Verification Phantom-based clinical quality control and detection of the MLC of CyberKnife M6 / 中华放射医学与防护杂志

Objective:To provide a new morning check method for the output dose stability of the multileaf collimator (MLC) of the CyberKnife M6 (CK-M6) system.Methods:The CT images of a verification phantom with a size of 20 cm × 20 cm × 10 cm were transmitted into the Precision Treatment Plan ning System (ver. 1.1.1.1). The high-precision alignment between the accelerator output front and the fixed position of the phantom surface was achieved using the fiducial tracking method. A 10 cm × 10 cm radiation field was formed by the MLC and a DailyCheck plan with an output of 200 MU was designed. The repeatability, sensitivity, and accuracy of the DailyCheck plan were measured, and the CK-M6 system was continuously tested for one month using the artificial fixed method and the DailyCheck plan designed in this study. Results:The average and the standard deviation of 10 repeated measurements by the DailyCheck plan were 492.28 pC and 0.09, respectively, indicating good stability. There was a linear correlation between the measured values and the output dose, with a correlation coefficient of R2 > 0.999. Moreover, there was a position deviation of 2 mm between the phantom and the accelerator output front, and the result ant effect on the measured values was equivalent to a dose deviation caused by an output of 1.24 MU. The result from the continuous measurement of both the artificial fixed method and the DailyCheck plan fell within permissible limits, showing high consistency. Conclusions:The DailyCheck plan established through the fiducial tracking of a verification phantom can achieve the convenient, quick, and accurate daily detection of the output dose stability of the MLC of CK-M6. Therefore, this method can be widely applied in the clinical quality control of the CK-M6 system.

Preliminary clinical study on treatment of prostate cancer with Cyber-Knife / 中华放射医学与防护杂志

Objective To evaluate the safety and effectiveness of ultra-hypofractionated stereotactic body radiotherapy in the treatment of prostate cancer.Methods A total of 26 patients with prostate cancer treated with Cyber-Knife from May 2010 to May 2018 were analyzed retrospectively.The median age of the patients was 69 years old (range,57 to 87).Ultra-hypofractionated radiotherapy was delivered in five fractions of 7.0-7.5 Gy for a total dose of 35.0-37.5 Gy.Androgen deprivation therapy (ADT) was administered in combination with the Cyber-Knife.The primary endpoints were radiation toxicity,PSA-response,local control and symptom alleviation,while the secondary endpoints were progression-free survival and overall survival.Results No graded ≥ 3 acute and late radiation toxicities occurred during follow-up.The acute toxicity of Grades 1 and 2 was 38.4％ and 19.2％,while the late toxicity of Grades 1 and 2 was 30.8％ and 3.8％,respectively.At a median follow-up of 22.44 months,for patients with localized stage,PSA level was decreased significantly after radiotherapy (Z =2.900,2.794,2.510,2.090,P＜0.05).However,there was no statistically significant difference for the metastatic group (P＞ 0.05).Conclusions Ultra-hypofractionated stereotactic body radiotherapy is a safe and effective treatment for patients with prostate cancer.

Clinical efficacy of CyberKnife stereotactic body radiation therapy for hepatic hilar cancer / 中华放射肿瘤学杂志

Objective To evaluate the efficacy and safety of CyberKnife stereotactic body radiation therapy (SBRT) in the treatment of hepatic hilar cancer.Methods A retrospective study was performed on the clinical data of 36 patients with hepatic hilar cancer who were admitted to our hospital and treated with CyberKnife SBRT from 2009 to 2015.In the 36 patients,37 lesions were found with tumor diameters ranging from 1.5 to 5.5 mm (median diameter 3 cm).The Synchrony respiratory tracking system was used for 21 lesions in 20 patients,while the XSight spinal tracking system was used for 16 lesions in 16 patients.Local progression was evaluated based on contrast-enhanced computed tomography and/or magnetic resonance imaging.The Kaplan-Meier method was used to calculate local control (LC) and overall survival (OS) rates,and the log-rank test was used for survival comparison and univariate prognostic analysis.Results The median follow-up time was 12.7 months.The 1-and 2-year postoperative LC rates were 90％ and 76％,respectively.The 1-year OS and progression-free survival (PFS) rates were 63％ and 39％,respectively.The median OS and PFS times were 15.2 and 10 months,respectively.The incidence of grade 3 adverse reactions was 11％.Conclusions The CyberKnife SBRT is a safe and effective way to treat hepatic hilar cancer.

A dosimetric analysis of lung tissue in early stage non-small cell lung cancer patients treated by Cyberknife radiotherapy / 中华放射医学与防护杂志

Objective To analyze the radiation dose to the normal lung tissue of patients with early stage of non-small cell lung cancer treated by Cyberknife. Methods A retrospective analysis was conducted by summarizing the treatment plans of 264 patients with early stage non-small cell lung cancer from January 2011 to December 2013 in Tianjin Medical University Cancer Institute and Hospital. Sorted by the tumor volumes and locations, the Cyberknife plans were evaluated by means of dose volume histograms ( DVH) , homogeneity indexes ( HI) , percentage volumes receiving at least x Gy ( Vx ) of dose, i. e. , V5 , V10 , V20 , and V30 of the ipsilateral and contralateral lungs. For the tumors approximate to the hilus, the contralateral lungs were included in the optimization process, and the dose-volume metrics were analyzed for the contralateral and bilateral lungs. Results For the tumors close to the chest wall, V5≥(15. 21 ± 3. 12)％ in ipsilateral lung tissue and V5≥(1. 34 ± 0. 67)％ in contralateral lung tissue were observed. For the tumors near the hilus, V5≥(39. 4 ± 11. 90) ％ in ipsilateral lung tissue and V5≥(1. 48 ± 0. 34) ％ in contralateral lung tissue were observed. The irradiated volume ratios of both ipsilateral and contralateral lung tissue increased with the enlargement of tumor sizes. After including the contralateral lung tissue into the optimization, the irradiated volume ratios of the contralateral and bilateral lung tissue (V5,V10) decreasedsignificantly(t=2.44,4.81,3.53,3.17,P<0.05). Conclusions Higherriskof radiation injury in both ipsilateral and contralateral lung tissue can be expected for tumors near the hilus than near the chest wall. After including contralateral lung tissue into the planning optimization, lower dose to the contralateral and whole lung tissue was achieved, indicating a better protection of normal lung tissue.

Prevention of radiative Rhinitis in Patients with Nasopharyngeal carcinoma by psychological Intervention combined with cod liver oil ointment / 中国生化药物杂志

Objective To investigate the preventive effect of psychological intervention combined with cod liver oil ointment on radiation nasal inflammation in nasopharyngeal carcinoma patients. Methods 90 patients with nasopharyngeal carcinoma treated in our hospital from January 2015 to December 2016 were randomly divided into study group and control group. The control group was treated with nasopharyngeal irrigation. The study group was given psychological intervention combined with cod liver oil ointment. Results The treatment effect of the study group was significantly better than that of the control group, and the incidence of radiation rhinitis was significantly lower than that of the control group. There was no significant difference between the two groups before the endoscopic score, the CT score of the sinus and the cilia transmission rate Improved, the study group was significantly better than the control group(P<0.05); before treatment, the two groups of patients with no significant differences in clinical symptoms, after treatment have been improved, the study group was significantly better than the control group(P<0.05). Conclusion The application of psychological intervention combined with cod liver oil ointment in radiotherapy of nasopharyngeal carcinoma is beneficial to prevent radiation rhinitis and improve the function of sinus function.

Clinical study of peripheral blood T cell subsets in patients with malignant lymphoma by flow cytometry / 实用肿瘤学杂志

Objective The aim of this study was to investigate the effect of flow cytometry on peripheral blood T cell subsets in patients with malignant lymphoma and its relationship with clinicopathological and tumor types.Methods Ninety-eight patients with malignant lymphoma treated in our hospital from August 2014 to September 2016 were selected as the study group.Ninety-eight healthy subjects were selected as the control group.The peripheral blood T cell subsets(CD3 +,CD4 +,CD8 +,CD4 +/CD8 +)were detected in patients and healthy controls by flow cytometry.Results The levels of CD3 +and CD4 +/CD8 +in the study group were (55.63±11.25)and(1.32±0.62),respectively,which were significantly lower than those(68.96±12.63)and (1.59±0.59)of the control group(P<0.05).The levels of CD4 +and CD8 +were(33.67±8.14)and(26.02±4.67),respectively in the study group,were no difference from the control group(34.12±8.33)and(25.67±4.53)(P>0.05).The levels of CD3+and CD4 +/CD8 +in patients with Hodgkin's lymphoma were(54.63±11.36),(1.22±0.65),respectively,and(55.52±12.02),(1.34±0.71)for non-hodgkin lymphoma.They were significantly decreoseg in the control group(68.96±12.63 for CD3 +and 1.59±0.59 for CD4 +/CD8 +) (P<0.05).The level of CD4 +and CD8 +were no difference amoupst Hodgkin's lymphoma(33.78±8.23 for CD4 +and 25.74±4.88 for CD8 +),non-Hodgkin's lymphoma(25.74±4.88 for CD4 +and 33.62±8.74 for CD8 +)and control group(34.12±8.33 for CD4 +and 25.67±4.53 for CD8 +)(P>0.05).The levels of CD3 +,CD4+and CD4 +/CD8 +in patients with Ⅲ ~Ⅳ stage malignant lymphoma were(52.66±12.47), (28.25±6.32)and(1.30±0.62),respectively,which were significantly lower than those(68.96±12.63), (34.12±8.33)and(1.59±0.59)in the control group(P<0.05).The level of CD3 +in patients with phase Ⅰ-Ⅱ malignant lymphoma(58.63±11.85)was significantly lower than that in the control group(68.96±12.63)(P<0.05).The level of CD8 +in patients with phase Ⅰ-Ⅱ malignant lymphoma(29.63±3.57)was significantly higher than that in the control group(25.67±4.53)(P<0.05).Conclusion The detection of peripheral blood T cell subsets by flow cytometry can be used as an important methods to diagnose the disease,staging and immune status of patients with malignant lymphoma,which has high application value.

Clinical study of peripheral blood T cell subsets in patients with malignant lymphoma by flow cytometry / 实用肿瘤学杂志

Objective The aim of this study was to investigate the effect of flow cytometry on peripheral blood T cell subsets in patients with malignant lymphoma and its relationship with clinicopathological and tumor types.Methods Ninety-eight patients with malignant lymphoma treated in our hospital from August 2014 to September 2016 were selected as the study group.Ninety-eight healthy subjects were selected as the control group.The peripheral blood T cell subsets(CD3 +,CD4 +,CD8 +,CD4 +/CD8 +)were detected in patients and healthy controls by flow cytometry.Results The levels of CD3 +and CD4 +/CD8 +in the study group were (55.63±11.25)and(1.32±0.62),respectively,which were significantly lower than those(68.96±12.63)and (1.59±0.59)of the control group(P<0.05).The levels of CD4 +and CD8 +were(33.67±8.14)and(26.02±4.67),respectively in the study group,were no difference from the control group(34.12±8.33)and(25.67±4.53)(P>0.05).The levels of CD3+and CD4 +/CD8 +in patients with Hodgkin's lymphoma were(54.63±11.36),(1.22±0.65),respectively,and(55.52±12.02),(1.34±0.71)for non-hodgkin lymphoma.They were significantly decreoseg in the control group(68.96±12.63 for CD3 +and 1.59±0.59 for CD4 +/CD8 +) (P<0.05).The level of CD4 +and CD8 +were no difference amoupst Hodgkin's lymphoma(33.78±8.23 for CD4 +and 25.74±4.88 for CD8 +),non-Hodgkin's lymphoma(25.74±4.88 for CD4 +and 33.62±8.74 for CD8 +)and control group(34.12±8.33 for CD4 +and 25.67±4.53 for CD8 +)(P>0.05).The levels of CD3 +,CD4+and CD4 +/CD8 +in patients with Ⅲ ~Ⅳ stage malignant lymphoma were(52.66±12.47), (28.25±6.32)and(1.30±0.62),respectively,which were significantly lower than those(68.96±12.63), (34.12±8.33)and(1.59±0.59)in the control group(P<0.05).The level of CD3 +in patients with phase Ⅰ-Ⅱ malignant lymphoma(58.63±11.85)was significantly lower than that in the control group(68.96±12.63)(P<0.05).The level of CD8 +in patients with phase Ⅰ-Ⅱ malignant lymphoma(29.63±3.57)was significantly higher than that in the control group(25.67±4.53)(P<0.05).Conclusion The detection of peripheral blood T cell subsets by flow cytometry can be used as an important methods to diagnose the disease,staging and immune status of patients with malignant lymphoma,which has high application value.

Clinical observation on the treatment efficacy of Cyberknife for iliac lymph node metastasis / 中华放射医学与防护杂志

Objective To evaluate the response rate and efficacy of Cyberknife in the treatment of iliac lymph node metastases (ILNM).Methods Twenty-two patients with 27 ILNM were treated by Cyberknife from May 2010 to May 2016.Tumor volume range from 0.88 to 125.66 cm3 (median 18.87 cm3).The total doses ranged from 21 to 51 Gy (median 39 Gy) and biological effective doses from 35.7 to 100 Gy (median 72.6 Gy) in 3-8 fractions (median 5).Sixty-four percent to eighty-two percent (median 72％) isodose line covered planning target.The survival rates were calculated by Kaplan-Meier method and compared with Log-rank test.Results Follow-up time ranged from 8 to 97 months (median 33 months).The complete response,partial response,stable disease and progression disease rates were 37％,48％,7.5％,48％,respectively.In addition,effective rate was 92.5％.Overall survival range from 4 to 68 months (median 21 months).The 1-,2-,3-year local control rate was all 90.6％ and the survival rates were 78.8％,60.6％ and 43.3％,respectively.Adverse reactions after treatment were gastrointestinal reactions such as nausea,vomiting,fatigue.The chemotherapy before Cyberknife helped to improve overall survival.The patients with backache or edema of lower extremity got rapid relief after treatment.Conclusion The treatment of ILNM with Cyberknife has provided a high response rate with minimal side effects.Cyberknife is a safe and effective local treatment method for ILNM.

Clinical efficacy of CyberKnife radiotherapy for locally advanced pancreatic carcinoma / 中华放射肿瘤学杂志

Objective To assess the efficacy and safety of CyberKnife radiotherapy in the treatment of locally advanced pancreatic carcinoma. Methods The data of 59 patients with locally advanced pancreatic carcinoma who were treated with CyberKnife radiotherapy from 2006 to 2014 were retrospectively analyzed. The tumor volume ranged from 13?? 0 cm3 to 125?? 1 cm3 with a median value of 27?? 1 cm3 . A dose of 35?50 Gy (median value= 45 Gy) in 3?8 fractions (median value = 5 fractions) was prescribed. The tumor progression was evaluated based on computed tomography. The overall survival (OS) and local progression?free survival ( LPFS) rates were calculated using the Kaplan?Meier method. Results The 1?and 2?year sample sizes were 26 and 17, respectively. The 1?and 2?year OS rates were 54% and 35%, respectively, while the 1?and 2?year LPFS rates were 91% and 70%, respectively. The median OS and LPFS times were 12?? 5 and 10?? 9 months, respectively. The overall incidence of grade 1?2 acute and late gastrointestinal toxicity was 61%. One patient with grade 3 late gastrointestinal toxicity had incomplete intestinal obstruction. Conclusions CyberKnife radiotherapy can achieve excellent treatment outcomes and mild complications in the treatment of locally advanced pancreatic carcinoma.

Robotic stereotactic irradiation and reirradiation for spinal metastases: safety and efficacy assessment / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Spine is the most common site of bone metastases in patients with cancer. Conventional external beam radiotherapy lacks precision to allow delivery of large fraction radiation but simultaneously limit the dose to spinal cord. The purpose of this study was to evaluate the safety and efficacy of CyberKnife(®) radiation therapy for spinal metastases.</p><p><b>METHODS</b>Seventy-three lesions in 62 patients treated with CyberKnife radiotherapy from September 2006 to June 2010 for spinal metastases were retrospectively reviewed. Thirteen tumors in 12 patients had received prior radiation. Patients were followed clinically and radiographically for at least 12 months or until death. In all patients, the spinal cord and thecal sac were contoured for dose-volume constraints, and maximum doses to 0.1, 0.5, 1, 2, and 5-ml volumes were analyzed.</p><p><b>RESULTS</b>Using the CyberKnife System, 20-48 Gy in one to five fractions for unirradiated patients, and 21-38 Gy in one to five fractions for the previously irradiatied patients, were delivered. Median 2-Gy normalized Biological Equvalent Dose (nBED) of unirradiated targets and irradiated targets were 49.6 Gy10/2 (range, 31.25-74.8 Gy10/2) and 46.9 Gy10/2 (range, 29.8-66 Gy10/2), respectively. With a median follow-up of 9.4 months (range, 2.5-45 months), twenty-nine patients (46.7%) were alive, whereas the others died of progressive disease. Fifty-six patients (93.3%) reported complete or partial reduction of pain after CyberKnife radiotherapy at one-month follow-up, 17 patients (28.3%) reported some degree of pain relief after first fraction of the treatment course. Two patients experienced local recurrence at fifth and ninth months post-radiotherapy. Median maximum nBED for spinal cord and thecal sac of naive targets were 68.6 Gy2/2 (range, 8.3-154.5 Gy2/2) and 83.5 Gy2/2 (range, 10.5-180.5 Gy2/2), respectively. Median maximum nBED for spinal cord and thecal sac for the re-irradiated targets were 58.6 Gy2/2 (range, 17.7-140 Gy2/2) and 70.5 Gy2/2 (range, 21.7-141.3 Gy2/2), respectively. No patient developed radiation related myelopathy during the follow-up period.</p><p><b>CONCLUSION</b>Cyberknife radiotherapy is clinically effective and safe for spinal metastases, even in previously irradiated patients.</p>

Analysis of glycosylation hemoglobin by capillary electrophoresis / 国际检验医学杂志

Objective To discuss the application value of the capillary electrophoresis in detecting the glycosylation hemoglobin (HbA1c)level.Methods By utilizing the uncoated fused silica capillary column(30 cm in length and 25 μm in diameter)and the specific adsorption peak,the HbA1c levels in the healthy people,patients with diabetes mellitus(DM)and high risk people were de-tected by the photodiode array(PDA)method at the wavelength of 415 nm.During the research process,the precision and accuracy were perfomred the accuracy analysis.Results HbA1c could be effectively separated from non-HbA1c,with a sharp peak.And the relative quantity of HbA1c could be determined.Conclusion The capillary electrophoresis is characterized by specificity,high precision,and high accuracy.Therefore,it should be widely applied in clinic.

Medium-and long-term results of one-stage debridement and total hip arthroplasty for advanced active tuberculosis of the hip / 中华骨科杂志

Objective To observe the medium-and long-term results of one-stage debridement and total hip arthroplasty (THA) for advanced active tuberculosis of the hip.Methods From January 2002 to December 2008,8 patients (9 hips) with advanced active tuberculosis of the hip underwent one-stage debridement and THA in our hospital.There were 5 males and 3 females,aged from 18 to 59 years (average,39.6 years).According to Babhuulkar and Pande imaging classification,there were 1 case of grade Ⅲ and 7 cases of grade Ⅳ.All patients had hip pain,which got serious during active and passive motion.All patients had dysfunction in stretch,abduction,rotation and flexion of the hip,and the flexion deformity ranged from 30° to 70° (average,46°).Thomas sign were positive in all patients.The erythrocyte sedimentation rate ranged from 45 to 125 mrr/1 h.The results of tuberculin test were all positive.X-rays showed osteoclasia,narrowing or disappearance of the joint space and surrounding abscess in all patients.The diagnosis of hip joint tuberculosis was confirmed by postoperative pathological examination in all patients.All patients were treated with antituberculous medications for 12 to 18 months,including preoperative IRES (≥ 2 weeks) and postoperative IRES (3 months),IRE (6 to 9 months) and IR (3 to 6 months).Results All patients were followed up for 50 to 150 months (average,88.8 months).One-stage healing of incision was obtained in all patients.X-rays showed no signs about loosening of prosthesis and recurrence of tuberculosis.The erythrocyte sedimentation rate returned to normal range within 6 months after operation.The average Harris score improved from preoperative 25.78±16.15 to 94.78±2.91 at final follow-up,and the difference was significant.Conclusion Under the standard antituberculosis chemotherapy,the one-stage debridement and THA are safe and feasible for advanced active tuberculosis of the hip,which can result in satisfactory medium-and long-term resuits.

Evaluation of extra absorbed dose generated by image guided system of the Cyberknife / 中华放射肿瘤学杂志

Objective To evaluate quantitatively the extra absorbed dose generated by image guided system of the Cyberknife.Methods The exposure parameters and the average frequency of images acquisition during the treatments with G3 Cyberknife in 300 cases with various tumor locations and tracking modes were collected for analysis ;The measurements of the absorbed doses in the phantom with 5 points after single exposure generated by image guided system in various exposure parameters were performed with equipment of phantom CIRS Model 002LFC and 002 PRA with ion chamber PTW30010 included.Based on the data we collected andmeasured,the conclusion of how much extra absorbed dose generated by image guided system of Cyberknife the patients received during Cyberknife treatments was drawn.Results With an average fractions of 3.94(the median was 4),the average exposure frequency was 36.5 times for static tracking per patient per fraction,while it was 49.2 times for dynamic tracking.The experimental results with various exposure parameters,positions and tissue densities showed that the minimum absorbed dose after single exposure was 0.5 μGy,while the maximum was 385 μGy.Conclusions The image guided system of the Cyberknife can induce quite low absorbed dose in patient,while providing all three types of image guided function.

Impacts of different tracking methods on short-term therapeutic effect of cyberknife in treatment of lung cancer / 中华放射肿瘤学杂志

Objective To investigate the impacts of fiducial tracking and X-sight tracking on the short-term therapeutic effect of cybernikife in the treatment of lung cancer.Methods Retrospective analysis was performed on 64 lung cancer patients (72 lesions),including 40 primary tumor patients (41 lesions) and 24 metastatic tumor patients (31 lesions),who were treated with cyberknife.Fiducial tracking was used for 45 lesions,while X-sight tracking was used for 27 lesions.The planning target volume was covered by 70％-94％ (median 80％) isodose contour.The irradiation dose was 60 Gy/3 fractions.The relationship between short-term therapeutic effect and tracking method was determined.Results Overall,the lesions undergoing fiducial tracking showed significantly higher response rate than those undergoing X-sight tracking (93％ vs.74％,x2 =6.84,P=0.033),and so was in lower lung lesions (15％ vs.7％,x2 ＝7.18,P=0.028).But the two tracking methods achieved similar effects in upper lung lesions (28％ vs.12％,x2 =2.36,P =0.310).In the lesions with treatment volumes smaller than 15 cm3,the fiducial tracking achieved significantly higher response rate than the X-sight tracking (25 ％ vs.12％,x2 =6.53,P =0.038),but the two tracking methods achieved similar effects in the lesions with treatment volumes not smaller than 15 cm3 (17％ vs 8％,x2 =1.57,P =0.460).Overall,the lesions undergoing X-sight tracking had significantly highertreatment failure rate than fiducial tracking (1 9 ％ vs.2 ％,x2 =6.33,P =0.021).Conclusions Different tracking methods may lead to different therapeutic effects of cyberknife in the treatment of lung cancer,which are related to lesion location and treatment volume.

Value of local progression-free survival for evaluating local outcome of peripheral lung cancer treated by cyberknife / 中华放射肿瘤学杂志

Objective To investigate the value of local progression-free survival (LPFS) for evaluating the local long-term outcome of peripheral lung cancer treated by cyberknife.Methods Retrospective analysis was performed on the clinical records of 81 cyberknife-treated lung cancer patients (90 foci),including 43 primary lung cancer patients (43 foci) and 38 metastatic lung cancer patients (47 foci).Of all the patients,58(63 foci) were treated at a dose of 60 Gy/3 fractions (20 Gy/fraction),and 23 (27 foci) at a dose of 54 Gy/3 fractions (18 Gy/fraction).The short-term treatment outcome and LPFS were used as the indices for observation;a logistic regression was used for analyzing the predictive value of LPFS for local long-term treatment outcome.Results After the evaluation of short-term treatment outcome,63％ of all the foci needed further evaluation.As the follow-up lasted,the number of foci which needed further evaluation decreased,most rapidly during 0.5-2 years after treatment.Re-evaluation results had predictive value for the treatment outcome in the subsequent follow-up,but the predictive value declined as the follow-up lasted.Conclusions LPFS is a recommendable index for evaluating the local outcome of primary or metastatic lung cancer treated by cyberknife,and it also has predicative value for local long-term treatment outcome.

Lung Injury and aquaporin-1mRNA expression during cardiopulmonary bypass / 中华胸心血管外科杂志

Objective To testify the lung injury induced by cardiopulmonary bypass(CPB) in canine model and observe the influence of CPB on the aquaporin-1 ( AQP1 ) mRNA expression in canine lung. Methods 8 mongrel dogs were used to perform the cardiopulmonary bypass. The hearts arrested for 90 minutes with mild hypothermia and rebeated for 6 hours. The hemodynamics, the ratio of lung dry weight and wet weight, the plasmic osmotic pressure, and the characteristics of light and fine structure were analyzed. The retro-transcription polyase chain reaction ( RT-PCR ) was used to measure the expression of AQP1 mRNA during the CPB. Results The hemodynamic data were stable in different time point during the CPB (P ＞0.05 ). The ratio of lung dry weight and wet weight was getting lower ( P ＜0.001) and the plasmic osmotic pressure was getting higher due to the prolongation of the CPB time and reperfusion time ( P ＜0.01). The light and electron microscopy showed the prominent aggregation of the white blood cell, severe interstitial edema and mild tear of respiratory membrane after 3 hour and 6-hour rebeat. AQP1 mRNA expression in lung was downregulated, 78.4% after 3-hour reperfusion and 55.5% after 6-hour reperfusion respectively, comparing to the level before CPB. Conclusion We recognize that the lung injury and lung edema were severe following 3-hour and 6-hour rebeat in CPB and hypothesize that the down-regulation of lung AQP1 mRNA expression may be a sign of pulmonary interstitial capillary injury induced by CPB.

Impact of number of implanted fiducials on image target localization accuracy / 中华放射肿瘤学杂志

Objective To find a proper number of implanted fiducials in order to reconcile both more accurate image tacking and less pain for the patients.Methods The phantom was made of two parts of different materials.The inner part was a ball-cube phantom developed by Accuray Corporation, which could be regarded as a rigid body, with 5 fiducials inside using as the reference to align the whole phantom in the experiment.The outer part was made of additional silicone rubber with two components to simulate soft tissue as a non-rigid body, which was implanted with 8 fiducials inside.All combinations of different number of fiducials were tracked to aquire the target location information, which were then compared with the reference position that was set by the inner 5 fiducials to obtain the deviations of the translation and the rotation parameters.Thus the impact of the number of fiducials on image target localization accuracy could be analyzed easily.Results When 4 fiducials are used for tracking, the decline of translation and rotation errors for every fiducial is largest (0.086 mm and 0.033°).The translation error was decreased by 0.343 mm from 1 to 4 fiducials, while by only 0.077 mm from 4 to 8 fiducials;the same decline was observed for rotation errors (0.131° for 3 to 4 fiducials , and 0.09° for 4 to 8 fiducials , respectively) .Conclusions When 4 fiducials are used for tracking, the decline of errors for every fiducial is maximum.When one more fiducial is adding, the image target localization accuracy can be enhanced obviously from 1 to 4 fiducials, but not as obvious for more than 4 fiducials.

Operative treatment of hip dislocation combined with acetabular fractures / 中华创伤杂志

Objective To evaluate the cLinical outcome and influencing factors of open reduction and internal fixation in treatment of hip dislocation combined with acetabular fractures. Methods A retrospective analysis was performed on 51 patients with hip dislocation combined with twetabular frac-tures, who were treated with open reduction and internal fixation under general anesthesia in the emergen-cy department on admission. Of all, 41 patients were treated with open reduction and plate/screw internal fixation, for which the reduction result was evaluated by postoperative X-rays and follow up X-rays accord-ing to Matta's criteria and the functional outcome by Merle d' Aubigne's criteria. Results Of 41 pa-tients, 33 were followed up for 1-7 years (mean 3.1 years). X-ray evaluation showed anatomic reduction in 27 patients (82%), imperfect reduction in five (15%) and poor reduction in one (3%). The clini-cal outcome at the time of final follow-up was graded as excellent in 18 patients (55%), good in 8 (24%), mederate in 3 (9%) and peor in4 (12%), with total excellence rate of 79%. Conclusion Prompt reduction of hip dislocation, precise reduction of the acetabular fracture and decrease of periopera-tive comphcations are key to excellent clinical outcome.

An initial report of cyberknife radiosurgery treatment in early stage lung cancer / 中华放射肿瘤学杂志

Objective To study the efficacy and toxicity of the cyberknife in the treatment of medically inoperable patients with early stage lung cancer. Methods From September 2006 to July 2007,17 patients with clinical stage Ⅰ a- Ⅰ b lung cancer were treated with cyberknife at Tianjin Cancer Hospital. Of the 11 patients receiving CT guided biopsy, 3 were squamous cell cancer and 8 were adenocarcinoma. Six patients refused intrusive operation and were diagnosed by PET-CT scan. All patients were medically inoperable evaluated by a thoracic surgeon. The PTV = GTV + 3 ～ 5 mm, and the median volume of PTV was 36 cm3 (6-82 cm3 ). The median total prescription dose was 50 Gy(45-60 Gy) at 3-5 fractions. Results The median follow-up time was 7 months (3-11 months). All the patients finished the treatment and were alive by the last follow-up. Slight fatigue was the most common complain. Evaluated by CT scan, 13 were complete response and 4 were partial response. No recurrence, progression or distant metastasis occured. There were 3 patients with grade Ⅰ granulocytopenia,3 grade Ⅰ pneumonitis and 1 grade Ⅱ pneumonitis. Conclusions The cyberknife radiosurgery treatment in early stage lung cancer shows a high rate of local control and minimal toxicity. Long time follow-up is necessary to evaluate the survival data and late toxicity.

Aquaporins in lung / 中国病理生理杂志

Aquaporins (AQPs) is a novel family of membrane protein which is in charge of the transportation of water across the membranes. It has been testified that AQPs may be related to many physiological functions and pathophysiological disorders. In lung, 6 subtypes of AQPs were found, 4 of which have been located in certain tissue. AQP1, AQP3, AQP4 and AQP5 are located in upper respiratory tract and may contribute to the mucus production, bronchial moisturizing and gland secretion. AQP1 and AQP5 are located in lower respiratory tract and may participate in directing the water movement across the blood-gas barrier. AQPs in natal lung may be an important factor to accelerate the reabsorption of the lung liquid. In adult, some diseases such as asthma, pulmonary edema, adult respiratory distress syndrome, which have been considered unbalanced water movement, may be also concerned with AQPs. The relationship between lung edema and AQPs have not been elucidated in details. It should be verified how AQPs work in more organs and tissues as well as in some diseases.