X线全身放射治疗中的实时剂量监测

目的探讨X线全身放射治疗中实时剂量监测的工具和方法。方法用X线全身照射用多通道半导体剂量仪对23例患者进行实时剂量监测,用Farmer剂量仪进行加速器输出剂量稳定性的监测。结果半导体监测剂量与预置剂量有较好的一致性,各部位的剂量均匀性能很好地符合临床要求,肺部剂量在期望剂量范围内。Farmer剂量仪监测显示加速器的长时间剂量输出是稳定的,与全身照射数据建立时同一空间位置相同条件下100MU所对应的输出剂量最大偏差在2%以内。结论多通道半导体剂量仪适合用于全身放射治疗患者体表的实时剂量监测,Farmer剂量仪是全身照射中输出剂量稳定性监测的有力工具。     

1例急性重度放射病人三年随访观察报告

患者男性,25岁,于1980年9月1日受到5.3万居里~(60)CO强γ源全身不均匀外照射。全身等效均匀照射剂量为522rad。初期临床表现和估算剂量符合急性重度骨髓型放     

全身照射的前期准备及在造血干细胞移植预处理中的应用

目的 探讨医用直线加速器高能X线全身照射(TBI)在造血干细胞移植预处理中的应用及治疗前的必要准备。方法 利用仿真人体体模和热释光测量设备，在高能X线全身照射条件下，对远距离大照射野的射线剂量均匀性进行测量和调整并测量了人体各重要组织和器官的吸收剂量。对已完成的12例TBI病例进行初步分析，观察临床应用效果。结果 经调整后的大照射野完全符合治疗要求，获得了人体内在全身照射条件下各器官的实际吸收剂量，为全身照射时照射剂量的评估和监测提供了可靠数据。完成的12例TBI治疗均成功。结论 经过仔细测量和调整后的医用直线加速器，完全可以胜任造血干细胞预处理全身照射的各项要求，临床应用可靠。     

家兔接受极低剂量γ射线照射诱导的外周血淋巴细胞遗传学 …

目的：探讨家兔接受不同的极低剂量γ射线全身照射后，对相继较大剂量照射所诱导的细胞，遗传学损伤的抗性。方法：用＾６０Ｃｏ－γ射线对家兔进行慢性全身均匀照射，当累积剂量分别达到０．０５，０．１０，０．１，０．２０、０．２５、０．３０Ｇｙ时，取静脉血，常规条件下培养，分别在淋巴细胞的Ｇｏ期和Ｇ２期以１．５ＧｙＸ射线１次照射，制备染色体标本。结果：Ｇ０期和Ｇ２期受大剂量照射后，分别在０．１５Ｇｙ和０．２０     

调强放疗对乳腺癌靶区剂量均匀性的影响

目的:通过研究乳腺癌调强放疗靶区剂量分布均匀性来评估此放疗技术的临床可行性。方法:随机选择5个早期乳腺癌病例,首先使用美国Xio治疗计划系统分别为其制定标准放疗计划和调强放疗计划,然后采用美国CIRS体模在加速器下照射来验证各个计划,计划的可行性则用美国RIT113胶片剂量分析软件判别,最后使用Xio治疗计划系统的剂量体积直方图计算每个计划处于95%至105%处方剂量以外的靶区百分体积来评估靶区剂量的均匀性。结论:静态多野调强放射治疗技术能显著改善早期乳腺癌保乳术后放疗患者乳腺靶区剂量分布均匀性,今后可能发展成为其常规治疗手段。     

脑转移癌螺旋断层放疗、调强及三维适形放疗计划的剂量学研究

目的 评估多发脑转移癌的螺旋断层放疗(tomotherapy,TOMO)、静态逆向凋强(intensity modulation radiation therapy,IMRT)与三维适形放射治疗(three dimensional conformal radiation therapy,3D-CRT)的剂量学特性,为临床选择提供依据.方法 选取l、2、3及多个病灶的脑转移癌患者的CT/MRI图像各10例,勾画靶区及正常器官后,分别传输至Precise plan、Pinancle及TOMO计划系统,给予全脑(PTVwb)40Gy/20F,同步给予局部转移灶(pGTVs)加量至60Gy/20F.根据RTOG02-25标准限制危及器官(organs at risk,OAR)剂量,三组计划完成后,分别对靶区的均匀性指数(homogeneity Index,HI)、不均匀性指数(heterogeneity index,UI)、等剂量曲线覆盖程度、剂量体积直方图(dose volume histogram,DVH)分布和正常器官受量最大剂量及平均剂量进行评估.结果 三种计划都能达到处方剂量需要和危及器官受量限制.TOMO计划对脑转移病灶及全脑的计划靶区均匀性、适形度、靶区覆盖程度和对3个以上病灶患者的晶体保护优于3D-CRT和IMRT计划;对中耳、内耳、1-2个转移病灶患者的视神经、3个以上转移病灶患者的脑干保护优于3D-CRT计划.IMRT计划对全脑的计划靶区的均匀性、适形度、靶区覆盖程度均和对中耳、1-2个转移病灶患者的视神经、3个以上转移病灶患者的脑干优于3D-CRT计划,且在3个以上转移灶患者更明显.3D-CRT计划针对转移灶的均匀性优于IMRT计划,且在3个以上转移灶患者更明显,对于眼球和1-2个转移灶患者晶体的保护优于IMRT和TOMO计划.结论 针对多发脑转移癌放疗,螺旋断层放疗计划优于静态调强放疗计划,静态调强放疗计划优于三维适形放疗计划且对于3个以上转移灶患者优势更明显.     

电子束全身照射的剂量学特性

目的研究全身电子束照射的剂量学特性,以指导临床应用。方法在西门子直线加速器上,采用Stanford大学医学院建立的双机架多照射野方法,利用CMS公司的Dynascan三维水箱和PTW剂量仪及KODAK公司的XV2胶片等设备,分别测量各项剂量学特性的指标。结果各项指标均符合电子束全身放疗的要求,有效治疗深度达到1.15 cm,体表剂量在80%以上,全身剂量均匀性为±11%以内,X射线污染低于2.3%,治疗位置的绝对剂量为44.6cGy,眼睛挡铅衰减为6%,总散射累积因子为2.5。治疗中患者特殊部位的自屏蔽作用明显。结论通过测量能掌握实际照射中的剂量学特点,对于处方剂量的确定,重要器官的保护以及欠量部位的补量,均具有指导意义。     

全身伽玛刀治疗癌性梗阻性黄疸临床疗效观察

目的 观察全身伽玛刀治疗癌性梗阻性黄疸的临床疗效。方法 收集32例癌性梗阻性黄疸，其中原发性肝癌8例，胰腺癌16例，胆管癌6例，胆囊癌术后转移2例：采用全身伽玛刀治疗，用50％～65％等剂量曲线包绕肿瘤边缘，治疗次数6一10次，单次剂量360～600CGY，每日一次，观察临床症状、体征及实验室检查结果，按国际肿瘤疗效标准评价疗效。结果 29例黄疸症状及胆红紊检查均不同程度减轻。轻度减轻(SD)4例，中度减轻及明显减轻(PR)22例，黄疸完全消失(CR)3例。结论 全身伽玛刀治疗癌性梗阻性黄疸疗效显著，副反应小，特别适合晚期无法手术的患者姑息治疗。     

家兔接受极低剂量γ射线照射诱导的外周血淋巴细胞遗传学适应性反应

目的：探讨家兔接受不同的极低剂量γ射线全身照射后，对相继较大剂量照射所诱导的细胞遗传学损伤的抗性。方法：用６０Ｃｏ－γ射线对家兔进行慢性全身均匀照射，当累积剂量分别达到０．０５，０．１０，０．１５，０．２０、０．２５、０．３０Ｇｙ时，取静脉血，常规条件下培养，分别在淋巴细胞的Ｇ０期和Ｇ２期以１．５ＧｙＸ射线１次照射，制备染色体标本。结果：Ｇ０期和Ｇ２期受大剂量照射后，分别在０．１５Ｇｙ和０．２０Ｇｙ以上可诱导出明显的适应性反应（Ｐ＜０．０５），而在０．１０Ｇｙ和０．１５Ｇｙ以下则不能诱导出适应性反应。结论：本文为能诱导出适应性反应的Ｄ１剂量提供了最低阀值。     

癌症患者10 MV X射线局部照射后染色体畸变的观察

辐射事故发生时情况较复杂，都是局部照射或全身不均匀照射。因此，对局部受照射人员进行剂量估算具有重要意义。本文对２２例癌症患者局部放疗前、第１次放疗后２４ｈ与照射前自身离体血以相同剂量及照射条件照射后，对其外周血淋巴细胞染色体进行了比较观察，以便对比局...     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.