Research progress on automatic treatment planning methods for radiotherapy / 中华放射肿瘤学杂志

The design of a conventional radiotherapy plan is a time-consuming and labor-intensive process, and relevant parameters need to be continuously adjusted in the plan optimization to identify the optimal plan. In addition, experience differences between planners, time invested in plan design, and institutional standards all affect the quality of the plan, which in turn influences clinical outcomes and patient prognosis. In recent years, automatic planning has developed rapidly, which can improve the efficiency of planning design while ensuring the quality of the plan. At present, there are several methods dedicated to the automation of radiotherapy planning design, such as the Rapid Plan and Auto-Planning functions in Eclipse and Pinnacle commercial treatment planning systems, and there are also studies applying artificial intelligence technology in dose prediction to achieve automatic planning. In this article, the research progress on automatic radiotherapy planning was reviewed, and the realization principles, clinical efficacy and existing problems of various automatic planning methods were illustrated.

The feasibility study of generalization of knowledge-based planning for cervical cancer / 中华放射医学与防护杂志

Objective:To design a knowledge-based cervical cancer planning model and apply it to cases of endometrial cancer and rectal cancer in order to explore the generalization of the model.Methods:A total of 179 cases of pelvic regions with different prescribed doses of dual-arc volumetric modulated arc therapy clinical plans were collected, of which 99 cases of cervical cancer clinical plans with a prescribed dose of 50.4 Gy were used as the training set to establish the RapidPlan model, and the remaining clinical plans were divided into 4 validation groups with 20 cases in each group. The clinical plans for cervical cancer and endometrial cancer with a prescription dose of 50.4 Gy were named groups A and B, while the clinical plan for endometrial cancer and rectal cancer with a prescription dose of 45 Gy were named groups C and D. The model was used to redesign the clinical plans in the 4 groups and the automatic plans were obtained. The planning target volume (PTV) and organ at risk (OAR) dosimetry parameters were compared between automatic plans and clinical plans.Results:The conformity index (CI) of the automatic plans in the A, B, C, and D groups were equivalent to that of the clinical plans ( P>0.05). The homogeneity index (HI) and D2% of the automatic plans in groups A, B, and C were all lower than those in clinical plans(HI, Z=-3.248, -3.360, -2.329, P<0.05; D2%, Z=-2.987, -3.397, -2.442, P<0.05). The HI and D2% of the automatic plans in group D were similar those in the clinical plans ( P>0.05). While ensuring the PTV coverage, the average value of OAR dosimetry parameters in all automatic plans groups were lower than that of the clinical plans. Conclusions:The RapidPlan model established by the cervical cancer clinical plans can complete the automatic plan design for endometrial cancer and rectal cancer under different prescription doses, which preliminarily proves the possibility of the generalization of the RapidPlan model.

Survey and Reflection on the Ethical Cognition of Human Sperm Bank among Sperm Donors / 中国医学伦理学

Objective:To investigate the ethical cognition of human sperm among the volunteers who intend to donor sperm,and to analyze the voluntteers' thoughts for donor behavior and its countermeasures.Methods:A questionnaire survey was conducted to investigate the volunteers who were the first time consulted sperm donation in the human sperm bank of the affiliated reproductive hospital of Shandong university.The cognition on the purpose of sperm,the causes of sperm shortage,privacy protection of the offspring,and the future of sperm banks in China were collected.Results:Donors were not well known the uses of sperm and privacy protection of the offspring.They thought traditional values and ethical worry caused sperm shortage and worried about the future of human sperm banks in China.Conclusion:The overall cognition on the sperm bank of the volunteers still exist certain one-sidedness and blind,which has seriously affected the enthusiasm of volunteers to donate sperm.The relevant departments should pay more attention to this,focus on promoting the propaganda and supervision work of ethical system of human sperm bank,construct objective,justice,and dedicative atmosphere for sperm donation,in order to dispel the volunteers' psychological concerns,and promote the healthy,fast and sustainable development of human sperm bank.

Incentive mechanism and implications of orphan drug market in the United States / 中国卫生政策研究

Serious market failure, as a result of insufficient incentive, exists in the orphan drugs market. Through legislation, the United States designed and established its owns systematic and linked orphan drugs incentive mechanism, which direct sat research, definition, clinical trials and approval of orphan drugs, so as to change the supply and demand status of orphan drugs. Such incentive mechanism erables the United States possess the most ap-proved orphan drugs in the world, and effectively relieves the problem of market failure of the orphan drugs. The ex-perience of the United States provides beneficial reference for the establishment and positive development of orphan drugs incentive mechanism in China.

The impact of dean's characteristics on the competitiveness of private hospitals：Based on a study of 100 private hospital data / 中国卫生政策研究

This paper selects the characteristics of hospital deans as a starting point to study the influence of private hospital competitiveness .According to the competitiveness of the private hospitals 100 list in Hong Kong , Eric Peter Hospital Management Research Center released in 2014 , regard the list derived competitiveness evaluation score as the independent variable , and according to the manual excerpt from hospital official website and publicly available information ,the Author has calculated the sample characteristics data of the list of 100 private hospitals and other con-trol variables .Research results demonstrate that private hospital deans 'age distribution structure is too large , and the average years of work in the health care practice is higher , with a higher proportion of senior professional titles and o-verseas study and work backgrounds .Through the establishment of multiple linear regression models for further study showed that the private hospital deans 'age , professional , technical titles and work experience has affected the com-petitiveness of the evaluation of the hospital .Therefore , this paper recommends that private hospitals should give full play to the advantages of expert dean and dean of the decision-making for core position should be clear , and the intro-duction and training of personnel presidency as a priority work .

Effects of metabotropic glutamate receptor 5 antagonist MPEP on behaviors and striatal postsynaptic density-95 protein expression in rats with levodopa-induced dyskinesia / 中华神经医学杂志

Objective To investigate the effects of metabotropic glutamate receptor 5 antagonist methyl-6-ethynyl-pyridine (MPEP) on behavior and striatal postsynaptic density-95 (PSD-95) protein expression changes in rats with levodopa-induced dyskinesia (LID).Methods Hemi-parkinsonian rat models were established by stereotaxically injection of 6-hydroxy dopamine (6-OHDA) in the right medial forebrain bundle;then,these 32 Parkinson's disease (PD) rats were randomly divided into four groups (n=8):levodopa (L-DOPA) treatment group,receiving L-DOPA 25 mg/kg+benserazide 6.25 mg/kg;saline group,giving the same volume of saline;MPEP treatment group,receiving 1.5 mg/kg MPEP;and L-DOPA+MPEP treatment group,accepted L-DOPA 25 mg/kg+benserazide 6.25 mg/kg+MPEP 1.5 mg/kg;All rats received intraperitoneal injections twice daily and continued for 21 days.At days 2,9,11,18 and 21,behavior changes of all rats were detected;the protein and mRNA levels of PSD-95 in striatal tissues were detected by Western blotting and real-time PCR,respectively.Results (1) Abnormal involuntary movement scores were significantly decreased in rats of L-DOPA+MPEP treatment group (42.33±12.43,41.80±13.69 and 40.30±9.76) as compared with those in L-DOPA treatment group (55.56±9.28,54.89±7.01 and 58.44±7.68) on days 11,18,and 21 (P＜0.05).Forepaw adjusting steps were significantly increased in Parkinson rats of L-DOPA+MPEP treatment group as compared with rats of L-DOPA treatment group (P＜0.05);and the increased extent was not decreased as time prolonging.Forepaw adjusting steps were also increased after MPEP treatment alone.Co-administration of L-DOPA with MPEP reversed the shortening of rotational response duration induced by L-DOPA.(2) The up-regulation of PSD-95 protein and mRNA levels in the lesioned striatum was noted in the L-DOPA treatment group (1.39 ±0.37 and 3.80 ±1.09),while this trend could be alleviated by coadministration of L-DOPA with MPEP (0.76±0.66 and 1.65±0.81).Conclusion MPEP can alleviate abnormal involuntary movements induced by L-DOPA and strengthen the anti-parkinsonian effect of L-DOPA,which may be related to regulation of striatal PSD-95 expression induced by L-DOPA.

Efficacy observation of botulinum toxin type A in elderly patients with primary intractable trigeminal neuralgia / 中华老年医学杂志

Objective To investigate the therapeutic effects of botulinum toxin type A (BTX-A) in elderly patients with primary intractable trigeminal neuralgia.Methods 27 elderly patients with primary intractable trigeminal neuralgia were treated with BTX-A local multiple point injection.The efficacy was assessed by visual analog scores (VAS) before and 1 week,2 weeks,1 month,3 months and 6 months after the treatment.Results VAS scores was (9.2±1.1),(5.8±3.0),(3.6± 2.3),(2.3±2.3),(3.2±2.9) and (4.6±3.2) before and 1 week,2 weeks,1 month,3 months and 6 months after BTX-A treatment respectively.VAS score was gradually decreased,reached the lowest at 1 month after BTX-A injection,and then was gradually increased.There were significant differences in VAS scores between between pre-and post-treatment (P＜0.05).The efficiency was 37.0％,85.2％,92.6％,70.4％ and 59.3％ at 1 week,2 weeks,1 month,3 months and 6 months after the treatment respectively.There were significant differences in efficacy between different time points after the treatment (all P＜0.05).3 patients had the transient numbness of mouth askew and incomplete eyelid closure and recovered spontaneously after 4-8 weeks.No severe adverse effects were found in the other 27 patients.Conclusions BTX-A is safe and effective in the treatment of primary intractable trigeminal neuralgia in elderly patients.

N-acetylcysteine protects bone marrow stromal cells against the toxicity of 6-hydroxydopamine / 中国组织工程研究

BACKGROUND: 6-hydroxydopamine, as an endogenous toxic factor in the pathogenesis of Parkinson's disease, participates in oxidative stress. N-acetylcysteine resists oxidation and removes free radicals effectively.OBJECTIVE: To investigate the toxicity of 6-hydroxydopamine in bone marrow stromal cells and the antagonistic effect of N-acetylcysteine on it. METHODS: Bone marrow stromal cells of Sprague-Dawley rats were cultured in vitro. Bone marrow stromal cells of passage 3 were treated with 6-hydroxydopamine with the final concentrations of 0,0.05,0.1g/L and N-acetylcysteine with the final concentrations of 0, 0.075,0.3,1.2,4.8g/L, respectively.RESULTS AND CONCLUSION: MTT assay showed that 6-hydroxydopamine (0.05 and 0.1 g/L) significantly decreased the viability of bone marrow stromal cells. This toxic effect of 6-hydroxydopamine was significantly inhibited by 0.3 g/L N-acetylcysteine. It suggests that antioxidant N-acetylcysteine may affect the toxic action of 6-hydroxydopamine.