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<p><b>BACKGROUND</b>Based on the excellent medical care and management system for Chinese veterans, as well as the detailed medical documentation available, we aim to construct a Chinese Veteran Clinical Research (CVCR) platform on non-communicable diseases (NCDs) and carry out studies of the primary disabling NCDs.</p><p><b>METHODS</b>The Geriatric Neurology Department of Chinese People's Liberation Army General Hospital and veterans' hospitals serve as the leading and participating units in the platform construction. The fundamental constituents of the platform are veteran communities. Stratified typical cluster sampling is adopted to recruit veteran communities. A cross-sectional study of mental, neurological, and substance use (MNS) disorders are performed in two stages using screening scale such as the Mini-Mental State Examination and Montreal cognitive assessment, followed by systematic neuropsychological assessments to make clinical diagnoses, evaluated disease awareness and care situation.</p><p><b>RESULTS</b>A total of 9 676 among 277 veteran communities from 18 cities are recruited into this platform, yielding a response rate of 83.86%. 8 812 subjects complete the MNS subproject screening and total response rate is 91.70%. The average participant age is (82.01±4.61) years, 69.47% of veterans are 80 years or older. Most participants are male (94.01%), 83.36% of subjects have at least a junior high school degree. The overall health status of veterans is good and stable. The most common NCD are cardiovascular disorders (86.44%), urinary and genital diseases (73.14%), eye and ear problems (66.25%), endocrine (56.56%) and neuro-psychiatric disturbances (50.78%).</p><p><b>CONCLUSION</b>We first construct a veterans' comprehensive clinical research platform for the study of NCDs that is primarily composed of highly educated Chinese males of advanced age and utilize this platform to complete a cross-sectional national investigation of MNS disorders among veterans. The good and stable health condition of the veterans could facilitate the long-term follow-up studies of NCDs and provide prospective data to the prevention and management of NCDs.</p>
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Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Povo Asiático , Estudos Transversais , Doença , Nível de Saúde , VeteranosRESUMO
Objective To analyze the prognostic factors of patients with leukemia treated with single fraction total body irradiation (SFTBI) followed by hernatopoietic stem cell transplantation (HSCT).Methods From January 2001 to September 2008, 102 patients received HSCT. The differences of the survival rate, relapse rate and incidence of interstitial pneumonia (IP) between groups regarding different genders, ages, pathological types, transplantation methods and TBI parameters were compared and the factors related with the survival rate, relapse rate and incidence of IP were analyzed. Results The followup time ranged from 15 to 1482 days (median, 406 days). The follow-up rate was 95.1%. 86 and 55patients were followed up more than one year and three years. The 1-and 3-year survival rates were 59.0%and 44.0%. In univariate analysis, the 3-year survival rate was signifcantly different between the groups with and without relapse before transplantation (20% vs. 55%, χ2 = 6.33, P = 0. 012), allogeneictranplantation versus autologous tranplantation (39% vs. 68%, χ2 = 8.06, P = 0.005), grade 3 or more acute graft versus host disease (aGVHD) and grade 0 -2 aGVHD (0% vs. 54%, χ2 = 7.52, P = 0.006),with and without relapse after transplantation (19% vs. 58%, χ2 = 10.13, P =0.001), with and without IP (23% vs. 58%, χ2 =8.35, P=0.004). Multivariate analysis showed that grade 3 or more aGVHD was the only statistically significant prognostic factors (χ2 = 12. 74 ,P =0. 000). The l-and 3-year relapse rateswere 30. 0% and 50. 0%. The incidence of relapse was obviously higher in the group with relapse before transplantation than that without (47% vs. 16%, χ2 =7. 32, P=0. 007). Multivariate analysis showed thatrelapse before transplantation was a significant factor predicting relapse after transplantation (χ2 = 9. 39,P =0. 020). The cumulative incidence of IP was 35.0%. The incidence of IP was different between groups with dose homogeneity > 3% and ≤ 3% (27% vs. 4%, χ2 = 5. 21, P = 0. 023), with and without acute parotitis (34% vs. 3%, χ2 = 14. 15, P= 0.000), allogeneic transplantation group and autologous transplantation group (31% vs. 8%, χ2= 7.70, P= 0.006). Multivariate analysis showed that transplantation methods, acute parotitis and dose homogeneity were statistically significant factors in predictingIP (χ2 = 10. 08 , 10. 08 and 7.69 , P = 0. 002 , 0. 002 and 0. 010 , respectively) . Conclusions Patients who develop grade 3 or higher aGVHD have poor prognosis. Dose homogeneity influences the incidence of IP. Patients undergoing allogeneic transplantation are apt to have IP. Acute parotitis is related with IP and might be a predictor.
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Objective To assess and compare chemical and immunochemical fecal occult blood tests (FOBTs) in diagnosis of gastrointestinal hemorrhage and their clinical significance. Methods The FOBT was carried out in 4474 in-patients, out-patients or subjects who had annual physical examination using both hemoccult Ⅱ (CFOBT) and colloidal gold chromagraphy (IFOBT) methods.Those who was positive for FOBTs would be re-tested for 2 times and followed by gastroscopy and colonoscopy as well as other examinations in order to find the reason and location of gastrointestinal hemorrhage. Results FOBT was positive in 390 (8.22%) patients, of which 163 (41.8%) were detected by CFOBT, 100(25.6%) by IFOBT, and 127(32.6%) by both CFOBT and IFOBT. The clinical, endoscopic and other examinations revealed that upper and lower gastrointestinal bleeding were found in 235 (60.3%) and 136 (34.9%) patients, respectively. The detective rates of upper and lower gastrointestinal bleeding were 90.2% and 67.6% by CFOBT respectively, and 42.5% and 93.4% by IFOBT, respectively. The obvious gastrointestinal bleeding could be detected by both CFOBT and IFOBT. The diseases related to gastrointestinal bleeding involved acute gastric mucosal lesion, peptic ulcer, gastric cancer and colonic polyp,colorectal cancer and piles, etc. Conclusions It is demonstrated that FOBT is still important in screening and diagnosis of gastrointestinal hemorrhage.The CFOBT is superior to IFOBT in detecting upper gastrointestinal bleeding, whereas the IFOBT is superior to CFOBT in detecting lower gastrointestinal bleeding.
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Objective To evaluate the effect of dose-rate and leaf position tolerance on the point dose in step-and-shoot intensity-modulated radiotherapy(IMRT). Methods IMRT plans of 2 prostate cancer patients were selected and recalculated for a water phantom.An ionization chamber was used to measure the dose of some points in the phantom at five nominal dose-rates:100 MU/min,200 MU/min,300 MU/min,400 MU/min and 500 MU/min.It was necessary to adiust the position of the water phantom to locate the ionization chamber in region where the dose gradient was very low in order to minimize the effect of dose gradient on the measured results.When measuring the effect of leaf position tolerance on point dose,the dose-rate was kept constant and the values of tolerance were 1 mm,2 mm,3 mm and 4 mm.This work was conducted on a Varian 23EX equipped with a Millennium 120-leaf multi-leat collimator(MLC).The treatment planning system was Varian Eclipse. Results As the dose-rate increased,the error between the measured dose and the calculated dose also enlarged.The difference between the maximum and the minimum was 1.2%.When MLC control system was working normally,tlle effect of leaf position tolerance on the measured point dose was very little and negligible. Conclusions The dose-rate must be selected suitably to ensure that the delivery can be finished in a short time with the radiobiological effect taking into account.It should be noted that the error between the measured dose and the calculated dose increases with the trend of inereasing more rapidly at higher dose rates.The value of leaf position tolerance should not be set too large,in order to minimize the difference between the measured dose and the planned dose in the region of steep gradient and find as early as possible when the multi-leaf collimator control system performs improperly.
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Objective To evaluate the radiation method and resuh of 450 patients received TBI(total body irradiation).Methods Single-dose Measurement was used to mark dose of TLD(thermo luminescence dosimeter).The values of actual dose in body midline were evaluated by calculating and correcting mean dose of incidence and emergence.Radiation methods:In four-field Irradiation.diagonals of fields coinside with the longitudinal axis of the patients,patient in supine and lateral positions received two pairs of parallel opposite radiation.Scheme of TBI came from a preparative radiation about one week before,and this four-field and equal-in-dose(about 10%of TBI)preparative radiation offered US the optimal scheme with aminimal dose non-uniformity by adjusting different dose proportion of supine and lateral position.In small field irradiation,patients received one pair of parallel opposite radiation from lateral side sitting on a special stool with backrest,the stool can be rotated CW or CCW,pedals can be move forward or backward and fixed.In opposite lateral irradiation,similar to four-field irradiation,patients received one pair of horizontal opposite radiation only in supine position.Five of these patients received FTBI(Fractional TBI). Results The average non-uniformity in midline of patients in four-field irradiation group(87 patients).small field irradiation group(91patients)and opposite lateral irradiation group(272 patients)is respectively ±8.1%,±7.4% and ±4.9%. Conclusions It iS a important process for QA and Qc to measure the dose of incidence and emergence real-timely with TLD or semiconductor dosimeter.We can adopt small field irradiation when the field iS not large enough to contain the patient from head to foot,and it showed advantages over four-field irradiation in treatment process and outcomes.We found the uniformity in body midline would be much better in supine position with diagonal＞180 cm than that in four-field irradiation and small field irradiation with diagonal＜110 cm.We compared supine position irradiation with opposite lateral irradiation,only to find which has its strong point.And actually we considered that FTBI treatment booth can be used more often in anterior and posterior parallel fields irradiation,patient semi-sitted,repeatedly received forward and backward radiation. In spit of not possessing radio-biological advantages as FTBI,STBI(Single TBI)is still a practical form of TBI.
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0 05) after treatment.At the same time,the clinical symptoms were improved significantly.Conclusion ① Testing expression level of HLA DR is helpful to diagnose and monitor the state of RA.② The change of expression level of HLA DR conforms to that of rheumatic factor.③ Examination of the change of expression level of HLA DR can help to judge the state and prognosis of RA.
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Objective To compare the dose to the contralateral breast, ipsilateral lung, and the whole lung in the tangential field radiotherapy for primary breast cancer using the dynamic wedge or physical wedge. Methods With thirteen breast cancer patients chosen, the dose distribution was computed for the plan used in practical treatment with the dynamic wedge and physical wedge. Plans were compared using dose volume histograms for the contralateral breast, ipsilateral lung and the whole lung. As for the contralateral breast, the dose distributions were not computed for the whole breast but computed for the two regions similar to a rectangular area in the axial slice and parts of the whole breast. The mean dose was used to evaluate CB1, CB2 and ipsilateral lung, and V_ 20 was used to evaluate the whole lung. The treatment planning system used was Varian CadPlan. An ionization chamber in a water phantom was used to measure some point doses to simulate the dose to the contralateral breast. Results When using the 30? dynamic wedge, the mean dose to CB1 and CB2 was 1.5%-3.9% and 1.1%- 2.6% , and the mean dose to the ipsilateral lung was 4.1%-14.7%. When using the 30? physical wedge, the mean dose to CB1 and CB2 were 1.5%-4.4% and 1.2%-3.0%, respectively, and the mean dose to the ipsilateral lung was 4.4%-15.2%. The values of V_ 20 were equal. When using the 15? dynamic wedge, the mean dose to CB1 and CB2 decreased compared to 15? physical wedge, but the value reduced was smaller than when using 30? wedge. Also, the measured results verified that the dose to the normal tissue is reduced using the dynamic wedge. Conclusions The mean dose to the contralateral breast was reduced by using the dynamic wedge instead of the physical wedge, and the mean dose to the ipsilateral lung or V_ 20 is reduced or equal to each other. So the probability of normal tissue complication such as a second breast malignancy or pneumonitis associated with radiotherapy are likely to be reduced.
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Purpose: To evaluate the influence of lung corrections on the target volume dose in radiation treatment of esophageal carcinoma by TPS HEVAPLAN. Materials and Methods: Three radiation field technique to middle esophagus were used as the model of this investigation .target volume doses were calculated with photons in different energies to compare with the divergence when the lung density were set to 1.0(without lung correction) 0.33 and 0.2 (with lung correction).Results: If no lung correction was performed, the actual radiation dose in target volume were 24%～28%, 18%～21%, 13%～15% and 7%～9% which were radiated with 60 Co, X-ray of 5MV, 8MV and 19MV. Conclusion: The lung density must be corrected in treating 60 Co unit.