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Objective:To evaluate the clinical efficacy of laparoscopic splenectomy and azygoportal disconnection (LSD) with intraoperative endoscopic variceal ligation (LSDL) in the treatment of esophagogastric variceal bleeding (EVR).Method:In this study,90 cirrhotic patients with esophagogastric variceal bleeding (EVB) were divided to receive either LSD ( n=45) or LSDL ( n=45) from Jan 2020 and Dec 2021. Results:There were no significant differences in estimated blood loss, incidence of blood transfusion, time to first flatus, off-bed activity and postoperative hospital stay between the two groups (all P>0.05). Compared with LSD group, operation time was longer in LSDL group[ (140±21) min vs. (150±19) min, t=2.420, P=0.018]. LSDL was associated with significantly decreased EVR rate in one year follow-up (2% vs. 18%, P=0.030). Univariate analysis and multivariate logistic regression revealed that LSDL was a significant independent protective factor for EVR as compared with LSD ( P<0.05). Conclusion:LSDL procedure is not only technically feasible and safe, it also contributed to lower postoperative EVR risk than single LSD.
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Objective:To evaluate whether vagus nerve-guided robotic splenectomy and azygoportal disconnection (VNRSD) is feasible and safe and to determine whether VNRSD can be competent for well protecting vagus nerve.Methods:In this prospective clinical study, 12 cirrhotic patients with portal hypertension, hypersplenism and esophagogastric variceal bleeding (EVB) who accepted VNRSD at the Clinical School of Medicine of Yangzhou University between January 2022 and March 2022 were included, including 5 females and 7 males, aged (56.6±11.6) years old. Clinical data such as visual analog scale (VAS) pain score, conversion to laparotomy, esophagogastric variceal bleeding, and death were collected. The patients were asked to reexamine in the outpatient department 1 month after the operation, and the diarrhea, delayed gastric emptying and epigastric fullness were followed up.Results:VNRSD was successfully performed in all patients. There was no conversion to open or laparoscopic operations. The operation time was (170.0±16.8) min, blood loss was (60.8±11.3) ml, VAS pain score on the first day was (2.2±0.9) scores, and the postoperative hospital stay was (7.7±0.7) d, the four patients had main portal vein system thrombosis on the 7th day after operation. At the first day after operation, all patients were mange to take semi-fluid and off-bed activity. There were no incisional complications, pneumonia, gastric fistula, pancreatic fistula, and abdominal infection. No patients suffered from diarrhea, delayed gastric emptying, and epigastric fullness. None of the patients suffered from esophagogastric variceal bleeding, hepatic encephalopathy or death after operation and one month after operation, and the esophagogastric variceal were significantly improved. And no patient complained of abdominal distension or diarrhea.Conclusion:VNRSD procedure is not only technically feasible and safe, but also effectively protects anterior and posterior vagal trunks and all their branches, completely eradicating digestive system complications.
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Objective:To identify dose-volume parameters to predict the incidence of acute intestinal toxicity in cervical cancer patients after postoperative adjuvant radiotherapy.Methods:Clinical data of 93 cervical cancer patients who underwent postoperative adjuvant intensity-modulated radiotherapy (IMRT) were retrospectively evaluated. The dose-volume parameters comprised the absolute volume of the bowel receiving 5-45 Gy (5 Gy interval) radiation dose and the total volume of the bowel. The acute radiation-induced intestinal toxicity was evaluated by Radiation Therapy Oncology Group (RTOG) criteria. The association between the irradiated bowel volume and acute intestinal toxicity was analyzed.Results:A total of 26 (28%) patients experienced grade ≥2 acute intestinal toxicity. A strong relationship between grade ≥2 acute intestinal toxicity and the irradiated small bowel volume was observed at the total volume of small bowel, small bowel V 5 Gy, V 10 Gy and V 15 Gy (all P<0.05). Small bowel V 10 Gy ( HR=1.028, 95% CI, 0.993-1.062, P=0.029) and small bowel ?V 15 Gy( HR=0.991, 95% CI, 0.969-1.013, P=0.034)were the independent risk factors for evident acute intestinal toxicity. Conclusion:Dose-volume parameters of the small bowel can be used as predictors for the occurrence of grade ≥2 acute intestinal toxicity in cervical cancer patients undergoing postoperative adjuvant radiotherapy.
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In recent years, the issue of "reproducibility" of scientific research results has become more and more prominent. Radiobiology is a medical science that studies the biological effect of radiation on living organisms, and there is also a serious problem of "reproducibility of findings". Inaccuracy of physical dose or incomplete dosimetric reports is one of the main causes. Use of guidelines, specifications and recommendations for dosimetric measurement, such as the standardized scoring system for dosimetric reports, will help improving the standardization and accuracy of physical dose measurement in radiobiological research. In this article, multiple guidelines and recommends for improving collaboration between radiobiology and radiation physics, as well as for dose standardization of radiobiological research were evaluated, aiming to provide reference for improving the reproducibility of radiobiological research.
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Although the use of postmastectomy radiation therapy (PMRT) has been proven to bring survival benefit to breast cancer patients, the use of chest wall tissue equivalent filler (bolus) remains controversial. In recent years, a large number of studies have shown that the use of bolus in PMRT does not significantly improve the local control rate, while it can significantly increase the acute skin toxicity, and even leads to more frequent and longer treatment interruption. Existing retrospective studies have indicated that for breast cancer patients undergoing mastectomy and systemic therapy, if there is no skin invasion, it is recommended not to routinely use bolus during radiotherapy. However, higher-level clinical studies are needed for further confirmation.
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Objective:To evaluate the pancreatic subclinical dysfunction after intensity-modulated radiation therapy (IMRT) for gastric cancer by analyzing biochemical indexes and pancreatic volume changes, and to reduce the dose of pancreas by dosimetric prediction and dose limitation.Methods:30 patients with gastric cancer who received 45 Gy postoperative adjuvant radiotherapy were retrospectively selected. The pancreas was delineated and its dose and anatomical relationship with planning target volume (PTV) were evaluated. Fasting blood glucose, serum lipase and amylase, and pancreatic volume changes before and after radiotherapy were analyzed. The correlation between the changes of biochemical indexes and volume and pancreatic dose was evaluated by Pearson analysis. The threshold of the dosimetric prediction was obtained by receiver operating characteristic (ROC) curve. Finally, the feasibility of dosimetric limitation in IMRT was assessed.Results:The pancreatic volume of 30 patients was 37.6 cm 3, and 89.0% of them were involved in PTV. D mean of the pancreas was 45.92 Gy, and 46.45 Gy, 46.46 Gy and 45.80 Gy for the pancreatic head, body and tail, respectively. The fasting blood glucose level did not significantly change. The serum lipase levels were significantly decreased by 66% and 77%(both P<0.001), and the serum amylase levels were significantly declined by 24% and 38%(both P<0.001) at 6 and 12 months after radiotherapy. Pancreatic volumes of 22 patients was decreased by 47% within 18 months after radiotherapy. ROC curve analysis showed that pancreatic V 45Gy had the optimal predictive value for the decrease by 1/3 of serum lipase and amylase levels at 6 months and serum amylase level at 12 months after radiotherapy, and the cut-off value was V 45Gy<85%. Pancreatic D mean yielded the optimal predictive value for the decrease by 2/3 of serum lipase level at 12 months after radiotherapy, and the cut-off value was D mean<45.01 Gy. After" whole pancreas" and" outside PTV pancreas" dose limit, V 45Gy of the pancreas was decreased by 11% and 7%, D mean of the pancreas was declined by 2% and 2%, and D mean of the pancreatic tail was decreased by 3%, respectively. Conclusions:Serum lipase and amylase levels significantly decline at 6 and 12 months after adjuvant radiotherapy for gastric cancer, and pancreatic volume is decreased significantly within 18 months after radiotherapy. Pancreatic V 45Gy<85% and D mean<45.01 Gy are the dose prediction values for the decrease of serum lipase and amylase levels. The dose can be reduced to certain extent by dosimetric restriction.
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Objective:To understand the normative status of physical dose description in domestic radiobiology studies through literature study.Methods:According to the scoring system recommended by the National Cancer Institute (NCI) and Desrosiers et al, evaluate (full Score: 10 points) the normalization of physical dosimetry description in the radiobiology-related articles published in two important journals, Chinese Journal of Radiation Oncology and Chinese Journal of Radiological Medicine and Protection, in past 5 years.Results:A total of 222 relevant articles from these two journals were included, and a median score of 5.0 was evaluated. Among them, 72.1% of the literatures scored 4.0-7.0 points, 68.0% of the literatures scored ≤5.5 points, and 18.5% scored ≤3.0 points. 90.1% and 97.7% of the literatures described " the type of ray" and " absorbed dose" , with the highest average score (0.90 and 0.98 points) respectively. The lowest average score of " dosimetry calibration" was 0 point.Conclusions:Although the most of literatures described " the type of ray" and " absorbed dose" , most other details of dosimetric parameters were not reported. Therefore, there is a deficiency in the standardized description of physical dosimetry in domestic radiobiology literatures, which may affect the reproducibility and interpretability of research result.
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Objective:To evaluate whether the decrease in peripheral blood monocyte count was a potential predictor for neutropenia in patients with nasopharyngeal carcinoma and cervical cancer.Methods:The medical records of 95 patients with nasopharyngeal carcinoma and cervical carcinoma who received intensity-modulated radiation therapy (IMRT) combined with paclitaxel liposomes and platinum (TP) synchronous chemotherapy and presented with neutropenia in the Second Affiliated Hospital of Soochow University from January 2017 to December 2018 were retrospectively analyzed. Paired sample t-test was used to assess whether the number of days when the monocytes initially dropped/decreased to lowest level/eventually increased to normal value was significantly less than those of the neutrophils. In addition, the chi-square test was performed to determine the correlation between the degree of reduction in the absolute neutrophil count (ANC) and baseline absolute monocyte count (AMC). Results:The change trend of AMC was consistent with that of ANC in the two cycles of concurrent chemotherapy. The number of days when AMC initially decreased/decreased to the lowest level/finally increased to normal value was significantly less than that of ANC (4 d vs. 6 d, 4 d vs. 10 d, P<0.001; 5 d vs. 6 d, 6 d vs. 9 d, 7 d vs. 12 d, P<0.001). However, no correlation was found between the baseline level of monocytes and the degree of subsequent neutropenia [(AMC<0.4×10 9) vs.( AMC≥0.4×10 9)=32 vs. 63, P=0.172]. Conclusions:Decreased monocyte count is an important potential predictor for neutropenia and a significant indicator for guiding the next monitoring of neutrophil count and treatment with granulocyte colony-stimulating factor.
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Intestinal injury is an important toxic response during radiation therapy of pelvic tumors. With the widespread use of precision radiotherapy techniques such as intensity modulated radiation therapy (IMRT), the dose exposed to normal tissues and organs has been significantly reduced. However, the toxic response of the bowel still limits the increase of the dose to the target volume. Therefore, the protection of important organs at risk (OAR), such as the bowel, becomes more and more important while giving adequate irradiated dose to the target volume. Most current studies used loop to contour bowel. For patients who underwent IMRT, the meaningful dose-volume predictors of grade 2 acute intestinal adverse events using bowel loop (small loop + big bowel) delineation included V45 Gy < 50 cm 3,V50 Gy < 13 cm 3, and V55 Gy < 3 cm 3, and the corresponding predicators using bowel bag delineation were V40 Gy < 170 cm 3,V45 Gy < 100 cm 3, and V50 Gy < 33 cm 3.
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Objective:To introduce the usefulness and advantages of needle-type choledochotomy in laparoscopic common bile duct exploration.Methods:A retrospective analysis for the data of 1 107 patients who successfully implemented laparoscopic common bile duct exploration in Subei People′s Hospital of Jiangsu Province from January 1, 2013 to December 31, 2020 were applied. All cases were divided into the study group 662 cases with needle-type choledochotomy) and the control group (445 cases with non-needle-type choledochotomy) according to the manipulation of common bile duct incision. The time-cost, incidences of bleeding and bile leakage, as well as the recurrence rate of bile duct stone and the incidence of bile duct stenosis were observed and compared between the two groups. Normally distributed data were expressed as mean±standard deviation ( Mean± SD) and compared by t test while count data were expressed as frequency or percentage and compared by chi-square test or Fisher′s exact test. Results:The bile duct incision time and bleeding rate were (14.45±2.46) s and 25.1% in the study group, (104.48±15.32) s and 68.1% in the control group, respectively. The differences between the two groups were statistically significant ( P<0.001). The incidence of stone recurrence, biliary leakage, and bile duct stricture were 3.0%, 3.6% and 0.3% in the study group, 4.9%, 5.6% and 0.4% in the control group, respectively. There were no statistically significant differences between the two groups ( P>0.05). Conclusion:Needle-type bile duct incision can be used as a routine manipulation in laparoscopic common bile duct exploration for its time-saving, less bleeding, safe and easy to handling.
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Objective@#To investigate nutrition literacy among parents of students in Bengbu, China, and examine their awareness of school lunches and satisfaction, so as to provide a basis for improving students nutrition.@*Methods@#Using a random cluster sampling method, this study carried out a survey among parents of students in grade 2, grade 5, and grade 8 from four primary and middle schools in the central and surrounding urban areas of Bengbu. A total of 2 051 parents were surveyed.@*Results@#The qualified rate of nutritional knowledge was 13.0% and the qualified rate of nutritional behavior was 63.0%. The qualified rate of nutritional knowledge behavior was 25.1%. The proportion of breakfasts consisting of at least three food groups was 28.3%. Nutritional knowledge was largely acquired through the Internet, accounting for 54.6%. The convenience of school lunches was identified as the main reason that parents opted for the school lunch program (86.7%). Parents satisfaction with school lunches was 56.8%.@*Conclusion@#It is necessary to strengthen the nutritional knowledge education of parents, and to enhance communication between schools and parents, as well as between parents and children.
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Objective:To investigate the clinical efficacy of Da Vinci robotic assisted vagus nerve-preserving splenectomy and azygoportal disconnection.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 10 cirrhotic portal hypertension patients with esophagogastric variceal bleeding and hypersplenism who were admitted to Clinical Medical College of Yangzhou University from February to May 2021 were collected. There were 4 males and 6 females, aged from 43 to 64 years, with a median age of 55 years. All 10 patients underwent Da Vinci robotic assisted vagus nerve-preserving splenectomy and azygoportal discon-nection. Observation indicators: surgical situations, intraoperative autologous blood transfusion, conversion to open laparotomy, allogeneic blood transfusion, the operation time, volume of intra-operative blood loss, time to initial diet intake, time for out-of-bed activity, postoperative complica-tion, duration of postoperative hospital stay and follow-up. Follow-up was conducted using out-patient examination and telephone interview to detect recurrent gastrointestinal hemorrhage and gastric retention up to July 2021. Measurement data with normal distribution were represented as Mean± SD and measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers. Results:All 10 patients underwent Da Vinci robotic assisted nerve-preserving splenectomy and azygoportal disconnection successfully, with intraopera-tive autologous blood transfusion and without conversion to open laparotomy or allogeneic blood transfusion. The operation time, volume of intraoperative blood loss, time to initial diet intake and time for out-of-bed activity of 10 patients were (180±14)minutes, (111±28)mL, (1.5±0.5)days and (2.5±0.7)days, respectively. Of the 10 patients, 1 case underwent mild pancreatic leakage, 1 case underwent pneumonia, 2 cases underwent portal vein thrombosis and 3 cases underwent splenic vein thrombosis. Patients with postoperative complications was cured after conservative treatment. The duration of postoperative hospital stay of 10 patients was (8.9±0.9)days. All 10 patients were discharged without perioperative death and followed up for 1 to 4 months, with a median follow-up time of 3 months. There was no patient undergoing gastrointestinal hemorrhage and gastric reten-tion.Conclusion:Da Vinci robotic assisted vagus nerve-preserving splenectomy and azygoportal disconnection is safe and feasible for the treatment of cirrhotic portal hypertension patients with esophagogastric variceal bleeding and hypersplenism.
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Objective:According to the SIOPE (2018) guidelines, the whole brain target of patients undergoing craniospinal irradiation was delineated and the underdose of sub-structures which were not delineated in original plan was verified, aiming to provide evidence for the risk of whole brain recurrence of craniospinal irradiation and accumulate experience for the clinical application of SIOPE guidelines.Methods:Twelve children who underwent craniospinal irradiation were selected. As per the SIOPE guidelines in 2018, the CTV sub (including the superior orbital fissure, foramen rotundum, foramen ovale, jugular foramen, hypoglossal canal, internal auditory meatus and optic nerve) were delineated based on the original CTV old (whole brain plus sieve plate) to form PTV new. A rough PTV (PTV rough) was formed by giving a margin of 15 mm forward-downward (skull base) and 3 mm in the other directions. CRT old and IMRT old plans were designed based on PTV old. CRT new and IMRT new plans were designed based on PTV new. CRT rough plan was designed based on PTV rough. The omission of sub-structures based on CTV old and the underdose of CTV sub in each plan were evaluated. Results:A total of 78.6% of superior orbital fissure, 71.99% of foramen rotundum, 96.76% of foramen ovale, 88.5% of jugular foramen, 97.71% of hypoglossal canal, 99.48% of internal auditory meatus and 100% of optic nerve volume were missed based on CTV old. The target dose coverage of CTV sub based on CRT old and IMRT old was only 91.70% and 89.83%, respectively. The underdose was observed in 16.66%, 3.57%, 20.83%, 1.78% and 1.19% of sub-structures in CRT old, CRT new, IMRT old, IMRT new and CRT rough plans, respectively. Of the underdose of all sub-structures, 38.36% and 46.58% occurred in CRT old and IMRT old plans, respectively. Among them, the least and the most significant underdose occurred in foramen rotundum (0%) and foramen ovale (36.66%), respectively. Conclusions:As per the SIOPE guidelines, traditional brain tissue delineation (including sieve plate) is likely to omit part of the target during the cranial target definition of craniospinal irradiation. The most significant underdose occurs in foramen ovale, and more obvious in the IMRT plan. The plan based on the delineation of sub-structures can significantly improve the underdose. When AP-PA irradiation is adopted, a rough PTV is recommended to obtain approximate target dose coverage and organ of risk sparing, whereas it requires further clinical verification.
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Objective To evaluate and predict the pelvic dose by analyzing two pelvic contour definitions and identify the influencing factors of the pelvic dose in postoperative IMRT for cervical cancer,aiming to provide reference for postoperative pelvis-sparing IMRT for cervical cancer.Methods Sixty cervical cancer patients receiving postoperative IMRT with unrestricted pelvic dose were selected.Two sets of pelvic contours (pelvic anatomy and pelvic Mell) were delineated as per the anatomical and Mell methods.The dose relationship between two methods was analyzed after redesigning the treatment plan by limiting dose of pelvic anatomy.The correlation analysis was performed by Pearson's correlation method.The factors affecting the pelvic anatomy dose were identified by Logistic multivariate regression analysis and a dose prediction model was subsequently established.Results The volumes of pelvic anatomy and pelvic Mell were 925.82 cm3 and 1 141.20 cm3(P=0.000).There was a significant correlation between them (r＞0.622,P=0.000).The dose of pelvic anatomy was significantly higher than that of pelvic Mell.The relationship of V10,V20 and V30 between them was y =-8 + 1.01x,y =-13 + 1.05x and y =-4 + 0.9x,respectively.The dose limits of pelvic Mell recommended by literatures (V10＜90％,V20＜75％,V30＜60％)were translated into V10 ＜ 97％,V20 ＜ 83％ and V30 ＜ 70％,respectively.The pelvic anatomy dose was significantly reduced after dose limiting.The V10,V20,V30 and Dmean were significantly decreased by 3.64％,12.69％,12.02％ and 6.93％(P=0.000,0.000,0.000),respectively.Multivariate analysis showed that the overlapping volume of pelvic anatomy within PTV was an independent influencing factor of pelvic anatomy dose (P＜0.05).Patients with a relative overlapping volume of less than 18％ could easily meet the dose limiting requirement.Conclusions Both two pelvic contour definitions can be applied in postoperative pelvis-sparing IMRT for cervical cancer.Use of pelvic dose limiting can significantly reduce the IMRT dose.The overlapping volume of the pelvis within PTV is an independent influencing factor of pelvic dose.Patients whose overlapping volume within the PTV relative to pelvis is less than 18％ can easily meet the dose limiting requirement.
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Objective:To evaluate the early side effects and influencing factors in patients undergoing intensity-modulated radiation therapy after cervical cancer surgery.Methods:A retrospective analysis of 106 patients with cervical cancer who underwent postoperative intensity-modulated radiation therapy in our hospital from January 2014 to December 2017 was conducted. The occurrence of toxic and side effects were summarized, and the related clinical indicators were analyzed using univariate and multivariate analyses.Results:The 3-year overall survival rate was 88.1%, and the 3-year progression-free survival rate was 84.8%. The incidence of acute hematologic toxicity greater than grade 3 was 33%. The incidence of early intestinal reactions was 35%, of which only 1.8% was greater than grade 3. Univariate analysis demonstrated that severe acute hematologic side effects were statistically significant ( χ2=1.789-17.895, P<0.05) with the level of hemoglobin before radiotherapy, radiation in the abdominal aortic lymphatic drainage area or not, an increase of local radiotherapy dose in the target area, and chemotherapy or not. Multivariate analysis showed that concurrent chemotherapy significantly increased the incidence of severe acute hematologic toxicity ( χ2=3.929, P<0.05). Conclusions:In patients with cervical cancer undergoing postoperative intensity-modulated radiation therapy, grade 3 and greater toxic side effects are mainly related to hematological toxicity, and the incidence of severe bowel toxicity in the early stage is low.
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Objective@#To evaluate and predict the pelvic dose by analyzing two pelvic contour definitions and identify the influencing factors of the pelvic dose in postoperative IMRT for cervical cancer, aiming to provide reference for postoperative pelvis-sparing IMRT for cervical cancer.@*Methods@#Sixty cervical cancer patients receiving postoperative IMRT with unrestricted pelvic dose were selected. Two sets of pelvic contours (pelvic anatomy and pelvic Mell) were delineated as per the anatomical and Mell methods. The dose relationship between two methods was analyzed after redesigning the treatment plan by limiting dose of pelvic anatomy. The correlation analysis was performed by Pearson’s correlation method. The factors affecting the pelvic anatomy dose were identified by Logistic multivariate regression analysis and a dose prediction model was subsequently established.@*Results@#The volumes of pelvic anatomy and pelvic Mell were 925.82 cm3 and 1141.20 cm3(P=0.000). There was a significant correlation between them (r>0.622, P=0.000). The dose of pelvic anatomy was significantly higher than that of pelvic Mell. The relationship of V10, V20 and V30 between them was y=-8+ 1.01x, y=-13+ 1.05x and y=-4+ 0.9x, respectively. The dose limits of pelvic Mell recommended by literatures(V10<90%, V20<75%, V30<60%) were translated into V10<97%, V20<83% and V30<70%, respectively. The pelvic anatomy dose was significantly reduced after dose limiting. The V10, V20, V30 and Dmean were significantly decreased by 3.64%, 12.69%, 12.02% and 6.93%(P=0.000, 0.000, 0.000), respectively. Multivariate analysis showed that the overlapping volume of pelvic anatomy within PTV was an independent influencing factor of pelvic anatomy dose (P<0.05). Patients with a relative overlapping volume of less than 18% could easily meet the dose limiting requirement.@*Conclusions@#Both two pelvic contour definitions can be applied in postoperative pelvis-sparing IMRT for cervical cancer. Use of pelvic dose limiting can significantly reduce the IMRT dose. The overlapping volume of the pelvis within PTV is an independent influencing factor of pelvic dose. Patients whose overlapping volume within the PTV relative to pelvis is less than 18% can easily meet the dose limiting requirement.
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Objective To investigate the clinical efficacy of laparoscopic splenectomy combined with pericardial devascularization in the treatment of cirrhotic patients with cirrhotic portal hypertension.Methods The retrospective and descriptive study was conducted.The clinicopathological data of 425 patients with cirrhotic portal hypertension who were admitted to Northern Jiangsu People's Hospital Affiliated to Yangzhou University were collected.There were 289 males and 136 females,aged (53±11)years,with a range from 21 to 79 years.All the patients were allocated into 3 periods according to the operation time,including 100 patients of early period from February 2012 to March 2014,156 patients of mature technology period from April 2014 to August 2016,and 169 patients of technology innovation period from september 2016 to December 2018.The patients of early period and mature technology period underwent laparoscopic splenectomy combined with pericardial devascularization,and the patients of technology innovation period underwent vagus nerve-preserving laparoscopic splenectomy combined with pericardial devascularization.Observation indicators:(1) surgical situations;(2) postoperative situations;(3) follow-up.Patients were followed up by outpatient examination to detect the upper digestive rebleeding,gastric retention,and diarrhea up to March 2019.Sequential therapy of endoscopic variceal ligation (EVL) was slectively performed on patients based on results of gastroscopy.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was analyzed using ANOVA,and paired comparison was analyzed using the t test.Measurement data with skewed distribution were represented as M (range),and comparison between groups was anlyzed using the Kruskal-Wallis rank sum test,and paired comparison was analyzed using the rank sum test.Count data were described as absolute numbers or percentages,and comparison between groups was analyzed using the chi-square test and Fisher exact probability.Results (1) Surgical situations:the operation time,volume of intraoperative blood loss,cases with intraoperative blood transfusion,cases with conversion to open surgery,and cases with emergency operation for bleeding were (187±46) minutes,150 mL (range,50-1 300 mL),2,2,1 for patients of early period,(164±22)minutes,50 mL (range,30-100 mL),1,1,1 for patients of mature technology period,and (150± 18)minutes,50 mL (range,10-300 mL),0,0,0 for patients of technology innovation period,respectively.There were significant differences in the operation time and volume of intraoperative blood loss between the three groups (F=55.482,x2 =94.620,P＜0.05).There was no significant difference in the cases with intraoperative blood transfusion,cases with conversion to open surgery,or cases with emergency operation between the three groups (P＞0.05).(2) Postoperative situations:425 patients had oral aspirin enteric-coated tablets for prevention of thrombus,with no perioperative death.Duration of postoperative hospital stay,cases with portal vein thrombosis at postoperative 7 days,cases with pancreatic fistula,cases with pulmonary infection,and cases with abdominal infection were (11.0±2.9) days,46,2,1,0 for patients of early period,(9.9±.1.7)days,81,3,0,0 for patients of mature technology period,and (8.8±1.3)days,83,2,1,1 for patients of technology innovation period,respectively.There was a significant difference in the duration of postoperative hospital stay between the three groups (F =39.836,P ＜ 0.05),between patients of mature technology and patients of early period (t =3.329,P＜0.05),between patients of mature technology period and patients of technology innovation (t =6.502,P＜0.05).There was no significant difference in the cases with portal vein thrombosis at postoperative 7 days between the three groups (x2 =0.865,P ＞ 0.05) and no significant difference in the cases with pancreatic fistula,cases with pulmonary infection,or cases with abdominal infection between the three groups (P＞0.05).Patients with portal vein thrombosis at postoperative 7 days had oral aspirin enteric-coated tablets or warfarin for treatment.Patients with pancreatic fistula,pulmonary infection,and abdominal infection were cured and discharged after conservative treatment.(3) Follow-up:all the 425 patients were followed up for 1-72 months,with a median follow-up of 36 months.Of the 425 patients,261 underwent postoperative sequential therapy of EVL,including 133 patients of mature technology period and 128 patients of technology innovation period.The incidence rate of upper digestive rebleeding was 3.83％ (10/261) of the 261 patients undergoing postoperative sequential therapy of EVL and 17.68％ (29/164) of 164 patients without postoperative sequential therapy of EVL,showing a significant difference between them (x2 =23.185,P＜0.05).The incidence rates of gastric retention and diarrhea were 96.24％ (128/133) and 61.65％ (82/133) for 133 patients undergoing sequential therapy of EVL in mature technology period,and 1.56％ (2/128) and 3.91％(5/128) for 128 patients undergoing sequential therapy of EVL in technology innovation period,showing significant differences between them (x2 =233.876,97.883,P＜0.05).Conclusions It is safe and feasible of laparoscopic splenectomy combined with pericardial devascularization for patients with cirrhotic portal hypertension,and intraoperative vagus nerve-preserving can reduce volume of intraoperative blood loss and incidence of postoperative complications.
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Objective@#To evaluate the precision of image registration between MRI simulation (MRIsim) and CT simulation compared to diagnostic MRI(MRIdiag) and to provide information for further application of MRIsim.@*Methods@#A total of 24 patients who underwent both MRIsim and MRIdiag were enrolled, including 8 patients with gliomas, 8 with nasopharyngeal carcinomas and 8 with prostate cancers. MRIsim and MRIdiag images of each patient were fused with CT. The OARs were delineated on three modalities of images and targets were delineated on fusion image of MRIsim with CT (F_CTMsim) and fusion image of MRIdiag with CT (F_CTMdiag) respectively. The concordance index (CI), Dice′s similarity coefficient (DSC) between the OARs and image similarity index (S) based on images from MRIsim, MRIdiag and CT were evaluated. IMRT plans were designed based targets on F_CTMsim and OARs on CT images, and differences in dosimetry of targets and OARs were evaluated subsequently.@*Results@#Volumes of most OAR from three modalities of images showed no statistically significant difference(P>0.05). All the CI and DSC between the OARs derived from MRIsim and CT were higher than those corresponding values from MRIdiag, and a statistically significant difference was achieved in 50% of these OARs (t=2.58-5.47, P<0.05). The S values of MRIsim and MRIdiag compared with CT were 0.89 and 0.83 respectively (t=5.77, P<0.05). MRIsim improved the S value by 10% (2%-56%) compared with MRIdiag. No further differences in dosimetry were found on all OARs and all targets(P>0.05).@*Conclusions@#The precision of image registration can be significantly improved by introducing MRIsim into radiotherapy planning design compared with MRIdiag. However, no significant differences in dosimetry were found on targets produced by rigid registration and manual adjustment method .
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Objective@#To investigate the clinical efficacy of laparoscopic splenectomy combined with pericardial devascularization in the treatment of cirrhotic patients with cirrhotic portal hypertension.@*Methods@#The retrospective and descriptive study was conducted. The clinicopathological data of 425 patients with cirrhotic portal hypertension who were admitted to Northern Jiangsu People′s Hospital Affiliated to Yangzhou University were collected. There were 289 males and 136 females, aged (53±11)years, with a range from 21 to 79 years. All the patients were allocated into 3 periods according to the operation time, including 100 patients of early period from February 2012 to March 2014, 156 patients of mature technology period from April 2014 to August 2016, and 169 patients of technology innovation period from september 2016 to December 2018. The patients of early period and mature technology period underwent laparoscopic splenectomy combined with pericardial devascularization, and the patients of technology innovation period underwent vagus nerve-preserving laparoscopic splenectomy combined with pericardial devascularization. Observation indicators: (1) surgical situations; (2) postoperative situations; (3) follow-up. Patients were followed up by outpatient examination to detect the upper digestive rebleeding, gastric retention, and diarrhea up to March 2019. Sequential therapy of endoscopic variceal ligation (EVL) was slectively performed on patients based on results of gastroscopy. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was analyzed using ANOVA, and paired comparison was analyzed using the t test. Measurement data with skewed distribution were represented as M (range), and comparison between groups was anlyzed using the Kruskal-Wallis rank sum test, and paired comparison was analyzed using the rank sum test. Count data were described as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test and Fisher exact probability.@*Results@#(1) Surgical situations: the operation time, volume of intraoperative blood loss, cases with intraoperative blood transfusion, cases with conversion to open surgery, and cases with emergency operation for bleeding were (187±46)minutes, 150 mL (range, 50-1 300 mL), 2, 2 , 1 for patients of early period, (164±22)minutes, 50 mL (range, 30-100 mL), 1, 1, 1 for patients of mature technology period, and (150±18)minutes, 50 mL (range, 10-300 mL), 0 , 0 , 0 for patients of technology innovation period, respectively. There were significant differences in the operation time and volume of intraoperative blood loss between the three groups (F=55.482, χ2=94.620, P<0.05). There was no significant difference in the cases with intraoperative blood transfusion, cases with conversion to open surgery, or cases with emergency operation between the three groups (P>0.05). (2) Postoperative situations: 425 patients had oral aspirin enteric-coated tablets for prevention of thrombus, with no perioperative death. Duration of postoperative hospital stay, cases with portal vein thrombosis at postoperative 7 days, cases with pancreatic fistula, cases with pulmonary infection, and cases with abdominal infection were (11.0±2.9)days, 46, 2, 1, 0 for patients of early period, (9.9±1.7)days, 81, 3, 0, 0 for patients of mature technology period, and (8.8±1.3)days, 83, 2, 1, 1 for patients of technology innovation period, respectively. There was a significant difference in the duration of postoperative hospital stay between the three groups (F=39.836, P<0.05), between patients of mature technology and patients of early period (t=3.329, P<0.05), between patients of mature technology period and patients of technology innovation (t=6.502, P<0.05). There was no significant difference in the cases with portal vein thrombosis at postoperative 7 days between the three groups (χ2=0.865, P>0.05) and no significant difference in the cases with pancreatic fistula, cases with pulmonary infection, or cases with abdominal infection between the three groups (P>0.05). Patients with portal vein thrombosis at postoperative 7 days had oral aspirin enteric-coated tablets or warfarin for treatment. Patients with pancreatic fistula, pulmonary infection, and abdominal infection were cured and discharged after conservative treatment. (3) Follow-up: all the 425 patients were followed up for 1-72 months, with a median follow-up of 36 months. Of the 425 patients, 261 underwent postoperative sequential therapy of EVL, including 133 patients of mature technology period and 128 patients of technology innovation period. The incidence rate of upper digestive rebleeding was 3.83%(10/261) of the 261 patients undergoing postoperative sequential therapy of EVL and 17.68%(29/164) of 164 patients without postoperative sequential therapy of EVL, showing a significant difference between them (χ2=23.185, P<0.05). The incidence rates of gastric retention and diarrhea were 96.24%(128/133) and 61.65%(82/133) for 133 patients undergoing sequential therapy of EVL in mature technology period, and 1.56%(2/128) and 3.91%(5/128) for 128 patients undergoing sequential therapy of EVL in technology innovation period, showing significant differences between them (χ2=233.876, 97.883, P<0.05).@*Conclusions@#It is safe and feasible of laparoscopic splenectomy combined with pericardial devascularization for patients with cirrhotic portal hypertension, and intraoperative vagus nerve-preserving can reduce volume of intraoperative blood loss and incidence of postoperative complications.
RESUMO
Pelvic insufficiency fractures ( PIF) is a vital complication after radiotherapy for pelvic neoplasms. It often leads to intractable pain and limited activity and is likely to be misdiagnosed as bone metastases and improperly treated. MRI is a common method for the diagnosis and differential diagnosis of PIF. The optimal approach to prevent PIF is to correctly identify the high-risk population and provide drug intervention when necessary. The low bone density state serves as a pivotal predictor at the beginning of radiotherapy. Reasonable selection of irradiation dose in pelvic lymphatic drainage area and minimizing the dose of pelvic bone probably reduce the incidence of PIF after radiotherapy.