Analysis of the rectum and bladder changes in prostate precise radiotherapy under the bowel and bladder preparation / 中华放射肿瘤学杂志

Objective:To analyze the clinically acceptable and reproducible bladder and rectum volumes of prostate cancer patients during radiotherapy under bladder and bowel preparation, aiming to provide quantitative indicators for bowel and bladder preparation before and after radiotherapy.Methods:Clinical data of 275 prostate cancer patients with strict bladder and bowel preparation and completion of whole course radical radiotherapy at Sun Yat-sen University Cancer Center from April 2015 to December 2020 were retrospectively analyzed. Patients were scanned with cone beam CT (CBCT) before each treatment and the setup error was recorded. Sixty-six patients were selected by simple random sampling and the bladder and rectum on daily CBCT was outlined using MIM software. The relationship between the ratio of daily bladder or rectum volume to the planned bladder or rectum volume (relative value of volume) and setup error was analyzed. Quantitative data were expressed as mean±SD. Normally distributed data were analyzed by paired t-test while non-normally distributed data were assessed by Kruskal-Wallis test.Results:The bladder and rectum volume on planning CT were (370.87±110.04) ml and (59.94±25.07) ml of 275 patients. The bladder and rectum volumes on planning CT were (357.51±107.38) ml and (65.28±35.37) ml respectively of the 66 selected patients with 1611 sets of CBCT images. And the bladder and rectum volumes on daily CBCT were (258.96±120.23) ml and (59.95 ± 30.40) ml. The bladder volume of patients was decreased by 3.59 ml per day on average during the treatment and 0.37 ml for the rectum volume. According to the bladder volume on planning CT, all patients were divided into three groups: <250 ml, 250-450 ml and >450 ml groups. The relative value of volume in the 250-450 ml group during the course of radiotherapy was the smallest. And the setup error in the superior and inferior (SI) direction was (0.28±0.24) cm and (0.19±0.17) cm in the left and right (LR) direction, significantly lower than those in the other two groups (both P≤0.027). According to the rectum volume on planning CT, all patients were divided into four groups: <50 ml, 50-<80 ml, 80-120 ml and >120 ml groups. The <50 ml group had the smallest relative value of volume during radiotherapy, and the setup error in the SI direction was (0.26±0.22) cm and (0.24±0.22) cm in the anterior and posterior (AP) direction, significantly smaller than those in the other groups (both P≤0.003). The setup errors in the SI, LR, AP directions of the enrolled 66 patients were (0.30±0.25) cm, (0.20±0.18) cm and (0.28±0.27) cm, respectively. Among them, the relative value of bladder volume in the AP direction was (0.73±0.37) in the setup error <0.3 cm group, which was statistically different from those in the setup error 0.3-0.5 cm and >0.5 cm groups (both P<0.05). Conclusion:Under the bladder and bowel preparation before planning CT, the appropriate bladder and rectum volumes are in the range of 250-450 ml and <50 ml, which yields higher reproducibility and smaller setup error.

Reproducibility study of Ovarian-Adnexal Reporting and Data System in describing adnexal masses / 中华超声影像学杂志

Objective:To investigate the intra- and inter-observer agreements of different experiencers using the Ovaria-adnexal Reporting and Data System (O-RADS) in the evaluation of adnexal masses.Methods:Totally 48 patients with adnexal masses (48 masses, mean size 9.5±4.7 cm, range 2.3-18.6 cm) found by ultrasound examination in the Third Affiliated Hospital of Sun Yat-sen University, from May 2019 to March 2020 were retrospectively analyzed. All the masses were confirmed by pathology or surgery. Four observers were divided into 2 senior doctors (Doctor 1 and Doctor 2) and 2 junior doctors (Doctor 3 and Doctor 4). Each observer independently evaluated adnexal masses twice using ultrasound O-RADS before and after systematic training, with an interval of 60 days. The intra-observer and inter-observer agreements were analyzed before and after training.Results:The inter-observer agreement between senior doctors were both excellent before and after systematic training (weight Kappa: 0.833 vs 0.802, percentage of agreement: 83.3% vs 81.3%). Whereas there was difference in the inter-observer agreement between non-experienced observers before and after training (weight Kappa: 0.399 vs 0.824, percentage of agreement: 50.0% vs 77.1%). After training, inter-observer agreement between junior doctors was significantly improved and comparable to senior (weight Kappa: 0.824 vs 0.802, percentage of agreement: 77.1% vs 81.3%). Before and after systematic training, the intra-observer agreements of the same doctor, the senior physicians were better than the junior (weight Kappa: 0.882 and 0.843 vs 0.440 and 0.605; percentage of agreement: 87.5% and 83.3% vs 58.3% and 54.2%).Conclusions:O-RADS risk classification system is a highly reproducible method in the subjective assessment of an adnexal mass among observers with varying levels of expertise. However, systematic training before clinical application is necessary and effective for non-experienced observers.

Feasibility of transperineal ultrasound in quantitative assessment of posterior compartment prolapse / 中华超声影像学杂志

Objective:To investigate the feasibility of transperineal ultrasound in quantitative assessment of posterior compartment prolapse among Chinese women.Methods:The prospective multicenter study enrolled 485 women between January 2017 and January 2019. All patients underwent a standard clinical interview, pelvic organ prolapse quantification (POP-Q) examination and transperineal ultrasound examination. Volume data of transperineal ultrasound examinations were obtained at rest and in maximal Valsalva maneuver.Results:The higher POP-Q stage of posterior compartment, the lower rectal ampulla position in maximal Valsalva maneuver (POP-Q stage=0 vs POP-Q stage=1, P<0.001; POP-Q stage=1 vs POP-Q stage≥2, P<0.001), and the greater rectal ampulla hypermobility (POP-Q stage=0 vs POP-Q stage=1, P<0.001; POP-Q stage=1 vs POP-Q stage≥ 2, P=0.007). The rectal ampulla position at rest and in maximal Valsalva maneuver and rectocele depth were correlated with prolapse symptoms ( r=-0.200, P<0.001; r=-0.252, P<0.001; r=0.086, P=0.045). The corresponding cut-off values of rectal ampulla position in maximal Valsalva in diagnosing posterior compartment prolapse (POP-Q stage ≥1) and clinical significant posterior compartment prolapse (POP-Q stage ≥2) were 7.32 mm below the symphysis pubis and 12 mm below the symphysis pubis, respectively, with the area under the ROC curve as 0.75 and 0.85, respectively. Conclusions:The ultrasonic measurements by transperineal ultrasound is significantly associated with POP-Q examination in posterior compartment, and it is demonstrated as a useful tool in quantitative assessment of the severity of posterior compartment prolapse.

Correlation between levator hiatus area, pelvic organ prolapse quantification and prolapse symptoms / 中华超声影像学杂志

Objective:To investigate the association between levator hiatus area, pelvic organ prolapse quantification (POP-Q) examination and prolapse symptoms.Methods:The prospective multicenter study enrolled 996 female patients between January 2017 and January 2019. All enrolled patients underwent a standard clinical interview, POP-Q examination and transperineal ultrasound examination. Volume data of pelvic floor ultrasound examinations were obtained at rest, during contraction and during maximal Valsalva maneuver. The association between levator hiatus area, POP-Q examination and prolapse symptoms was analyzed. The performance of levator hiatus area on maximal Valsalva for assessing significant POP(POP-Q stage≥2) and prolapse symptoms were also evaluated.Results:There were significant differences of levator hiatus area at rest, during contraction and during maximal Valsalva among patients with different POP-Q stages (all P<0.001). Levator hiatus area during maximal Valsalva showed the highest correlation with abdominal dragging sensation ( r=0.277, P<0.001). The area under the ROC curve (AUC) of levator hiatus area during maximal Valsalva for significant POP (POP-Q stage≥2) was significantly higher than that for prolapse symptoms (AUC: 0.77 vs 0.69, P<0.001). Conclusions:Levator hiatus area on transperineal has moderate correlation with POP-Q examination and their association is stronger than the correlation between ultrasound findings and prolapse symptoms.

The applicability of sound touch elastography and sound touch quantify in measuring liver and spleen stiffness / 中华超声影像学杂志

Objective To assess the applicability of sound touch elastography ( ST E) and sound touch quantify ( ST Q ) in measuring liver and spleen stiffness . Methods One hundred and eighteen healthy volunteers were included and underwent ST E and ST Q . T he success rate ,variability and reproducibility of ST E and ST Q were analyzed . T he accurate sampling size and number of tests for liver ST Q were also analyzed . Results T he success rates ,variability ,reproducibility of ST E and ST Q in liver were 97 .5% and 99 .2% ,8 .7% and 12 .0% ,0 .917 and 0 .916 , respectively . While those with spleen were 76 .3% and 66 .9% ,12 .4% and 16 .4% ,0 .847 and 0 .706 ,respectively . The sampling size of 1 .5 cm×1 .0 cm yield the lowest variability ( 8 .5% ) ( F ＝6 .562 , P ＝0 .002) ,and there was no significant difference between results of detecting 5 times and 10 times( P ＝0 .571) . T he liver and spleen stiffness of ST E were 5 .75 kPa ( 95%CI :5 .60－5 .91 kPa) and 15 .58 kPa ( 95% CI :14 .99 －16 .16 kPa) . Conclusions The measurement of liver stiffness using both ST E and ST Q have a high success rate and low variability . However ,ST E is better than STQ in measuring spleen stiffness .

Evaluation of functional departments′ position values at a general hospital in Beijing / 中华医院管理杂志

Objective To assess the relative value of individual positions in the functional departments of a general hospital in Beijing,for reference of improving the salary allocation system and fine management of human resources.Methods The expert consultation method and International Position Evaluation system were used to quantitatively assess the tasks,work difficulty,size of responsibility and the qualifications required for every.Results A total of 38 experts contributed to this research which studied 140 positions including all functional departments of this hospital.The department having the most positions is the finance department(17)and the least is the Youth League committee(1).The position scoring the highest(805)was the director of medical affairs department;that scoring the lowest(263)was the food and beverage service positions of the diet and nutrition department.There was an evident turning point at score 547.Conclusions Functional departments′ position setting of this hospital proves reasonable,and the assessment scoring can reflect the value of the position in related dimensions.The result can be used as reference indexes for the hospital to perfect its human resource management system and improve the remuneration precision.

Clinical manifestation and ultrasonic examination characteristics of ventricular myocardium in 36 cases with noncompaction / 心血管康复医学杂志

Objective:To analyze ultrasonic and clinical manifestation of noncompaction of the ventricular myocardi‐um (NVM) in order to guide clinical early diagnosis and treatment .Methods :Echocardiographic manifestations of 36 NVM patients were observed .Combined with electrocardiogram (ECG) ,cardiac MRI and coronary angiography (CAG) etc .,clinical manifestations of NVM were comprehensively analyzed .Results:Multiple coarse trabecular muscles and deep crypts among them were founded in heart chamber in all cases .Color Doppler showed that blood flow inside the crypts communicated with blood flow in heart chamber ,there were 33 cases (91.6% ) of left ventri‐cle type and three cases (8.4% ) of right ventricle type .Different types of abnormal ECG existed in all cases and at‐rial fibrillation occupied the largest proportion (50% ,18/36) .Some MRI results were accorded with those of ultra‐sound .In most cases ,CAG didn′t show coronary stenosis .Conclusion : Echocardiography is most convenient and effective examination ,which can provide important basis for diagnosis and treatment of noncompaction of ventricular myocardium .