Recovery of hyperreactivity in rats with simultaneous septal and subcortical lesions.

Rats with lesions of the forebrain septal area, simultaneously combined with lesions of one of several subcortical or cortical sites within the cerebrocortical system were rated for behavioral reactivity to probing stimulation, capture and handling. All of the cerebrocortical system lesions prevented recovery of septal hyperreactivity over a 21-day postoperative recovery interval in the combined lesion groups. Once ratings of reactivity recommenced, all of the combined lesion groups, with the possible exception of the combined lateral geniculate body-septal group, declined in reactivity more rapidly than a group of rats with septal lesions alone tested beginning 2 days after surgery. Rats with septal or cerebrocortical lesions alone were not hyperreactive at the end of the 21-day recovery interval. Mechanisms involving lesion-induced changes in monoaminergic activity are favored over neuroanatomical explanations in accounting for the recovery of function phenomena observed in the experiment.     

HT全脑+病灶同步推量放疗多发性脑转移瘤剂量学及临床分析

目的 回顾分析应用HT行全脑+病灶同步推量治疗多发性脑转移瘤患者的剂量学数据及临床结果,评估计划合理性及HT治疗的疗效与安全性。方法 2014—2017年共43例脑转移患者(≥3个病灶)纳入分析。全脑40 Gy分20次,病灶60 Gy分20次。疗中复查脑MRI,如病灶缩小则缩野。以TC、CI、PITV、HI进行计划评估。临床观察指标包括LRFS、IPFS、PFS、OS和不良反应。结果 中位病灶数为6 个(3~36个),中位病灶总体积8.74 cm³。病灶TC、CI、PITV和HI分别为0.96±0.028、0.51±0.164、2.09±1.245和0.12±0.066。全脑TC和HI分别为0.95±0.033和0.43±0.161。26%患者进行疗中缩野,二程计划危及器官受量降低。1年LRFS、IPFS、PFS和OS分别为96%、80%、39%和86%。无≥3级不良反应发生。结论 HT技术实施全脑+病灶同步推量放疗计划适形度、均匀度好,治疗安全有效,可作为多发性脑转移瘤患者优选治疗方案,疗中缩野可更好地保护正常组织。     

全脑+同步推量放射治疗中海马保护计划设计研究

目的:探讨应用Elekta Synergy医用直线加速器容积旋转调强放射治疗(VMAT),实现全脑+转移灶同步推量放射治疗的海马保护计划设计。方法:选取10例肺癌脑转移患者进行全脑放射治疗+转移灶同步推量,并进行海马保护。勾画转移灶肿瘤靶区(GTV)、全脑临床靶区(CTV)、左右海马区,以及脑干、脊髓、眼球、晶体等其他正常组织,转移灶外扩3 mm形成计划肿瘤靶区(PGTV),全脑外扩3 mm形成计划靶区(PTV),海马区外扩5 mm形成海马保护区域。利用Pinnacle9.8治疗计划系统设计VMAT计划,处方剂量PGTV为45 Gy/15 F,PTV为36 Gy/15 F。结果:10例患者PGTV的45 Gy覆盖为99.8%,均匀性指数平均值为0.09。PTV的36 Gy靶区覆盖80%,30 Gy靶区覆盖90.1%,左、右海马平均体积分别为3.2 cm^3和2.8 cm^3,海马保护区域平均体积分别为25.2 cm^3和23 cm^3。左、右海马的平均剂量为6.91 Gy和5.32 Gy,最大剂量分别为10.7 Gy和8.3 Gy;左、右海马保护区域的平均剂量为7.93 Gy和10.3 Gy,最大剂量为14.8 Gy和13.5 Gy。左右晶体最大剂量平均值分别为5.56 Gy和5.69 Gy。结论:在全脑放射治疗中,利用ElektaSynergy直线加速器VMAT技术能在保证靶区剂量覆盖和靶区适形性、均匀性的情况下降低海马受照剂量,达到安全剂量范围,可实现对患者海马神经认知功能的保护。     

浅析虚不受补

因虚施补不能获得满意的临床效果,是认证欠准确和施补技法稍欠所致。对于脾胃虚弱而属虚证者,补法过猛,用药过于滋腻,会有腻膈碍胃的壅中之弊,属不宜。或虽为虚证,又与余邪、痰浊、内毒、瘀血相混杂,仅施以补虚,则属不及。前者在选药中,避开质厚滋腻之品,后者可变通为平补、清补、通补、消补等,以敦促正气来复。     

同时测量高血压患者左右臂血压的临床研究

目的通过同时测量高血压患者左右上肢血压,观察高血压者左右上肢血压的差异。方法随机选取100名高血压患者,通过串联2台台式水银柱血压计,同时测量同一个体左右上肢血压。结果任何一个气囊充气或放气两水银柱同步地升降,其速度肉眼可见无差异,男性组、女性组及总体同时测量的血压右上肢收缩压、舒张压略高于左上肢,但差异无统计学意义（P〉0.05）。结论同时测量高血压患者左右上肢血压的方法科学性强,简单实用,患者易于接受。同时测量左右上肢血压的方法为高血压患者诊断及治疗效果提供了可靠依据。     

2型糖尿病家系成员血压与胰岛素抵抗的关系

目的:探讨2型糖尿病家系成员血压与胰岛素抵抗的关系,为糖尿病的一级康复预防提供依据。方法:对2型糖尿病家系成员进行口服葡萄糖耐量试验(OGTT),按1997年美国糖尿病学会诊断标准将家系成员分成糖尿病一级亲属糖耐量正常(NGT)组(96例),糖耐量减低(IGT)组(46例)和新诊断糖尿病组(63例),检测其血压、血脂、血浆胰岛素,计算胰岛素敏感性指数(ISI),与无糖尿病家族史的健康人(57例)相比较。结果:家系各组成员收缩压、舒张压、三酰甘油水平均显著高于正常对照组,如NGT组收缩压(119±17)mmHg,IGT组为(128±18)mmHg,新诊断糖尿病组(129±20)mmHg,正常对照组(109±17)mmHg(P<0.05或P<0.01),ISI和高密度脂蛋白胆固醇(HDL-C)显著低于正常对照组,如ISI在NGT组为-3.80±0.39,在IGT组-4.17±0.50,新诊断糖尿病组-4.53±0.53,正常对照组-3.58±0.58。血压与ISI、HDL-c呈显著负相关关系,与三酰甘油、体质量指数呈显著正相关关系,在多种因素中,ISI对收缩压的影响程度最大。结论:2型糖尿病家系一级亲属在糖耐量正常时,血压均已开始升高,随着代偿性高胰岛素血症持续到IGT及糖尿病阶段,血压进一步升高,而ISI则持续降低。一级亲属的血压变化可能是家族性2型糖尿病的遗传标志之一。     

FS快速序列分析同时测定水样中多种金属元素

目的：建立简便、快速、高效的同时测定样品中多种金属元素的方法.方法：利用原子吸收光谱仪的快速序列分析技术,同时测定4种待测元素.结果：以铁、锰、铜、锌4种元素测定为例,线性范围均在0～2.00 mg/L和0～3.00 mg/L,最低检出限≤0.003 mg/L,RSD＜5%,而且回收率也在95%～102%之间.结论：用240FS快速序列技术同时测定多种金属元素简单、快速、灵敏,既减少工作量,又节省样品,非常值得推广.     

李业甫“病证合参，筋骨并举”学术思想治疗腰椎间盘突出症

腰椎间盘突出症临床较为常见,发病率日益增高,起病年龄愈发年轻化。推拿是中医学的重要组成部分,推拿治疗腰椎间盘突出症具有确切疗效。李业甫教授早年师从朱春霆、王松山、钱福卿等名家学习推拿手法,其手法又自成一体,独树一帜,首创牵引复位法治疗腰推间盘突出症。李业甫教授认为,腰椎间盘突出症的基本病因是脊柱及周围软组织退行性改变,腰部筋骨失衡是腰椎间盘突出症之重要病机,推拿临证应病症合参、筋骨并举,方可取效。     

Limited benefit of inversely optimised intensity modulation in breast conserving radiotherapy with simultaneously integrated boost

Background and purpose

To examine whether in breast-conserving radiotherapy (RT) with simultaneously integrated boost (SIB), application of inversely planned intensity-modulated radiotherapy (IMRT-SIB) instead of three-dimensional RT (3D-CRT-SIB) has benefits that justify the additional costs, and to evaluate whether a potential benefit of IMRT-SIB depends on specific patient characteristics.

Material and methods

3D-CRT-SIB and various IMRT-SIB treatment plans were constructed and optimised for 30 patients with early stage left-sided breast cancer. Coverage of planning target volumes (PTVs) and dose delivered to organs at risk (OARs) were determined for each plan. Overlap between heart and breast PTV (OHB), size of breast and boost PTVs and boost location were examined in their ability to identify patients that might benefit from IMRT-SIB.

Results

All plans had adequate PTV coverage. IMRT-SIB generally reduced dose levels delivered to heart, lungs, and normal breast tissue relative to 3D-CRT-SIB. However, IMRT-SIB benefit differed per patient. For many patients, comparable results were obtained with 3D-CRT-SIB, while patients with OHB > 1.4 cm and a relatively large boost PTV volume (>125 cm³) gained most from the use of IMRT-SIB.

Conclusions

In breast-conserving RT, results obtained with 3D-CRT-SIB and IMRT-SIB are generally comparable. Patient characteristics could be used to identify patients that are most likely to benefit from IMRT-SIB.     

Safety of pre- or postoperative accelerated radiotherapy in 5 fractions: A randomized pilot trial

ObjectiveNeo-adjuvant radiotherapy (NART) for breast cancer has shown promising survival results in retrospective trials. However, there are some obstacles such as a chemotherapy delay, an increased overall treatment time (OTT) and the risk of increasing surgical morbidity. Accelerated radiotherapy (RT) in 5 fractions allows to deliver NART in a very short time span and minimizes the delay of surgery and chemotherapy. This trial investigates this NART schedule for safety, feasibility and OTT.Material and methodsTwenty patients eligible for neo-adjuvant chemotherapy (NACT) and breast conserving surgery, were randomized between NART before NACT or NACT and postoperative RT. In both arms, RT treatment was given in 5 fractions to the whole breast with a simultaneously integrated boost (SIB) on the tumor(bed). Lymph node irradiation was given concomitantly in case of lymph node involvement. OTT was defined as the time from diagnosis to last surgery in the intervention group, while in the control group the time between diagnosis and last RT-fraction was used. In the intervention group NACT-delay was defined as time between diagnosis and start of chemotherapy.Results20 patients were included, and 19 patients completed treatment. OTT was significantly shorter in the intervention group (mean 218 days, range 196–253) compared to the control group (mean 237, range 211–268, p = 0.001). The difference in mean duration from diagnosis to the first treatment was a non-significant 4 days longer (31 vs 27 days, p = 0.28), but the start of NACT after diagnosis was delayed by 21 days (48 vs 27 days, p < 0.001). NART did not result in additional surgery complications.ConclusionThis pilot trial is the first to report on accelerated NART in 5 fractions with SIB. NART before NACT resulted in a shorter OTT with good safety results.