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The patient, a 56-year old male, was admitted to the hospital for recurrent bladder cancer in November 29, 2021. The patient had previously undergone partial cystectomy, simultaneous radio-chemotherapy to preserve the bladder, and repeated 4 times TURBt. CT suggested T 3 stage bladder cancer in left bladder wall, and causing left hydronephrosis. Under general anesthesia, robot-assisted laparoscopic radical cystectomy and complete intraperitoneal orthotopic ileal neobladder reconstruction were performed. The operation was successful, the postoperative recovery was good, and the patient was discharged 7 days after surgery. Postoperative pathological diagnosis was T 2b, high-grade urothelial carcinoma with left pelvic lymph node metastasis. Three months after operation, the patient had no recurrence, the new bladder function was good, the urine could be completely controlled during the day, and the intestinal and renal functions recovered well. At present, we carried out adjuvant chemotherapy (Gemcitabine+ Cisplatin)to this patient. The technical of radical cystectomy and orthotopic ileal neobladder with a history of surgery and radiotherapy is high, expensive experience in laparoscopic surgery and elaborate actions of robotic surgery are important prerequisites for completing such surgery.
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Parkinson's disease (PD) is the second most common neurodegenerative disease, but none of the current treatments for PD can halt the progress of the disease due to the limited understanding of the pathogenesis. In PD development, the communication between the brain and the gastrointestinal system influenced by gut microbiota is known as microbiota-gut-brain axis. However, the explicit mechanisms of microbiota dysbiosis in PD development have not been well elucidated yet. FLZ, a novel squamosamide derivative, has been proved to be effective in many PD models and is undergoing the phase I clinical trial to treat PD in China. Moreover, our previous pharmacokinetic study revealed that gut microbiota could regulate the absorption of FLZ
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Objective: To observe the time-effect relationship of moxibustion for primary dysmenorrhea (PD) due to stagnation and congelation of cold-damp, thus explore the optimal choice of moxibustion duration, and provide evidence for achieving satisfactory efficacy in moxibustion treatment. Methods: A total of 90 patients with PD due to stagnatin and congelation of cold-damp were divided into three groups by the random number table method, with 30 cases in each group. All the patients in the three groups were given moxibustion treatment at Guanyuan (CV 4), 20 min in group A, 40 min in group B and 60 min in group C. The changes in the pain measurement score in the three groups were observed after treatment. Results: After treatment, there were significant differences in the clinical efficacy among the three groups (P<0.05); the clinical efficacy was better in group B and group C than that in group A (P<0.05), and that in group B was better than that in group C (P<0.05). Besides, the pain measurement score changed significantly after treatment in the three groups (all P<0.05), and the between-group differences were also statistically significant (P<0.05); the pain measurement scores in group B and group C were lower than that in group A (P<0.05), and that in group B was lower than that in group C (P<0.05). Conclusion: Given the same stimulating frequency and intervention time of moxibustion, 40-minute duration demonstrates relatively better efficacy for PD due to stagnation and congelation of cold-damp.
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Interstitial permanent radioactive seed implantation delivers a high local dose to tumors and sharply drops off at surrounding normal tissues. Radioactive seeds implanted via ultrasound or computed tomography (CT) guidance are minimally invasive and facilitate quick recovery. Transrectal ultrasound-guided 125I seed implantation assisted by a transperineal plane template is standard for early-stage prostate carcinoma, with a highly consistent target volume dose distribution. The postplan dose evaluation is consistent with the preplan evaluation. Until now, there was no workflow for seed implantation elsewhere in the body, and it was difficult to effectively preplan for seed implantation because of patients' position changes, organ movement, and bone structure interference. Along with three-dimensional (3D) printing techniques and seed implantation planning systems for brachytherapy, coplanar and X Y axis coordinate templates were created, referred to as 3D-printed coplanar templates (3D-PCT). 125I seed implantation under CT guidance with 3D-PCT assistance has been very successful in some carcinomas. Preplanning was very consistent with postplanning of the gross tumor volume. All needles are kept parallel for 3D-PCT, with no coplanar needle rearrangement. No standard workflow for 3D-PCT-assisted seed implantation exists at present. The consensus topics for CT-assisted guidance compared to 3D-PCT-assisted guidance for seed implantation are as follows: Indications for seed implantation, preplanning, definition of radiation doses and dosimetry evaluation, 3D-PCT workflow, radiation protection, and quality of staff. Despite current data supporting 125I seed implantation for some solid carcinomas, there is a need for prospectively-randomized multicenter clinical trials to gather strong evidence for using 125I seed implantation in other solid carcinomas
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OBJECTIVE@#To explore the training mode of individual urine volume control, to take indi-vidual expected urine volume as the goal of bladder control in patients with urinary system tumors, and to improve the accuracy of bladder control during radiotherapy by active training of bladder receptivity.@*METHODS@#Twenty-five patients of urinary system tumors were enrolled from May 2019 to September 2019, of whom, 21 patients had prostate cancer, and 4 had bladder cancer. Training of bladder filling started before CT simulation. The patients were required to take the individual bladder filling as the training goal, and the optimal bladder volume range was suggested to be 200－400 mL. After 2－4 weeks of training, the prescribed volume of the bladder was determined according to the patient's bladder receptivity. The volume of the bladder was measured by images of plain CT and images 8-minutes after intravenous contrast injection. The patient's bladder volume was measured using BladderScan before treatment. CBCT (Cone-beam CT) was performed, and bladder volume was measured before treatment. The bladder volume was measured again using BladderScan after treatment.@*RESULTS@#The mean bladder volume of simulation (VCT01) was (262±130) mL, ranging from 78 mL to 505 mL. The mean self-evaluation bladder volume before radiotherapy (VEVA01) was (238±107) mL, ranging from 100 mL to 400 mL. The mean BladderScan measured volume before radiotherapy (VBVI01) was (253±123) mL, ranging from 60 mL to 476 mL. The mean cone-beam CT measured volume before radiotherapy (VCBCT) was (270±120) mL, ranging from 104 mL to 513 mL. There was a correlation between VEVA01 and VBVI01, VCT01 and VBVI01, VCT01, and VBVI01, and there was no significant difference in paired t-test. There was a correlation between differences of self-evaluation bladder volume before radiotherapy(VEVA01) and simulation CT (VCT01) and differences of self-evaluation bladder volume before radiotherapy (VEVA01) and cone-beam CT (VCBCT), and there was no significant difference in paired samples by t-test.@*CONCLUSION@#During radiotherapy for urinary system tumors, such as prostate cancer and bladder cancer, with the assistance of BladderScan, the patients could try to hold their urine moderately according to their conditions, and individualized bladder prescription may be beneficial to achieve stable bladder volume during radiotherapy.
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Humanos , Masculino , Tomografía Computarizada de Haz Cónico , Neoplasias de la Próstata , Planificación de la Radioterapia Asistida por Computador , Neoplasias de la Vejiga Urinaria/radioterapiaRESUMEN
Objective To compare the preoperative and postoperative dosimetric parameters in the treatment of spinal metastasis,and to verify the accuracy of 3D-printing non-coplanar template (3D-PNCT)combined with CT-guided 125I seed implantation for the treatment of spinal metastasis.Methods The treatment plans of 7 patients with spinal metastasis (9 lesions) from 2016 to 2018 receiving 3D-PNCT in combination with CT-guided 125I seed implantation were retrospectively analyzed.The dosimetric parameters including homogeneity index (HI),conformal index (CI),external index (EI),dose of 90％ target volume (Dg0),mPD,volume percent of 100％,150％,and 200％ prescribed dose V100、V150、V200 and D2cm3 of spinal cord were compared before and after operation.The british columbia cancer ageny particle implantation quality evaluation standard was applied to evaluate the quality of implantation.Results The HI,EI and CI,Dg0,mPD,V100,V150,V200 and D2cm3 of spinal cord did not significantly differ before and after the plan (all P＞0.05).Five were evaluated as excellent and 4 were assessed as good.Conclusion The postoperative dosimetric parameters of 3D-PNCT combined with CT guided 125I seed implantation of spinal metastasis are basically consistent with preoperative dosimetric parameters.The postoperative plans are evaluated as excellent or good,suggesting that the technology has a good therapeutic accuracy in the treatment of spinal metastasis.
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Objective@#To compare the preoperative and postoperative dosimetric parameters in the treatment of spinal metastasis, and to verify the accuracy of 3D-printing non-coplanar template (3D-PNCT) combined with CT-guided 125I seed implantation for the treatment of spinal metastasis.@*Methods@#The treatment plans of 7 patients with spinal metastasis (9 lesions) from 2016 to 2018 receiving 3D-PNCT in combination with CT-guided 125I seed implantation were retrospectively analyzed. The dosimetric parameters including homogeneity index (HI), conformal index (CI), external index (EI), dose of 90% target volume(D90), mPD, volume percent of 100%, 150%, and 200% prescribed dose V100、V150、V200 and D2cm3 of spinal cord were compared before and after operation. The british columbia cancer ageny particle implantation quality evaluation standard was applied to evaluate the quality of implantation.@*Results@#The HI, EI and CI, D90, mPD, V100, V150, V200 and D2cm3 of spinal cord did not significantly differ before and after the plan (all P>0.05). Five were evaluated as excellent and 4 were assessed as good.@*Conclusion@#The postoperative dosimetric parameters of 3D-PNCT combined with CT guided 125I seed implantation of spinal metastasis are basically consistent with preoperative dosimetric parameters. The postoperative plans are evaluated as excellent or good, suggesting that the technology has a good therapeutic accuracy in the treatment of spinal metastasis.
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The progression of hyperuricemia disease is often accompanied by damage to renal function. However, there are few studies on hyperuricemia nephropathy, especially its association with intestinal flora. This study combines metabolomics and gut microbiota diversity analysis to explore metabolic changes using a rat model as well as the changes in intestinal flora composition. The results showed that amino acid metabolism was disturbed with serine, glutamate and glutamine being downregulated whilst glycine, hydroxyproline and alanine being upregulated. The combined glycine, serine and glutamate could predict hyperuricemia nephropathy with an area under the curve of 1.00. Imbalanced intestinal flora was also observed. , , , , and other conditional pathogens increased significantly in the model group, while and , the short-chain fatty acid producing bacteria, declined greatly. At phylum, family and genus levels, disordered nitrogen circulation in gut microbiota was detected. In the model group, the uric acid decomposition pathway was enhanced with reinforced urea liver-intestine circulation. The results implied that the intestinal flora play a vital role in the pathogenesis of hyperuricemia nephropathy. Hence, modulation of gut microbiota or targeting at metabolic enzymes, , urease, could assist the treatment and prevention of this disease.
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Objective To verify the accuracy of three-dimensional printing coplanar coordinate template (3D-PCCT) technology for 125I seeds implantations in chest tumor at dosimetry level.Methods From January 2016 to June 2017,a total of 22 patients (15 males,7 females;median age 62 years) with chest tumors who received 3D-PCCT assisted 125I seeds implantation in Peking University Third Hospital were enrolled in this retrospective study.There were 8 patients with primary lung cancer and 14 with metastatic carcinoma.The sites for implantation included lung (12 cases),mediastinum (2 cases) and chest wall (8 cases).The prescribed dose was 110-180 Gy.The preoperative plan design,puncture and seeds implantation guided by template were carried out and the dose distribution of postoperative plan was compared with that of preoperative plan.Dose parameters included dose delivered to 90％ gross tumor volume (D90),minimum peripheral dose,the percentage of GTV receiving 100％ prescription dose (V100),the percentage of GTV receiving 150％ prescription dose (V150),conformity index,external index of target volume,uniformity index,D2 cm3 of spinal cord and aorta,and V20 of affected side lung.Wilcoxon signed rank test was used to analyze the data.Results The median D90 was 150.4(125.6,187.0) Gy.Postoperative D90 was higher than the prescribed dose in 68％ (15/22) cases.For median value of most parameters,there were no significant differences between the postoperative plans and preoperative plans (all P＞0.05) except for the actual V100,which was lower than the preplanned (95.5％ vs 97.2％;P=O.040).Conclusion 3D-PCCT could provide good accuracy in 125I seeds implantation for chest tumor.
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Objective To evaluate the clinical efficacy and safety of CT-guided 125 I seed implantation in the treatment of recurrent head and neck tumors after radiotherapy. Methods Clinical data of 101 patients who received CT-guided radioactive 125 I seed implantation for recurrent head and neck cancer after radiotherapy from 2007 to 2015 were retrospectively analyzed. The median accumulated dose of external radiotherapy was 66 Gy and the median dose after seed implantation (D90) was 117 Gy. The local progression-free survival and overall survival were analyzed by Kaplan-Meier method. Univariate analysis was performed by log-rank test and multivariate analysis was conducted by using Cox regression model. Results The median follow-up time was 12. 2 months. The 5-year local progression-free survival rate was 26. 6％.The 5-year overall survival rate was 15. 5％. Univariate analysis demonstrated that age,pathological type,implantation site,lesion volume,D90 and short-term efficacy were correlated with local control,and KPS score,lesion volume ,D90,and short-term efficacy were associated with survival (all P<0. 05). Multivariate analysis revealed that pathological type,lesion volume ,D90 and short-term efficacy were independent factors related to local control (P= 0. 000, 0. 002,0. 003 and 0. 014).In terms of the adverse events,skin/ mucosal ulceration was observed in 25. 7％ and pain occurred in 13. 9％ of all patients. No correlation was noted between the adverse events and dose.Conclusions CT-guided radioactive 125 I seed implantation is an efficacious and safe treatment of recurrent head and neck tumors after radiotherapy. Non-squamous carcinoma,small lesion volume and high dose (D90) indicate excellent local control.
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Objective To investigate the utilization rate of gold fiducial markers and reasons for abandonment of gold fiducial markers in the CyberKnife VSI System, and to provide reference data for implantation of gold fiducial markers and radiotherapy planning. Methods From March to August,2017,a total of 47 patients had gold fiducial markers implanted or pasted. In those patients, 42 patients had gold fiducial markers implanted,including 32 receiving computed tomography(CT)-guided 3D-printing coplanar template assisted implantation, 1 receiving CT-guided 3D-printing non-coplanar template assisted implantation,1 receiving CT-guided implantation,and 8 receiving ultrasound-guided implantation. A total of 44 patients received the CyberKnife treatment, including 2 patients who failed to use gold fiducial markers and were treated with spine tracking instead and 3 patients missing the treatment for other reasons. The numbers of utilized and abandoned gold fiducial markers were recorded for calculation of the utilization and abandonment rates. The reasons for abandonment of gold fiducial markers were analyzed and classified. Results A total of 134 gold fiducial markers were implanted into or pasted to the 44 patients.In all the gold fiducial markers, 111 were utilized and 23 abandoned, yielding a utilization rate of 82.8% and an abandonment rate of 17.2%.The reasons for abandonment of gold fiducial markers included large rigidity error(26.1%), unqualified implanted fold fiducial markers(17.4%), displacement of gold fiducial markers(26.1%), and others(30.4%). Conclusions Compared with the CT-guided or ultrasound-guided implantation of gold fiducial markers, the CT-guided 3D-printing coplanar or non-coplanar template assisted implantation of gold fiducial markers requires only two puncture needles for each implantation and implants two gold fiducial markers by a single needle,which reduces the number of puncture needles,risk of puncture-induced injury,and incidence of complications after implantation. Not all the gold fiducial markers implanted by a variety of ways will be utilized. Some gold fiducial markers will be abandoned for different reasons,which should be taken into account during implantation of gold fiducial markers.
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Objective To investigate the feasibility of 3D-printing coplanar coordinate template (3D-PCT) for guiding 125I radioactive seed implantation in the treatment of pelvic wall recurrence of cervical cancer on ensuring the accuracy of dose.Methods From Oct 2016 to Dec 2017 in Peking University Third Hospital,totally 10 patients with pelvic wall recurrent cervical cancer after radiotherapy were treated with 125I radioactive seed implantation assisted by 3D-PCT.The median age was 53.5 years old (37-71 years old).KPS score of the cohort were more than 70.All patients had received pelvic radiation therapy previously.The median volume of the lesion was 31.9 cm3 (3.5-58.0 cm3).The prescription dose was 120-180 Gy.The activity of seeds was 0.55-0.67 mCi(1 Ci =3.7 × 1010Bq),while the number of seeds was 12-81 (median 50) on preoperative plan.Radioactive seeds implantation was performed under 3D-PCT guidance according to the preoperative plan.The actual number of implanted seeds was 53 (10-82).Dosimetry parameters of preoperative plan and postoperative plan including D90,D100,V100,V150,V200,external index (EI),conformal index (CI),heterogeneity index (HI),and organat-risk doses of D2 cm3,D1 cm3 and D0.1 cm3 were compared using the nonparametric test.Results The seed number of postoperative plan was more than that of preoperative plan (Z =-2.255,P ＜ 0.05),but all of the dosimetric parameters showed no significant difference (P ＞ 0.05).D2 cm3 and D1 cm3 of rectum for postoperative plan were lower than that of preoperative plan (Z =-2.100,-2.240,P ＜ 0.05),while other dose parameters of normal tisssues showed no statistically significant difference (P ＞ 0.05).Conclusions Assisted by 3D-PCT for 125I radioactive seed implantation in pelvic wall recurrence of cervical cancer,the actual postoperative dose could meet the requirement of the preoperatie plan through the intraoperative optimization of dose.3D-PCT could ensure the precise of delivered dose of 125I radioactive seed implantation.
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Objective To compare the dose distribution of postoperative plans with preoperative plans of 3D-printing template (coplanar and non-coplanar) assisted and CT-guided 125I seed implantation for the treatment of soft tissue sarcoma,and to explore the accuracy of treatment at dosimetry level.Methods From December 2015 to July 2017,19 patients with soft tissue sarcoma (a total of 25 lesions)were treated with 3D printing template assisted and CT-guided 125I seed implantation in Peking University Third Hospital.All patients underwent preoperative assessment,CT simulation orientation,preoperative planning,3D-template printing,3D-template reduction,needle and seed implantation,postoperative dosimetry assessment,postoperative care and follow-up.The preoperative and postoperative dosimetric parameters were conpared.Ten cases of soft tissue sarcoma in superficial trunk or limbs were screened.Preoperative planning of coplanar template and non-coplanar template were designed respectively.The dosimetric parameters of preoperative planning guided of two templates were compared.Results Twentyfive 3D-printing templates were designed and constructed,and 25 lesions were totalled.There was no statistical difference between preoperative and postoperative dosimetric parameters.There was no statistical difference of the preoperative plan's dosimetric parameters between coplanar and non-coplanar in soft tissue sarcoma of superficial trunk/limbs.Conclusions The validation of actual dose distribution in postoperative plans assisted by 3D-printing template in 125I seed implantation showed that most of parameters could meet the expectation of preoperative plans,which indicated the improvement in accuracy for this new modality.For soft tissue sarcoma located in the superficial trunk/limbs,it was recommended to select the 3D-printing coplanar template firstly.
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Objective To analyze the qualified rate of the fiducial markers during 3D-printing co-planar template assisted CT-guided implantation in stereotactic body radiation therapy by CyberKnife,and to explore the cause of the unavailable markers in order to provide the reference for the fiducial implantation,treatment planning and radiotherapy delivery.Methods From March to December 2017,a total of 52 cases were planned to stereotactic body radiation therapy(SBRT) using CyberKnife by fiducial tracking,and the fiducial markers were implanted based on CT-guided 3D-printing co-planar template,including 22 in lung,12 in liver,5 in mediastinal lymph node,8 in retroperitoneal lymph node,3 in pancreas,each in celiac and pelvic lymph nodes,respectively.Except 7 cases not fit for CyberKnife treatment,45 cases finished the treatment of CyberKnife,but there were 3 cases changed to spine tracking due to unqualified fiducial markers.The number of fiducial markers used and the qualified rate of fiducial markers were analyzed,and the cause of unqualified fiducial markers was studied.Results A total of 131 fiducial markers were impanted into 42 cases who finally received the treatment of CyberKnife by fiducial tracking,including 85 fiducial markers qualified (64.89％) and 46 fiducial markers unqualified (35.11％).The main causes of the unqualified fiducial markers varied,including outrange of rigidity error(26.08％),fiducial markers unavailable(41.31％),and other (32.61％).Conclusions The 3D-printing co-planar template assisted CT-guided implantation could reduce the number of puncture needles used,help to decrease the risk of puncture and trauma and the incidence of complications after the fiducial markers implantation.However,the fiducial markers implanted by this way would be abandoned by a variety of causes and should be taken into account before the fiducial markers implantation.
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Objective To compare the dosimetric data between preoperative plans and postoperative verification in computed tomography (CT)-guided and 3D-printing non-coplanar templateassisted 125I seed implantation for pelvic tumor,and to explore the feasibility and accuracy of the personalized template designmethod.Methods A total of 51 patients registered from Dec 2015 to Dec 2016 who were applied with 3D-printing guided template assisted radioactive seed implantations in the hospital were included in this study.A prescribed dose of 110-160 Gy was adopted.3D-printing templates were designed and produced for 51 cases.The dosimetric parameters:Dg0,minimum peripheral dose (mPD),V100,V150,V200,conformal index (CI),external index (EI),and homogeneity index (HI) were compared between pre-and post-plans.Results 51 cases' templates were in place well during the operations.Compared with the preoperative planning,the postoperative D90,V100,V150,V200,CI,EI and HI differences had no statistical difference (P ＞ 0.05);mPD is larger than before (t =-2.96,P ＜ 0.05).Conclusions The main dosimetric parameters of postoperative verification were consistent well with the preoperative planning and have good accuracy,which could meet the clinical requirements.
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Objective To investigate the accuracy of 3D-printing non-coplanar template (3D-PNCT) assisted 125I seed implantation with CT guidance in the pelvic recurrent cervical between the preplan and post-plan dosimetric parameters.Methods Nine patients with pelvic recurrent cervical cancer received 125I seed implantation under CT guidance assisted with 3D-PNCT.A pre-plan based brachytherapy treatment planning system (B-TPS) assisted with 3D-PNCT for seed needle depth,direction and angle was designed.The dosimetry parameters including homogeneity index (HI),dose of 90％ target volume (Dg0),mPD,volume percent of 100％,150％ and 200％ prescribed dose V100,V150 and V200 and organ at risk between the pre-plan and post-plan were compared.Results Total seeds number was 675 (median 44,25-114) according to pre-plan,and 669 (median 47,25-113) seeds were implanted actually.138 needles need implant according to preplan,and 132 needles was implanted actually.The median angle deviation was 1.99 ° ± 2.94°(0 °-13 °).There was no significant difference of HI,EI and CI between perand post-plan.The differences of D90,MPD,V100,V150 and V200 between pre-and post-plan were not significant.Conclusions The confidence of pre-plan and post-plan for 3D-PNCT assisted 125I seed implantation in the pelvic recurrent cervical cancer could be accurately performed under CT guidance.
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Objective To investigate the acute side effect of 3D printing individual non-coplanar template for 125I seed implantation in head and neck recurrent/ metastatic carcinoma.Methods Between January 2016 and December 2016,42 patients of local recurrent malignant tumor of head and neck received 3D printing guide plate assist radioactive seeds implantations,and included in the study.The tumor volume ranged from 2.4 to 102.8 cm3 (median 28.6 cm3).The prescribed dose is 110-160 Gy,and the seeds activity were 0.34 to 0.70 mCi (1 Ci =3.7 × 1010 Bq).All patients carried out preoperative planning design,individual guide plate production,seed implantation,postoperative dose assessment,and followup.The side effects of skin,mucous membrane,blood and spinal cord were statistically analyzed.Results All patients were operated successfully.The follow-up time was 4-14 months (median 8.5 months).There were no adverse reactions at grade three or above.Three patients had grade one skin reaction.One patient experienced grade one mucosal reaction,two experienced grade two mucosal reactions.The skin response was correlated with the dose of the skin (x2 =7.067,P =0.032).No hematologic toxicity or radiation myelopathy was observed and no seed displacement was found.Conclusions 3D-printing guide plate can provide good accuracy for positioning and direction.For local recurrent malignant tumor of head and neck,there were no obvious adverse reactions and the operation was simple and the dosage was accurate.
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Objective To establish a model for the calculation of biologically effective dose (BED) and EQD2 (Equivalent dose in 2 Gy fractions) in radioactive seed implantation brachytherapy.Methods The BED formula for EBRT(external beam radiotherapy) and for continuous low dose-rate irradiation established under the L-Q model were introduced.The EDQ2 formula for the continuous low dose-rate irradiation (radioactive seed implantation) was established according to the definition of EQD2 and the formula of BED.The α/β values of common tissues and the Tr 1/2 values reported in the literature were summarized.The EDQ2 formula were further simplified by using the actual values.The empirical formula of EDQ2 for early reaction tissues and late reaction tissues were proposed,named as Wang-Peng empirical formula.EDQ2≈ (10/12) D (Wang-Peng Formula 1) was fit for early response tissue,and EDQ2≈ D/2 (Wang-Peng Formula 2) for late reaction tissues.Further examples on the clinical applications of the proposed formula were given,including primary lung cancer,supraclavicular lymph node metastasis of esophageal cancer and celic lymph node metastasis of cervical carcinoma.Results According to the Wang-Peng empirical formula,the EDQ2 of the late reaction tissue adjacent to the tumor was only about half that of the tumor tissue,so the radioactive seed implantation brachytherapy naturally protected the late reaction tissue by the biological equivalent dose.The actual calculation,showed that the empirical formula of early reaction tissue was more accurate,but the empirical formula of late reaction orgtissue was less inaccurate and could only be roughly estimated.Conclusions The BED calculation formula introduced here and the set of EQD2 calculation formula and Wang-Peng empirical formula established here were theoretically feasible and could be used for the conversion and superposition between the physical dose of radioactive seed implantation brachytherapy and the external irradiation dose.But it should be careful to apply the formula,pay attention to the default conditions,and carefully interpret the calculated results.
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Objective To investigate the influence of aspirin and/or clopidogrel treatment on platelet aggregation rate in coronary heart disease (CHD) patients,and discuss the factors related to anti-platelet drug resistance.Methods A total of 160 patients with CHD and received aspirin and/or clopidogrel treatment were enrolled in the Second Xiangya Hospital,Central South University,and were divided into stable coronary heart disease (SCHD) group (n =90) and acute coronary syndrome (ACS) group (n =70).Meanwhile,non-coronary heart disease (NCHD) patients who did not receive anti-platelet drug treatment were enrolled as controls (n =50).Clinical data of the subjects were recorded.The maximum platelet aggregation rate induced by arachidonic acid (MAR-AA) and adenosine diphosphate (MAR-ADP) were evaluated with sequential platelet counting method.The factors related to drug resistance were analyzed with Logistic regression analysis.Results Compared to NCHD group,there were lower MAR-AA and MAR-ADP in two groups of CHD (all P ＜ 0.05).In ACS patients,MAR-AA and MAR-ADP are significantly lower (P ＜0.05) in patients who receive the aspirin and clopidogrel.The rate of anti-platelet drug resistance in ACS group was significantly higher than that in SCHD group (20.0％ vs 10.0％,P ＜ 0.05).Multivariate logistic regression analysis showed that low HDL-C (＜ 1.0 mmol/L) was an independent risk factor related to the anti-platelet drug resistance (OR =4.36,95 ％ CI:1.36-14.02,P =0.025).Conclusions The antiplatelet treatment with aspirin and/or clopidogrel can significantly reduce the platelet reactivity in CHD patients,but some patients still present anti-platelet drug resistance.The combination of aspirin and clopidogrel is better.The rate of drug resistance in ACS patients is high.Low HDL-C might be associated with anti-platelet drug resistance.
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Objective To compare the pre-and post-operative tumor target volume and to examine the consistency in physical dosimetric parameters of organs at risk (OAR) following 3D-printed coplanar template (3D-PCT)-assisted and CT-guided radioactive seed implantation.Methods The 3D-printed coplanar template was designed using a computer software, and the coordinate system was established where the center was used as the basis for setting the x axis and y axis.Crosses defining the center of treatment were drawn on the patient''s body and matched with the corresponding central point, x axis, and y axis of the coplanar template.3D-PCT-assisted and CT-guided radioactive seed implantation was performed based on the pre-operative plan, and the pre-operative, operative, and post-operative plans were designed to evaluate the target tumor volume and the normal dose received by the tissues.In addition, dosimetric parameters, including D90(minimum dose received by 90% of the gross target volume), V100, V150, V200(percentage of GTV that received 100%, 150%, and 200% of the prescribed dose, respectively), minimum peripheral dose (MPD), conformal index (CI), external index (EI), and homogeneity index (HI) in the pre-operative and post-operative plans were also assessed and compared using the Wilcoxon test. Results Fourteen patients treated in our institution from August to October, 2016 were included in this study. The median age of the patients was 61.5 years, and the median Karnofsky Performance Scale score was 80. A total of 14 lesions from the 14 patients were treated by seed implantation in the neck (n=4), chest (n=3), abdomen (n=5), and pelvis (n=2). Of the 14 patients that underwent implantation, 8 had previously received radiation therapy, and 6 had not received radiation therapy. Dosage optimization was performed for all patients during the operation. The median activity of the implanted seeds was 0.625 mCi (0.55-0.75 mCi,1 Ci=3.7×1010 Bq), and the preoperatively planned median number of needling and implanted seeds were 9(4-34) and 45.5(10-162), respectively. However, the actual median number of needling and implanted seeds were 9.5(4-34) and 45.5(10-162), respectively. Dosimetric analysis showed that there were no significant changes in tumor volume (P=0.135), D90(P=0.208), MPD (P=0.104), V100(P=0.542), V150(P=0.754), V200(P=0.583), CI (P=0.426), EI (P=0.326), and HI (P=0.952) after implantation. Conclusions 3D-PCT guidance and dosage optimization can result in good consistency between pre-and post-operative plans for radioactive seed implantation. 3D-PCT is a convenient and cheap technique suitable for large-scale clinical application.