Comparison of imbolization accuracy between styrofoam and breast carrier in intensity-modulated radiotherapy after breast conservative surgery for breast cancer patients / 中华放射肿瘤学杂志

Objective To investigate the difference of styrofoam and breast carrier in postposition fixation of intensity-modulated radiotherapy after breast conservative surgery for breast cancer patients.Methods From February 2018 to August 2018,tweenty-four patients with breast cancer in Sun Yet-Sen Memorial Hospital of Sun Yet-sen University were selected for this study,who underwent hypofactionationed radiotherapy after breast conservative surgery with total dose 42.56 Gy/16Fractions.They were randomized into styrofoam test group and breastcarrier control group.Cone beam CT as used to record the positioning error under the directions of left and right (x),head and foot (y),abdomen and back (y) within two groups at the first,third,fifth,seventh,eleventh time before irradiation.Furthermore,the PTV extension margin was calculated and the positioning time of two groups was recorded.Two sets of pendulum errors were analyzed by independent sample T-test,and the outspread value of inter-fractional set up error of the PTV was calculated.Results The errors of the test group and the control group in the direction of x,y,z were as follows:(2.36±1.89) and (2.56±2.05) mm (P=0.49),(1.76± 1.78) and (3.28±2.79) mm (P＜0.05),(1.47± 1.49) and (1.73± 1.81) mm (P=0.28).The extension values of inter-fractional set up error of CTV to PTV were 2.97,2.92,2.21 mm and 3.41,4.09,2.59 mm respectively.The time of single positioning was (3.4± 1.1) and (5.5 ± 3.1) min respectively (P=0.01).Conclusion Styrofoam has better positioning accuracy and efficiency compared with breast carrier.

Clinical characteristics in lymphangioleiomyomatosis-related pulmonary hypertension: an observation on 50 patients / 医学前沿

Lymphangioleiomyomatosis (LAM) is a rare diffuse cystic lung disease. Knowledge on LAM-related pulmonary hypertension (PH) is limited. This study aimed to analyze the clinical characteristics of LAM with elevated pulmonary artery pressure (PAP) and evaluate the potential efficacy of sirolimus. The study involved 50 LAM patients who underwent echocardiography. According to the tricuspid regurgitation velocity (TRV), these patients were divided into the TRV ⩽ 2.8 m/s group and TRV > 2.8 m/s group. Both groups comprised 25 females with an average age of 38.6 ± 8.1 and 41.5 ± 8.9 years. In the TRV > 2.8 m/s group, the estimated systolic PAP (SPAP) was significantly elevated (52.08 ± 12.45 mmHg vs. 30.24 ± 5.25 mmHg, P < 0.01). Linear analysis showed that SPAP was correlated with forced expiratory volume in 1 s (FEV), diffusing capacity of the lungs for carbon monoxide, alveolar arterial oxygen gradient (PO), and 6 min walking distance (r =-0.392, -0.351, 0.450, and -0.591, respectively; P < 0.05), in which PO was a risk factor for SPAP elevation (β = 0.064, OR = 1.066, P < 0.05). Moreover, in 10 patients who received sirolimus therapy, SPAP decreased from 57.0 12.6 mmHg to 35.2 ± 11.1 mmHg. The study showed that LAM patients with PH exhibit poor pulmonary function and hypoxemia and may benefit from sirolimus treatment.

Automated function imaging for predicting severe stenosis of left anterior descending coronary artery / 中国医学影像技术

Objective To explore the value of automated function imaging (AFI) based on two-dimensional speckle tracking imaging (2D-STI) technique longitudinal strain for predicting severe stenosis of left anterior descending (LAD) coronary artery in patients with suspected coronary heart disease (CHD).Methods Ninety-two patients with suspected CHD were divided into two groups according to the coronary angiography (CAG) results.There were 49 cases in group A (LAD stenosis rate ＜70％) and 43 cases in group B (LAD stenosis rate ≥70％).The two dimensional gray scale dynamic images were obtained in apical four-chamber view,apical two-chamber view and long axis of left ventricle (LV) view.Eighteen segments of LV longitudinal peak systolic strain,global longitudinal strain (GLS) and territorial longitudinal strain (TLS) supplied with LAD were measured with AFI software.The conventional ultrasonic parameters and the two-dimensional longitudinal strain parameters were compared between the two groups and ROC curve analysis of these parameters was used to predict LAD severe stenosis.Results There was no significant difference in the conventional ultrasonic parameters between the two groups (all P＞0.05).The group B had lower GLS,TLS than group A (both P＜0.001).GLS and TLS showed the highest area under ROC curve (0.715 and 0.705) for predicting LAD severe stenosis.The cut-off value,sensitivity and specificity for predicting LAD severe stenosis were-19.58 ％,63.3 ％,67.4 ％ in TLS,and-20.85 ％,74.4 ％,61.2 ％ in GLS respectively.Conclusion The longitudinal strain parameters measured with AFI based on 2D-STI technique can be used to predict LAD severe stenosis in patients with CHD,and GLS is more sensitive than TLS.

Automated function imaging for predicting severe stenosis of left anterior descending coronary artery / 中国医学影像技术

Objective To explore the value of automated function imaging (AFI) based on two-dimensional speckle tracking imaging (2D-STI) technique longitudinal strain for predicting severe stenosis of left anterior descending (LAD) coronary artery in patients with suspected coronary heart disease (CHD).Methods Ninety-two patients with suspected CHD were divided into two groups according to the coronary angiography (CAG) results.There were 49 cases in group A (LAD stenosis rate ＜70％) and 43 cases in group B (LAD stenosis rate ≥70％).The two dimensional gray scale dynamic images were obtained in apical four-chamber view,apical two-chamber view and long axis of left ventricle (LV) view.Eighteen segments of LV longitudinal peak systolic strain,global longitudinal strain (GLS) and territorial longitudinal strain (TLS) supplied with LAD were measured with AFI software.The conventional ultrasonic parameters and the two-dimensional longitudinal strain parameters were compared between the two groups and ROC curve analysis of these parameters was used to predict LAD severe stenosis.Results There was no significant difference in the conventional ultrasonic parameters between the two groups (all P＞0.05).The group B had lower GLS,TLS than group A (both P＜0.001).GLS and TLS showed the highest area under ROC curve (0.715 and 0.705) for predicting LAD severe stenosis.The cut-off value,sensitivity and specificity for predicting LAD severe stenosis were-19.58 ％,63.3 ％,67.4 ％ in TLS,and-20.85 ％,74.4 ％,61.2 ％ in GLS respectively.Conclusion The longitudinal strain parameters measured with AFI based on 2D-STI technique can be used to predict LAD severe stenosis in patients with CHD,and GLS is more sensitive than TLS.

Layer-specific strain assessment of left ventricular systolic function changes in patients with non-ST-elevation acute coronary syndrome / 中华医学超声杂志（电子版）

Objective To analyze territorial and global longitudinal layer-specific strain of left ventricle by two-dimensional speckle tracking imaging (2D-STI) in patients with suspected non-ST-elevation acute coronary syndrome (NSTE-ACS) and to explore the value of layer-specific strain parameters for prediction of significant coronary artery stenosis. Methods Seventy-five patients with suspected NSTE-ACS in People′s Hosptial of Subei from September 2016 to January 2017 were enrolled and all patients underwent coronary arteriography (CAG). Among them, there were 24 subjects in control group (coronary artery without stenosis or stenosis rate <50%) and 51 subjects in coronary atherosclerotic heart disease group (coronary heart disease, CHD). According to whether coronary artery occlusion, the CHD group was divided into coronary stenosis group (32 subjects) and coronary occlusion group (19 subjects). Using EchoPAC software, two-dimensional dynamic images were analyzed to obtain left ventricle 18-segment systolic longitudinal layer-specific strain and to calculate the territorial longitudinal strain (TLS) of endocadium, mid-myocardium and epicardium (TLSendo, TLSmid, TLSepi) and left ventricle global longitudinal strain (GLS) of endocadium, mid-myocardium and epicardium (GLSendo, GLSmid, GLSepi). The differences of left ventricle territorial and global longitudinal layer-specific strain parameters among 3 groups were compared by one-way analysis of variance and the differences between two groups were compared by LSD-t test. The receiver operating characteristic (ROC) curve of each parameter was constructed to predict significant coronary stenosis by using the results of CAG as the gold standard. Results Compared with control group and coronary stenosis group, TLSendo, TLSmid, TLSepi and GLSendo, GLSmid, GLSepi all decreased in patients with coronary occlusion, and the differences were statistically significant (coronary occlusion group vs. control group: t values were -5.819, -5.049, -4.845, -5.955, -5.036 and -4.724, respectively, P values were all less than 0.01;coronary occlusion group vs.coronary stenosis group:t values were-2.983,-3.059, -2.903, -2.989, -3.192 and -3.387, respectively, P values were all less than 0.01). And compared with control group, only TLSendo and GLSendo decreased in patients with coronary stenosis, and the differences were statistically significant (t values were -3.981 and -4.164, respectively, P values were all less than 0.01). TLSendo, TLSmid, TLSepi and GLSendo, GLSmid, GLSepi showed a gradient decrease in all 3 groups, but only in the control group the comparison between two of the three layers showed statistically significant differences(TLSepi vs. TLSendo,GLSepi vs. GLSendo:t values were both-10.083,P values were all less than 0.01;TLSepi vs.TLSmid,GLSepi vs.GLSmid:t values were both-4.559,P values were all less than 0.01;TLSmid vs.TLSendo,GLSmid vs.GLSendo:t values were both-5.549,P values were all less than 0.01). The absolute differences between endocardial and epicardial TLS and GLS (?TLS and?GLS) decreased gradually from the control group, to coronary stenosis group and to coronary occlusion group,and the differences were statistically significant(coronary occlusion group vs.control group:t values were 6.915 and 7.489, respectively, P values were all less than 0.01; coronary stenosis group vs. control group: t values were 4.923 and 7.202, respectively, P values were all less than 0.01; ?TLS of patients in the coronary occlusion group vs.coronary stenosis group:t value was 2.250,P value was less than 0.05),which reflected a pronounced decrease in endocardial function. By ROC curve analysis, GLSendo and TLSendo showed the highest area under the curve in predicting significant coronary artery stenosis, which were better than strain parameters of mid-myocardium, epicardium and the entire wall thickness of the myocardium. Conclusions Left ventricle showed systolic dysfunction in all three layers in suspected NSTE-ACS patients with CHD, especially the endocardium. The longitudinal layer-specific strain parameters by 2D-STI can be used for quantitative evaluation of the territorial and global systolic dysfunction differences of left ventricle in all layers in suspected NSTE-ACS patients with CHD, which can also be used for prediction of significant coronary artery stenosis.

Value of real-time three-dimensional echocardiography in evaluating right ventricular structure and hemodynamic parameters of patients with pulmonary hypertension / 中华医学超声杂志（电子版）

Objective To explore the value of real-time three-dimensional echocardiography (RT-3DE) in evaluating right ventricular structure and hemodynamic parameters of patients with pulmonary hypertension (PH).Methods A total of 89 PH patients in Subei People′s Hospital from July 2014 to December 2016 were selected as PH group, and 49 subjects with health examination were designed as control group. According to pulmonary arterial systolic pressure (PASP), the 89 patients with PH were divided into mild PH group (n=29), moderate PH group (n=32) and severe PH group (n=28). The indexes of right heart structure such as right ventricular diameter (RVTD), left ventricular diameter (LVTD), right ventricular end diastolic volume (EDV), end systolic volume (ESV), stroke volume (SV) and right ventricular ejection fraction (RVEF) as well as hemodynamic parameters such as pulmonary systolic pressure (SPAP), pulmonary artery diastolic pressure (DPAP), mean pulmonary artery pressure (MPAP) and right ventricular output (RCO) were detected by RT-3DE in all the subjects. The indexes of right heart structure and hemodynamic parameters were compared by independent-samplet test between PH group and control group, and indexes of right heart structure and hemodynamic parameters were compared by variance analysis among different PH groups. The SNK-q test was used for the further comparison between any two groups.Results The RVTD, EDV and ESV in the PH group were significantly higher than those in the control group, while LVTD, SV and RVEF were significantly lower than those in the control group (t=-2.73,P=0.003;t=-4.37,P=0.001;t=-4.57,P=0.002;t=-3.49,P=0.039;t=-2.01,P=0.043;t=6.36,P=0.001). The RVTD, EDV and ESV in moderate PH group and severe PH group were significantly higher than those in the mild PH group, while the LVTD, SV and RVEF were significantly lower than those in the mild PH group (q=4.318, 4.713, 3.873, 3.921, 5.127, 5.347, 5.618, 5.903, 4.318, 4.501, 5.327, 5.981, allP<0.05). The LVTD, EDV, ESV, SV, RVEF in the severe PH group were significantly lower than those in the moderate PH group, while the RVTD was significantly higher than the moderate PH group (q=3.708, 3.249, 4.807, 3.953, 3.197, 3.764, allP<0.05). The SPAP, DPAP and MPAP in PH group were significantly higher than those in control group, while RCO was significantly lower than that that in the control group (t=0.637,P=0.001;t=0.875,P=0.001;t=0.783, P=0.001;t=0.691,P=0.035). The SPAP, DPAP and MPAP in moderate PH group and severe PH group were significantly higher than those in the mild PH group, and the SPAP in the severe PH group was significantly higher than that in the moderate PH group (q=4.349,P=0.041;q=5.871,P=0.039;q=4.201,P=0.042;q=4.869,P=0.043;q=3.981,P=0.034;q=3.991,P=0.035;q=0.421,P=0.039). There were no significant differences in DPAP and MPAP between the moderate PH group and the severe PH group. The RCO decreased gradually in the mild PH group, the moderate PH group and the severe PH group, and there were significant differences between any two groups (q=3.541,P=0.033;q=3.204,P=0.030;q=0.391,P=0.043). Conclusion In PH patients, the right ventricular function declined, and RT-3DE can accurately evaluate the right ventricular function in patients with different degrees of pulmonary hypertension.