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.     

解建国治疗癌症常用药对经验述要

解建国教授是国家级名老中医、辽宁省首届名中医,从事中医药治疗疑难顽怪病的临床及科研工作40余载。临床用药喜用药对,擅用药对。文章介绍解建国教授运用药对治疗癌症的经验。解老师临床治疗癌症,整体上以扶正缩瘤药对为基础,结合病变脏腑功能不同,以各脏腑药对为辅,同时结合病变症状表现不同,佐以对症效药药对。其所用药对之性味归经、剂量配比皆有深意,是充分考虑癌病及其病机特点,精研药物功效配伍,并通过长期临床实践所成的宝贵经验。特色鲜明,疗效确切,故加以总结整理,以飨同道。     

基于BGP、TGF-β1的表达探究蛇床子素对去卵巢致骨质疏松大鼠的作用

目的观察蛇床子素对去卵巢致骨质疏松大鼠的影响。方法选取3月龄雌性SD大鼠30只,随机分为蛇床子素组(A组)、模型对照组(B组)、假手术组(C组),各10只。A、B 2组摘除卵巢构建去势大鼠骨质疏松模型,C组仅进行手术、不摘除卵巢。造模成功后,分别给予相应药物灌胃,连续给药12周,处死。然后测量骨密度,检测治疗后血清BGP、TGF-β1、钙指标。结果B组大鼠股骨骨密度较C组明显降低(P<0.05);经12周治疗,A组股骨骨密度较B组明显升高(P<0.05)。与C组比较,B组大鼠血清中BGP含量升高、TGF-β1降低(P<0.05);与B组比较,A组大鼠血清中BGP降低、TGF-β1含量升高(P<0.05)。与C组比较,B组大鼠血清Ca水平明显降低(P<0.05);与B组比较,A组大鼠血清Ca水平明显升高(P<0.05)。差异均有统计学意义。结论蛇床子素能够有效通过调节大鼠体内激素分泌改善去卵巢大鼠的骨代谢异常,提高骨密度,对骨质疏松症起到一定的防治作用。     

优化牙支持式上颌骨前部牵引成骨术与上颌骨Le FortⅠ型前徙术治疗唇腭裂患者的效果及对其腭咽部结构的影响分析

目的探讨优化牙支持式上颌骨前部牵引成骨术与上颌骨Le FortⅠ型前徙术治疗唇腭裂患者的效果,以及对其腭咽部结构的影响。方法将大连市口腔医院2017年1月一2020年1月收治的63例唇腭裂伴上颌骨发育不足患者纳人研究,依据随机数字表法分为观察组31例和对照组32例。对照组实施上颌骨Le FortⅠ型前徙术治疗,观察组实施优化牙支持式上颌骨前部牵引成骨术治疗。比较并分析两组治疗前后腭咽部形态参数、上颌骨前移距离、吹气试验和语言清晰度测听结果。采用Pearson相关性分析明确上颌骨前移距离与腭咽部形态各项参数之间的关系。结果治疗后观察组静止位的腭咽腔深度低干对照组,差异有统计学意义(P<0.05);两组治疗前后腭咽部形态其余各项参数及上颌骨前移距离,差异均无统计学意义(P>0.05)。治疗后观察组不捏鼻、捏鼻吹气试验时间均短干对照组,语言清晰度高干对照组,差异均有统计学意义(P〈O.O5)。Pearson相关性分析显示,上颌骨前移距离与各项腭咽部形态参数均无相关性(P>0.05)。结论优化牙支持式上颌骨前部牵引成骨术与上颌骨Le FortⅠ型前徙术治疗唇腭裂均有效,但是,优化牙支持式上颌骨前部牵引成骨术相较于上颌骨Le FortⅠ型前徙术,对患者腭咽部结构影响较小,值得推荐采用。     

高血压左室肥厚伴发左心衰竭行心脏彩色多普勒超声的临床诊断价值分析

目的:分析在高血压左室肥厚并左心力衰竭患者诊断中应用心脏彩色多普勒超声的诊断价值。方法:随机抽取2017年8月~2019年9月本院73例高血压左室肥厚并左心力衰竭病例并纳入观察组,另选择健康体检者70例并纳入对照组。均进行心脏彩色多普勒超声诊断,对比组间各指标的差异以及不同心功能分级患者的心脏彩超指标测定结果。结果:观察组的SBP、DBP、LVM、LVEF、LVFS、LVESD、LVEDD检测结果均高于对照组,且两组各指标比较中P<0.05;心功能Ⅲ级组患者的LVEDD、LAD、E/Ea均高于Ⅰ级与Ⅱ级组患者,同时LVEF低于Ⅰ级与Ⅱ级组患者,且各组间比较中P<0.05;心功能Ⅱ级组患者的LVEDD、LAD、E/Ea均高于Ⅰ级患者,同时LVEF低于Ⅰ级组患者,且组间比较中P<0.05。结论:实施心脏彩色多普勒超声检查有利于实现患者的明确诊断,可对其心功能情况的有效判别提供参考依据。     

探讨腹部外科微创手术治疗的升级

腹部外科手术涉及部位解剖复杂,血管丰富,术中病人变异较大,手术难度大,一直是微创外科的难点。科技创新的发展,手术机器人系统的应用,很好地助力了腹部外科再上微创新台阶,腹腔镜微创手术治疗也得到了进一步升级。由于手术机器人系统具有三维手术视野,能自动消除生理颤动,手术器械手臂能自由灵活旋转达到传统机器无法完成的部位和角度,有效突破了传统腹腔镜的局限性,从而提高手术质量、减少损伤和出血,使得治疗更高效、更安全,加快了围手术期快速康复,秉承了手术“精细化、个体化、微创化”的宗旨,因此,利用手术机器人开展腹部高难度复杂手术也是国内外手术的发展方向与趋势。积极开拓和升级微创新空间,重视手术机器人系统的应用,让更多病人获益。     

内皮型一氧化氮合酶基因Glu298Asp多态性与原发性高血压的关系

目的探讨中国大连人群eNOs基因Glu298Asp多态性与原发性高血压的关系。方法选取277名高血压患者及547名血压正常者,提取基因组DNA,使用聚合酶链反应(PCR)及限制性片段长度多态性(RFLP)分析确定eNOs Glu298Asp多态性。进行两组问的比较并使用Logistic,回归分析年龄、性别、家族史、TC、TG、BMI及基因型对高血压的影响。结果基因型频率及等位基因频率在高血压和对照组的分布无差异。高血压组氨基酸298位GG、GT、TT基因型频率分别为84．1％、14．4％、1．4％,在对照组为85．6％、13．5％、0．9％(P=O．73)。Asp等位基因的频率在高血压组及对照组分别为8．7％和7．7％,(P=0．50)。对年龄、性别和BMI及有无家族史进行亚组分析也未发现基因型的分布在各组间有差异。采用隐性遗传模型把GG和GT基因型合并,GG GT和TT基因型的分布在两组间仍未发现有显著差异(P=0．49)。Logistic回归显示年龄、BMI、家族史及饮酒是高血压发病的独立危险因素,OR值分别为1．09(P<0．001)、1．28(P<0．001)、9．53(P<0．001)和2．26(P<0．05)。结论本实验显示年龄、BMI、家族史及饮酒是高血压的独立危险因素。eNOs基因Glu298Asp突变可能不是大连人原发性高血压的主要易感基因。     

OCTA在视网膜静脉阻塞诊疗中的应用价值

目的：探讨OCTA检查在视网膜静脉阻塞诊疗中的重要应用价值。

方法：采用回顾性病例对照研究,选取2018-01/10于大连市第三人民医院眼科门诊确诊为视网膜静脉阻塞的患者38例38眼,其患病眼为A组,对侧健康眼为B组。所有患者均接受OCTA对黄斑区视网膜行3mm×3mm范围的模式扫描,获得表层视网膜、深层视网膜、外层视网膜及脉络膜毛细血管层4个层面黄斑血流密度图,测量表层视网膜中心凹无血管区面积(FAZ),Image J软件计算4个层面黄斑区血流密度(MVD),OCT模式测量黄斑中心凹的水平厚度与垂直厚度(CFT)。

结果：A组和B组浅层视网膜FAZ、水平CFT及垂直CFT测量均有差异(P<0.01)。A组和B组表层视网膜及深层视网MVD均有差异(P<0.01),外层视网膜层MVD、脉络膜毛细血管层MVD结果无差异(P=0.542、0.489)。BCVA(LogMAR)分别与表层视网膜FAZ、水平CFT及垂直CFT呈正相关(r=0.482、0.652、0.621,均P<0.01),与表层视网膜MVD及深层视网膜MVD呈负相关(r=-0.486、-0.465,均P<0.01)。

结论：应用OCTA检查对提示视网膜静脉阻塞患者黄斑区视网膜的微循环障碍和视力预后有重要指导意义。     

附子理中丸汤剂临床新用

附子理中丸系由《伤寒论》中的理中丸加附子而成,具有温中健脾作用。用于脾胃虚寒、脘腹冷痛,呕吐泻泄,手足不温。本着中医"异病同治"的理念,临床运用附子理中汤加减治疗心下痞、消渴、胸痹伴下肢水肿(慢性心衰)、复发性口腔溃疡伴慢性腹泻、便秘等疾病均取得满意效果,值得临床推广。此文章从上述疾病的病因病机、理法方药等方面进行分析阐述其作用机制。     

Strengthening medical radiation technologist recognition through advanced practice in Canada: A narrative review

BackgroundLack of professional recognition from the public and other healthcare professionals has been a long-standing issue for medical radiation technologists (MRTs) in Canada. This situation was further highlighted by the pandemic when several provinces refused to recognize MRTs as essential workers. In addition to continued advocacy to develop interprofessional awareness of the MRT discipline, prioritizing the creation of advanced practice opportunities will increase the perceived value of MRTs to healthcare.MethodsLiterature for this review was found by searching the electronic databases of PubMed, CINAHL, Google Scholar, and Athabasca University. Relevant reports from credible Canadian organizations, global MRT professional association websites, frameworks for advanced practice, and one dissertation were also reviewed.DiscussionThe implementation of advanced practice radiography roles present a tremendous opportunity to increase the visibility and recognition of the MRT profession in both clinical and research domains. In Canada, role extension in radiography has underscored the significance and need for advanced practice.ConclusionTo keep pace with growing demand for medical imaging, the use of human health resources must be re-evaluated to optimize care delivery and capitalize on the full skill set of MRTs.