The indicators of selecting patients with breast cancer undergoing postoperative radiotherapy for deep inspiration breath hold technique / 中华放射肿瘤学杂志

Cardiotoxicity caused by postoperative radiotherapy can increase the risk of cardiovascular adverse events in patients with breast cancer, especially those with left breast cancer, which is proportional to the dose of radiation to the heart. It has been proved that deep inspiration breath-hold (DIBH) technique can significantly reduce the cardiac dose in patients with left breast cancer, but the benefits of this technique vary greatly among different patients, and its implementation requires additional equipment, time, manpower and other resources. Hence, it is necessary to select patients who are suitable for this technique in advance. In addition to comprehensive analysis of general factors before simulation positioning that affect DIBH selection, this review also systematically summarized relevant indicators of CT simulation positioning images. These anatomical indicators included the measurement of the cardiac contact distances in parasagittal (CCD ps) plane, the lateral heart-to-chest distance (HCD), the product of maximum heart width (HW max) and the maximum heart depth (HD max) during CT simulation positioning, and the maximum heart distance, heart volume in the irradiation field (HVIF), the difference of lung volume and heart volume between free breathing (FB) and DIBH measured after CT localization. All of them showed some instructive significance for evaluating whether DIBH should be applied in tangent field based radiotherapy planning. The automatic planning (rapid plan) function in the treatment planning system could quickly predict the benefit of DIBH for breast cancer patients. The purpose of this article is to help clinicians select patients who are suitable for DIBH technique, guaranteeing that DIBH technique resources can be used reasonably.

Análise comparativa das doses cardíacas recebidas por pacientes com câncer de mama esquerda planejadas com duas formas alternativas de delineamento do CTV da cadeia mamária interna / Comparative analysis of heart doses received by patients with left breast cancer planned with two alternative internal mamary delineation CTVs

Propósito. Com a publicação, na última década, do resultado de grandes estudos demonstrando a correlação entre a dose de radiação recebida no coração e o aumento de eventos cardíacos adverso. Nosso estudo investiga a possibilidade de reduzir a dose cardíaca de radiação sem utilizar os protocolos ideais de inspiração profunda (DIBH). Metodologia. Analisamos os parâmetros dosimétricos referentes a 43 pacientes recebidas no departamento de radioterapia da Santa Casa de Maceió tratadas com radioterapia adjuvante em mama ou plastrão esquerdos incluindo fossa e cadeia mamária interna (MI). Todas as pacientes foram submetidas a duas tomografias e planejamentos distintos, com e sem inspiração profunda (DIBH), em um protocolo simplificado adequado para a realidade do Sistema Único de Saúde (SUS). Foram analisados os efeitos dosimétricos sobre o volume alvo, o coração, o pulmão esquerdo com o DIBH simplificado e com formas alternativas de delineamento da cadeia mamária interna. Resultados. Em nosso estudo, o protocolo de DIBH simplificado demonstrou uma redução da dose média cardíaca mesmo em pacientes incluindo radiação nodal regional ampla (692 cGy vs 502 cGy - p < 0,0001). As doses médias no ventrículo esquerdo (VE) (1222 cGy vs 857 cGy ­ p < 0,0001), na artéria coronária anterior descendente (LAD) (3739 cGy vs 3345 cGy ­ p = 0,0001) e outros parâmetros como o V25% do coração (12,4% vs 7,7% - p < 0,0001) também se mostraram reduzidas. Os delineamentos alternativos da cadeia mamária interna (MI) não produziram alterações significantes nas doses cardíacas ou pulmonares. O melhor parâmetro para predizer o benefício do DIBH foi a expansibilidade do pulmão esquerdo (r = 0,6 - p < 0,0001), sendo que os pacientes com relação entre o pulmão normal e o inspirado menor que 1,3-1,4 não obtiveram benefício significativo. Doses pulmonares também tiveram melhora estatisticamente significativa com o DIBH (média 1448 cGy vs 1294 cGy ­ p < 0,0001; V20 32,6% vs 28,2% - p <0,0001; V5 48,7% vs 45,4% - p < 0,0005), Conclusão. Nosso estudo indica que um protocolo simplificado de DIBH pode ser uma alternativa para beneficiar pacientes selecionados que necessitam reduzir a dose cárdica de radiação em tratamentos e mama esquerda e drenagens regionais em serviços de radioterapia de alta demanda e recursos limitados

Purpose. In the last decade, seminars studies demonstrated the correlation between radiation doses received in the heart with the incidence of cardiac disease, such as acute coronary events. This aroused the interest in new techniques to reduce this problem. Numerous studies have already shown that Deep Inspiration Breath Hold (DIBH) may be the best option for reducing cardiac dose. However, the vast majority of these investigations were carried out in a different scenario from the one found in our reality. Our study investigated the feasibility of reducing the cardiac dose without using an ideal DIBH protocol, which are difficult to implement in services with high demand and low economic support. Methods. The dosimetric parameters of 43 patients from the radiotherapy department of Santa Casa de Maceió were analyzed. All patients were treated with adjuvant radiotherapy to the left breast, including supraclavicular fossa and internal mammary chain (IM). The patients underwent two different CT scans and planning, with and without DIBH, in a simplified protocol suitable for the reality of tour public health system (Free Breath Hold; no respiratory training; selection of only the patients with greater benefit). The dosimetric impact on the heart, its substructures and the left lung were studied with the simplified DIBH and with alternative forms of delineation to the IM. Results. The simplified DIBH protocol demonstrated, in our study, a reduction in mean cardiac dose for patients including wide regional nodal radiation (692 cGy vs 502 cGy - p < 0.0001). The doses for the Left ventricular (1222 cGy vs 857 cGy ­ p < 0.0001), the Left anterior-descending coronary (3739 cGy vs 3345 cGy ­ p = 0.0001) and other parameters such as heart V25% (12.4% vs 7, 7% - p < 0.0001) were also reduced. The doses to the heart did not achieve statistically significant reduction with alternative delineation of the MI CTV. The best parameter predicting the benefit of DIBH was the left lung expansion (r = 0.6 - p < 0.0001), with patients with a ratio lower than 1.3-1,4 having no significant benefit. Pulmonary doses also showed a statistically significant improvement with DIBH (Dmed 1448 cGy vs 1294 cGy ­ p < 0.0001; V20 32.6% vs 28.2% - p <0.0001; V5 48.7% vs 45, 4% - p < 0.0005), but the reductions were small, as was the increase in pulmonary dose when the MI CTV is outlined to joining the supraclavicular fossa. Conclusion. Our study indicates that a simplified DIBH protocol may serve as an option to benefit selected patients with locally advanced breast cancer treated in departments with high occupation of the Linacs and low capacity for investment in new technology

Current research on surface guided radiation therapy / 中国辐射卫生

Surface guided radiation therapy (SGRT) is a method of radiation therapy with non-invasive and non-radiation image guidance technology, which uses continuous real-time imaging to monitor the whole course of treatment. This paper summarizes the characteristics, representative products, application in clinical research and treatment, and quality control of SGRT. This emerging technology plays an increasingly important role in delivering more precise, safe, and comfortable radiotherapy to patients.

Feasibility of pulse oxygen saturation for the condition evaluation of acute respiratory distress syndrome patients in the Lijiang region / 中华危重病急救医学

Objective:To explore the feasibility of using pulse oxygen saturation (SpO 2) to evaluate the condition of patients with acute respiratory distress syndrome (ARDS) in the Lijiang region. Methods:Patients with ARDS who visited the department of emergency of People's Hospital of Lijiang from August to December 2020 were selected as study subjects. Patients were divided by severity into mild ARDS group [200 mmHg (1mmHg = 0.133 kPa)≤oxygenation index (PaO 2/FiO 2, P/F)≤300 mmHg] and moderate to severe ARDS group (P/F≤200 mmHg). The general condition, clinical diagnosis, arterial blood gas analysis results of the patients were recorded, and the differences of the above indexes between the two groups of ARDS were compared. Spearman correlation analysis was used to analyze the correlation between SpO 2 and arterial oxygen saturation (SaO 2). SpO 2 was carried into the Ellis equation and the Rice equation to calculate the derived P/F and analyze the correlation between the derived P/F and the P/F measured in arterial blood gas analysis; receiver operator characteristic curve (ROC curves) were plotted, the sensitivity and specificity of SpO 2/fraction of inspiration oxygen (SpO 2/FiO 2, S/F) instead of P/F to assess oxygenation in patients with ARDS was calculated. To evaluate the feasibility of SpO 2 for the condition evaluation of patients with ARDS in the Lijiang region. Results:Compared with the mild ARDS group, the arterial partial pressure of oxygen (PaO 2), SaO 2 and hemoglobin (Hb) were significantly decreased in the moderate to severe ARDS group [PaO 2 (mmHg): 50.5 (39.3, 56.5) vs. 60.0 (55.0, 67.5), SaO 2: 0.86 (0.73, 0.91) vs. 0. 93 (0.90, 0.96), Hb (g/L): 142±27 vs. 156±24, respectively, all P < 0.05]. Correlation analysis revealed a significant positive correlation between SpO 2 and SaO 2 in ARDS patients residing at high altitude ( R = 0.650, P = 0.000). The P/F derived by the Rice formula was significantly and positively correlated with the P/F derived from arterial blood gas analysis ( R = 0.802, P = 0.000). The deduced P/F in mild and moderate to severe ARDS groups were all significantly correlated with the measured P/F ( R values were 0.562, 0.647, both P = 0.000). The P/F derived using the Ellis formula showed a significant positive correlation with the P/F derived from arterial blood gas analysis ( R = 0.822, P = 0.000). The deduced P/F of mild ARDS group and moderate to severe ARDS group were all positively correlated with the measured P/F ( R values were 0.556, 0.589, P values were 0.000, 0.010). There was a significant positive correlation between S/F and P/F in ARDS patients ( R = 0.828, P = 0.000), and the regression equation was S/F = 1.33 P/F+52.41. ROC curve analysis showed that S/F had some predictive value for patients with mild and moderate to severe ARDS, and area under ROC curve (AUC) and 95% confidence interval (95% CI) were 0.903 (0.829-0.977), 0.936 (0.870-1.000), both P = 0.000. When the cut-off value was 452 mmHg, S/F had a sensitivity of 100% and a specificity of 80.9% for predicting mild ARDS. When the cut-off value was 319 mmHg, S/F predicted moderate to severe ARDS with 95.1% sensitivity and 86.2% specificity. Conclusions:At high altitude, SpO 2 and SaO 2 have been correlated in patients with ARDS, and P/F derived using SpO 2 and measured P/F were significantly correlated in patients with ARDS, especially in those with moderate to severe ARDS. SpO 2 may be useful in the assessment of severity of illness in patients with ARDS at high altitude.

Efectos del entrenamiento respiratorio aislado en las variables respiratorias y vocales / Effects of isolated respiratory training on breathing and voice variables

La implementación del entrenamiento respiratorio aislado en la rehabilitación y el entrenamiento de la voz es una práctica común en los países de habla hispana. Ac-tualmente, no existe ningún manuscrito en español que revise la información teórica y empírica del entrenamiento respiratorio en este contexto. El propósito de la presente revisión es entregar la evidencia actualizada del efecto del entrenamiento respiratorio aislado en la voz. El entrenamiento de la fuerza respiratoria ha demostrado tener consecuencias positivas en los parámetros medidos; no obstante, los datos disponibles hasta ahora no reporta efectos significativos en la voz, exceptuando los casos de personas con trastornos neurológicos de base y presbifonía. Si el entrenamiento respiratorio con el uso de dispositivos no ha demostrado impactar favorablemente sobre otras disfonías (no neurológicas ni presbifonía) ni en sujetos sanos profesionales de la voz, no existiría razón para esperar que los ejercicios respiratorios aislados que se suelen incluir en las rutinas de entrenadores vocales, fonoaudiólogos, logopedas y foniatras tengan un efecto positivo. Considerando que el entrenamiento de la fuerza muscular respiratoria parece actuar sobre algunos parámetros vocales en personas con alteraciones neurológicas y presbifonía, futuras investigaciones deberían considerar la exploración del posible efecto positivo en otros parámetros vocales no medidos aún en este tipo de población

Isolated breathing training in rehabilitation and voice training is a common prac-tice in Spanish-speaking countries. Currently, there are no documents in Spanish that study the theoretical and empirical information related to respiratory training in this context. The purpose of the present review is to provide updated information regarding the current evidence of the possible effect of isolated respiratory training on voice. Respiratory strength training has been shown to have positive effects on respiratory parameters, however, the available evidence does not report significant effects on the voice, except for people with underlying neurological disorders and presbyphonia. If respiratory training using devices designed for these purposes has not been shown to positively impact vocal characteristics of subjects with dyspho-nia (not neurological or presbyphonia) or of healthy professional voice users, there is no reason to expect that the isolated breathing exercises that are often included in the routines of vocal trainers and speech therapists will have a positive effect on voice variables. Considering that respiratory muscle strength training seems to positively affect some vocal parameters in people with neurological disorders and presbyphonia, future research should consider exploring the possible effect on other vocal parameters not yet measured in this type of population

Effect of different interfaces on FiO_2 and CO_2 rebreathing during noninvasive positive pressure ventilation / 中国实用内科杂志

OBJECTIVE: To investigate the effect of different interfaces on FiO_2 and CO_2 rebreathing(ViCO_2) during noninvasive positive pressure ventilation. METHODS: The Active Servo Lung respiratory simulation system was used to simulate a hypercapnia COPD patient received NPPV through injection of CO_2 gas from the place closest to the outlet of simulated lung to maintain end-tidal carbon dioxide partial pressure at 80 mmHg,and oxygen delivery during NPPV was simulated by means of injection of 5 L/min oxygen through the hole of interface. FiO_2 and ViCO_2 were integral calculated through the synchronous collect real-time pressure, flow rate, oxygen concentration and CO_2 concentration. The effect of different type and models of interfaces on FiO_2 and ViCO_2 were compared, and the bivariate correlation analysis was applied to investigate the correlation of FiO_2 and ViCO_2. RESULTS: The inner volume, leak volume and leak position of different interfaces were different. The FiO_2 of the oral-nasal mask and nasal mask were significantly different(P<0.05), which were(39.81±9.06)% and(43.91±6.33)%,respectively. The FiO_2 of the different models of interfaces was significantly different(P<0.05), the FiO_2 of the No.4 oral-nasal mask was the lowest(28.29±0.08)%, and the FiO_2 of the No. 10 oral-nasal mask was the highest(53.83±0.63)%. The ViCO_2 of the oral-nasal mask and nasal mask wasn't significantly different(P=0.19), which was(15.26±1.27)mL and(14.79±2.21)mL, respectively. The ViCO_2 of the different models of interfaces was significantly different(P<0.05), the FiO_2 of the No.8 nasal mask was the lowest(12.48±0.29%), and the ViCO_2 of the No. 10 nasal mask was the highest(18.38±0.31)%. There was a significant correlation between FiO_2 and ViCO_2(r=0.41, P<0.05), and the general linear equation was Y=14.51+1.82 X(R~2=0.168). CONCLUSION: Different interfaces have significant effects on FiO_2 and ViCO_2 during NPPV,and FiO_2 and ViCO_2 are positively correlated.

An effective patient training for deep inspiration breath hold technique of left-sided breast on computed tomography simulation procedure at King Chulalongkorn Memorial Hospital

PURPOSE: To observe the effectiveness of the practical instruction sheet and the educational video for left-sided breast treatment in a patient receiving deep inspiration breath hold (DIBH) technique. Two parameters, simulation time and patient satisfaction, were assessed through the questionnaire. METHODS: Two different approaches, which were the instruction sheet and educational video, were combinedly used to assist patients during DIBH procedures. The guideline was assigned at least 1 week before the simulation date. On the simulation day, patients would fill the questionnaire regarding their satisfaction with the DIBH instruction. The questionnaire was categorized into five levels: extremely satisfied to dissatisfied, sequentially. The patients were divided into four groups: not DIBH technique, DIBH without instruction materials, the DIBH with instruction sheet or educational video, and DIBH with both of instruction sheet and educational video. RESULTS: Total number of 112 cases of left-sided breast cancer were analyzed. The simulation time during DIBH procedure significantly reduced when patients followed the instruction. There was no significant difference in simulation time on the DIBH procedures between patient compliance via instruction sheet or educational video or even following both of them. The excellent level was found at 4.6 ± 0.1 and 4.5 ± 0.1, for patients coaching via instruction sheet as well as on the educational video, respectively. CONCLUSION: Patient coaching before simulation could potentially reduce the lengthy time in the simulation process for DIBH technique. Practicing the DIBH technique before treatment is strongly advised.

Application of deep inspiration breath-hold technique in radiotherapy / 中华放射肿瘤学杂志

In radiotherapy for thoracic and abdominal tumors, the negative effect of respiratory movement on radiotherapy persist throughout the whole process of radiotherapy. Deep inspiration breath-hold technique (DIBH) is a method of respiratory movement management in radiotherapy, which can reduce the negative effect of respiratory movement upon radiotherapy in the whole process of radiotherapy. Meantime, DIBH technique has its own characteristics and operation requirements compared with other respiratory movement management measures (such as 4D CT, gated technology and tracking, etc.). The aim of this review was to introduce the advantages, disadvantages and the application status of DIBH technique.

Liver dose reduction by deep inspiration breath hold technique in right-sided breast irradiation

PURPOSE: Deep inspiration breath hold (DIBH) is a well-established technique that enables efficient cardiac sparing in patients with left-sided breast cancer. The aim of the current study was to determine if DIBH is effective for reducing radiation exposure of of liver and other organs at risk in right breast radiotherapy (RT).MATERIALS AND METHODS: Twenty patients with right-sided breast cancer were enrolled in this study. Three-dimensional conformal RT plans were generated for each patient, with two different computed tomography scans of free breathing (FB) and DIBH. Nodes were contoured according to the Radiation Therapy Oncology Group contouring guidelines. Dose-volume histograms for the target volume coverage and organs at risk were evaluated and analyzed.RESULTS: DIBH plans showed significant reduction in mean liver dose (5.59 ± 2.07 Gy vs. 2.54 ± 1.40 Gy; p = 0.0003), V(20Gy) (148.38 ± 73.05 vs. 64.19 ± 51.07 mL; p = 0.0003) and V(10Gy) (195.34 ± 93.57 vs. 89.81 ± 57.28 mL; p = 0.0003) volumes compared with FB plans. Right lung doses were also significantly reduced in DIBH plans. Heart and left lung doses showed small but statistically significant improvement with application of the DIBH technique.CONCLUSION: We report that the use of DIBH for right-sided breast cancer significantly reduces the radiation doses to the liver, lungs, and heart.

Enlightenment of the United Nations high-level summit on non-communicable disease prevention and control on the development of public health system in China / 中华预防医学杂志

The Third UN High-level Meeting on Non-Communicable Diseases was held on September 2018. The conference carried out a series of activities on the theme of "Time To Deliver", and adopted the 2018 Political Declaration on Non-Communicable Diseases. The new "5×5" strategy for non-communicable diseases prevention and control was clearly put forward, slow progress of non-communicable diseases prevention and control was criticized and the seven major challenges hindering the progress of non-communicable diseases prevention and control was analyzed, the main role and responsibility of governments at all levels in coping with the challenges of non-communicable diseases was reiterated, and put forward clear requirements. The declaration also reiterates the importance of strengthening public health measures. The meeting and declaration aroused strong repercussions and were regarded as a milestone to promote the global prevention and control of non-communicable diseases, and also brought a series of important inspirations for the development of public health in China in the new era. In order to cope with the heavy burden of non-communicable diseases in China, we must give full play to our institutional advantages, mobilization advantages and organizational advantages, adhere to prevention-oriented, emphasize the role of professional public health institutions, and consolidate and strengthen the disease control system and capacity building.

Outline and Inspiration of 2017 Edition of British Pharmacopoeia / 中国药房

OBJECTIVE: To summarize 2017 edition of British Pharmacopoeia, and to facilitate the use of it by drug inspectors. METHODS: The main contents and layout of 2017 edition of British Pharmacopoeia were overviewed; the similarities and differences between Chinese Pharmacopoeia and British Pharmacopoeia were described by means of literature research and general comparison with the 2015 edition of Chinese Pharmacopoeia. The reference for Chinese Pharmacopoeia was put forward. RESULTS & CONCLUSIONS: British Pharmacopoeia includes 7 parts as "introduction" "explanatory notes" "text variety" "infrared control chromatogram", and divided into 6 volumes, such as "pharmaceutical raw materials" "formulated preparations" "veterinary drugs". Compared with the previous edition, 2017 edition added 69 new varieties, removed 9 monographs and modified 91 varieties technologically. Compared with Chinese Pharmacopoeia, British Pharmacopoeia additionally included veterinary drugs, homeopathic preparations, surgical materials, infrared spectrogram, etc. Compared with the update of Chinese Pharmacopoeia every 5 years, British Pharmacopoeia Commission updated and revised the British Pharmacopoeia every year, and provided reliable reference for the establishment of scientific analysis methods in time. At the same time, British Pharmacopoeia Commission established British Pharmacopoeia online website www. pharmacopoeia. com to provide a more convenient and fast platform for users; British Pharmacopoeia Commission paid special attention to maintaining close ties with drug manufacturers, regulators, the European Medicines Agency (EMA) and the Chinese Herbal Medicine Products Committee in EMA so as to revise drug standards timely. It provides enlightenment and reference for the revision of Chinese Pharmacopoeia.

Application of electronic medical record data in clinical decisions in the United States :inspirations for China / 中华医院管理杂志

With three typical applications of the US Veterans Administration as an example ,the paper introduced the use by the Administration EMR data in clinical decision. The author held that China should build a professional EM R data clinical decision system ,establish professional third-party clinical decision organs ,leverage EMR data sharing in building medical alliances ,and normalize policies and decrees ,for the purposes of better assistance to clinical workers and better healthcare for the people .

Evolution and inspirations of the core system for medical quality and safety / 中华医院管理杂志

The paper studied the evolution of the core system for medical quality and safety, separating the process into a stage of incubation and seeding, a stage of development and one of maturity. This process features the characteristics of the time, greater scientificity and rigorousness, and opening of the system. Medical theory and clinical practices should strictly follow the Medical Quality Management Regulations, and enforce strict implementation and supervision upon the core system by means of information technologies and big data analysis strategy. These measures will keep elevating the level of medical quality and safety management.

Application and set-up error of deep inspiration breath-hold (DIBH) technique for whole breast irradiation in left breast cancer / 中华放射肿瘤学杂志

Objective To analyze the correlation between treatment time and radiotherapy plan of deep inspiration breath-hold (DIBH) technique for the whole breast irradiation (WBI) in the left breast cancer after breast-conserving surgery,verify the inter-fractional reproducibility of radiotherapy,observe the heart location and dosimetric changes and calculate the effect of DIBH upon the WBI setup error after the surgery.Methods We prospectively enrolled 15 patients with left breast cancer undergoing WBI after breast-conserving surgery,who met the requirement of D1BH.Treatment time was recorded,its correlation with the number of field and monitor unit was analyzed.Inter-fractional setup errors and PTV delineation were calculated using cone beam CT (CBCT).The accuracy of the position and dose of the heart during radiotherapy was verified by the imaging fusion of CBCT and CT images.The variables among groups were analyzed by non-parametric Firedman test.Results The average treatment time of DIBH radiotherapy was 4.6 minutes.The treatment time was correlated with the maximal and total number of sub-fields and total monitor units.During DIBH treatment,the mean cardiac displacement volume was 19.1 cm3(3.8％).The mean cardiac dose difference between CBCT and planning CT was 5.1 cGy,and there was no significant difference in the heart V5-V30.The mean inter-fractional system setup error (∑) and random setup error (σ) in the left-right (x),superior-inferior (y) and anterior-posterior (z) direction were ∑x 1.9 mm,∑y 2.1 mm,∑z 2.0 mm,σx 1.3 mm,σy 1.3 mm,σz 1.4 mm,respectively.The corresponding minimal margins for setup error were 5.7 mm,6.2 mm and 6.0 mm,respectively.Conclusion DIBH for WBI after breast-conserving surgery does not significantly prolong the treatment time.Treatment time is related to treatment plan.DIBH yields high inter-fractional reproducibility and protects the heart.

Cardiac dosimetry of deep inspiration breath-hold technique in whole breast irradiation for left breast cancer after breast-conserving surgery / 中华放射肿瘤学杂志

Objective To study the effect of deep inspiration breath-hold(DIBH)technique on the heart dose in whole breast irradiation(WBI)for left breast cancer after breast-conserving surgery, and to investigate the anatomical factors for heart dose. Methods Fifteen patients with left breast cancer who received WBI after breast-conserving surgery and met breathing control requirements were prospectively enrolled as subjects. Simulated CT scans were performed during free breathing(FB)and DIBH. The WBI plans were optimized based on DIBH images.The position,volume,and radiation doses to the heart and lung were compared between the status of FB and DIBH. Correlation of heart dose with various anatomical factors was analyzed in FB status. Between-group comparison of categorical data was made by nonparametric Wilcoxon rank test.A two-variable correlation analysis was made by the Pearson method.Results There was no significant difference in heart volume between the status of FB and DIBH(P=0.773).The volume of both lungs was significantly larger in DIBH status than in FB status(P=0.001). The mean and maximum doses and V5-V40for the heart,left anterior descending coronary artery,left ventricle,right ventricle,and left lung were significantly lower in DIBH status than in FB status(all P<0.05). The greater DIBH increased the lung volume,the greater the mean heart dose decreased. In FB status,the left breast volume,heart-to-lung volume ratio,distance between the inferior margins of breast and heart,and maximum heart margin distance showed a linear correlation with heart dose. Particularly, the heart-to-lung volume ratio and maximum heart margin distance were independently correlated with heart dose. Conclusions DIBH technique in WBI for left breast cancer after breast-conserving surgery significantly reduces heart and lung doses compared with FB. Changes in lung volume are the basis for improving the relative anatomical location of the heart. The heart-to-lung volume ratio and maximum heart margin distance may provide a reference for DIBH technique.

Intellectual Property Provisions Relating to Drug Regulation in the TPP Agreement / 中国药学杂志

OBJECTIVE: To study the intellectual property provisions relating to drug regulation in the TPP agreement, analysize the interaction mechanism between drug regulation and intellectual property rights on the basis of information sharing, study the possible impact, and then discusses the references to China. METHODS: This article analysizes the TPP final text and relevant research literatures, study the interaction mechanism between drug regulation and intellectual property rights and the possible impact of, and then discuss the relevantlaw of China. RESULTS: The TPP agreement provides several intellectual property provisions relating to drug regulation, demanding the concordant relation between the registration of pharmaceutical and patent protection period, drug data protection and patent protection, which will establish the interaction mechanism based on information sharing. The intellectual property provisions relating to drug regulation are a summary of the experience of the TPP parties forming a coordinated and interactive mechanism between encouraging innovation and ensuring drug safety and an attempt to a wide range practice, which will have abroad impact on the biopharmaceutical industry. CONCLUSION: Refer to the relevant experience in TPP agreement, China can amend the Pharmaceutical Administration Law and the Patent Law in the process of revision by improving the information sharing mechanism to achieve a higher level of institutional interaction.

Effect of deep inspiration breath-hold technique on dosimetry of target volume and organs at risk in mediastinal lymphoma irradiation / 中华放射肿瘤学杂志

Objective Objective To evaluate the effect of deep inspiration breath-hold technique (DIBH) on the dosimetry of target volume and organs at risk (OARs) in mediastinal lymphoma irradiation.Methods This was a prospectively study and five patients with stage Ⅰ and Ⅱ mediastinal lymphomas were included continuously.The absolute target volume,the absolute OAR doses,and the relative doses to volume were compared between DIBH and free-breathing (FB) scans,based on the principles of the affected site irradiation and the butterfly field.The differences were analyzed using paired t test.Results The median age of these five patients was 30 years.Compared with FB scan,DIBH scan led to significant decreases in the gross tumor volume (GTV)(Δ=29.4 cm3,P=0.006) and the planning target volume (PTV)(Δ=322 cm3,P=0.005) before chemotherapy,while no significant difference in clinical target volume (CTV) was found.Meanwhile,the lung volume of DIBH scan was significantly increased (mean Δ=1456 cm3,P=0.001),while the heart width of DIBH scan was significantly reduced (Δ=1.3 cm,P=0.012),as compared with those of FB scan.The mean doses to the lung and heart were significantly lower in DIBH scan than in FB scan (heart:8.5±4.7 Gy vs.11.6±4.7 Gy,P=0.022;lung:7.6±1.1 Gy vs.11.6±1.4 Gy,P=0.000).The absolute target volume of the heart was significantly reduced at V15 and above in DIBH scan than in FB scan (all P<0.05).Relative doses to volume of the lung and heart were significantly reduced at each dose level (from V5 to V35) in DIBH scan than in FB scan (all P<0.05).Conclusions DIBH technique can significantly reduce PTV,enlarge lung volume,and reduce the mean dose and relative doses to volume of the lung and heart at each level (from V5 to V35) compared with FB scan in mediastinal lymphoma radiation.

Evaluation of the effect of deep inspiration breath-hold on radiation therapy for left breast cancer and the correlation between cardiac chest wall contact distance and cardiac exposure / 中国综合临床

Objective To compare the exposure to heart and other organs of the application of DIBH (deep inspiration breath-hold)and FB(free breath)in the left breast cancer radiotherapy,and the relationship between CCD(cardiac contact distance)and heart dose was analyzed.Methods Thirty patients with left breast cancer were examined with CT scans using DIBH and FB respectively,and then the dose was calculated by TPS(treatment planning system).The dose of heart,left anterior descending branch and left ventricle were analyzed by DVH(dose volume histogram).FB-CCDax(Axial cardiac chest wall contact distance)and FB-CCDps(sagittal heart chest wall contact distance)in CT images were measured based on FB.Results The parameters showed that,in radiotherapy with the application of DBIH technology,the irradiated volume of heart, left anterior descending branch(LAD),left ventricle(LV)of were significantly lower than that in the organs in the FB,the mean dose(Dmean)of heart of the former was 0.8 Gy,compared with 2.7 Gy in the latter one(P<0.005).The Dmean of LAD was 4.0Gy,compared with 12.7Gy in the latter one(P<0.001); The Dmean of LV was 1.2Gy,compared with 3.6Gy in the latter one(P<0.005).In the DIBH and FB radiotherapy,the Dmean of the heart,left anterior descending branch and left ventricle was correlated with FB-CCDps,but not with FB-CCDax.Conclusion DIBH is a simple treatment technique that can effectively reduce the cardiac radiation dose without loss of target dose.FB-CCDps is a potential predictor of cardiac exposure,and the longer the FB-CCDps distance is,the higher the cardiac dose is.The study found that at least 70% of patients with left breast cancer would benefit from DIBH and reduce the radiation exposure to normal cardiac structures,so DIBH should be used as a routine clinical application.

Application of deep inspiration breath hold in postoperative radiotherapy for left-side breast cancer / 中华放射医学与防护杂志

Objective To investigate the dosimetric differences among three types of breath hold mode ( free breath:FB, thoracic deep inspiration breath hold: T-DIBH, abdomen deep inspiration breath hold:A-DIBH) and to explore the optimal breath hold method in the postoperative radiotherapy of left-side breast cancer patients with minimum dose to normal tissues and organs at risk. Methods A total of eighteen patients with left-side breast cancer patients who underwent postoperative radiotherapy were enrolled in this study. Three CT simulation scans with three different breath hold method ( FB, T-DIBH, and A-DIBH ) were performed for each patient. Dosimetric differences were compared among plans generated on these three different CT image sets. Results There was no significant difference in the volume, mean dose, and homogeneity of planning target volume ( PTV) among plans generated from three different image sets (P>0. 05). The mean heart dose, mean LAD dose and mean ipsilateral lung dose in plans generated from CT image sets with FB, T-DIBH and A-DIBH were (3. 21 ± 1. 02), (1. 74 ± 0. 51), (1. 31 ±0. 41) Gy (W =171, P <0. 05), (34. 61 ± 13. 51), (14. 38 ±10. 20), (9. 21 ± 6. 53) Gy (W=171, P<0. 05), and (8. 31 ±2. 75), (7. 46 ±1. 96), (6. 89 ±1. 79) Gy (W=171, P<0. 05), respectively. Conclusions Compared with plans with FB, plans with DIBH ( T-DIBH and A-DIBH ) achieved lower cardiac, LAD and pulmonary doses. A-DIBH achieved a better normal dose reduction than T-DIBH.

Influencia del tiempo inspiratorio prolongado durante la ventilación transoperatoria controlada por presión / The influence of lengthening the inspiration time during pressure-controlled intraoperative ventilation

Introducción: la enfermedad pulmonar obstructiva crónica es la sexta causa de muerte a nivel mundial. La prolongación del tiempo inspiratorio es una práctica con ventajas y desventajas. Objetivo: comparar los beneficios de diferentes tiempos inspiratorios sobre la oxigenación, las presiones en la vía respiratorias y las variaciones hemodinámicas. Métodos: estudio analítico longitudinal prospectivo con un grupo. Universo de 36 pacientes que cumplieron con los criterios de inclusión. Resultados: la media de la edad fue de 70,5 años ± 8,3 años, el 59 por ciento fueron mujeres. El 38,7 por ciento fueron hipertensos, y el 41,2 por ciento cardiópatas. Las presiones pico fueron de 26,6 mbar Ti corto y en el Ti largo 19,1 mbar (t student 1,28). Las medias de las presiones mesetas se comportaron diferentes con Ti corto de 20,6 mbar y Ti largo 19,6 mbar con t student de 0,04. Las medias de las frecuencias respiratorias en el Ti corto fueron de 12,6 resp/min y en el Ti largo 10,7 resp/min con t student fue de 5,92. La relación entre saturación de oxigeno/fracción inspirada de oxigeno en el Ti corto fue de 243 y en el Ti largo 248, pero la t student fue de 5,9. Conclusiones: la prolongación del tiempo inspiratorio durante la ventilación intraoperatoria controlada por presión en pacientes con enfermedad pulmonar obstructiva crónica es ventajosa porque reduce las presiones de la vía respiratoria y mantiene los parámetros de oxigenación y hemodinámicos con relación al tiempo inspiratorio convencional, por lo que pudiera ser una alternativa para el manejo anestésico de estos pacientes(AU)

Introduction: Chronic obstructive pulmonary disease is the sixth leading cause of death worldwide. Lengthening the inspiration time is a practice with advantages and disadvantages. Objective: To compare the benefits of different inspiration times on oxygenation, airway pressures and hemodynamic changes. Methods: Prospective longitudinal analytic study with a group. Sample group of 36 patients who met the inclusion criteria. Results: The mean age was 70.5 years ± 8.3 years, 59 percent were women. 38.7 percent were hypertensive, and 41.2 percent were cardiac patients. The peak pressures were 26.6 mbar in the short Ti and 19.1 mbar in the long Ti (Student's t-distribution was 1.28). The means of the plateau pressure behaved different: with short Ti, 20.6 mbar, and with long Ti, 19.6 mbar, with Student's t-distribution: 0.04. Mean respiratory rates in the short Ti were 12.6 breaths/min and in the long Ti, 10.7 breaths/min, with Student's t-distribution 5.92. The relation between oxygen saturation and fraction of inspired oxygen in the Ti short was 243 and in the long Ti was 248, but the Student's t-distribution was 5.9 t. Conclusions: Lengthened inspiratory time during intraoperative pressure-controlled ventilation in patients with chronic obstructive pulmonary disease is advantageous because it reduces the airway pressure and maintains oxygenation and hemodynamic parameters versus conventional inspiration time, so it could be an alternative for the anesthetic management of these patients(AU)