Feasibility of treatment planning for 4D-CT high ventilation functional lung avoided radiotherapy in thoracic cancer / 中华放射医学与防护杂志

Objective:To establish a radiotherapy treatment planning process of high ventilation functional lung avoided (HVFLA) for thoracic tumors based on 4D-CT lung ventilation functional images and determine the treatment planning strategy of HVFLA radiotherapy, and so as to provide support for the clinical trials of HVFLA radiotherapy in thoracic cancer patients.Methods:A deep learning-based 4D-CT lung ventilation functional imaging model was established and integrated into the radiotherapy treatment planning process. Furthermore, ten thoracic cancer patients with 4D-CT simulation positioning were retrospectively enrolled in this study. The established model was used to obtain the 4D-CT lung ventilation functional imaging for each patient. According to the relative value of lung ventilation, the lung ventilation areas are equally segmented into high, medium and low lung ventilation and then imported them into Pinnacle 3 treatment planning system. According to the prescription dose of target and dose constraints of organ at risks (OARs), the clinical and HVFLA treatment plans were designed for each patient using volumetric modulated radiotherapy technique, and each plan should meet the clinical requirements and adding dose constraints of high ventilation functional lung for HVFLA plan. The dosimetric indexes of the target, OARs (lungs, heart and cord) and high functional lung (HFL) were used to evaluated the plan quality. The dosimetric indexes included D2, D98 and mean dose of target, V5, V10, V20, V30 and mean dose of lungs and HFL, V30, V40 and mean dose of heart, and D1 cm 3 of cord. Paired samples t-test was used for statistical analysis of the two groups of plans. Results:The target and OARs of the clinical plan and HVFLA plan meet the clinical requirements. The HVFLA plan resulted in a statistically significant reduction in the mean dose, V5, V10, V20, and V30 of the high functional lung by 1.2 Gy, 5.9%, 4.2%, 2.6%, and 2.3%, respectively ( t=-8.07, 4.02, -6.02, -7.06, -6.77, P<0.05). There was no statistical difference in the dosimetric indexes of lungs, heart and cord. Conclusions:We established the treatment planning process of HVFLA radiotherapy based on 4D-CT lung ventilation functional images. The HVFLA plan can effectively reduce the dose of HFL, while the doses of lungs, heart and cord had no significant difference compared with the clinical plan. The strategy of HVFLA radiotherapy planning is feasible to provide support for the implementation of HVFLA radiotherapy in thoracic cancer patients.

Control of sodium and potassium homeostasis by renal distal convoluted tubules

Distal convoluted tubules (DCT), which contain the Na-Cl cotransporter (NCC) inhibited by thiazide diuretics, undergo complex modulation to preserve Na+ and K+ homeostasis. The lysine kinases 1 and 4 (WNK1 and WNK4), identified as hyperactive in the hereditary disease pseudohypoaldosteronism type 2, are responsible for activation of NCC and consequent hypokalemia and hypertension. WNK4, highly expressed in DCT, activates the SPAK/OSR1 kinases, which phosphorylate NCC and other regulatory proteins and transporters in the distal nephron. WNK4 works as a chloride sensor through a Cl- binding site, which acts as an on/off switch at this kinase in response to changes of basolateral membrane electrical potential, the driving force of cellular Cl- efflux. High intracellular Cl- in hyperkalemia decreases NCC phosphorylation and low intracellular Cl- in hypokalemia increases NCC phosphorylation and activity, which makes plasma K+ concentration a central modulator of NCC and of K+ secretion. The WNK4 phosphorylation by cSrc or SGK1, activated by angiotensin II or aldosterone, respectively, is another relevant mechanism of NCC, ENaC, and ROMK modulation in states such as volume reduction, hyperkalemia, and hypokalemia. Loss of NCC function induces upregulation of electroneutral NaCl reabsorption by type B intercalated cells through the combined activity of pendrin and NDCBE, as demonstrated in double knockout mice (KO) animal models, Ncc/pendrin or Ncc/NDCBE. The analysis of ks-Nedd-4-2 KO animal models introduced the modulation of NEDD4-2 by intracellular Mg2+ activity as an important regulator of NCC, explaining the thiazide-induced persistent hypokalemia.

A CLINICOHAEMATOLOGICAL PROFILE OF ADVERSE TRANSFUSION REACTIONS AND ITS ASSOCIATION WITH BLOOD COMPONENTS

Different blood components are associated with various types of adverse transfusion reactions and are linked to several factors including the number, rate and volume of transfusions. The given study was conducted to study the relationship between various transfusion reactions and its causative factors. This study was a prospective study carried out over eighteen months on all patients who received a blood transfusion and blood components including various adverse reactions and events related to transfusion. These were correlated with tests for compatibility including general blood picture ,tests for haemolysis ,hematuria and haemoglobinuria, Coombs Test (Direct and Indirect), culture along with relevant clinical details of the patient. Out of a total of 31451 units of blood issued, 47 adverse transfusion reactions were noted with a maximum number in the age group of > 18 years (87.3%) with M: F being 1.6: 1 .0.24% of adverse transfusion reactions were by Packed red blood cell transfusion and mostly were immediate transfusion with a mean volume of 100 ml and mean time of 20 minutes. Febrile Non Hemolytic Transfusion Reaction (FNHTR) was the most common Adverse Transfusion Reaction (ATR)(0.128%) with 2 cases positive for Direct Coombs Test. A thorough serological and immunological examination and the addition of methods like buffy coat reduction and leucocyte filtration help in reducing the incidences of hemolytic transfusion reactions and transmitted infections and establishing a hemovigilance system help in the attainment of the goal of safe transfusion

Case study: Use of decentralized clinical technologies in lower urinary tract symptoms

@#<p style="text-align: justify;" data-mce-style="text-align: justify;"><span style="color: #525a63; font-family: Lato, sans-serif; font-size: 16px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; background-color: #ffffff; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; display: inline !important; float: none;" data-mce-style="color: #525a63; font-family: Lato, sans-serif; font-size: 16px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; background-color: #ffffff; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; display: inline !important; float: none;">A clinical study with 49 participants was started and completed at the height of the Covid-19 pandemic with the use of decentralized clinical trial (DCT) methodologies. All participants and the study team remained safe and were able to conduct the study efficiently. Patients were able to provide consent electronically, received experimental supplements and were given the option to provide feedback through the system’s telemedicine feature.</span></p>

Viewpoint: Decentralized clinical trials have arrived and staying for good

@#The Covid-19 pandemic challenged every healthcare system, and the disruption of clinical trials was not the least of it. Many clinical trials halted or did not activate as sponsors and investigators grappled with the risk of infection if patients involved in clinical trials visited trial sites. The clinical studies that managed to continue and complete were those that immediately adopted decentralized clinical trials (DCT) technologies such as eSource. Patients were engaged from the comfort and convenience of their homes during the clinical trials with the use of DCT technologies. The flexibility in recruitment, engagement, and monitoring of clinical trial participants are among the reasons why DCTs are here to stay.

Application of prospective respiratory gating based on 4D-CT in precise radiotherapy for lung cancer / 中华放射肿瘤学杂志

Objective:The respiratory waveform of lung cancer patients based on 4D-CT respiratory gating was analyzed to evaluate the accuracy of gating during radiotherapy, and to explore the off-target in the 4D-CT respiratory gating radiotherapy.Methods:Clinical data of 18 patients with lung cancer admitted to Radiotherapy Department of Jiangsu Cancer Hospital were collected to obtain the respiratory waveform data during 4D-CT respiratory gating radiotherapy. The waveform in each treatment working cycle was compared with the waveform in 4D-CT scan to study whether there was a possibility of the off-target in the treatment of lung cancer patients.Results:There were 154 treatment sessions and 20,790 treatment breathing cycles in 18 patients, among which the threshold of gated opening beam miss amplitude (Δm-en) was greater than 0 in 95 treatment breathing cycles in 7 patients, accounting for 0.46% of all breathing cycles, and the threshold of gated closing beam miss amplitude (Δm-dis) was greater than 0 in 1419 treatment breathing cycles in 13 patients, accounting for 6.83% of all cycles. Among the 13 patients withΔm-dis greater than 0, actual tumor range of motion (R G) was greater than the sum of the value of target margin (M) and the value of plan tumor range of motion (R T) in 7 patients, R G was more than 1.5 times of M+R T in 7 patients, and there were also 7 patients in the phase of rapid rise and fall of respiratory curve. The correlation efficients between R G-M-R T and the percentage of beam on miss phase (T en%) and the percentage of beam closing off phase (T dis%) were 0.41 and 0.57, respectively. Conclusion:When R G is more than 1.5 times of M+R T value and the gating beam on phase contains the phases in the rapid rise and fall of the respiratory curve, the possibility of the off-target during radiotherapy is significantly increased.

Primary Autoimmune Hemolytic Anemia Due To Warm Reactive Autoantibodies: A Rare Case Report

Autoimmune hemolytic anemia (AIHA) is an acquired form of hemolytic anemia in which autoantibodies target red blood cell (RBC) membrane antigens, inducing cell rupture (lysis). It affects both pediatric and adult populations, although its presentation in childhood is relatively rare, with the annual incidence [3]estimated to be approximately 0.8 per 100,000 individuals under 18 years old . Here we report one such a rare case of autoimmune hemolytic anemia due to primary warm reactive autoantibodies in a 3 year old female child. As there was presence of hemolysis in peripheral blood smear & other investigations also, Direct coomb's test was done & it came out to be positive which was suggestive of autoimmune hemolytic anemia, as following laboratory reports are suggestive of continuous destruction of RBC & after introduction of steroids parameters of hemolysis came out to be normal suggestive of warm reactive autoantibodies type of AIHA. Clinically also patient improved & her urine colour also became normal after when prednisolone started. Patient also did not have any features of secondary causes of warm autoantibody like Systemic lupus erythematous, immunodeficiency disorders, ulcerative colitis & lymphoproliferative disorders so it was considered primary or idiopathic. W-AIHAtends to have a chronic course and is not expected to subside without treatment. It can be a fatal disease, with a mortality rate of up to 4% in children, either because of the acuity of the presentation or because of being refractory to treatment and requiring multiple lines of therapy with frequently associated toxicity. Fortunately, our patient responded to steroid therapy.

Application of 3D-CT simulation image in the description of gastric artery variation to guide laparoscopic total gastrectomy / 中华胃肠外科杂志

Objective: Anatomic variations in the perigastric vessels during laparoscopic radical gastrectomy often affect the operator's judgment and prolong the operation time, and even cause accidental injury and surgical complications, and hence the safety and quality of the operation cannot be ensured. In this study, multiple slice CT was reconstructed by 3-dimensional CT simulation software (3D-CT), and 3D-CT images were used to describe the variation of celiac trunk and splenic artery before surgery. The guiding role of the different variation of vessels was analyzed for laparoscopic total gastrectomy+D2 lymph node dissection (LTG+D2LD). Methods: A retrospective cohort study was conducted. Case inclusion criteria: (1) Gastric cancer was at an advanced stage. All the patients were preoperatively examined by digestive endoscopy and 64-row enhanced CT scan, and were histopathologically diagnosed with gastric adenocarcinoma. (2) 3D-CT simulation images were reconstructed to guide the operation. (3) LTG+D2LD surgery was performed by the same surgical team. (4) Clinical data were complete, and all the patients had signed the informed consent. From 2014 to 2018, 98 patients with gastric cancer at the Gastrointestinal Surgery Department of Henan Provincial People's Hospital were enrolled. According to the Adachi classification, celiac trunk variation was divided into common type (Adachi type I) and rare type (Adachi type II-VI). According to the Natsume classification, splenic artery was classified into "flat type" and "curved type". Based on 3D-CT simulation images, variation of celiac trunk and splenic artery was described, and the differences in operation time, intraoperative blood loss and the number of postoperative retrieved lymph nodes were compared between groups with different types of arterial variation. Results: For celiac trunk, common type was found in 84 cases (86%) and rare type was found in 14 cases, including 6 cases (6%) of type II, 2 cases (2%) of type III, 2 cases (2%) of type IV, 3 cases (3%) of type V, 1 case (1%) of type VI. No other types were found. There were no statistically significant differences in clinical characteristics and number of retrieved lymph nodes between patients of the common type group and rare type group (all P>0.05). Compared with common type patients, those of rare type had longer operative time [(321.1±29.0) minutes vs. (295.1±46.5) minutes, t=2.081, P=0.040] and more intraoperative blood loss (median: 66.0 ml vs. 32.0 ml, Z=-4.974, P=0.001). For splenic artery, 41 patients (42%) were flat type and 57 patients (58%) were curved type. There were no statistically significant differences between the two groups in terms of clinical characteristics, intraoperative blood loss, operative time and number of retrieved lymph nodes (all P>0.05). Conclusions: The method of describing the variation in the perigastric vessels by 3D-CT simulation has certain clinical value in laparoscopic radical gastrectomy. The duration of LTG+D2LD is prolonged and the intraoperative blood loss is increased with the variation of celiac trunk, while the variation of splenic artery has no effect on LTG+D2LD.

Application of 3D-CT reconstruction technology to predicting difficult airway in patients with odontogenic infections / 上海交通大学学报（医学版）

Objective: To evaluate the application of 3D-CT airway reconstruction images to predicting difficult airway in patients with odontogenic infections. Methods: A retrospective analysis was performed on patients with odontogenic infections who were treated by incision and drainage under general anesthesia at Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from August 2017 to July 2019, and patients who were evaluated as difficult airway receiving awake tracheal intubation were selected as the case group (n=27). From the "Hospital Inpatient System", patients who were evaluated as non-difficult airway receiving fast induction were selected as the control group (n=27). Maxillofacial CT scans of all the patients were collected. The Dolphin Imaging software version 11.9 Premium was used to perform 3D-CT reconstruction of the airway. The upper airway was divided into oropharynx and hypopharynx, and the oropharynx was divided into velopharynx and glossopharyngeal. The indicators such as airway volume, median sagittal area, minimal cross-sectional area, and thickness of pharyngeal soft tissue were collected. The indicators of the difference between the two groups were compared and selected. Logistic re-gression analysis was conducted to investigate the association of these factors with difficult airway. Results: The volume of velopharynx and hypopharynx, the median sagittal area of velopharynx, oropharynx and hypopharynx, the mean cross-sectional area of velopharynx and hypopharynx, the minimal cross-sectional area and its lateral dimension of oropharyngeal of patients in the case group were significantly smaller than those of the controls (P<0.05). Thickness of pharyngeal soft tissue in the most inferior-anterior point of the second and the third cervical vertebrae of patients in the case group was significantly higher than that of the controls (P<0.05). The Logistic regression analysis showed that the median sagittal area of velopharynx, oropharynx and hypopharynx, the volume and mean cross-sectional area of hy-popharynx, and thickness of pharyngeal soft tissue in the most inferior-anterior point of the second and the third cervical vertebrae of patients were related to difficult airway in patients with odontogenic infections (P<0.05). Conclusion: Airway 3D-CT reconstruction can clearly show the airway anatomy of patients with odontogenic infections. The median sagittal area of pharynx, the volume and mean cross-sectional area of hypopharynx, and thickness of pharyngeal soft tissue in the most inferior-anterior point of the second and the third cervical vertebrae may will be used as predictors of difficult airway in patients with odontogenic infections.

Determination of the time since death by histological changes in distal convoluted tubule in human kidneys

Background: The DCT is lined with simple cuboidal cells that are shorter than those of the proximal convolutedtubule (PCT). The lumen appears larger in DCT, the histological changes DCT in kidney after death have beenstudied in various land animals and sea marine animals but yet very few studies with same view which mayprovide keen and fruitful results for human distal convoluted tubule in kidney have been done. It will be helpfulfor estimation of time after death.Aim: To determine the time since death by histological changes in Distal convoluted tubule.Materials and Methods: 50 Human kidneys samples at different time intervals between 4hrs to 52.30 hr,temperature between17.3/22.3-31.3/450C, humidity between 11/36 to 75/95, were of different age and sex obtainedas and when available from cadavers with a known time of death where death had resulted from natural death,suffocation and trauma, dead individual health and not suffering from disease affecting kidney.Result: Increase the rate of postmortem histological changes in DCT was found to be increased with rise in thetemperature and duration. In Distal convoluted tubules lumens were found swelling of epithelial cells. Retractionof epithelium from the basement membrane and its disruption with individualization of cells, nuclear pyknosis,karyolysis and loss of tubular architecture with debris in the lumen were observed.Conclusion: In this current research, sequence of postmortem histological changes in DCT was studied. Thesecriteria’s presented in this study could be used to determine the time after death

Percutaneous left ventricular transapical access guided by cardiac 3D CT angiography combined with echocardiography / 中国胸心血管外科临床杂志

@#Objective    To investigate the reliability and safety of the technique of percutaneous left ventricular transapical access guided by cardiac three dimensional CT angiography (3D-CTA) combined with echocardiography applied in structural heart defects. Methods    The clinical data of 9 patients (7 males and 2 females with a median age of 50 years ranging from 43 to 64 years) with paravalvular leaks closed by percutaneous left ventricular transapical access in West China Hospital, from April 2015 to August 2018, were retrospectively analyzed. We applied preoperative cardiac 3D-CTA to define the puncture site and trace, which was established by combining with real-time guidance of transesophageal echocardiography (TEE/3D-TEE), and an occluder was deployed at the apical access point for hemostasis with real-time guidance of transthoracic echocardiography (TTE). Results    The puncture needles were successfully introduced into the left ventricular cavity at one time in all patients without injury of lung tissue, coronary artery or papillary muscle. There was no occluder displacement or apex bleeding. One patient developed pleural effusion caused by intercostal artery injury. Conclusion    That cardiac 3D-CTA is used to define puncture sites and trace with advantages of simplicity and repeatability. A safe access and secure exit of left ventricle can be achieved by combining with real-time guidance of echocardiography. There are acceptable technology-related complications.

Dosimetry advantage of respiratory gating in the treatment of hepatocellular carcinoma with large segmentation / 实用肿瘤学杂志

Objective The aim of this study was to investigate the dosimetric advantages of Gating in the treatment of prima-ry hepatic cancer with large segmentation. Methods A retrospective analysis of 10 patients with primary liver cancer from August 2017 to November 2018 after interventional therapy was performed using three consecutive phases of end-tidal phase to achieve pa-tient-controlled large-segment radiotherapy. Ten patients underwent 4DCT localization scan,and 10 respiratory phase sequences were reconstructed by respiratory wave-form,and the images were transmitted to the MIM6. 7. 6 workstation. In the MIM workstation, full-time phase maximum density projection(MIP-10),full-time phase average density projection(Mean-10),end-expiration 3 phase maximum density projection(MIP-3) and end-expiration 3 phase average density projection( Mean-3) were generated re-spectively,where MIP was used for target delineation and Mean for dose calculation. The radiotherapy doctor delineated IGTV-10 and IGTV-3 on the MIM workstation,and released CTV-10,CTV-3,PTV-10 and PTV-3 to compare the volume differences of the target area. After the target area was drawn,the image was transmitted from the MIM workstation to the Eclipse treatment planning sys-tem,and the full-time phase plan(Plan-10)with the same conditions and three consecutive phase-phase gating plans(Plan-3) were prepared. The prescriptive dosage was given at 50 Gy/10 f/2weeks. Comparing the HI and CI of the target area,the comparison of organs at risk included: the average dose of liver Dmean,the irradiation volume of liver less than 15Gy,the Dmax of small intestine, the Dmax of colon, the Dmax of stomach, the average dose of the kidney Dmean, the heart Dmax, and the spinal cord Dmax. Results The volume of the target area delineated at the end of expiratory phase was less than that of the target area outlined by the full-time phase in IGTV,CTV and PTV,and the difference was statistically significant(P<0. 05). In the two groups of seven field coplanar lage-segment radiotherapy plans,the 3-phase respiratory gating plan significantly reduced the dose of the organs at risk, and the difference was statistically significant(P<0. 05). At the same time,there was no statistically difference in the HI and CI be-tween of the two groups(P>0. 05). Conclusion The gated target area delineation and planning design of the three consecutive pha-ses of end-tidal phase reduce the volume of IGTV,CTV and PTV target regions compared with the selection of full-time phase,and have obvious advantages in the planned dosimetry. The irradiation dose that threatens the organs is worthy of being promoted and ap-plied in the large-scale radiotherapy of liver cancer.

Dinámica Pulmonar de Estructuras Anatómicas de Interés en Imágenes 4DCT / Pulmonary Dynamics of Anatomical Structures of Interest in 4DCT Images

Resumen: El presente trabajo muestra una aplicación del algoritmo Chan-Vese para la segmentación semi-automática de estructuras anatómicas de interés (pulmones y tumor pulmonar) en imágenes de 4DCT de tórax, así como su reconstrucción tridimensional. La segmentación y reconstrucción se realizó en 10 imágenes de TAC, las cuales conforman un ciclo inspiración-espiración. Se calculó el desplazamiento máximo para el caso del tumor pulmonar usando las reconstrucciones del inicio de la inspiración, el inicio de la espiración, y la información del voxel. El método propuesto logra segmentar de manera apropiada las estructuras estudiadas sin importar su tamaño y forma. La reconstrucción tridimensional nos permite visualizar la dinámica de las estructuras de interés a lo largo del ciclo respiratorio. En un futuro se espera poder contar con mayor evidencia del buen desempeño del método propuesto y contar con la retroalimentación del experto clínico, ya que el conocimiento de características de estructuras anatómicas, como su dimensión y posición espacial, ayuda en la planificación de tratamientos de Radioterapia (RT), logrando optimizar las dosis de radiación hacia las células cancerosas y minimizarla en órganos sanos. Por lo tanto, la información encontrada en este trabajo puede resultar de interés para la planificación de tratamientos de RT.

Abstract: This paper presents an application of the Chan-Vese algorithm for a semi-automatic segmentation of anatomical structures of interest (lungs and lung tumor) in thorax 4DCT images, as well as its threedimensional reconstruction. Segmentations and reconstructions were performed in 10 CT images, which conform an inspiration-expiration cycle. The maximum displacement of the lung tumor was calculated using the reconstructions of the beginning of inspiration, beginning of expiration, and the voxel size information. The proposed method was able to succesfully segment the studied structures regardless of their size and shape. The threedimensional reconstruction allow us to visualize the dynamics of the structures of interest throughout the respiratory cycle. In the near future, we are expecting to be able to have more evidence of the good performance of the proposed segmentation approach, and to have feedback from a clinical expert, giving the fact that the knowledge of anatomical structures characteristics, such as their size and spatial location, may help in the planning of radiotherapy treatments (RT), optimizing the radiation dose to cancer cells and minimizing it in healthy organs. Therefore, the information found in this work may be of interest for the planning of RT treatments.

Application of active breathing control (ABC) and four dimensional CT technology in stereotactic radiotherapy of lung tumor / 中华放射医学与防护杂志

Objective To investigate the difference of lung and target volume and dosimetry characteristics features of deep inhalation breathing holding-active breathing control (ABC) and the four dimensional CT (4D-CT) free breathing in stereotactic body radiation therapy (SBRT) technology for patients with lung cancer.Methods 10 patients with pulmonary malignant tumor who were proposed SBRT treatment were selected,and received CT under free breath (FB-CT),4D-CT scan under quiet respiration (4D-CT) and active breathing control CT scan (ABC-CT),respectively.With SBRT technology under the same condition designed four corresponding plans,FB-CT,ABC-CT,4D-CT and 4D-CT0 which was the end inspiratory phase of 4D-CT respectively.The lung volume(V),PTV,V5,V20,mean lung dose(MLD) and normal tissue complication probability(NTCP) of four treatment programs were counted and compared.Results Compared with FB-CT,V,PTV,V5,V20,MLD and NTCP of ABC-CT were 51.48％,-65.34％,-42.64％,-56.62％,-40.22％ and-98.53％ (t=-7.14 to6.16,P＜0.05);PTV,V5,V20,MLD and NTCP of 4D-CT were-40.14％,-16.90％,-37.16％,-17.85％ and-90.96％ (t =0.54 to 3.22,P＜0.05);PTV,V5,V20,MLD and NTCP of 4D-CT0 were-68.98％,-30.21％,-48.49％,-37.45％ and-95.82％ (t=1.32 to 5.46,P＜0.05),respectively.Compared with FB-CT,the lung volume of 4D-CT and 4D-CT0 had no statistical difference (P ＞ 0.05).Conclusions ABC-CT methods have ideal clinical characteristics,with larger double lung volume,smaller artifacts of image,and higher target matching precision.ABC-CT methods reduce the dose of normal lung tissues significantly.

Evaluating the impact of respiratory motion on lung dosimetry using 4D-CT for non-small cell lung cancer / 中华放射医学与防护杂志

Objective To evaluate the impact of respiratory motion on lung dosimetry using 4D-CT during lung cancer radiotherapy.Methods Ten cases were randomly selected from non-small cell lung cancer (NSCLC) patients treated in our department.The 4D-CT machine was adopted for simulation before treatment and 10 respiratory phases were obtained for each patient.Target volumes were delineated on the maximum intensity projection (MIP) images,and plans were generated on average intensity projection (ALP) images.Plans were transferred to CT images of each respiratory phase,and we calculated the dosage on lungs and subsequently evaluated the volume dosage to lungs and the entire body.Results The mean dosage to lungs are greatly affected by the respiratory phase.This difference also depended on tumor location.When it was inside the lung,the average dosage shows the same trend as the respiratory motion,with the change rate of 2.18％,which was less than the change of lung volume 4.49％ (t =4.189,P ＜ 0.05).When the tumor was located nearby the lung,the mean dosage showed the opposite trend with respiratory motion,with the change rate of 3.76％,which was also less than the change of lung volume 4.49％ (t =25.007,P ＜ 0.05).The effect of respiratory motion on V5,V10,V20 of body was small,and the magnitude of change for whole body dosages were 0.47％,0.28％,0.17％ respectively,which was smaller than the change of lung volume 4.49％ (t =11.371,11.188,11.377,P ＜ 0.05).Volume dose of lung V5,V10,V20 and lung volume change trends were the same,and the magnitude of change for lung volume dosages were 2.39％,1.91％,1.80％ respectively,and were smaller than the change of lung volume 4.49％ (t =2.279,2.298,2.485,P ＜ 0.05).Conclusions The mean dosage to lungs shows a great difference between different respiratory phases.More attention should be paid when evaluating the lung volume during treatment planning.

Analysis of Femoral Tunnel Position Targeted at Bifurcate Ridge Using Anteromedial Portal Technique in Anatomic Anterior Cruciate Ligament Reconstruction / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to analyze the position of the 10-mm-sized femur tunnel drilled aiming for the bifurcate ridge using anteromedial portal technique with 'Figure of 4 position' by 3-dimensional computed tomography (3D-CT) reconstruction images after anatomic anterior cruciate ligament (ACL) reconstruction and to evaluate it's propriety. MATERIALS AND METHODS: Out of 35 patients who underwent anatomic ACL reconstruction from March 2012 to February 2013, 32 patients who undergone postoperative 3D-CT scans were included in this study retrospectively. Medial surface of the lateral femoral condyle was reconstructed using Mimics, and then the position of the femoral tunnel was evaluated using the Bernard quadrant method and the results were compared with those of published literatures. The mean age of the patients was 32.6 years old. There were 25 cases of double-bundle ACL reconstruction with one femoral-two tibial tunnel. There were 7 cases of single bundle ACL reconstruction with one femoral-one tibial tunnel. RESULTS: The mean distance of the femoral tunnel center was 32.2%+/-2.9% (range, 27.4%-37.6%) along the line parallel to the Blumensaat's line from the posterior condylar surface and 46.7%+/-2.3% (range, 43.5%-51.1%) along the line perpendicular to the Blumensaat's line from the roof of the notch. In comparison with the results of published literature, although the center of the femoral tunnel was presented in the femoral footprint, it was located slightly more shallow and inferior than the center of the ACL footprints. CONCLUSION: The bifurcate ridge may be a good anatomic landmark when making a 10-mm-sized single femoral tunnel in 'Figure of 4 position' using the anteromedial portal technique.

Application of 4D-CT and deformable registration in assessment of dose accumulation in radiotherapy for hepatocellular carcinoma / 中华放射医学与防护杂志

Objective To explore the effect of respiration on dose accumulation for target volume and normal liver in radiotherapy for hepatocellular carcinoma (HCC) while applying 4D-CT and deformable registration.Methods Nineteen HCC patients who had received transcatheter arterial chemoembolization were enrolled in this study.All patients underwent 3D-and 4D-CT simulation in free breathing.The 3D dose (Dose-3D) was calculated from the treatment planning designed on the 3D-CT image.The Dose-3D then was recalculated on ten phases of 4D-CT images respectively,and the end-inspiration and end-expiration doses were defined as Dose El and Dose-EE.The 4D dose (Dose-4D) was obtained by deforming and accumulating ten-phase doses of 4D-CT images on the end-expiration phase image.The dosimetric differences of planning target volume and normal liver were compared among Dose-3D,Dose-4D,Dose-EI and Dose-EE.Results The D99 and D95of planning target volume (PTV) in Dose-3D were higher than those of Dose-4D,Dose-Fl and Dose EE (x2 =32.75,26.31,P ＜ 0.05).The conformal index (CI) and homogeneity index (HI) in Dose-3D were better than those of Dose-4D,Dose-E1 and Dose-EE,in which CI decreased from 0.78 to0.63,0.60 and 0.57,while HI increased from 0.08 to 0.15,0.16 and 0.19 (x2 =37.80,31.86,P ＜0.05).No statistically significant differences were found in dosimetric indices of PTV between Dose-4D and Dose EI,Dose-EE,and between Dose-El and Dose-EE (P ＞ 0.05).The mean dose (D),V5,V10,V20,V30 and V40 of normal liver were similar among four dose distributions (P ＞ 0.05).Conclusions More objective and precise dose distribution for target volume and normal liver could be obtained by applying both 4D-CT and deformable registration,which is beneficial to accurately predicting the dosevolume indices of radiation-induced liver injury and offering more reliable evidence of escalation for target dose.

Evaluation of the Forearm Dominancy Artery for Invasive Vascular Procedure with 3D-CT Angiography

The aim of this study was to evaluate the vascular dominance in the forearm as a factor in determining the choice of invasive vascular procedures in arteries of the forearm, using 3D-computerized tomography (3D-CT) angiographies of 92 forearms. The diameters of the ulnar and radial arteries were measured just distal to the bifurcation of the brachial artery, at the midpoint between the bifurcation and the wrist, and at the wrist crease. In 79 cases, the ulnar artery was larger than the radial artery after the bifurcation of the brachial artery. However, no statistically significant difference was observed at either the mid-forearm or the wrist crease. In the remaining 13 cases, the diameter of the radial artery was larger or the same as that of the ulnar artery after the bifurcation, but at the more distal sites no regular pattern could be detected. The findings suggest that 3D-CT angiography offers valuable preoperative details of the forearm vessels for cases requiring invasive vascular procedures on the forearm.

Comparación in vitro de la actividad antimicrobiana de AhPlus, RSA y Ledermix contra Enterococcus faecalis / In vitro comparison of anti-microbial activity of AH Plus, RSA and Ledermix against Enterococcus faecalis

Objetivo: Evaluar in vitro la actividad antimicrobiana de dos selladores endodónticos RSA, AH Plus y de la pasta LedermixN sobre Enterococcus faecalis con tres diferentes técnicas. Método: Prueba de contacto directo. En una superficie de acrílico se colocó el sellador y se inoculó una suspensión de E. faecalis, se dejó en un microtubo con 1mL de caldo BHI, se realizaron diluciones logarítmicas sembrándose en placas de agar sangre para cuantificar las unidades formadoras de colonia. Prueba de dilución. Los selladores y la pasta se colocaron en un cilindro de plástico, la bacteria se inoculó en el caldo de cultivo y se realizó el mismo procedimiento de cuantificación. Prueba de dilución en agar. Se realizaron tres pozos en una placa de agar sangre y se rellenaron con los dos cementos, la pasta de LedermixN se inoculó una suspensión de E. faecalis en la superficie, para evaluar zonas de inhibición de crecimiento. Resultados: La pasta de Lesdermix N tuvo mayor porcentaje de actividad antimicrobiana en la prueba de contacto directo. Ningún cemento ni la pasta presentó actividad antimicrobiana en la prueba de dilución y en la prueba de dilución en agar; en ésta el sellador AH plus y la pasta LedermixN presentaron un halo de hemólisis en las placas de agar sangre. Conclusiones: La técnica de contacto directo es la más adecuada para evaluar el efecto antimicrobiano de los cementos.

Aim: In vitro assessment of antimicrobial activity sustained by two root canal sealers: RSA®, AH Plus® as well as LedermixN® paste upon Enterococcus faecalis using three different techniques. Method: Direct contact test (DCT). Sealers were placed on an acrylic surface. A E. faecalis suspension was inoculated and left in a microtube with 1 mL of BHI broth. Logarithmic dilutions were conducted spreading them in blood agar plates so as to quantify CFU's (colony forming units). Dilution test (DT). Sealers and paste were placed in a plastic cylinder. Bacteriae were inoculated in the culture broth and the same quantification procedure was undertaken. Agar dilution test (ADT). On a blood agar plate three wells were manufactured: they were filled with both cements. On the LedermixN paste surface a E. faecalis suspension was inoculated so as to assess growth inhibition areas. Results: In the Direct contact test, LedermixN paste showed higher antimicrobial activity percentage. Neither of both cements nor the paste presented antimicrobial activity in dilution and Agar dilution test. In the Agar dilution test, AH Plus sealer and LedermixN paste exhibited a hemolysis halo in the blood agar plates. Conclusions: Direct contact test technique was considered the most appropriate to assess antimicrobial effects of cements.

Application of femoral neck anteversion′s correction in the treatment of children′s developmental dysplasia of the hip / 重庆医学

Objective To discuss application of femoral neck anteversion′s correction in the treatment of children′s developmen-tal dysplasia of the hip .Methods 98 children diagnosed DDH from Jan 2006 to Jan 2010 were treated and followed up ranging from 12 to 48 months ,average 32 months .Before the operations ,FNA index were evaluated by X-ray and thin slice hip joint scan and 3D reconstruction to guide the rotary osteotomy .After the operations ,FNA index were rechecked .Results According to Mckay′s clas-sification ,clinical assessment was performed .84 hips were evaluated as excellent (73 .68% ) ,20 hips as good(17 .55% ) ,10 hips as acceptable(8 .77% ) ,and no poor hip (0% ) was reported .FNA decreased averagely 16 .3° ± 2 .0° .FNA had significant difference with themselves before the operations(P0 .05) .Conclusion The change of FNA is one of the most important pathological changes .FNA′s correction is one of the most valuable to guarantee success operation .