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Objective:To provide a basis for selecting the optimization method for intracavitary/interstitial brachytherapy (IC/ISBT) of cervical cancer by comparing graphical optimization (GO), inverse planning simulated annealing (IPSA), and hybrid inverse planning optimization (HIPO) using dosimetric and radiobiological models.Methods:This study selected 65 patients with cervical cancer who were treated with image-guided IC/ISBT. The afterloading therapy plans for these patients were optimized using GO, IPSA, and HIPO individually, with a prescription dose high-risk clinical target volume (HRCTV) D90 of 6 Gy. The non-parametric Friedman test and the non-parametric Wilcoxon rank test were employed to analyze the differences in duration, dose-volume parameters, and radiobiology between the three types of optimized plans. Results:Inverse planning optimization (IPSA: 46.53 s; HIPO: 98.36 s) took less time than GO (135.03 s). In terms of gross target volume (GTV) dose, the high-dose irradiation V150% (53.66%) was slightly higher in the HIPO-optimized plans, while the V200% (30.29%) was higher in the GO-optimized plans. The GO-optimized plans had a higher conformity index (CI; 0.91) than other plans, showing statistically significant differences. Compared with other plans, the HIPO-optimized plans showed the lowest doses of D1 cm 3 and D2 cm 3 at bladders and rectums and non-statistically significant doses at small intestines ( P > 0.05). In terms of the equivalent uniform biologically effective dose (EUBED) for HRCTV, the HIPO-optimized plans showed a higher value (12.35 Gy) than the GO-optimized plans (12.23 Gy) and the IPSA-optimized plans (12.13 Gy). Moreover, the EUBED at bladders was the lowest (2.38 Gy) in the GO-optimized plans, the EUBED at rectums was the lowest (3.74 Gy) in the HIPO-optimized plans, and the EUBED at small intestines was non-significantly different among the three types of optimized plans ( P = 0.055). There was no significant difference in the tumor control probability (TCP) predicted using the three types of optimized plans ( P > 0.05). The normal tissue complication probabilities (NTCPs) of bladders and rectums predicted using the HIPO-optimized plans were lower than those predicted using the GO- and IPSA-optimized plans( χ2 = 12.95-38.43, P < 0.01), and the NTCP of small intestines did not show significant differences ( P > 0.05). Conclusions:Among the three types of optimization algorithms, inverse optimization takes less time than GO. GO-optimized plans are more conformal than IPSA- and HIPO-optimized plans. HIPO-optimized plans can increase the biological coverage dose of the target volume and reduce the maximum physical/biological exposure and NTCP at bladders and rectums. Therefore, HIPO is recommended preferentially as an optimization algorithm for IC/ISBT for cervical cancer.
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Objective:To establish a three-dimensional (3D) U-net-based deep learning model, and to predict the 3D dose distribution in CT-guided cervical cancer brachytherapy by using the established model.Methods:The brachytherapy plans of 114 cervical cancer cases with a prescription dose of 6 Gy for each case were studied. These cases were divided into training, validation, and testing groups, including 84, 11, and 19 patients, respectively. A total of 500 epochs of training were performed by using a 3D U-net model. Then, the dosimetric parameters of the testing groups were individually evaluated, including the mean dose deviation (MDD) and mean absolute dose deviation (MADD) at the voxel level, the Dice similarity coefficient (DSC) of the volumes enclosed by isodose surfaces, the conformal index (CI) of the prescription dose, the D90 and average dose Dmean delivered to high-risk clinical target volumes (HR-CTVs), and the D1 cm 3 and D2 cm 3 delivered to bladders, recta, intestines, and colons, respectively. Results:The overall MDD and MADD of the 3D dose matrix from 19 cases of the testing group were (-0.01 ± 0.03) and (0.04 ± 0.01) Gy, respectively. The CI of the prescription dose was 0.70 ± 0.04. The DSC of 50%-150% prescription dose was 0.89-0.94. The mean deviation of D90 and Dmean to HR-CTVs were 2.22% and -4.30%, respectively. The maximum deviations of the D1 cm 3 and D2 cm 3 to bladders, recta, intestines, and colons were 2.46% and 2.58%, respectively. The 3D U-net deep learning model took 2.5 s on average to predict a patient′s dose. Conclusions:In this study, a 3D U-net-based deep learning model for predicting 3D dose distribution in the treatment of cervical cancer was established, thus laying a foundation for the automatic design of cervical cancer brachytherapy.
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OBJECTIVE： To investigate the distribution， drug supply and quantity of licensed pharmacists in retail pharmacies around Third Grade Class A Hospitals， and to provide reference for decision-making of related management departments. METHODS： Field investigation and questionnaire survey were used to investigate the distribution， type， operating area， annual turnover， drug type， ranking of consumption sum， daily prescription amount and pharmacist allocation of 5 Third Grade Class A Hospitals in Beijing and general information of 100 surveyed pharmacists in 2017. RESULTS： There were 43 retail pharmacies in total within 1 km of 5 Third Grade Class A Hospitals， with an average of 8.60 retail pharmacies for each hospital. The number of retail pharmacies with distance between 200-400 m and 800-1 000 m was the largest （11）， of which 21 （48.84％） were chain drugstores. The operating area of 38 pharmacies （88.37％） was in the range of 100-175 m2， mainly ranging 100-125 m2 （16 pharmacies， 37.21％）. The annual turnover of 40 pharmacies were counted and ranged 50-10 000 ten thousand yuan， among which the pharmacies 0-200 m away from the hospital had the highest annual turnover. The average variety of drugs （prescription drugs and over-the-counter drugs） was 2 511 kinds. 34 pharmacies （79.07％） had more varieties of over-the-counter drugs than prescription drugs， and the consumption sum of over-the-counter drugs was higher than that of prescription drugs in 26 pharmacies （60.47％）. Top 3 drugs in the list of consumption sum were antineoplastic drugs， cardiovascular drugs and anti-infective drugs. Average daily prescriptions of 28 drugstores （65.11％） were less than 10 pieces； average daily prescription were more than 20 pieces in only 7 pharmacies （16.28％）. On average， each pharmacy had 7.4 staff members and 1.37 licensed pharmacists. 58 staff members’ first degree was junior college （58％）， 38 staff members’ first degree was technical secondary school or high school （38％）， and only 3 （3％） staff members’ first degree was undergraduates or above. CONCLUSIONS： With the gradual promotion of “health care policy” and the outflow of more hospital prescriptions， the retail pharmacies around hospitals should increase their numbers， expand the operating area， accelerate the construction of licensed pharmacists and improve the education level of pharmacists so as to improve the pharmaceutical care ability.
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Objective:To summarize the experience and effect of clinical pharmacists participating in the consultation for infection cases in paediatrics.Methods:All of medical records involving the anti-infective consultation of clinical pharmacists from July 2014 to June 2017 in our hospital were retrospectively analyzed,and the data including gender,age,primary diseases,infection sites,disposal opinions,suggestion adoption and treatment outcome were statistically analyzed. Results: During July 2014 to June 2017, clinical pharmacists participated in the consultation for 187 infection cases. Among them,69 cases were newborns. The consultation reasons mainly included the selection and adjustment of antimicrobial agents which accounted for 83.42% (156 cases).There were 105 cases of positive etiological examination. According to the outcome of diseases, the total effective rate of consultation performed by clinical pharmacists was 92.31%. Conclusion:Due to the specificity of children's infective diseases,participaton in the treatment by clinical pharmacists is important for the diagnosis and treatment of children patients and the improvement of rational drug use in paediatrics.
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Objective To observe the effect of herbal decoction for invigorating the spleen to dissolve damp on infantile rotavirus enteritis (IRVE) and myocardial enzymes.Methods Eighty patients were randomized into a treated group and a control group.The former was treated with the herbal decoction which could invigorate the functions of spleen to dissolve damp,the latter treated with Smecta.The course of treatment for both groups was 3 days.The changes in the symptoms of diarrhea,vomiting,and fever were observed and the myocardial enzymes including aspartate aminotransferase (AST),lactic dehydrogenase (LDH),creatine phosphokinase (CK) and CK-MB were determined.Results The effect of the treated group in stopping diarrhea,relieving fever,and stopping vomiting was all superior to that of the contro1 group (P0.05).Conclusion The herbal decoction for invigorating the spleen to dissolve damp in the treatment of IRVE functions to shorten the course of disease,improve the symptoms,and reduce the damage of cardiac muscles.
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OBJECTIVE:To simultaneously determine the contents of paracetamol and caffeine in999Ganmaoling granules with TLC.METHODS:Chloroform-ethylacetate-methanol-annmonia water(15∶4∶3∶0.3)was taken as developing a?gent.The spots were scanned with CS-930TLC scanner at? S =245nm,? R =315nm for paracetamol and at? S =270nm,? R =350nm for caffeine.RESULTS:Average recovery of paracetamol was99.33%,RSD=1.28%;Average recovery of caffeine was100.1%,RSD=1.71%;The labelling contents of paracetamol and caffeine in three batches of samples were99.02%,98.48%,99.23%and99.74%,98.57%,99.24%respectively.CONCLUSION:The method is simple,quick and accurate.It can be used for the quality control of999Ganmaoling.