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Purpose: To investigate the impact of tumor position displacements (TPDs) on tumor dose coverage in photon and proton stereotactic body radiation therapy (SBRT) treatments for lung cancer patients. Methods: From our institutional database of 2877 fractions from 770 lung cancer patients treated with photon SBRT in 2017-2021, 163 fractions from 88 patients with recorded iso-center shifts of >1.5 cm in any direction under kV-cone-beam CT guidance were identified. By double registrations with bony and tumor alignments, the difference between the iso-center shifts of these two alignments was categorized as TPDs. One fraction from each of 15 patients who had TPD magnitudes >3 mm were selected for this study. For each patient, one proton plan using intensity modulated proton therapy (IMPT) with robust optimization was generated retrospectively. All photon plans had V100%RX>99% of GTVs and V100%RX>98% of ITVs. Proton plans were evaluated with two worse-case scenario (voxelwise worst and worst scenario) using 5mm and 3.5% uncertainty to achieve the same planning goals as the corresponding photon plans. These two evaluation proton plans were named proton-1st and proton-2nd plans. The dosimetric effect of TPD was simulated by shifting tumor contours with the corresponding shift on patient specific planning CT and by recalculating the dose of the original plan. Results: The range of magnitude of TPDs was 3.58-28.71 mm. In photon plans, TPDs did not impact tumor dose coverage, still achieving V100%RX of the GTV≥99% and V100%RX of the ITV≥98%. In proton plans for patients with TPDs>10 mm, inadequate target dose coverage was observed. More specifically, 8 fractions of proton-1st plans and 4 fractions of proton-2nd had V100%RX of the GTV<99% and V100%RX of the ITV<98%. Conclusions: Adequate tumor dose coverage was achieved in photon SBRT for magnitude of TPDs up to 20 mm. TPDs had greater impact in proton SBRT and adaptive planning was needed when the magnitude of TPDs>10 mm to provide adequate tumor dose coverage.
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PURPOSE: The main purpose of this study was to identify how the accuracy of the tibial rotation reference axes varied in populations with different tibial tubercle locations. We hypothesized that the accuracy of the axes of tibial rotation would be affected by the changes of tibial tubercle locations. METHODS: Surgical epicondylar axis (SEA), medial third of the patellar tendon (1/3MPT), medial third of the tibial tuberosity (1/3MTT), medial border of the tibial tuberosity (MTT) and Akagi line were drawn. The angle between SEA and horizontal line with the angle between the four tibial rotation axes and the horizontal line was compared by T test. Then, the correlation between TTTG with the angles between the four axes and SEA vertical lines was analyzed. The TTTG was divided into three subgroups (TTTG < 10 mm, 10 mm ≤ TTTG < 15 mm, TTTG ≥ 15 mm), then t test was performed for the angles between the vertical lines of the SEA and the four rotation axes of the tibia in each group. RESULTS: Among the four tibial rotation axes, only the difference between MTT and the line perpendicular to SEA had no statistical significance (NS.). The four tibial rotational axes were all positively correlated with TTTG (p < 0.001). When TTTG ≥ 15 mm, Akagi line was 2.5° ± 6.9°internally rotated to the line perpendicular to SEA, while the 1/3MPT and MTT was 0.9° ± 5.3°and 1.3° ± 5.9°externally rotated to the line perpendicular to the SEA when TTTG < 10 mm and 10 mm ≤ TTTG < 15 mm, respectively. CONCLUSIONS: MTT showed the best consistency with SEA. TT-TG had a significant positive correlation with all four tibial rotational axes. In patients with TTTG < 10 mm, 10 mm ≤ TTTG < 15 mm and TTTG ≥ 15 mm, the 1/3MPT, MTT and Akagi line demonstrated good alignment consistency with SEA, respectively.
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Artroplastia do Joelho , Ligamento Patelar , Osso e Ossos , Humanos , Articulação do Joelho , Rotação , TíbiaRESUMO
Objective:To explore the effect of continuous feeding on the growth and development of premature infants.Methods:A total of 82 cases of premature infants in our hospital were selected as the research objects, whose birth time was from March 2018 to March 2019. According to different feeding methods, they were divided into control group and observation group, 41 cases in each group. The control group was fed intermittently and the observation group was fed continuously. Before and after 6 months of feeding, the levels of serum growth hormone and insulin-like growth factor-1, the mental development index(MDI) and physical development index(PDI), body mass, head circumference and height, and adverse reactions were compared.Results:The time of jaundice regression and hospitalization time in the observation group were (8.01±1.52) d, (28.41±3.57) d, shorter than (10.28±2.29) d, (36.19±6.47) d in the control group, the difference was statistically significant ( t value was 5.288, 6.741, P<0.05). There was no significant difference between the control group and the observation group in the levels of serum growth hormone and insulin-like growth factor-1 before feeding ( t value was 0.160, 0.075, P>0.05). After feeding for 6 months, the levels of serum growth hormone and insulin-like growth factor-1 in the experimental group were higher than those in the control group ( t value was 6.895, 19.537, P<0.05). Six months after feeding, the MDI and PDI of the observation group were 115.2±67.93 and 107.6±48.66 respectively, higher than 96.17±13.57, 94.52±10.89 in the control group ( t value was 7.777, 6.038, P<0.05). After feeding for 6 months,the growth level of body weight,head circumference and height in the observation group was higher than that in the control group ( t value was 7.590,10.124,15.661, P<0.05). The adverse reactions of premature infants in hospital infection, multiple apnea, gastric retention and neonatal necrotizing enterocolitis were lower than those in the control group ( χ2 value was 5.399-21.006, P<0.05). Conclusions:Continuous feeding can significantly improve the level of growth hormone and insulin-like growth factor-1 in premature infants, which is conducive to their growth and development, reduce the occurrence of adverse reactions and shorten the hospitalization time of premature infants, which has a certain clinical application value.
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Objective To investigate the relationship between serum markers β amyloid (Aβ), tau and thyroid hormone levels and post-stroke cognitive impairment (PSCI) in the acute phase of cerebral infarction. Methods A total of 214 patients with acute cerebral infarction were enrolled. The baseline data and serological indicators were collected and the cognitive function of patients was evaluated. All patients were divided into cognitive impairment group and normal group based on follow-up results. The differences of Aβ1-42, tau protein and thyroxine levels between the two groups and their relationship with disease progression were analyzed. The Cox regression analysis and ROC curve were used to compare the above parameters to predict the development of PSCI. Results The total protein level of Tau (210.6 ±98.9 pg/mL) was higher and Aβ1-42 (426.1 ±123.5 pg/mL) and triiodothyronine (T3) (1.43 ±0.57 nmol/L), free thyroxine (FT4) (13.15±2.23 pmol/L) was significantly lower in the cognitive impairment group than in the normal group (P<0.05). Tau protein (r=-0.457), Aβ1-42 (r=0.348), T3 (r=0.211), and FT4 (r=0.306) were all associated with disease progression (P<0.05). Cox regression analysis showed that Aβ1-42 and T3 were important influencing factors in the occurrence of PSCI. The area under the curve of Aβ1-42 combined with T3 was 0.841. The specificity and the sensitivity were 74.8% and 85.3%, respectively, with a diagnostic cutoff value of 0.572. Conclusion Aβ1-42 and T3 levels in the acute phase of cerebral infarction may predict the progression of PSCI.
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Objective To evaluate graft isometry after anatomic single bundle reconstruction of anterior cruciate ligament (ACL) using dynamic computed tomography (CT).Methods A retrospective study was conducted of the 14 patients who had undergone single bundle ACL reconstruction from June to August 2015.They were all men,with an average age of 28.6 years (range,from 18 to 39 years).At 6 months after operation,they received dynamic CT scanning during a cycle of knee extension to flexion.3D bone models representing the knee at different flexion positions (0°,30°,60°,90°,and 120°) in each patient were reconstructed from the CT images.The grid method was used to locate the positions of the central footprints of the tibial and femoral tunnels.The lengths between the entries of the femoral and tibial tunnels were measured from each tunnel entry to reflect the graft length change.Furthermore,we measured the isometry at the over-the-top position of the femur and at the anatomic tibial position.Results All the tunnel entries were located at the central area of the ACL anatomic attachment.The reconstructed ACL was the longest when the knee was in full extension.The length was gradually shortened between the femoral and tibial tunnels during flexion of the knee from 0° to 90°.The anatomic position showed an average of 4.82 mm shortening and the over-the-top position an average of 3.28 mm shortening.The length excursion increased in early flexion from 0° to 30° (2.91 ±0.91 mm on average) and reduced in later flexion from 90° to 120° (2.98 ± 1.41 mm on average).Conclusions None of the reconstructed ACL was isometric.A graft length may be the longest when the knee is in full extension and decrease gradually during the flexion from 0° to 90° and increase gradually during the flexion of 90° to 120°.The graft should be fixed when the knee is in the flexion of 30°.
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<p><b>OBJECTIVE</b>To explore the association of fish intake with the risk of renal cancer.</p><p><b>METHODS</b>PubMed, Embase, CNKI and CA databases were searched for case-control studies or cohort studies examining the relationship between fish or fish products intake and renal cancer. Heterogeneity among the selected studies was assessed using I2 score, and the publication bias was assessed using funnel plots.</p><p><b>RESULTS</b>Seventeen articles were included in the analysis with a heterogeneity across the studies (P=0.003, I(2)=52.3%). A random-effects model was used to generate the pooled risk ratio (RR) and 95% confidence interval (CI), and no statistically significant association was found between the risk of renal cancer and fish intake (RR=0.90; 95% CI, 0.78-1.02). In subgroup analysis, no evidence was found that the study design, study region or publication date influenced the results; but in the gender subgroup analysis, fish intake we found to decrease the risk of renal cancer in men but not in women.</p><p><b>CONCLUSION</b>The results of meta-analysis do not support an association between fish intake and a lowered risk of renal cancer.</p>
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Feminino , Humanos , Masculino , Carcinoma de Células Renais , Dieta , Produtos Pesqueiros , Neoplasias Renais , Razão de Chances , Fatores de RiscoRESUMO
Objective To study the relationship between the dose indicator of computed radiography (CR) and the entrance surface dose (ESD),and to build a model for estimating ESD based on this relationship.Methods Taking Kodak CR system as the research object,a theoretical model for estimating the ESD was established according to theoretical derivations,and the key parameters in the model were determined through experiments in a CR system.Further experiments in another CR system were also conducted to verify the model.Results The ESDs were not only dependent on the dose indicator provided by the CR system,but also influenced by other factors,such as tube potential,patient's body thickness and energy response of the imaging plate.The estimation results of the model agreed well with the experiment results,and the relative deviation was confirmed within 20％.Conclusions The dose indicator based model can provide a relatively fast and easy way for evaluating the doses of patients undergoing X-ray diagnoses with the CR system.