Assessment of Lung Tumour Motion and Volume Size Dependencies Using Various Evaluation Measures

The purpose of the study was to assess internal target volume changes through the breathing cycle and associated tumour motion for lung patients and to establish possible correlations between different parameters. Respiration-induced volume changes with breathing cycle and the associated tumour motion were analyzed for 11 patients. Selected phases were the maximum and average intensity projections and the 10 phases of equal duration and separation obtained through the respiratory cycle. Tumour centre of mass (COM) motion planes were generated using least square fitting, and their angles and orientations were then compared between the cases studied. Trajectories that are composed by the points of COM location in different phases were identified, and their interrelation was assessed through different similarity measures. The results were used to determine if there is any correlation between parameters chosen and if the margins conventionally used for the planning target volume creation successfully encompassed lung tumour motion and volume change. The results show that the extent of tumour motion was related to its volume and location. The tumour displacement was predominantly left and inferior. Planar fitting to COM motion data through respiratory phases demonstrated some correlation in best fit motion plane positions between different data sets. In the plane fit comparison, for each patient, the lower root mean square error values showed that a good planar fit can be achieved for the COM motion path. The evaluation of the inhale and exhale trajectories may allow, for certain tumour locations and size, contouring on only inhalation or exhalation phases, knowing that tumour motion will be adequately covered on the other phases. Taking all the data into account and knowing the tumour size and location, a good estimate can be made of the motion plane position in the three-dimensional space and the required dosimetric margins.     

研究16排螺旋CT三维重建技术对于舟状骨骨折的诊断价值

目的研究16排螺旋CT三维重建技术对于舟状骨骨折的诊断价值。方法选取在我院进行检查的舟状骨骨折患者78例,将其随机分为观察组和对照组,对照组患者使用X线检查,观察组采用16排螺旋CT三维重建技术进行检查,比较和分析两组患者的检查结果。结果观察组患者舟状骨骨折检查的准确率是100%,对照组的检查准确率是82.05%,两组检查结果差异较为明显(P0.05),具有统计学意义。结论 16排螺旋CT三维重建技术在检查和诊断舟状骨骨折时,具有显著效果。     

Predictive significance of standardized uptake value parameters of FDG-PET in patients with non-small cell lung carcinoma

¹⁸F-fluoro-2-deoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) is widely used to diagnose and stage non-small cell lung cancer (NSCLC). The aim of this retrospective study was to evaluate the predictive ability of different FDG standardized uptake values (SUVs) in 74 patients with newly diagnosed NSCLC. ¹⁸F-FDG PET/CT scans were performed and different SUV parameters (SUV_max, SUV_avg, SUV_T/L, and SUV_T/A) obtained, and their relationship with clinical characteristics were investigated. Meanwhile, correlation and multiple stepwise regression analyses were performed to determine the primary predictor of SUVs for NSCLC. Age, gender, and tumor size significantly affected SUV parameters. The mean SUVs of squamous cell carcinoma were higher than those of adenocarcinoma. Poorly differentiated tumors exhibited higher SUVs than well-differentiated ones. Further analyses based on the pathologic type revealed that the SUV_max, SUV_avg, and SUV_T/L of poorly differentiated adenocarcinoma tumors were higher than those of moderately or well-differentiated tumors. Among these four SUV parameters, SUV_T/L was the primary predictor for tumor differentiation. However, in adenocarcinoma, SUV_max was the determining factor for tumor differentiation. Our results showed that these four SUV parameters had predictive significance related to NSCLC tumor differentiation; SUV_T/L appeared to be most useful overall, but SUV_max was the best index for adenocarcinoma tumor differentiation.     

A systematic literature review of nutrition interventions in vending machines that encourage consumers to make healthier choices

Internationally, vending machines are scrutinized for selling energy‐dense nutrient‐poor foods and beverages, and the contribution to overconsumption and subsequent risk of obesity. The aim of this review is to determine the efficacy of nutrition interventions in vending machine in eliciting behaviour change to improve diet quality or weight status of consumers. Electronic databases Cochrane, EMBASE, CINAHL, Science Direct and PubMed were searched from inception. Inclusion criteria: (i) populations that have access to vending machines; (ii) nutrition interventions; (iii) measured outcomes of behaviour change (e.g. sales data, dietary intake or weight change); and (iv) experimental trials where controls were not exposed to the intervention. Risk of bias was assessed independently by two researchers, and higher quality research formed the basis of this qualitative review. Twelve articles from 136 searched were included for synthesis. Intervention settings included schools, universities and workplaces. Reducing price or increasing the availability increased sales of healthier choices. The results of point‐of‐purchase nutrition information interventions were heterogeneous and when measured changes to purchases were small. This review offers evidence that pricing and availability strategies are effective at improving the nutritional quality foods and beverages purchased from vending machines. Evidence on how these interventions alter consumer's overall diet or body mass index is needed.     

CT与MRI对脑梗死后出血性转变的诊断价值

目的探讨CT与MRI在脑梗死后出血性转变(HT)中的诊断价值。方法对2011-01—2014-04我院收治的45例HT患者的临床资料进行回顾性分析,对CT与MRI的检查结果进行对比。结果45例患者中,脑内血肿34例(75.6%),脑梗死病灶内片状、斑点状或条状出血11例(24.4%)。其中大面积脑梗死继发出血24例(53.3%),中等面积继发出血15例(33.3%),小面积脑梗死继发出血6例(13.3%);CT检出HT 10例(22.2%),MRI检出45例(100%),差异有统计学意义(P0.05);在对不同部位的HT检查中,CT检出幕上出血9例(20.0%),幕下出血1例(2.2%);MRI检出幕上出血39例(86.7%),幕下出血6例(13.3%)。MRI对幕上及幕下出血的检出率均优于CT(P0.05)。结论在HT的诊断中,MRI比CT更加准确和敏感,在判断出血时间、指导临床治疗以及预后判断中具有重要意义。     

Setting the bar: Standards for ecosystem services

Progress in ecosystem service science has been rapid, and there is now a healthy appetite among key public and private sector decision makers for this science. However, changing policy and management is a long-term project, one that raises a number of specific practical challenges. One impediment to broad adoption of ecosystem service information is the lack of standards that define terminology, acceptable data and methods, and reporting requirements. Ecosystem service standards should be tailored to specific use contexts, such as national income and wealth accounts, corporate sustainability reporting, land-use planning, and environmental impact assessments. Many standard-setting organizations already exist, and the research community will make the most headway toward rapid uptake of ecosystem service science by working directly with these organizations. Progress has been made in aligning with existing organizations in areas such as product certification and sustainability reporting, but a major challenge remains in mainstreaming ecosystem service information into core public and private use contexts, such as agricultural and energy subsidy design, national income accounts, and corporate accounts.     

Intrinsic diffusion sensitivity of the balanced steady‐state free precession (bSSFP) imaging sequence

The purpose of this work was to analyze the intrinsic diffusion sensitivity of the balanced steady‐state free precession (bSSFP) imaging sequence, meaning the observation of diffusion‐induced attenuation of the bSSFP steady‐state signal due to the imaging gradients. Although these diffusion effects are usually neglected for most clinical gradient systems, such strong gradient systems are employed for high resolution imaging of small animals or MR Microscopy. The impact on the bSSFP signal of the imaging gradients characterized by their b‐values was analyzed with simulations and experiments at a 7T animal scanner using a gradient system with maximum gradient amplitude of approx. 700 mT/m. It was found that the readout gradients have a stronger impact on the attenuation than the phase encoding gradients. Also, as the PE gradients are varying with each repetition interval, the diffusion effects induce strong modulations of the bSSFP signal over the sequence repetition cycles depending on the phase encoding gradient table. It is shown that a signal gain can be obtained through a change of flip angle as a new optimal flip angle maximizing the signal can be defined. The dependency of the diffusion effects on relaxation times and b‐values were explored with simulations. The attenuation increases with T₂. In conclusion, diffusion attenuation of the bSSFP signal becomes significant for high resolution imaging voxel size (roughly < 100 μm) of long T₂ substances. Copyright © 2015 John Wiley & Sons, Ltd.     

糖尿病动态血糖监测系统的临床应用研究进展

糖尿病属于临床高发的代谢性疾病,该疾病无法被彻底治愈,需长期通过调控机体血糖水平控制疾病,在该疾病的治疗过程中血糖的监测属于重中之重的措施,随着医疗技术的不断发展、完善,临床现推出一种血糖监测系统为动态血糖监测系统,可对血糖全天的动态变化进行监测,显著规避了传统监测方式间断性的缺点,对疾病治疗效果以及患者机体代谢控制情给予更客观的评价,特别是对于突发的餐后高血糖以及低血糖等并发症给予有效监测。现为探究将其应用于临床实践操作中的具体价值,本文从将该检测方式应用至临床治疗中的效果方面展开论述,为具体实施效果提供参考。     

发热、血钠联合中性粒细胞百分比对肺结核继发结核性脑膜炎的诊断价值

 目的 探讨发热、血钠联合中性粒细胞百分比对肺结核继发结核性脑膜炎（TBM）的诊断价值。方法 收集2015年10月—2018年10月某院收治的肺结核患者临床资料，将146例诊断为肺结核继发TBM的患者作为研究组，按入院时间以1∶4的比例分层抽取584例肺结核未继发TBM的患者作为对照组，比较两组患者血钠、中性粒细胞百分比、临床发热症状指标及三者联合诊断肺结核继发TBM的效能，计算曲线下面积（AUC）并确定临界点。结果 30条纤维支气管镜使用后未清洗前，内镜外表面RLU中位值为911.5，合格率为16.7%；酶洗后机洗前，内镜外表面RLU中位值为234.0，合格率为43.3%。每组30条纤维支气管镜经消毒剂分别浸泡消毒5、3 min后的气管镜外表面RLU中位值分别为25.0、23.5，合格率均为100.0%。血钠及中性粒细胞百分比诊断肺结核继发TBM患者的临界点分别为135.30 mmol/L、73.40%。发热、血钠、中性粒细胞百分比及三者联合诊断肺结核继发TBM的AUC（95%CI）分别为0.732（0.688~0.776）、0.768（0.719~0.818）、0.727（0.679~0.776）、0.845（0.807~0.882），差异均有统计学意义（均P<0.05）；敏感度分别为80.82%、56.85%、65.07%、63.70%，特异度分别为65.58%、87.50%、73.46%、89.38%，前三者曲线下面积差异无统计学意义，三者联合诊断效能更高。结论 发热、血钠<135.30 mmol/L或血中性粒细胞百分比>73.40%对肺结核继发TBM均有诊断意义，三者无明显优劣之分，但三者联合对肺结核继发TBM有更高的诊断价值。     

胸腔镜下治疗肺癌患者的效果分析

目的:研讨肺癌患者在胸腔镜辅助下行手术治疗的临床价值。方法:选择本院收治于2017年8月~2019年8月的68例肺癌患者作为观察对象,并按1:1比例随机归为2组,A组接受常规开胸手术治疗,B组接受胸腔镜手术治疗,对比A、B组手术的处理成效。结果:A、B组手术出血量与淋巴结清扫数相比差异较小,P>0.05,无统计学意义;但B组较A组在手术时间、切口长度等方面占明显优势,P<0.05,有统计学意义。B组发生切口感染、肺部漏气等并发症的总概率较A组降低更显著,P<0.05,有统计学意义。结论:对肺癌患者实施胸腔镜手术治疗,手术切口小、操作时间短、术后恢复快,并可明显减少术后并发症的发生,在安全性方面较有保障,值得推荐。