A comprehensive method for calculating total body irradiation

PurposeTo provide means for calculating the dose received by various tissues of the patient, calculate lung shield, and verify received dose using a phantom as a tool for quality assurance for a planned Total Body Irradiation (TBI) procedure in radiotherapy.MethodUsing Microsoft Visual Basic, MATLAB, and Python, a program for Total Body Irradiation Calculation in Radiotherapy (TBICR) is constructed. It uses patient translation and beam zone method for total body irradiation calculations to compute the proper dose received by the patient and determine the lung shield thickness. There are three main user-friendly interfaces in the application. The first one allows the user to upload the TBI topography and estimate the distances needed for TBI calculations. The second one enables the user to count the number of beam zones needed for each point and estimate the effective area (A_eff) for each level. The third interface estimates the velocity required to deliver the relative dose depending on patient separation, Monitor Units (MU), couch speed and travel distance. It allows the user to compute the required lung shield thickness, read any patient's CT DICOM file and acquire dose in any distinct location using machine learning model to predict the dose.ResultsThe TBICR software has been successfully validated by reproducing all of the manual calculations in an exact and timely manner. TBICR generated more accurate results and confirmed the absorbed dose to patient through measurements on Anderson phantom.ConclusionsA computer program for the calculation of total body irradiation (TBI) is described in full. The dose received at each point on the patient, the calculation of lung shield and the determination of the velocity and time required for the couch movement are all made possible using the software. The ease of use, precision, data storage and printing are some important features of the present software.     

儿童青少年近视防控研究的3个热点问题

为了提高近视眼防控的工作能力, 围绕近视眼防制, 该文分析了远视储备的意义及其正确运用, 指出目前需要注意的问题, 总结以往他人的经验, 在分析理疗仪器尤其是红光原理的仪器、低浓度阿托品滴眼液防控近视眼的机制的基础上, 提出了标本兼治的近视防控体系设想和今后研究的方向。     

Maternal adversity and variation in the rate of children entering local authority care during infancy in England: a longitudinal ecological study

BackgroundEngland has seen unsustainable increases in the number of children entering care in recent years. One in five children entering care are infants, although rate of infant entry to care varies considerably by local authority. Understanding this variation and its drivers could inform upstream strategies to improve outcomes for children at risk of, or receiving, care. Parental ill health or risk behaviour from pregnancy onwards could trigger state involvement in infants’ care. Therefore, we explored whether adversity indicated within women's hospitalisation history, pre-delivery, could help to explain local authority variation in rates of infant entry to care.MethodsWe combined data on hospitalisations (hospital episode statistics) and entries to care (children looked after return) with publicly available data on local authority characteristics (2011 Census, Office for National Statistics Population Estimates, and Public Health England Fingertips) for 131 English local authorities. Our primary outcome was annual (April–March) local authority rate of infant entry to care (per 10 000 infants in the local authority population) between April 1, 2006, and March 31, 2014. We used linear mixed-effects models to analyse the relationship between the outcome and local authority-specific proportion of livebirths with maternal history of adversity-related hospital admissions (ie, substance misuse, mental health problems, or violence-related admissions in the 3 years before delivery), adjusted for seven other predictors for entry to care (including local authority-specific prevalence of maternal deprivation, births to teenage mothers, and community violence).FindingsRate of infant entry to care (mean 85·16 per 10 000 [SD 41·07, range 0·00–318·51) and proportion of livebirths with maternal history of adversity-related hospital admissions (mean 4·62% [2·44, 0·52–16·19]) varied greatly by local authority. Prevalence of maternal adversity accounted for 24% (95% CI 14–35%) of variation in rate of entry. After adjustment, a percentage point increase in prevalence of maternal adversity (both within and between local authorities) was associated with an additional 2·56 infants (95% CI 1·31–3·82) per 10 000 entering care.InterpretationPrevalence of maternal adversity before birth helps explain differing rates of infant entry to care among English local authorities. This study also highlights the need for linked parent–child data on health and child protection to inform policy interventions to improve maternal wellbeing and potentially reduce entries to care.FundingNational Institute for Health Research—Great Ormond Street Hospital Biomedical Research Centre.     

经自然腔道取标本手术在结直肠外科手术中的应用进展

随着腔镜技术的进一步发展以及微创理念应用于结直肠外科疾病的诊治中,结直肠相关疾病的诊治发生了翻天覆地的变化。由传统的经腹手术到腹腔镜手术、经自然腔道手术,再到经自然腔道取标本手术(NOSES),结直肠疾病的外科诊治在微创领域取得了巨大成果。NOSES技术是目前结直肠外科在微创领域前沿的手术方式之一,它通过经直肠、阴道取标本来避免了腹壁的辅助取标本切口,从而将结直肠外科手术进一步微创化。NOSES技术集传统腹腔镜手术的优势与现代微创外科的理念于一体,它在确保手术效果的基础上集中体现了微创、加速康复外科、功能外科、"无疤"等理念的特点。本文主要就国内外各中心开展NOSES技术在结直肠外科诊治开展中的相关经验、心得和体会进行综述。     

不可切除胃癌转化治疗的研究进展

胃癌在全国范围内是发病率最高的恶性肿瘤之一，在癌症相关死亡原因中排名第三。目前外科手术仍然是胃癌获得根治性治疗的主要手段，但是其中有30%~40%的进展期胃癌患者在初诊时就失去了根治手术的机会，因此不可切除胃癌转化为可切除胃癌是患者获得"治愈"的最佳选择。随着近些年来新型药物的出现、治疗手段的多样化及多学科诊治模式的发展，"转化治疗"的理念应运而生，从而延长患者生存时间并提高其生活质量。本文就不可切除胃癌的治疗现状与进展、"转化治疗"的应用等进行综述。     

Contribution of CCK1 receptors to cardiovascular and respiratory effects of cholecystokinin in anesthetized rats

The study investigated the share of vagal input at infra- and supra-nodosal level and the contribution of CCK₁ and CCK₂ receptors to the cardiorespiratory responses produced by an intravenous injection of sulfated cholecystokinin octapeptide (CCK-8) in anesthetized rats.This compound administered intravenously at a dose of 50 μg/kg induced short-lived decline in tidal volume and respiratory rate resulting in depression of minute ventilation. Midcervical vagotomy had no effect on CCK-8-evoked ventilatory changes, whereas supranodosal denervation abolished slowing down of breathing. Cardiovascular response to CCK challenge was characterized by a transient decrease followed by an augmentation in the mean blood pressure (MAP) in the intact animals. Vagotomy performed at both levels abrogated the declining phase of MAP. Blood pressure changes were associated with decreased heart rate present in all neural states. All cardiovascular and respiratory effects were antagonized by pre-treatment with devazepide-CCK₁ receptors' antagonist, whereas CI988-antagonist of CCK₂ receptors was ineffective.In conclusion, our results indicate that CCK-8 modulates slowing down of respiratory rhythm via CCK₁ receptors located in the nodose ganglia (NG) and depresses tidal volume via central CCK₁ dependent mechanism. CCK-8-evoked decline in blood pressure may be due to activation of vagal afferents, whereas pressor responses seem to be mediated by an activation of CCK₁ receptors in the central nervous system. Bradycardia was probably induced by the direct action of CCK-8 on the heart pacemaker cells.     

实验动物标准颞骨切片规范

颞骨切片技术是观察和评估实验性内耳病理学改变的重要手段。由于内耳复杂的迷宫式立体结构,从不同方向和角度获取的颞骨切片很难进行相互间的组织病理学比较。因此,统一颞骨标准切片技术规范,对于评判内耳听觉感受器和前庭各个平衡感受器以及耳蜗和前庭周边神经元的病变部位和病变程度十分重要,因为只有统一了规范的颞骨样品制备和切片角度,才有可能对实验性内耳病变做出正确的比较和评判。颞骨切片的标准方向是将切片平面平行于外耳道和内听道的水平面,从上鼓室向下鼓室方向依次收集到的需要进行重点评估的切片层次分别为上半规管壶腹嵴和外半规管壶腹嵴、椭圆囊斑和球囊斑及前庭上神经元、球囊斑和前庭下神经元、耳蜗中轴、内淋巴管及内淋巴囊、以及后半规管壶腹嵴。本文还根据作者的实践经验讨论了颞骨切片样品制备过程中有关样品固定、脱钙、颞骨整体染色、渗透和定向包埋等技术细节,期望能对从事内耳病理学研究的同道有所帮助。