital stay of anastomotic leak patients .Results There was no significant difference in incidence rate of anastomotic leak between observation and control groups .There was no death ,no respiratory failure in observa-tion group;rate of chest incisional infection in observation group was 18.2%(2/11).Mortality rate,respiratory failure rate and chest incisional infection rate in control group were 33.3%(3/9)、44.4%(4/9)and 77.8%(7/9)respectively.Incidence and duration of moderate or high fever (36.4%and 2.3 ±1.2d respectively)in obser-vation group were significantly lower than those in control group (100 % and 8.6 ±2.3 d respectively)(P<0.05).Duration of antibiotic use,duration of leak healing and length of hospitalization (9.6 ±3.2 d,23.6 ±5.5 d and 22.6 ±5.7 d respectively)were significantly shorter than those in control group (21.3 ±6.8 d,38.3 ±8.4 d and 38.5 ±9.6 d,P<0.05)respectively).Conclusion Although mediastinal drainage could not prevent anasto-motic leak in patients underwent esophagectomy ,it could definitely decrease death and respiratory failure resulted from anastomotic leak .Mediastinal drainage could also decrease severity of intrathoracic infection caused by anas -tomotic leak and shorten the duration of leak healing .
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Objective To investigate the effects of aquaporin 3 (AQP3) and phospholipase D2 (PLD2) on the proliferation and apoptosis of a human cutaneous squamous cell carcinoma cell line A431.Methods Three small interfering RNAs (siRNAs) were constructed targeting the AQP3 and PLD2 genes separately,and transfected into A431 cells using liposomes.Then,fluorescence quantitative PCR was performed to find the most efficient siRNAs.Western blot was conducted to detect the protein expression levels of AQP3 and PLD2 in A431 cells after transfection with the selected AQP3-siRNA and PLD2-siRNA.Some A431 cells were divided into five groups:normal control group without any treatment,transfection reagent group treated with the oligofectamine reagent only,negative control group transfected with the negative control siRNA,AQP3-siRNA group transfected with the selected AQP3-siRNA,PLD2-siRNA group transfected with the selected PLD2-siRNA.After additional culture,cell counting kit-8 assay was performed to evaluate the proliferation of A431 cells,flow cytometry to detect the apoptosis of A431 cells after annexin V-fluorescein isocyanate/propidium iodide double-staining.Statistical analysis was carried out by the paired t test.Results The transfection with AQP3-siRNA and PLD2-siRNA induced a significant decrease in the mRNA and protein expressions of AQP3 and PLD2 respectively in A431 cells when compared with the untransfected cells.Compared with the negative control group,the proliferation of A431 cells was significantly decelerated at 24,48 and 72 hours after transfection in the AQP3-siRNA group (t =24.10,11.00,9.54,respectively,all P ＜ 0.01) and PLD2-siRNA group (t =30.47,7.02,8.73,respectively,all P ＜ 0.01).A significant increase was observed in the apoptosis of A431 cells at 48 and 72 hours after transfection with AQP3-siRNA (t =11.36,20.91,respectively,both P ＜ 0.01),and at 72 hours after transfection with PLD2-siRNA (t =4.86,P ＜ 0.05) compared with the negative control group.Conclusion The down-regulation of AQP3 and PLD2 expressions by siRNA can inhibit the proliferation,but induce the apoptosis,of A431 cells.
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BACKGROUND:Studies have shown that limited lumbar discectomy can harvest better clinical efficacy, but also face a higher risk of recurrence. In clinic, how to guarantee access to good effect, and meanwhile to reduce the probability of recurrent disc herniation? The annulus repair technology may be an effective way, but it is rarely reported. OBJECTIVE:To investigate the early clinical effects of endoscopic lumbar discectomy associated with annulus repair in the treatment of lumbar disc herniation. METHODS: Totaly 224 patients with lumbar disc herniation who accepted discectomy surgery were selected from the Department of Spinal Surgery, the Third Affiliated Hospital of Southern Medical University from January 2011 to January 2013, including 56 cases of microendoscopic discectomy associated with annulus repair (repair group) and 168 cases of microendoscopic discectomy (control group). Oswestry disability index and visual analog scale scores for lumbago and lower limb pain were recorded before and at 10 days, 3 months, 6 months, 12 months and 18 months after operation. Simultaneously, operative time, blood loss, surgical complications, and postoperative recurrence of lumbar disc herniation were recorded. RESULTS AND CONCLUSION:In the repair group, only 51 patients completed the folow-up, while al the patients in the control group completed the folow-up. There was no difference between the repair and control groups before and after surgery in the Oswestry disability index and visual analog scale scores for lumbago and lower limb pain (P > 0.05), but at 10 days after surgery, the Oswestry disability index and visual analog scale scores for lumbago and lower limb pain were significantly decreased in the repair group (P < 0.05), and this trend continued until the 18th month after surgery. There were no dural tears, disc space infection, hematoma formation in the spinal canal and other serious complications. The recurrence rate was 9.5% in the control group and 3.9% in the repair group. 31.2% of relapsed patients in the control group received the second operation, while on patient in the repair group received reoperation. These findings indicate that microendoscopic discectomy associated with annulus repair can obtain remarkable early clinical results, and effectively reduce the recurrent rate and risk of secondary lumbar disc surgery, which is safe and reliable.
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Objective To observe the expressions of senescence-associated biomarkers in fibroblasts after repeated exposures to subtoxic doses of ultraviolet B (UVB), and to study the effect of ginsenoside Rb1 and Rg1 as well as Lycium barbarum polysaccharide on the UVB-induced premature senescence and on the expressions of senescence-associated signals including pl6, p21 and pS3. Methods Skin fibroblasts were classified into 8 groups to receive pretreatment with traditional Chinese medicine (TCM) monomers only, UVB irradiation only, no treatment, or both pretreatment and irradiation. UVB was given successively at a dose of 15 mJ/cm~2 for 10 times, and the concentration of three monomers was 50 mg/L. After 5 days of treatment, light microscopy was used to observe the morphology of fibroblasts, transmission electron microscopy to study the cell ultrastructure,β-galactosidase histochemical staining to detect senescent cells, flow cytometry to analyze cell cycle, and RT-PCR to measure the mRNA expressions of p16, p21 and p53 in these skin fibroblasts. Results None of the 3 monomers had any effect on cell morphology, P-galactosidase activity, cell cycle or the mRNA expression of p53, p21 and pl6 in skin fibroblasts. After UVB irradiation, some changes occurred to cell morphology and ultrastructure; 91.5% of the cells were stained positively for P-galactosidase. The proportion of cells in G1 phase was 88.63% ± 4.67% in irradiated fibroblasts, significantly different from that in untreated controls (49.18% ± 5.53%, P< 0.05) and that in irradiated fibroblasts pretreated with ginsenoside Rbl and Rgl as well as Lycium barbarum polysaccharide (71.04% ± 1.64%, 70.38% ± 2.58%, 80.09% ± 3.46%, all P < 0.05). Compared with untreated fibroblasts, the mRNA expression of p53, p21 and pl6 significantly increased in irradiated fibroblasts (P < 0.05), however, the induced increase in the mRNA expression of pl6 was inhibited by all the three monomers (all P< 0.05), that of p2l by ginsenoside Rb1 and Rg1 (P< 0.05), and that of p53 by ginsenoside Rbl and Lycium barbarum polysaccharide (both P < 0.05). Conclusions Ginsenoside Rbl, Rgl and lycium barbarum polysaccharide can inhibit UVB-induced premature senescence, which may be associated with the down-regulation of mRNA expressions of pl6, p21 and p53.
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0.05)and the total costs of the 3 groups were 1 111.82 yuan,1 132.82 yuan and 1 219.62 yuan,respectively.CONCLUSION:Group A(Ceftriaxone Sodium)has been proved to be preferable for children's bronchopneumonia.
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Objective To study the effects of the IL-1 receptor antagonist (IL-1Ra) on matrix metalloproteinase 1 (MMP-1) expression in UV-irradiated fibroblasts. Methods Simulating the impact of environmental ultraviolet (UV) light on human skin, UVA-irradiated human fibroblasts were cultured in medium obtained from UVB-irradiated HaCaT cells. MMP-1 was detected by ELISA in the culture medium of fibroblasts. After treatment with IL-1Ra, the mRNA expression levels of C-Jun, C-Fos and GAPDH (internal control) of fibroblasts were measured by real-time fluorescent quantitative RT-PCR. Results Production of MMP-1 by UVA (10 J/cm2)-irradiated fibroblasts was increased in culture medium from UVB-irradiated HaCaT cells. The fibroblasts produced significantly higher levels of MMP-1 in culture medium from HaCaT cells treated without UVB than those with 15 mJ/cm2 UVB (t = 8.413,P= 0.014). However, IL-1Ra inhibited MMP-1 production of fibroblasts in a dose-dependent manner. Standard curves of real-time fluorescent quantitative RT-PCR showed a linear correlation between the copy number and the threshold cycle (Tc). Melting curves confirmed the specificity of PCR products. The original copy numbers of C-Jun and C-Fos as well as the ratios of the numbers to the GAPDH copy number showed that IL-1Ra inhibited the C-Jun mRNA expression of fibroblasts in a dose-dependent manner but had no significant effects on C-Fos mRNA expression. Conclusions The culture medium from UVB-irradiated HaCaT cells can promote MMP-1 production by UVA-irradiated fibroblasts. IL-1Ra reduces MMP-1 production via inhibition of C-Jun mRNA expression.