Anti-scarring effects of triamcinolone acetonide-loaded hydrogel sustained-release sheeting on stab incision glaucoma surgery in rabbit / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To observe the anti-scarring effects and safety of triamcinolone acetonide(TA)-loaded hydrogel sustained-release sheeting on stab incision glaucoma surgery(SIGS)with “one-step tunnel method” in rabbit eyes.METHODS:A total of 48 healthy New Zealand white rabbits were randomly selected and divided into 4 groups(12 rabbits in each group), trabeculectomy(Trab)group, SIGS group, polyvinyl alcohol hydrogel(PVAH)sheeting was implanted under the conjunctiva flap during SIGS(PVAH group), and hydrogel sustained-release sheeting loaded with TA was implanted under the conjunctiva flap during SIGS(TA/PVAH group). On the 1, 2, 3, and 4 wk after surgery, the intraocular pressure, filtering bubble morphology, anterior chamber reaction, and other complications were observed and recorded in each group. Then animals were euthanized, and the surgery area tissues of right eye were taken for pathological tissue paraffin section. Masson staining, picric acid-Sirius rose red staining, as well as α-smooth muscle actin(α-SMA)and fibroblast growth factor 2(FGF2)immunohistochemistry staining was performed on every section. The infiltration of inflammatory cells, proliferation of fibroblasts and synthesis of type I and type III collagen fibers in local tissues were observed. The average positive area ratio of α-SMA and FGF2 antibody immunohistochemical staining in each group was calculated and compared.RESULTS: The TA/PVAH group maintained diffuse and elevated functional filtering blebs, while flat filtering blebs appeared in Trab, SIGS and PVAH groups at 2 wk after surgery. Functional filtering blebs were present in 1 eye(33%), 2 eyes(67%)in the PVAH and TA/PVAH group at 4 wk after surgery, respectively, while the other filtering blebs were flattened. Masson staining showed that the hydrogels in PVAH and TA/PVAH groups did not degrade at 4 wk after surgery. Compared with the Trab and SIGS groups, the filtration passages were more obvious, with less collagen fiber proliferation. Sirius red staining showed that the expression of type I collagen and type III collagen in the TA/PVAH group was less than that in the Trab group, SIGS group and PVAH group at 4 wk after surgery. Immunohistochemical staining showed that the α-SMA expression in the TA/PVAH group was significantly lower than that in the Trab and SIGS groups at 1 wk after surgery(P<0.01). The α-SMA expression was the highest in the Trab and SIGS groups at 2 wk after surgery, while the α-SMA expression in the PHAP and TA/PVAH groups was significantly lower than that in the first two groups(P<0.01). Compared with the Trab group, the expression of FGF2 in the PVAH and TA/PVAH group was significantly increased at 1, 2, 3 and 4 wk after surgery(P<0.05). Compared with the SIGS group, FGF2 expression in the TA/PVAH group was significantly increased at 4 wk after surgery(P<0.05).CONCLUSION:In SIGS surgery of rabbit eyes, implanting hydrogel sustained-release sheeting loaded with TA under conjunctival flap can effectively inhibit the scarring of the filtering bleb, which may be the interaction of the anti-scar effect of TA and the stent function of hydrogel.

Construction and validation of prediction model for diabetic retinopathy / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To analyze and screen influencing factors of diabetic patients complicated with retinopathy, and establish and validate prediction model of nomogram.METHODS: A total of 1 252 patients from the Diabetes Complications Early Warning Dataset of the National Population Health Data Archive(PHDA)between January 2013 to January 2021 were selected and randomly divided into a modeling group(n=941)and a validation group(n=311). Univariate analysis, LASSO regression and Logistic regression analysis were used to screen out the influencing factors of diabetic retinopathy, and a nomogram prediction model was established. The receiver operating characteristic curve, Hosmer-Lemeshow test and calibration curve were used to evaluate the model. The clinical benefit was evaluated by the decision curve analysis(DCA).RESULTS: Age, hypertension, nephropathy, systolic blood pressure(SBP), glycated hemoglobin(HbA1c), high-density lipoprotein cholesterol(HDL-C), and blood urea(BU)were the influencing factors of diabetic retinopathy. The area under the curve(AUC)of the modeling group was 0.792(95%CI: 0.763-0.821), and the AUC of the validation group was 0.769(95%CI: 0.716-0.822). The Hosmer-Lemeshow goodness of fit test and calibration curve suggested that the theoretical value of the model was in good agreement(modeling group: χ2=14.520, P=0.069; validation group: χ2=14.400, P=0.072). The DCA results showed that the threshold probabilities range was 0.09-0.89 for modeling group and 0.07-0.84 for the validation group, which suggested the clinical net benefit was higher.CONCLUSION: This study constructed a risk prediction model including age, hypertension, nephropathy, SBP, HbA1c, HDL-C, and BU. The model has a high discrimination and consistency, and can be used to predict the risk of diabetic retinopathy in patients with diabetes.

Comparison of clinical efficacy between simultaneous integrated boostintensity-modulated radiotherapy (SIB-IMRT) and late-course boost intensity-modulated radiotherapy (LB-IMRT) for early-stage breast cancer after breast-conserving surgery / 中华放射肿瘤学杂志

Subject To compare the irradiation-induced injury and clinical efficacy between SIB-IMRT and LB-IMRT for early-stage breast cancer after breast-conserving surgery.Methods:From November 2002 to February 2012, 353 early breast cancer patients who underwent IMRT after breast-preserving surgery at Shandong Cancer Hospital were selected, of whom 218 patients receiving SIB-IMRT and 135 patients receiving LB-IMRT.The prescription dose of the SIB-IMRT group was the ipsilateral breast (PTV b ) 1.8-1.9 Gy, 27-28 times, and concurrent tumor bed (PTV t) 2.15-2.3 Gy, 27-28 times. In the LB-IMRT group, the prescription dose was PTV b 2.0 Gy, 25 times, followed by PTV t boost 2.0 Gy, 5-8 times. Results:The median follow-up time was 92 months. The excellent, good, fair, and poor cosmetic results in the SIB-IMRT and LB-IMRT groups were 10.1% and 12.6%, 85.8% and 80.7%, 3.7% and 5.2%, 0.5%, and 0.7%, respectively ( P=0.731). The 5-year locoregional recurrence rates (LRRs) in the SIB-IMRT and LB-IMRT groups were 3.21% and 5.93% and the 10-year LRRs were 4.13% and 6.67%, respectively ( P=0.209, 0.280). The 3-, 5-, 8-, and 10-year overall survival rate in the SIB-IMRT and LB-IMRT groups were 97.7% and 97.8%, 96.3% and 95.2%, 94.9% and 92.0%, 93.6% and 90.3%, respectively ( P=0.288). The 3-, 5-, 8-, and 10-year disease-free survival in the SIB-IMRT and LB-IMRT groups were 95.4% and 93.8%, 91.8% and 87.7%, 89.9% and 84.1%, 89.0% and 82.1%, respectively ( P=0.160). Conclusion:There is no significant difference in the cosmetic effect, local control rate, and survival rate between SIB-IMRT and LB-IMRT after breast-preserving surgery in patients with early-stage breast cancer. SIB-IMRT is a safe and feasible treatment.

Selection of surgical methods for breast cancer and follow-up analysis / 国际外科学杂志

Objective:To analyze the surgical methods of operable breast cancer and analyze the follow-up results.Methods:A retrospective analysis of the clinical and pathological data of 636 operable breast cancer patients admitted to Zibo First Hospital from July 2008 to April 2018, including the clinical stage, pathological staging. Analyze of the proportion of four surgical methods, and through follow-up, analyze the treatment effect of different surgical methods.Results:All patients are female, aged 26-80 years, the clinical stage of 636 patients: Tis 18 cases, stage Ⅰ 143 cases, stage Ⅱ 354 cases, stage Ⅲ 114 cases, stage Ⅳ 7 cases. There are four types of surgery: ① breast conserving surgery + sentinel lymph node biopsy in 124 cases (19.50%); ② breast conserving surgery + axillary lymph node dissection in 39 cases (6.13%); ③ mastectomy + sentinel lymph node biopsy in 163 cases (25.63%); ④ modified radical surgery in 310 cases (48.74%). Sentinel lymph node biopsy in 427 cases (67.14%), success in 404 patients (94.61%); all patients with lymph node negative 384 cases (60.38%). Follow-up for 1 to 9 years, 11 cases of local recurrence after breast-conserving surgery, It accounted for 6.75% of breast-conserving surgery; 43 cases of local recurrence of chest wall after mastectomy, accounting for mastectomy 9.09%; 33 cases of recurrence and metastasis of axillary lymph nodes and supraclavicular lymph nodes, 4 cases of axillary recurrence after sentinel lymph node biopsy.Conclusions:The proportion of breast-conserving surgery in this group of patients was high and the local recurrence rate of breast-conserving surgery was less than that of mastectomy group; the proportion of simple modified radical surgery declined further; patients with axillary lymph node metastasis were less in the whole group. The choice of reasonable operation method is an important factor to improve the prognosis of breast cancer.

A comparative study of international and Chinese public health emergency management from the perspective of knowledge domains mapping

BACKGROUND@#At the end of 2019, the outbreak of coronavirus disease 2019 (COVID-19) severely damaged and endangered people's lives. The public health emergency management system in China has played an essential role in handling the response to the outbreak, which has been appreciated by the World Health Organization and some countries. Hence, it is necessary to conduct an overall analysis of the development of the health emergency management system in China. This can provide a reference for scholars to aid in understanding the current situation and to reveal new research topics.@*METHODS@#We collected 2247 international articles from the Web of Science database and 959 Chinese articles from the China National Knowledge Infrastructure database. Bibliometric and mapping knowledge domain analysis methods were used in this study for temporal distribution analysis, cooperation network analysis, and co-word network analysis.@*RESULTS@#The first international article in this field was published in 1991, while the first Chinese article was published in 2005. The research institutions producing these studies mainly existed in universities and health organizations. Developed countries and European countries published the most articles overall, while eastern China published the most articles within China. There were 52 burst words for international articles published from 1999-2018 and 18 burst words for Chinese articles published from 2003-2018. International top-ranked articles according to the number of citations appeared in 2005, 2007, 2009, 2014, 2015, and 2016, while the corresponding Chinese articles appeared in 2003, 2004, 2009, and 2011.@*CONCLUSIONS@#There are differences in the regional and economic distribution of international and Chinese cooperation networks. International research is often related to timely issues mainly by focusing on emergency preparedness and monitoring of public health events, while China has focused on public health emergencies and their disposition. International research began on terrorism and bioterrorism, followed by disaster planning and emergency preparedness, epidemics, and infectious diseases. China considered severe acute respiratory syndrome as the starting research background and the legal system construction as the research starting point, which was followed by the mechanism, structure, system, and training abroad for public health emergency management.

Investigation and Analysis of the Current Operation Situation o f Online Drugstores in China / 中国药房

OBJECTIVE： To investigate the current situation and existing problems of online drugstores in China and put forward corresponding countermeasures and suggestions， so as to provide a basis for promoting and improving the standardization of online drugstores in China. METHODS： The number of online drugstores was counted by inquiring about the online drugstores in all provinces， autonomous regions and municipalities directly under the central government published by the “Public inquiry” column on the official website of the previous China Food and Drug Administration （CFDA）. According to the administrative division， stratified sampling of online drugstores was conducted. The website domain names of sampled online drugstores and their Taobao stores， Jingdong stores， Wechat public accounts， Wechat small programs and other platforms were retrieved to analyze their operation methods. At the same time， the online drugstores which actually had online trading behavior were investigated and analyzed from three aspects， including business scope， propaganda behavior and service behavior. RESULTS & CONCLUSIONS： A total of 693 online drugstores were obtained from the official website of CFDA， and the domain names of only 14 （41.2％） of 34 online drugstores selected by stratified sampling were their corresponding online drugstores. Other online drugstores had some problems， such as domain name could not be opened or was not related websites. There were 14 online drugstores dealing in drugs through their own websites， of which 12 also operated on third-party platforms such as Taobao， Jingdong and Wechat. The problems of 27 drugstores with online online trading behavior mainly included non-standard operating varieties， illegal sale of prescription drugs， disunity of qualification mark，false propaganda，untimely online customer service response and imperfect drug distribution system， etc. It is suggested that relevant supervisory and administrative departments strengthen supervision， standardize the management of domain names and trading platforms of online drugstores， and vigorously crack down on and control illegal online transactions. Online drugstores should improve their service levels， standardize their own website construction， improve the level of real-time customer service and drug distribution services， so as to improve the current operation situation of online drugstores in China.

Comparison and analysis of the efficacy and safety of minimally invasive surgery and craniotomy in the treatment of hypertensive intracerebral hemorrhage

Objective: This study was aimed to compare and analyze the effects and safety of minimally invasive and craniotomy in the treatment of hypertensive intracerebral hemorrhage

Methods: A total of 130 patients with hypertensive intracerebral hemorrhage were recruited. The patients were randomly divided into two groups [research and control group]. Research group was treated with endoscopic minimally invasive surgery, while control group was treated with craniotomy and hematoma clearance. The basic situation, clinical effects, prognosis, nerve function and inflammatory factors of the two groups were compared while the condition of postoperative complications was also observed

Results: The operative time of patients in research group showed statistically significant [P<0.05] difference when compared with control group. Hematoma clearance rate and intraoperative blood loss of research group was significantly better than control group. There was no significant difference [P>0.05] between the two groups in preoperative hemorrhage and edema around the hematoma, however hemorrhage and edema around the hematoma after four weeks of surgery in the research group was significantly [P<0.05] lower than control group. After four weeks of treatment, the BI and SSS score, SP and IL-2 level of the research group were significantly higher than control group [P<0.05], while MRS score, IL-6, hs-CRP, TNF-? and SF was significantly lower than control group [P<0.05]

Conclusion: Compared with craniotomy, minimally invasive surgery is more effective in the treatment of hypertensive intracerebral hemorrhage, as well as it is more conducive to restore neurological function, improve prognosis and reduce serum inflammatory factor levels

Targeted surveillance and infection-related risk factors of nosocomial infection in patients after neurosurgical operation

The purpose of this study was to investigate the risk factors of nosocomial infection in patients after neurosurgical operations, so as to provide reasonable, effective preventative measures in the future. A total of 1,600 patients with brain tumors, hydrocephalus, craniocerebral trauma and vascular disease treated in the neurosurgery room were chosen for targeted surveillance; and through analysis on the clinical data of patients, the incidence of nosocomial infection, the site of infection and the distribution of pathogens, we investigated the infection-related risk factors. After operation, there were 128 cases with nosocomial infection, with the infection rate of 8.0%; among the several diseases, the postoperative infection rate of brain tumors was 28.13%, the postoperative infection rate of hydrocephalus was 21.88%, and the susceptible sitesin the first three places were lower respiratory tract, intracranial, urinary tract; a total of 69 pathogens were separated from 128 cases with nosocomial infection, and the first three pathogens were Acinetobacter baumannii, Klebsiella pneumoniae, Staphylococcus aureus, accounting for 21.74%, 17.39%, 11.59% respectively. The incidence of nosocomial infection was higher in patients with invasive operation during the procedure, with significant difference [P<0.05]. By targeted surveillance on the nosocomial infection in patients after neurosurgical operations, the nosocomial infection rate was high after neurosurgical operations. By strictly implementing the aseptic operation, it could reduce the invasive operation; effectively reduce the infection rate of patients, to facilitate the healing of patients and early rehabilitation

Impacts of Leukoaraiosis on Short-term Outcome of Acute Cerebral Infarction / 中国康复理论与实践

@#Objective To explore the impacts of leukoaraiosls (LA) on the short-term outcome of acute cerebral infarction. Methods 204 patients after acute cerebral infarction were reviewed from January 2012 to August 2014. They were divided into 4 groups according to the brain magnetic resonance imaging: cerebral infarction without LA (LA-0), and with LA (LA-1, LA-2 and LA-3). The Logistic regression analysis was applied with the short-term outcome of cerebral infarction as the dependent variable, and 16 possible factor as independent variables. Results There were 4 independent factors risk to the worse outcome of acute cerebral infarction, including LA, age, hypertension and cerebral infarction size (OR>1, P<0.05). Conclusion LA is an independent risk factors to the worse short-term outcome of acute cerebral infarction.

Impacts of Leukoaraiosis on Short-term Outcome of Acute Cerebral Infarction / 中国康复理论与实践

Objective To explore the impacts of leukoaraiosls (LA) on the short-term outcome of acute cerebral infarction. Methods 204 patients after acute cerebral infarction were reviewed from January 2012 to August 2014. They were divided into 4 groups according to the brain magnetic resonance imaging:cerebral infarction without LA (LA-0), and with LA (LA-1, LA-2 and LA-3). The Logistic regression analysis was applied with the short-term outcome of cerebral infarction as the dependent variable, and 16 possible factor as independent vari-ables. Results There were 4 independent factors risk to the worse outcome of acute cerebral infarction, including LA, age, hypertension and cerebral infarction size (OR>1, P<0.05). Conclusion LA is an independent risk factors to the worse short-term outcome of acute cerebral in-farction.

Clinical therapeutic effect of diltiazem treating coronary artery spasm / 心血管康复医学杂志

Objective:To explore clinical therapeutic effect and safety of diltiazem treating coronary artery spasm. Methods:A total of 100 patients with coronary artery spasm were selected in our hospital.According to number ta-ble method,they were randomly and equally divided into routine treatment group (n=50,received,lipid regulation and expanding coronory artery etc.)and diltiazem group (n=50,received diltiazem pumping based on routine treat-ment).Clinical and ECG therapeutic effect,changes of blood lipids,nitric oxide (NO)and endothelin-1 (ET-1) levels before and after treatment and safety were compared between two groups.Results:(1 )Compared with rou-tine treatment group,there were significant increase in total effective rates of clinical effect (60.00% vs.94.00%) and ECG (62.00% vs.92.00%)in diltiazem group,P<0.01 both;(2)Compared with before treatment,there were significant improvements in all ECG indexes,heart rate and blood pressure in two groups after treatment,and those of diltiazem group were significantly better than those of routine treatment group (P<0.05 all);(3)Com-pared with before treatment and routine treatment group,there were significant improvements in blood lipid levels in diltiazem group after treatment (P<0.05 all);(4)Compared with before treatment and routine treatment group,there was significant rise in NO level [(95.17±19.99)μmol/L,(95.17±21.22)μmol/L vs.(106.71± 22.38)μmol/L]and significant reduction in ET-1 level [(64.09±16.29)ng/L,(59.98±14.28)ng/L vs.(44.91± 6.38)ng/L]in diltiazem group after treatment (P<0.05 all);(6)During treatment,there were no adverse reac-tion in both groups.Conclusion:Diltiazem based on routine medication possess significant therapeutic effect and high safety for treating coronary artery spasm,which is worth extension in clinic.

Effect of cognitive behavioral intervention on anxiety and depression of patient with acute myocardial infarction / 现代临床护理

Objective To explore the effect of cognitive behavior intervention on anxiety and depression of patients with acute myocardial infarction(AMI).Methods Seventy patients with acute myocardial infarction were randomly divided into observation group and control group,35 cases in each group. All cases were cared with routine nursing method. Besides,cognitive behavior intervention was applied in the observation group. The self-rating anxiety scale(SAS)and self-rating depression scale(SDS)were used to measure the patients' mental status before and after the intervention.Result The SAS and SDS scores of the observation group after intervention were significantly lower than those of the control group(P<0.05).Conclusion The cognitive behavioral intervention is effective in alleviating anxiety and depression in patients with acute myocardial infarction,promoting them to establish the correct attitude and keeping calm in face of disease so as to relieve the anxiety and depression of AMI patients.

Comparison of the volume and localization of internal gross target volume and planning target volume delineated by clips and seroma based on 4D-CT scan for external-beam partial breast irradiation after breast conserving surgery / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To explore the differences in volume and localization of the internal gross target volume and planning target volume delineated by clips and/or seroma based on four-dimensional computed tomography (4D-CT) during free-breathing in breast cancer patients after breast conserving surgery.</p><p><b>METHODS</b>Fifteen breast cancer patients after breast-conserving surgery (BCS) were recruited for external-beam partial breast irradiation (EB-PBI). On the ten sets CT images, the gross tumor volumes (GTV) formed by the clips, the seroma, and both the clips and seroma were delineated and defined as GTVc, GTVs and GTVc+s, respectively. Ten GTVc, GTVs and GTVc+s on the ten sets CT images produced the IGTVc, IGTVs, IGTVc+s. The PTVc, PTVs, PTVc+s were created by adding 15 mm to the IGTVc, IGTVs, IGTVc+s, respectively. The IGTV and PTV volume and distance between the centers of IGTVc, IGTVs, IGTVc+s and PTVc, PTVs, PTVc+s were all recorded. Conformity index (CI) and degree of inclusion (DI) were calculated for IGTV/IGTV and PTV/PTV, respectively.</p><p><b>RESULTS</b>The volume of IGTVc+s[(35.73 ± 19.77) cm³] was significantly larger than the IGTVc [(28.35 ± 17.54) cm³] and IGTVs [(24.19 ± 21.53) cm³] (P < 0.05), and the volume of PTVc+s [(191.59 ± 69.74) cm³] was significantly larger than that of the PTVc [(161.53 ± 61.07) cm³] and PTVs [(148.98 ± 62.22)cm³] (P < 0.05). There were significant differences between the DIs of IGTVc in IGTVc+s and IGTVc+s in IGTVc, the DIs of IGTVs in IGTVc+s and IGTVc+s in IGTVs, the DIs of PTVc in PTVc+s and PTVc+s in PTVc, and the DIs of PTVs vs. PTVc+s and PTVc+s in PTVs (P < 0.05 for all). The CI of IGTVc/IGTVc+s (0.63 ± 0.14) and the CI of IGTVs/IGTVc+s (0.54 ± 0.17) were significant larger than that of the CI of IGTVc/IGTVs (0.40 ± 0.14)(P < 0.05). There were non-significant differences among the CI of PTVc/PTVs, PTVc/PTVc+s and PTVs/PTVc+s (0.73 ± 0.12, 0.78 ± 0.13 vs. 0.75 ± 0.17). The DIs and CIs of IGTV/IGTV and PTV/PTV were negatively correlated with their centroid distance (P < 0.05).</p><p><b>CONCLUSIONS</b>There are volume difference and spatial mismatch between the target volumes delineated on the basis of surgical clips and seroma. The DI and CI between the PTVs are larger than that between the IGTV. External-beam partial breast irradiation should be implemented based on the PTV that is defined based on both seroma and surgical clips.</p>

Comparison of the whole breast target volume delineated according to surface marks, palpation and glandular tissue on CT images after breast-conserving surgery / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To compare the methods of delineating the whole breast target volume based on surface marks, palpation and glandular tissue on CT images, and to explore the contouring criteria after breast-conserving surgery.</p><p><b>METHODS</b>In 15 patients with breast cancer after breast-conserving surgery, the whole breast target was delineated in 3D CT simulation images each by three different methods. The target volume delineated according to anatomical marks were named CTVan, according to breast palpation named CTVpa, and according to glandular mammary tissue showing by CT images named CTVgl. The volumes of CTVan, CTVpa and CTVgl, and the degree of inclusion (DI) and conformal index (CI) between the targets were measured.</p><p><b>RESULTS</b>The mean volumes of CTVan, CTVpa and CTVgl were (792.23 ± 282.25) cm(3), (618.33 ± 295.90) cm(3) and (196.83 ± 117.62) cm(3), respectively. The differences among the three methods were statistically significant (P < 0.001). The difference between CTVan and CTVpa had no statistical significance (P = 0.08), and both the differences between CTVan and CTVgl, and between CTVpa and CTVgl had statistical significance (both P < 0.001). The CI between CTVan and CTVpa (0.644 ± 0.122) was significantly larger than the CI between CTVan and CTVgl (0.264 ± 0.108), and the CI between CTVpa and CTVgl (0.328 ± 0.115)(P < 0.001). The DI of CTVan to CTVpa was 0.709 ± 0.144,DI of CTVgl to CTVan was 0.994 ± 0.005 and DI of CTVgl to CTVpa was 0.989 ± 0.008. The differences of inner, outer, upper and lower boundaries of CTVpa and CTVan were (3.35 ± 7.23) mm, (5.57 ± 13.37) mm, (1.75 ± 11.62) mm, and (11.25 ± 4.07)mm, respectively. The cranial and medial boundaries had a negative correlation with CTVpa (P < 0.05 for all).</p><p><b>CONCLUSIONS</b>The differences among the three methods in the delineation of whole breast target volume are statistically significant. The target volume delineated according to the glandular mammary tissue displayed by CT scan is significantly smaller than that by the other two methods. Combination of breast palpation and anatomical marks may be helpful in delineating the whole breast target volume is relatively reasonable at present.</p>

Correlations between displacements of GTV, surgical clips, and skin markers in external-beam partial breast irradiation:a study based on 4DCT / 中华放射肿瘤学杂志

Objective To investigate the correlations between the displacements of surgical clips,skin markers and the gross tumor volume (GTV) delineated by surgical clip and seroma based on fourdimensional computed tomography (4DCT) during normal breathing.Methods On each of the 10 respiratory phases of 4DCT with 15 patients of breast cancer,the surgical cavity,which was defined as GTV and formed by both surgical clips and seroma,all surgical clips in the cavity,and skin markers on the skin were delineated by the same radiation oncologist.The center displacements of GTV,selected boundary surgical clips and skin markers in the left-right (LR),anterior-posterior (AP),and superior-inferior (SI) directions were recorded and analyzed by Pearson method.Results In the AP direction,there was a positive correlation between the displacements of the GTV and the inner clip (r =0.643,P =O.013).In the SI direction,the displacement of GTV was positively correlated with those of the lower clip and the skin marker at anterior body midline (r =0.857 and 0.643,P =0.002 and 0.013).In the LR and AP directions,there was a positive correlation between the displacements of the outer clip and the ipsilateral skin marker (r =0.757 and 0.697,P =0.001 and 0.025),but they were negatively correlated with each other in the SI direction (r =-0.647,P =0.043).In the AP direction,there was a positive correlation between the displacements of the inner clip and the skin marker at the anterior body midline (r =0.738,P =0.015).Conclusions The correlations between the displacement of GTV delineated by surgical clips and seroma and the displacements of surgical slips and skin markers vary under different conditions,and so does the correlation between the displacements of surgical clips and skin markers.

Propensity score matching-based therapeutic effect evaluation in patients with hepatocellular carcinoma / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the therapeutic effects of transcatheter arterial chemoembolization (TACE) with or without radiofrequency ablation (RFA) in hepatocellular carcinoma (HCC) patients based on propensity score matching.</p><p><b>METHODS</b>A logistic regression model was established with the treatment assignment as the dependent variable and the covariates as the independent variables. For each HCC patient, the propensity score was calculated from the model for caliper matching, and a survival analysis of the matched data were carried out.</p><p><b>RESULTS</b>The covariates between the groups were balanced after caliper matching based on the propensity scores. Before matching, the one-, two-, and three-year survival rates of TACE and TACE+RFA were 52.07% and 59.08%, 32.24% and 36.43%, and 316.54% and 19.39%, with the median survival time of 1.20 and 1.40 years, respectively, showing no significant differences in the overall survival rate between the two groups. After matching, the 1-year, 2-year, and 3-year survival rates of TACE and TACE+RFA groups were 54.39% and 62.28%, 23.15% and 40.08%, and 10.20% and 18.52%, with the median survival time of 1.10 years and 1.50 years, respectively, showing significant differences in the overall survival between the two groups. The survival rate in TACE+RFA group was higher than that of TACE only group.</p><p><b>CONCLUSION</b>Propensity score matching can effectively reduce the confounding bias of non-randomized clinical observational data for a more accurate evaluation of the therapeutic effect in HCC patients.</p>

Impact of delineator and delineating criteria on the target delineation of the peripheral lung cancer based on four-dimensional computed tomography / 中华放射医学与防护杂志

Objective To investigate the impact of delineator and delineating criteria on the target delineation of the peripheral lung cancer based on four-dimensional computed tomography (4D-CT).Methods The 4D simulation CT images of twelve patients with peripheral lung cancer were selected.Before and after the establishment of the target delineation criteria,six radiation oncologists were asked to delineate the targets based on 4D-CT images at the end-inhalation phase (0％),end-exhalation phase (50％),and three-dimensional computed tomography (3D-CT) images respectively.The delineated targets were denominated as GTV0,GTV50,GTV3D.IGTVIN+Ex was created by combining GTV0 and GTV50.IGTVMIP was delineated based on the maximum intensity projection (MIP) of 4D-CT.The interand intra-observer variability before and after the establishment of the delineation criteria was compared.Results The mean coefficients of variation of GTV0,GTV50,GTV3D,IGTVMIP and IGTVIN+Ex delineated by the six delineators before and after the establishment of the delineation criteria were 0.50 ± 0.25 vs 0.24 ±0.10,0.52 ±0.38 vs 0.26 ±0.12,0.45 ±0.19 vs 0.20 ±0.07,0.54 ±0.27 vs 0.23 ±0.09 and 0.44±0.23 vs 0.26 ±0.09,respectively.The differences were statistically significant(t =3.38,2.44,3.60,4.20,3.11,P ＜ 0.05).No statistically significant difference was found in the volume of the same target for GTV0,GTV50,GTV3D,IGTVMIP and IGTVIN+Ex delineated by the six oncologists before and after the establishment of the delineation criteria.For delineator 3 and 6,the differences of GTV0,GTV50,IGTVIN+EX before and after establishment of the delineation criteria were statistically significant(t =2.46,2.91,3.28,P ＜0.05 ;t =2.40,2.79,3.22,P ＜0.05).For delineator 4,the differences of GTV0,GTV50,IGTVIN+EX,IGTVMIP,GTV3D before and after establishment of the delineation criteria were statistically significant (t =2.70,3.21,3.04,3.99,3.00,P ＜ 0.05).Conclusions The unified delineation criteria can significantly reduce the inter-observer variability in delineating the GTVs based on 3D-CT or 4D-CT images,and in delineating the IGTVMIP based on 4D-CT images of peripheral lung cancer patients.However,regarding the same delineator,various influences of the unified delineation criteria on the target delineation are observed.

Risk Factors for Leukoaraiosis: A Logistic Regression Analysis / 中国康复理论与实践

@#Objective To investigate the risk factors for leukoaraiosis. Methods 204 cases of inpatients were registered. The severity of leukoaraiosis was as the dependent variable, the possible risk factors were as independent variables, unconditional logistic regression was analyzed with SAS 9.2 software, significant level α=0.10. Results 5 factors, that were carotid stenosis, age, low density lipoprotein cholesterol,apolipoprotein B and apolipoprotein A, were included, in which the former 4 were risk factors (OR>1, P<0.05), the latter was protection factor (OR=0.715, P=0.0993). Conclusion The vascular risk factors contribute to formation of leukoaraiosis, and carotid stenosis relate to leukoaraiosis.

Measurement of Intra-Fraction Displacement of the Mediastinal Metastatic Lymph Nodes Using Four-Dimensional CT in Non-Small Cell Lung Cancer

OBJECTIVE: To measure the intra-fraction displacements of the mediastinal metastatic lymph nodes by using four-dimensional CT (4D-CT) in non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: Twenty-four patients with NSCLC, who were to be treated by using three dimensional conformal radiation therapy (3D-CRT), underwent a 4D-CT simulation during free breathing. The mediastinal metastatic lymph nodes were delineated on the CT images of 10 phases of the breath cycle. The lymph nodes were grouped as the upper, middle and lower mediastinal groups depending on the mediastinal regions. The displacements of the center of the lymph node in the left-right (LR), anterior-posterior (AP), and superior-inferior (SI) directions were measured. RESULTS: The mean displacements of the center of the mediastinal lymph node in the LR, AP, and SI directions were 2.24 mm, 1.87 mm, and 3.28 mm, respectively. There were statistically significant differences between the displacements in the SI and LR, and the SI and AP directions (p < 0.05). For the middle and lower mediastinal lymph nodes, the displacement difference between the AP and SI was statistically significant (p = 0.005; p = 0.015), while there was no significant difference between the LR and AP directions (p < 0.05). CONCLUSION: The metastatic mediastinal lymph node movements are different in the LR, AP, and SI directions in patients with NSCLC, particularly for the middle and lower mediastinal lymph nodes. The spatial non-uniform margins should be considered for the metastatic mediastinal lymph nodes in involved-field radiotherapy.