脚本函数在鼻咽癌在线自适应放疗中的可行性研究

目的利用Pinnacle V9.10计划系统脚本函数,在没有配置动态计划模块的情况下,实现鼻咽癌在线自适应放疗。方法编辑并嵌入脚本函数,借助西门子滑轨CT和IBA Compass三维剂量验证系统,在医生和物理师共同参与下,依次进行一例鼻咽癌放疗计划的移植、靶区和危及器官轮廓的移植和修改、计划评估、新计划的生成和剂量的在线验证。结果利用脚本函数及人工手动操作相结合的方式完成了4个分次的在线自适应放疗,其中计划更新1次。结论脚本函数的应用能够协助放疗工作人员实现在线自适应放疗,但在线计划的重新优化效率和累积剂量的精确评估问题仍需进一步解决。     

Training implications of maximal forces on a computer-controlled and motor-driven leg press by age group, sex, footplate direction, and speed

Strength training that overloads lengthening muscle fibers may result in greater strength gains with less effort and perceived exertion than conventional training modalities. This study evaluates a device capable of this overloading (a motor-driven and computer-controlled leg press) to develop recommendations for future training interventions. Unimpaired younger and older men and women (7/group, total n=28) performed three maximal-effort trials for both directions of footplate motion (IN and OUT) at three speed profiles (knee rotation speeds of 15, 25, and 35°/s) on a motor-driven and computer-controlled leg press. Normalized forces were tested for effects of age group, sex, direction of footplate motion, and knee rotation speed. Peak forces were 57% greater for younger and 20% greater for IN. Trends of greater IN relative to OUT forces (IN overloading) were present in women, but this was due to an inverse correlation between strength and IN overloading that was independent of age group and sex. Leg press strength training on a device that is capable of overloading lengthening muscle fibers is a promising new training method that appears to have the greatest potential benefits for the weakest participants. Training target profiles on the device tested and others similar to it should be set based on participant-specific maximums across the ROM in both IN and OUT directions at a speed in the middle of the range to be trained.     

Anterior cervical decompression and fusion on neck range of motion,pain, and function: a prospective analysis

Background contextIntractable cervical radiculopathy secondary to stenosis or herniated nucleus pulposus is commonly treated with an anterior cervical decompression and fusion (ACDF) procedure. However, there is little evidence in the literature that demonstrates the impact such surgery has on long-term range of motion (ROM) outcomes.PurposeThe objective of this study was to compare cervical ROM and patient-reported outcomes in patients before and after a 1, 2, or 3 level ACDF.Study designProspective, nonexperimental.Patient sampleForty-six patients.Outcome measuresThe following were measured preoperatively and also at 3 and 6 months after ACDF: active ROM (full and painfree) in three planes (ie, sagittal, coronal, and horizontal), pain visual analog scale, Neck Disability Index, and headache frequency.MethodsPatients undergoing an ACDF for cervical radiculopathy had their cervical ROM measured preoperatively and also at 3 and 6 months after the procedure. Neck Disability Index and pain visual analog scale values were also recorded at the same time.ResultsBoth painfree and full active ROM did not change significantly from the preoperative measurement to the 3-month postoperative measurement (ps>.05); however, painfree and full active ROM did increase significantly in all three planes of motion from the preoperative measurement to the 6-month postoperative measurement regardless of the number of levels fused (ps≤.023). Visual analog scale, Neck Disability Index, and headache frequency all improved significantly over time (ps≤.017).ConclusionsOur results suggest that patients who have had an ACDF for cervical radiculopathy will experience improved ROM 6 months postoperatively. In addition, patients can expect a decrease in pain, an improvement in neck function, and a decrease in headache frequency.     

A home‐based progressive resistance exercise programme for patients with venous leg ulcers: a feasibility study

This study aimed to assess the feasibility of a home‐based exercise programme and examine the effects on the healing rates of venous leg ulcers. A 12‐week randomised controlled trial was conducted investigating the effects of an exercise intervention compared to a usual care group. Participants in both groups (n = 13) had active venous ulceration and were treated in a metropolitan hospital outpatients clinic in Australia. Data were collected on recruitment from medical records, clinical assessment and questionnaires. Follow‐up data on progress in healing and treatments were collected fortnightly for 12 weeks. Calf muscle pump function data were collected at baseline and 12 weeks from recruitment. Range of ankle motion data were collected at baseline, 6 and 12 weeks from recruitment. This pilot study indicated that the intervention was feasible. Clinical significance was observed in the intervention group with a 32% greater decrease in ulcer size (P = 0·34) than the usual care group, and a 10% (P = 0·74) improvement in the number of participants healed in the intervention group compared to the usual care group. Significant differences between groups over time were observed in calf muscle pump function parameters [ejection fraction (P = 0·05), residual volume fraction (P = 0·04)] and range of ankle motion (P = 0·01). This pilot study is one of the first to examine and measure clinical healing rates for participants involved in a home‐based progressive resistance exercise programme. Further research is warranted with a larger multi‐site study.     

Newborn and infant discrimination: revisiting footprints

Formal registration of newborns and infants is a necessity to secure their rights for health care or education and to support law enforcement agencies in the fight against the trafficking of children or their illegal adoption. Ideally, all these requirements can be met using a newborn and infant biometric. Difficulties arise due to the small size and fragility of the infants’ physical structures and the effects of rapid physical growth. We review the literature for suitable biometrics and investigate the footprint; asking (a) if there is a time frame shortly after birth when the friction ridge skin pattern of a newborn can be reliably captured; and (b) if the footprint crease pattern is a suitable newborn and infant biometric. For (a), we were unable to confirm the existence of such a time frame. For (b), we performed automatic verification experiments on a small test set of 20 pairs of crease patterns, and then a larger test set, achieving EERs of 22.22% and 46.39%, respectively. The comparison of two dizygotic twins did not show any noteworthy performance difference. Based on these results we do not recommend the foot crease pattern as a newborn or infant biometric for automatic verification.     

超声弹性成像评估组织热消融范围的研究进展

肿瘤热消融技术是在现代影像学基础上诞生、发展的新技术。实时监测与术后即刻评估消融范围是保证治疗安全、取得良好疗效的关键。超声弹性成像作为一种新的超声组织定征技术,在肿瘤热疗监测方面正受到越来越多的关注。本文介绍了弹性成像在离体实验、动物实验、临床实验肿瘤热疗无创监测中的应用研究,概述了国内外研究现状,并讨论了弹性成像技术在肿瘤无创监测中的未来研究方向。     

某机构药物临床试验数据核查发现问题及改进措施

目的：对某机构药物临床试验项目数据核查发现的问题进行系统分析,剖析项目开展过程中发现的问题的原因,提出意见和建议,以提高临床试验质量,为同行提出参考。方法：收集某机构16个项目数据核查发现的问题,对照"药物临床试验数据现场核查要点"进行分类,对16个项目数据核查发现的问题进行分析。结果：11个项目存在违反数据核查要点的问题53项,其中在受试者的筛选/入组相关数据链的完整性方面存在问题7项（占13.21%）;在知情同意书的签署与试验过程的真实完整性方面存在问题2项（占3.77%）;在临床试验过程记录及临床检查、化验等数据的溯源方面存在问题29项（占54.72%）;在CRF中违背方案和严重不良事件例数等关键数据方面存在问题2项（占3.77%）;在试验用药品管理过程与记录方面存在问题9项（占16.98%）;在临床试验的生物样本采集、保存、运送与交接记录方面存在问题1项（占1.89%）;在原始数据、统计分析和总结报告与锁定的数据库一致性方面存在问题3项（占5.66%）。结论：本次分析显示,某机构在临床试验过程记录及临床检查、化验等数据的溯源方面、受试者的筛选/入组相关数据链的完整性方面和药品管理方面存在问题较多,加强对临床试验的质量控制,确保临床试验质量,保护受试者的权益。     

指掌骨骨折合并软组织损伤的微型锁定钢板皮外固定应用效果及对关节活动度的影响

目的 探讨微型锁定钢板皮外固定应用于指掌骨骨折合并软组织损伤患者中的治疗效果及其对关节活动度的影响。方法 选取指掌骨合并软组织损伤的患者60例为研究对象,随机分为对照组（30例）和观察组（30例）。对照组实施常规固定手术,观察组实施微型锁定钢板皮外固定,并依照患者软组织损伤实际情况采取石膏进行外固定。术后对比两组患者骨折愈合时间、围术期指标、Jamar握力、总关节活动度（total angle of motion,TAM）、上肢功能评定（disabilities of the arm,shoulder and hand,DASH）、术后不良反应情况及生活质量。结果 两组患者手术时间比较差异无统计学意义（P>0.05）,观察组患者骨折愈合时间、住院时间和DASH评分低于对照组（P<0.05）,TAM评分、生活质量评分和Jamar握力高于对照组（P<0.05）。观察组不良反应发生率（0.67%）低于对照组（33.33%,P<0.05）。结论 采取微型锁定钢板皮外固定方式对指掌骨骨折合并软组织损伤进行治疗,再采取石膏进行外固定,虽然增加患者的手术时间,但是能够减少患者骨折愈合时间,安全性较高,另外能够更好地促进患者恢复关节功能,提升患者生活质量。     

准直器叶片到位精度对宫颈癌容积调强计划验证的影响

目的 探讨加速器多叶准直器（MLC）叶片到位精度对宫颈癌容积调强放疗计划剂量验证通过率的影响。方法 在加速器常规质控基础上,选用Mapcheck和Arccheck两种半导体探测器矩阵在校准MLC叶片到位精度前后,分别测量30例宫颈癌容积调强放疗计划的二维和三维剂量分布。采用3%、3 mm和2%、2 mm标准,计算二维和三维剂量验证的Gamma通过率;并通过3DVH软件进一步将三维剂量分布误差与患者解剖结构建立起相互关系,评估加速器MLC叶片到位精度对宫颈癌容积调强放疗计划通过率的影响。结果 MLC校准前后,3%、3 mm标准下Mapcheck测得的Gamma通过率分别为（88.80±1.81）%和（99.25±0.53）%,平均提高10.45%;Arccheck测得的Gamma通过率分别为（87.61±1.98）%和（98.13±0.99）%（P<0.05）,平均提高了10.52%。3DVH测得的Gamma通过率分别为（89.87±2.28）%和（98.30±1.15）%（P<0.05）,平均提高了8.43%。结论 MLC叶片到位精度是影响加速器宫颈癌容积调强放疗计划执行准确性的主要因素之一。通过使用Autocal软件,可以快速、准确的完成多叶准直器的校准工作。