宫颈癌术后静态调强放疗与容积旋转调强放疗的比较

目的：比较宫颈癌术后静态调强放疗（intensity modulated radiotherapy,IMRT）与容积旋转调强放疗（volumetric modulated arc therapy,VMAT）近期不良反应发生率以及剂量学参数,为早期宫颈癌根治术后放疗的选择提供参考依据。方法：收集整理接受IMRT或VMAT治疗的宫颈癌根治术后患者各50例,观察所有患者放疗期间急性不良反应的发生率,比较两组放疗计划危及器官的受照剂量,计划靶区的适形度指数（conformity index,CI）、均匀性指数（homogeneity index,HI）、照射时间及跳数（the number of monitor unit,MU）。结果：VMAT组急性放射性肠炎的发生率明显低于IMRT组,两者差异有统计学意义（38% vs. 64%,P < 0.05）;与IMRT组相比,上消化道反应发生率明显降低（20% vs. 6%,P < 0.05）;VMAT组直肠V40、小肠V40均低于IMRT组（P < 0.01）,而直肠和小肠的V20、V30在两组中均无统计学差异（P > 0.05）;两组中膀胱V20、V30、V40均无统计学差异（P > 0.05）;VMAT计划CI优于IMRT计划（P < 0.05）;HI在两组中无统计学差异（P > 0.05）;与IMRT计划比较,VMAT计划的MU值和治疗时间分别减少了50％和54％（P < 0.01）。结论：宫颈癌根治术后患者选择VMAT治疗,可在一定程度上减少患者急性放射性肠炎和上消化道反应的发生率,减轻正常器官的受照剂量,缩短放疗时间,从而提高患者术后放疗的耐受性。     

三维适形放疗、调强放疗和容积调强放疗在宫颈癌术后患者中的应用

目的比较三维适形放疗(3D-CRT)、调强放疗(IMRT) 和容积调强放疗（VMAT)技术在术后伴有中、高危因素的早期宫颈癌患者中的疗效及不良反应,探讨术后伴有中、高危因素的早期宫颈癌患者术后辅助放疗的最佳治疗模式。方法接受术后辅助放疗的120例具有中、高危因素的早期宫颈癌患者,按照随机数字表法平均分成3组,其中3D-CRT、IMRT及VMAT各40例,比较观察3种治疗方式的疗效及不良反应。结果3组1、2、3年生存率比较差异无统计学意义(P>0.05)。在不良反应方面,使用IMRT和VMAT技术患者的不良反应发生率相似(P>0.05);急性胃肠道反应和泌尿道反应发生率,IMRT和VMAT技术优于3D-CRT技术（P<0.05）;放射性肠炎及膀胱炎的发生率,3D-CRT、IMRT和VMAT技术未发现差异(P>0.05)。结论具有中、高危因素的早期宫颈癌术后患者,采用IMRT、VMAT和3D-CRT技术放疗,其短期生存率相似,IMRT和VMAT不良反应的发生率低于3D-CRT;IMRT和VMAT不良反应发生率无明显差异。     

旋转容积调强技术和固定野适形调强放疗治疗鼻咽癌剂量学差异对比分析

目的:比较旋转容积调强技术(VMAT)和固定野适形调强放疗(IMRT)治疗鼻咽癌的剂量学差异。方法:以海南医学院第二附属医院2019年1月至2021年12月收治的114例鼻咽癌放疗患者为研究对象，分为A、B两组各57例，A组采用VMAT放疗，B组采用IMRT放疗。比较两组患者的疗效、靶区剂量、风险器官(OAR)受量、治疗效率(加速器跳数、治疗时间)、不良反应。结果:治疗后，两组患者治疗总缓解率、靶区剂量比较差异无统计学意义(均P>0.05);A组患者视神经、晶体、腮腺、下颌骨受量低于B组，差异有统计学意义(均P<0.05);A组治疗中加速器跳数、治疗时间均少于B组，差异有统计学意义(均P<0.05);两组治疗期间不良反应发生率比较差异无统计学意义(P>0.05)。结论:VMAT、IMRT治疗鼻咽癌患者效果相当，但应用VMAT可减少病灶周围正常器官的受量，对提升治疗效率及安全性有利。     

局部复发鼻咽癌患者再程放疗技术的剂量学参数比较

目的： 比较容积旋转调强（VMAT）、固定野调强（IMRT）和三维适形（3D-CRT）放疗技术在局部复发鼻咽癌患者治疗中的剂量学参数,分析3种治疗计划的剂量学特性。方法:选择12例局部复发的鼻咽癌患者,采用Pinnacle 9.2和eciseplan 2.03治疗计划系统,每例患者均设计VMAT﹑IMRT和3D-CRT ,比较3组计划的剂量分布及危及器官受量等。结果: MAT及IMRT组适形度指数（CI）相似,但均优于3D-CRT组,组间比较差异有统计学意义（P<0.05）。3组计划的靶区不均匀指数（HI）相近,组间比较差异无统计学意义（P>0.05）。3D-CRT组机器跳数(MU)及出束时间优于其他2组,VMAT组优于IMRT组,组间比较差异均有统计学意义（P<0.05）。危及器官受量,3组计划脑干及晶体受量比较差异无统计学意义（P>0.05）;VMAT组和IMRT组脊髓、视神经、视交叉和大脑颞叶的受量明显优于3D-CRT组,组间比较差异有统计学意义（P<0.05）,但VMAT组与IMRT组比较差异无统计学意义（P>0.05）。 结论： 3种放疗技术的治疗计划剂量分布有差异,VMAT与IMRT计划均能较好覆盖靶区,并减少周围正常组织受量,满足临床需求。VMAT计划的靶区适形度、MU和出束时间优于IMRT计划。3D-CRT仅在MU和治疗时间上有优势。     

宫颈癌腹主动脉旁淋巴结转移静态调强放疗与容积旋转调强放疗的剂量学比较

目的：比较静态调强放疗（intensity modulated radiotherapy,IMRT）与容积旋转调强放疗（volumetric modulated arc therapy,VMAT）在宫颈癌伴腹主动脉旁淋巴结（para?aortic lymph node,PALN）转移患者放疗中的剂量学参数,为局部晚期宫颈癌放疗方式的选择提供参考依据。方法：对20例病理学证实经PET?CT检查诊断为宫颈鳞癌PALN转移接受放疗的患者,对同一CT图像分别进行IMRT和VMAT计划设计,比较两种放疗计划的靶区剂量和危及器官（organ at risk,OAR）的剂量学差异、靶区适形性指数（conformity index,CI）、均匀性指数（homogeneity index,HI）、加速器跳数（number of monitor units,MU）和治疗时间。结果：IMRT和VMAT组计划的靶区剂量均能够满足剂量学要求,在靶区CI和HI上,VMAT计划优于IMRT计划。OAR保护方面,VMAT 计划中两侧肾脏平均剂量低于IMRT计划,直肠V40、直肠V50、小肠V40和膀胱V40的剂量均低于IMRT计划（P＜0.05）。VMAT计划的MU（859.92 ± 248.47）低于IMRT计划（1 649.50±167.44,t=11.836,P＜0.001）。VMAT 计划的治疗时间［（304.30 ± 41.98）s］明显短于IMRT计划［（435.90 ± 37.52）s,t=12.750,P＜0.001］。结论：宫颈癌伴PALN转移患者,采取IMRT和VMAT技术均可达到临床靶区剂量要求和OAR的剂量保护,而VMAT计划在靶区CI和HI上优于IMRT计划,同时VMAT具有降低OAR剂量的优势,MU明显降低,照射时间缩短,提高了患者放疗的耐受性,提升了宫颈癌放射治疗的效率。     

容积旋转调强放疗与调强适形放疗治疗脑胶质瘤患者的效果比较

目的:比较容积旋转调强放疗(VMAT)与调强适形放疗(IMRT)治疗脑胶质瘤患者的效果。方法:选取86例脑胶质瘤患者为研究对象,按随机数字表法将其分为观察组与对照组各43例。观察组采用VMAT治疗,对照组采用IMRT治疗,比较两组临床疗效、治疗前后表皮生长因子(EGF)水平、血管内皮生长因子(VEGF)水平、卡氏功能状态(KPS)评分、健康状态调查简表(SF-36)评分和不良反应发生率。结果:观察组治疗总有效率为88.37%(38/43),高于对照组的69.77%(30/43),差异有统计学意义(P<0.05);治疗后,观察组EGF和VEGF水平均低于对照组,KPS和SF-36评分均高于对照组,差异有统计学意义(P<0.05);观察组不良反应发生率为25.58%(11/43),低于对照组的48.84%(21/43),差异有统计学意义(P<0.05)。结论:VMAT治疗脑胶质瘤患者可提高治疗总有效率、KPS评分和SF-36评分,降低EGF水平、VEGF水平和不良反应发生率,效果优于IMRT治疗。     

胶质母细胞瘤术后IMRT和VMAT的剂量学比较

目的 比较胶质母细胞瘤术后放疗采用逆向调强(IMRT)和容积旋转调强(VMAT)技术在靶区和危及器官的剂量学差异,并比较不同技术的机器跳数、计划优化时间和治疗时间的差异,探讨VMAT技术在胶质母细胞瘤放疗中应用的可行性和优劣性.方法 收集胶质母细胞瘤病例资料10例,术后3周内行MR增强扫描及CT增强定位扫描,层厚3 mm,采用医科达的Oncentra治疗计划系统进行MR-CT图像融合,医生勾画靶区和危及器官;物理师对个病例分别设计5野的IMRT计划、单弧VMAT计划(VMAT1)和双弧VMAT计划(VMAT2),处方剂量为PTV 60 Gy/30f.利用剂量体积直方图(DVH)和等剂量分布曲线比较靶区的覆盖率、适形指数、均匀指数以及危及器官的受照剂量,比较不同技术的机器跳数、优化时间和治疗时间的差异.结果 3组计划靶区剂量分布均较好,IMRT、VMAT1和VMAT2的靶区PTV 95%体积达到的剂量组间比较差异无统计学意义;适形指数组间差异有统计学意义,VMAT的适形指数比IMRT好,但单弧VMAT与双弧VMAT两组间差异无统计学意义.均匀指数3组间差异无统计学意义.危及器官包括脑干、患侧晶体、对侧晶体、患侧视神经、对侧视神经和视交叉,所有危及器官的最高剂量在3组计划中差异均无统计学意义.机器跳数3组间差异有统计学意义,IMRT组与VMAT1组比VMAT2组的跳数少.治疗时间3组间差异有统计学意义,IMRT组与VMAT1组比VMAT2组的治疗时间少,VMAT1组治疗时间最短.计算优化的时间IMRT最短,双弧VMAT最长,3组计划差异均有统计学意义.结论 胶质母细胞瘤术后放疗计划设计采用单、双弧的VMAT计划的靶区适型指数都好于IMRT组.单弧的VMAT计划的机器跳数与IMRT计划相当,但治疗时间短.双弧的VMAT计划的机器跳数多、治疗时间长.计算优化的时间IMRT短,VMAT长.     

容积旋转调强放疗治疗局部晚期非小细胞肺癌的临床效果

目的研究容积旋转调强放疗(VMAT)治疗局部晚期非小细胞肺癌近期疗效及急性放射性损伤发生情况。方法选取2016年1月至2017年8月六安市中医院肿瘤放疗科收治的50例ⅢA～ⅢB期局部晚期非小细胞肺癌患者,采用随机数字表法分为VMAT组和静态适形调强(IMRT)组,每组25例。分别接受VMAT和IMRT治疗,并同步给予足叶乙苷+顺铂方案化疗。随访至放化疗结束后1个月,观察两组患者近期疗效及放疗并发症情况。结果 VMAT组和IMRT组患者疾病控制率分别为92%和88%,差异无统计学意义(P> 0. 05); VMAT组和IMRT组放射性肺炎、放射性食管炎、放射性心脏损害发生率分别为32%、40%、8%、56%和76%、32%、4%、52%,其中VMAT组放射性肺炎发生率低于IMRT组,差异有统计学意义(P <0. 05)。结论 VMRT技术在临床疗效方面并不优于IMRT,但其可能一定程度降低了放射性肺炎发生率。     

宫颈癌术后调强放疗的临床观察

目的:观察具有不良预后因素的宫颈癌术后患者行盆腔适形调强放疗(intensity-modulated radiotherapy,IMRT)的急性放疗反应和近期疗效。方法:63例Ⅰ~Ⅱa期具有不良预后因素的宫颈癌术后患者,随机分成调强放疗组和常规放疗组,观察两组急性放疗反应和近期疗效。结果:调强放疗组急性不良放疗反应轻,无3级以上不良反应。两组在皮肤(χ2=46.96)及下消化道(χ2=25.49)急性放疗反应方面比较,差异有统计学意义(P<0.05)。两组放疗近期疗效及1年生存率比较,差异无统计学意义(P>0.05)。结论:IMRT进行宫颈癌术后放疗,患者急性放疗反应较轻。     

调强放疗与容积旋转调强放疗在非小细胞肺癌肿瘤体积差异患者中的应用比较

目的 探讨非小细胞肺癌（NSCLC）不同肿瘤体积差异患者采用不同放疗技术的优势。方法 选择30例NSCLC患者,分别设计调强放疗（IMRT）和容积旋转调强放疗（VMAT）计划,统计分析靶区可给予最高剂量(D₉₅)、均匀度指数（HI）、适形度指数（CI）和危及器官照射体积等,并对结果采用配对t检验分析。结果 整体VMAT计划的HI、肺的V₅小于IMRT计划,差异有统计学意义（P<0.05）,VMAT计划能给予的靶区剂量(D₉₅)大于IMRT计划,差异有统计学意义（P<0.05）,其他无统计学意义。按“靶肺体积比”分组后,靶肺体积比≤0.1组和0.1<靶肺体积比≤0.2组：VMAT的HI更低,差异有统计学意义（P<0.05）,其他无统计学意义;0.2<靶肺体积比≤0.3组：VMAT计划的HI、肺的V₅小于IMRT计划,IMRT计划的V₄₀低于VMAT计划,差异有统计学意义（P<0.05）,其他无统计学意义;0.3<靶肺体积比≤0.4组：VM...     

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.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

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.     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

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.