基于胶片测量方法研究金属植入物对放疗剂量分布的影响

目的:采用胶片剂量仪测量方法研究不同材质金属植入物对放疗剂量分布的影响。方法:应用西门子ARTISTE直线加速器6MV X线在VENUS-SPD模体中分别对钛合金内固定板及不锈钢钢板进行照射,采用美国ISP公司GAFCHROMIC EBT2胶片进行测量并采用Film QA Pro3.0胶片分析软件将测量结果与治疗计划系统计算结果进行比较和评估。结果:不锈钢板和钛合金板X方向离轴曲线胶片测量值与TPS计算值的最大剂量偏差分别为9.6%和6.6%,相同DTA和△D条件下,不锈钢板和钛合金板治疗计划计算与胶片剂量测量通量分布比较Gamma检验通过率分别为78.11%和81.07%。结论:不同材质金属植入物对放疗剂量分布存在明显影响,治疗计划系统不能精确计算和评估金属植入物的剂量分布,建议实际放射治疗中对金属植入物患者进行剂量分布修正。     

山东新华 SL－IC 型模拟机的工作原理及故障维修

<正>0引言随着放射治疗技术的不断进步,常规模拟定位机已成为整个放射治疗过程必备的模拟定位工具之一。广东省云浮市人民医院放疗中心于2006年购进一台山东新华SL-IC型常规X射线模拟定位机,该设备主要由模拟定位系统、X射线高压系统和医用电视系统组成。模拟机在使用中往往会出现各种故障,从而影响放疗定位工作的正常开展,一旦出现故障,如何及时排除,值得临床医学工程师关     

GATE在核医学成像和放射治疗中的蒙特卡洛模拟

目的:探讨GATE在核医学成像SPECT和PET、光子和质子放射治疗中的蒙特卡洛模拟,并利用GATE平台研究碳纤维床板对光子放疗时剂量的影响。方法:首先模拟运行GATE V6.1提供的三个例子,分别对应于SPECT、PET和RT,其中RT又分为光子治疗和质子治疗。对SPECT和PET模拟中光子的散射情况进行统计分析,详细比较RT模拟中光子束和质子束在水模体中的能量沉积特性。然后在GATE平台上编程模拟了光子治疗束分别在有碳纤维床板和无床板时射入水模体中,比较并分析这两种情况下水模体中的剂量分布差异。结果:GATE V6.1的三个例子模拟中,SPECT中的未散射光子稳定在36%左右,PET中未散射的真符合计数稳定在44.5%左右,RT模拟中质子相比于光子在深度方向上有明显的剂量分布优势,而光子在横向方向的剂量分布稍好于质子。在碳纤维床板对光子放疗时剂量影响的模拟中,有碳纤维床板相对于无床板时,水模体的表层剂量有明显的提高。结论:GATE能够稳定准确的对核医学成像SPECT和PET及放射治疗过程进行蒙特卡洛模拟。它可以为放射治疗剂量验证、临床放射治疗计划以及核医学成像引导放射治疗的研究提供强大帮助。     

食管癌三维适形放疗和常规放疗比较

目的 对比研究三维适形放疗(3DCRT)和常规模拟机定位放疗两种不同方法在食管癌放射治疗中的优缺点.方法 20例食管癌患者采用3DCRT方法进行治疗,应用同一治疗计划系统,制定适形放疗和常规模拟机定位放疗方案.结果 与常规模拟定位机定位放疗相比,食管癌照射中3DCRT有最好的剂量分布,既可明显提高靶区的剂量,同时能较好地保护正常组织.结论 食管癌的适形放疗技术能降低正常组织的放射损伤和并发症,提高放疗治疗的适形度,改善靶区的剂量分布.     

光辅助X射线体表定位在骨科植入物内固定中的应用

背景：以往骨科内固定常使用C臂机进行体表定位,但固定中的反复透视会加大对人体的损伤及延长固定时间。 目的：探寻一种简便实用、更有利于骨科内固定的光辅助X射线体表定位技术。 方法：使用自制的简易装置将雷达状的红色激光投射在体表来辅助C臂机进行体表定位。使用SD大鼠和新西兰大白兔设计动物实验,模拟软组织内异物定位、骨折髓内钉远端锁钉置入、脊柱椎弓根螺钉进针点定位3种骨科内固定方法。分别使用传统C臂机和光辅助X射线体表定位技术各进行 30次定位。分析2种方法对操作的影响,并分析深度和活体因素对光辅助X射线体表定位技术的影响。 结果与结论：与传统C臂机定位相比,光辅助X射线体表定位技术在实验过程中能够更快的进行体表定位(P < 0.05),但定位的深度和活体因素会影响光辅助X射线体表定位技术的准确度(P < 0.05)。说明光辅助X射线体表定位技术具有简便、快速、动态化的优点,可方便骨科内固定的进行,但在固定过程中需考虑各种因素对定位准确性的影响,减小或消除这些影响因素将更好的发挥光辅助X射线体表定位技术的优势。     

不同骨科植入物修复老年髋部疾病：并发症及死亡因素分析

文章快速阅读：  文题释义：骨科植入物：通过侵入的方法,全部导入人体替代组织或保留在体内操作位置的器械;通过侵入的方法,部分导入人体并保留在操作位置至少30 d的医疗器械,也可认作是植入物。主要有骨接合植入物和骨与关节替代物等。   背景：骨科老年髋部手术患者常常合并有多种疾病,植入物置入后易发生并发症。目的：不同骨科植入物修复老年髋部疾病患者的特点及置入后并发症和死亡影响因素的研究。方法：249例老年患者分别接受全髋关节置换、股骨头置换、股骨近端髓内钉、Gamma钉、空心钉置入治疗。对不同植入物的患者的年龄、性别、髋部疾病类型、麻醉风险评估、心理精神因素、入院血红蛋白、置入前白蛋白、置入前合并症察尔森合并症指数、麻醉方式、骨科植入物、手术持续时间、术中出血、住院时间、并发症、死亡与存活进行分析。结果与结论：5种骨科植入物修复老年髋部疾病：①不同骨科植入物在患者年龄、麻醉风险评估评分、入院血红蛋白、置入前白蛋白水平方面差异有显著性意义,在住院时间、手术持续时间、术中出血量差异有显著性意义,与并发症及死亡差异无显著性意义。②住院时间、置入前白蛋白及置入前合并症察尔森合并症指数≥3是影响并发症最显著的指标。年龄、入院血红蛋白和置入前合并症察尔森合并症指数≥3是影响死亡最显著的指标。③置入前全面评估患者情况的意义：老年髋部疾病患者行手术治疗时,骨科植入物虽然不是影响置入后并发症及死亡发生的影响因素,但是实施人工关节置换的患者可早期下床负重活动,降低置入后并发症及死亡率;对于高龄、贫血、低白蛋白血症及察尔森合并症指数≥3的患者,要给予高度重视,尽早评估患者察尔森合并症指数,积极处理合并症,纠正贫血和低蛋白血症,预防置入后并发症的发生,可缩短住院时间,降低置入后死亡率。 中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程 ORCID:0000-0001-5998-0857(王宸)     

骨科金属内植物置入后中高频电疗的应用

背景:中高频电疗是临床疾病治疗常用的物理治疗方法,广泛应用于各科,特别是骨科康复治疗。但康复治疗学通常将"局部金属植入物"作为中高频电疗的禁忌证,所以骨科金属内植物置入后通常不能进行中高频电疗。目的:综述目前国内外对骨科金属植入物置入后中高频电疗的研究现状,阐明中高频电疗对骨科金属植入物置入后对组织恢复的促进作用以及热损伤,探究中高频电疗在骨科金属植入物置入后对组织产生的影响及临床应用。方法:由第一作者应用计算机检索Pub Med数据及CNKI数据库,在标题和摘要中以"中、高频电疗,金属植入物,热损伤"或"middle and high frequency electrotherapy,metal implant,heat damage"为检索词,纳入与中高频电疗在骨科金属植入物置入后应用的相关研究文章。排除重复及较陈旧的文献。共40篇文献符合标准,中文33篇,英文7篇。结果与结论:随着钛合金等新的植入物材料的发展,越来越多的基础和临床研究发现治疗剂量的中高频电疗能够促进组织愈合,消除肿胀,并缓解疼痛。但目前还有许多疑问未完全解释清楚,比如中高频电疗对金属植入物周围造成损伤的剂量、造成热损伤的类型、组织学改变等;如果采用不同涂层的钛合金植入物,是否能减少热损伤,这些都需要进一步研究。     

骨科内固定植入物影像学评价的意义

背景：随着骨组织工程在临床骨科领域的发展,内固定植入后的稳定性一直是临床研究的重点,那么通过什么途径才能更好地掌握其置入后的生物力学变化呢？ 目的：总结影像学在骨科植入物的应用级生物力学评估。 方法：应用计算机检索CNKI和Pubmed数据库中1999-01/2012-06关于影像学评估骨科植入物的文章,在标题和摘要中以“骨科,置入,钢板,螺钉,X射线、CT、MRI”或“orthopedics,implantation,steel plate,screw,X-ray,CT、MRI”为检索词进行检索。选择文章内容与骨科内固定植入物影像学评价有关者,同一领域文献则选择近期发表或发表在权威杂志文章。初检得到172篇文献,根据纳入标准选择关于骨科植入物影像学评价的25篇文献进行综述。 结果与结论：X射线平片、CT和MRI在骨科内固定置入后的评价有非常重要的作用,通过影像学途径可以掌握植入物置入后的位置、角度、植入材料与宿主的融合、自身的腐蚀等,评价植入物的生物力学稳定性和植入宿主后的生物相容性。X射线平片显示骨结构细节最好,MRI软组织、软骨对比最好,CT介于两者之间,X射线平片、CT、MRI各有优势,放射影响科和骨科医生了解各种检查的特点、利弊,结合患者的自身情况,选择合适检查方法,才更有利于把握置入后的疗效。     

拓扑优化技术在骨科植入物创新设计的应用进展

得益于近年来增材制造技术（又称3D打印技术）的迅速发展,有别于传统规格化骨科植入物,制造内外部结构复杂的新型植入物成为可能。有限元分析方法一直以来都是骨科植入物创新设计极具价值的研究手段之一,并具有高效率、低成本、可靠性高等特点,而在此基础上进一步延伸的拓扑优化技术因其在非参数结构优化中的广泛应用,现已从结构工程领域逐渐被拓展到定制化骨科植入物的设计中,初步显示出其巨大的应用价值。本文综述了拓扑优化技术在骨科植入物领域的应用和发展过程,特别对其在脊柱、关节和创伤骨科器械设计中的应用现状进行了详细的论述。最后,总结现有技术的局限性,展望了拓扑优化在定制化骨科植入物研究领域的发展趋势。     

三维放射治疗的进展

本文简介了目前三维放射治疗的发展情况,着重介绍了三维适形放射治疗、动态多叶光阑、调强放射治疗、三维放疗计划系统常用工具、计算机优化方法和逆向治疗计划问题、以及ＣＴ模拟定位机的最新进展,指出三维放射治疗的发展趋势,面临的问题和研究方向。     

Schizophrenia in a North Swedish geographical isolate, 1900–1977. Epidemiology, genetics and biochemistry

Over 200 schizophrenic patients belonging to three major and interrelated pedigree complexes have been investigated over the past 30 years in a North Swedish geographically isolated population, presently numbering about 6,000. An intensive investigation of a number of biochemical correlates and genetic markers in a few selected families belonging to one of the major pedigrees has indicated new strategies for the current research program.
Schizophrenia, as defined operationally, is significantly associated with decreased activities of two enzymes (1) blood platelet monoamine oxidase, (2) plasma dopamine-β-hydroxylase, and (3) with the genetic marker Gc² (group specific antigen). Both enzymes are subject to genetic variation. A positive score for linkage between schizophrenia and low plasma DBH activity has been calculated, but, so far, available data are insufficient for discrimination between linkage and partial contribution of genetically controlled low plasma DBH to the pathogenesis of the disease. Alternatively, both mechanisms could be involved.
As a model for continued research, schizophrenia is explained as based on a double dominant-recessive genotype (Aabb), representing a vulnerability which in about 50 % of cases develops into clinical schizophrenia. It is suggested that the dominant mutation (A) operates on or affects MAO activity, and that the recessive genotype (bb) is instrumental in low variates of DBH activity and very likely such variates within the normal range of physiological variation. Moreover, it is suggested that the combined effects of MAO- and DBH-reduced efficiency on the metabolism of e.g. dopamine could be an essential pathogenic mechanism for the schizophrenic illness which is segregating in this population.     

Renal dysplasia and asplenia in two sibs

A family is reported in which two sibs, one male and the other female, both died within 24 hours of birth with enlarged polycystic kidneys. Postmortem histology in the second child showed gross renal dysplasia. In both children the pancreas was enlarged, nodular and cystic but the liver appeared macroscopically normal. In the second child, histological examination confirmed pancreatic fibrosis with cystic dilation of ducts, but showed portal fibrosis with bile duct proliferation in the liver.
This combination of findings is very reminiscent of those in a girl and her brother reported by Ivemark et al. (1959). The children reported here also showed absence or hypoplasia of the spleen, cardiac anomalies and other features of the Ivemark syndrome (Ivemark 1955), a quite different, usually sporadic, congenital disorder. It is suggested that the children described here have a distinct lethal congenital disorder, probably inherited in an autosomal recessive manner.     

The dominant diseases of modernized societies as omega-3 essential fatty acid deficiency syndrome: Substrate beriberi

About 1900, modern food selection and processing caused widespread $\text{epidemics}$ of the B vitamin deficiency diseases of beriberi and pellagra which, for genetic reasons, often expressed as different diseases ranging from bowel and heart disease to dermatoses and psychoses. But the B vitamins merely help convert essential fatty acids (EFA) into the prostaglandin (PG) tissue regulators and it now turns out that, through hydrogenation, milling and selection of w3-poor southern foods, we have also been systematically depleting, by as much as 90%, a newly discovered trace Nordic EFA (w3) of special importance to primates and sole precursor of the PG3(4) series, even as a concurrent fiber deficiency increases body demand for EFA. Since substrate EFA is processed by many B vitamin catalysts, an EFA deficiency will mimic a $\text{panh}$ypovitaminosis B, i.e., a mixture of $\text{substrate}$ beriberi and $\text{substrate}$ pellagra resembling vitamin beriberi and pellagra but exhibiting as even more diverse $\text{endemic}$ disease. This would consitute a second stage of the Modern Malnutrition and explain why some workers now hold the dominant diseases of modermized societies to be new, nutritionally based, pellagraform yet lipid-related and to range, once again, from heart disease to psychosis. It is an assumption that our dominant diseases are unrelated to each other or are merely revealed by our diagnostic acumen and therapeutic success; and that hydrogenating millions of tons of food oils annually, to destroy the rancidity producing w3-EFA, is safe for $\text{primates}$. Extensive beriberiform disease is reported here in 32 typical cases taken from medical practice which responds strikingly to linseed oil supplements (60% w3-EFA) in confirmation of identical results in Capuchins.     

'Very sore nights and days': the child's experience of illness in early modern England, c.1580-1720

Sick children were ubiquitous in early modern England, and yet they have received very little attention from historians. Taking the elusive perspective of the child, this article explores the physical, emotional, and spiritual experience of illness in England between approximately 1580 and 1720. What was it like being ill and suffering pain? How did the young respond emotionally to the anticipation of death? It is argued that children’s experiences were characterised by profound ambivalence: illness could be terrifying and distressing, but also a source of emotional and spiritual fulfilment and joy. This interpretation challenges the common assumption amongst medical historians that the experiences of early modern patients were utterly miserable. It also sheds light on children’s emotional feelings for their parents, a subject often overlooked in the historiography of childhood. The primary sources used in this article include diaries, autobiographies, letters, the biographies of pious children, printed possession cases, doctors’ casebooks, and theological treatises concerning the afterlife.     

Guidelines for the Validation and Use of Immunoassays for Determination of Introduced Proteins in Biotechnology Enhanced Crops and Derived Food Ingredients

Recent advancements in agricultural biotechnology have created a need for analytical techniques to determine introduced proteins in crops enhanced through modern biotechnology techniques. These proteins are expressed in plant tissues and may be present in food ingredients. Immunoassays are ideally suited for protein detection and may be used as both quantitative and threshold methods. Microplate ELISA and lateral flow devices are two of the most commonly used immunoassay formats for agricultural biotechnology applications. This paper provides general background information and a discussion of criteria for the validation and application of immunochemical methods to the analysis of proteins introduced into plants and food ingredients using biotechnology methods. It is the result of a collaborative effort of members of the Analytical Environmental Immunochemical Consortium. This collaborative effort represents the combined expertise of several organizations to reach consensus on establishing guidelines for the validation and use of immunoassays. Further, the paper offers developers and users a consistent approach to adopting the technology as well as aid in producing accurate and meaningful results.     

HLA in North Colombia Chimila Amerindians

HLA-A,-B,-C,-DRB1 and -DQB1 alleles have been studied in Chimila Amerindians from Sabana de San Angel (North Colombian Coast) by using high resolution molecular typing. A frequent extended haplotype was found:HLA-A*24:02-B*51:10-C*15:02-BRB1*04:07-DQB1*03:02 (28.7%) which has also been described in Amerinndian Mayos Mexican population (Mexico, California Gulf, Pacific Ocean). Other haplotypes had already been found in Amerindians from Mexico (Pacific and Atlantic Coast), Peru (highlands and Amazon Basin), Bolivia and North USA. A geographic pattern according to HLA allele or haplotype frequencies is lacking in Amerindians, as already known. Also, five new extended haplotypes were found in Chimila Amerindians. Their HLA-A*24:02 high frequencies characteristic is shared with aboriginal populations of Taiwan; also, HLA-C*01:02 high frequencies are found in New Zealand Maoris, New Caledonians and Kimberly Aborigines from Australia. Finally, this study may show a model of evolutionary factors acting and rising one HLA allele frequency (-A*24:02), but not in others that belong to the same or different HLA loci.     

Ultracryotomy: development and application (with examples from the yeast cytology) (author's transl)

The preparation steps usually necessary for obtaining ultrathin frozen sections of biological material (chemical prefixation, enclosing, cryoprotective treatment, freezing, sectioning, and post-staining the sections for transmission electron microscopy) are submitted to a critical analysis. The application of cryo-ultramicrotomy, in particularly for cytochemical purposes, is reviewed. Fundamental considerations of chemical prefixation and poststaining are supported by examples from yeast cytology. Furthermore, the efficiency of the cryo-ultramicrotomy (electron optical resolution of ultrastructural details) is demonstrated on yeast cells and protoplasts.     

The universal muscular chamber. A basic unit of the genitourinary, cardiovascular, gastro-intestinal, skeletal, cutaneous, respiratory and other systems, endocameral hypertension; and spasm, the key to their idiopathic diseases and arthropathies

Starting with the integument, we see many organs are contractile sacs or multiples thereof, which tubes or bags constitute the major part of the entire body. Recognition of this basic unit and its characteristics sheds new light, individually and collectively, on many disorders previously considered unrelated. Muscular tears and perforations develop in the walls of these chambers, being no way peculiar to those organs, wherein, hydrochloric acid occurs. So, it is not necessary to explain the absence of excessive acid from patients who exhibit holes in the gastric, uterine, aortic, duodenal, rectal, pulmonary, retina, and other walls. Muscle, not acid is the great common factor relating idiopathic disorders in the gastrointestinal tract to each other and to similar diseases in other systems. When the units are linked together, the lesions tend to appear as arthropathies, i.e. at the joints. Rephrasing common-place observations, frees us from conventional, conceptual cul-de-sacs. An observation is only as good as its interpretation, so all possibilities must be considered, otherwise, we will remain blinded by our misconceptions.     

Der Einfluß von Nahrungsmitteln und Rauchen auf die klinisch-chemische Diagnostik von Phäochromozytom,Neuroblastom und Karzinoid-Syndrom

Zusammenfassung Der Einfluß von verschiedenen Nahrungsmitteln auf Methoden zur Bestimmung von Adrenalin (AD), Noradrenalin (NA), Vanillinmandelsäure (VMS), Metanephrinen (MN), Homovanillinsäure (HVS) und 5-Hydroxyindolessigsäure (5-HIE) im 24 h-Harn zur Diagnose des Phäochromozytoms bzw. Karzinoid-Syndroms wurde untersucht. Die in die Untersuchung einbezogenen Nahrungsmittel waren: Tee, Kaffee, Mandeln, Ananas, Käse, Walnüsse, Vanillepudding, Bananen, Tomaten und Milchschokolade. Außerdem wurde der Einfluß des Zigarettenrauchens auf die Bestimmung von AD, NA, VMS und MN untersucht.Walnüsse führten zu einer starken Erhöhung der 5-HIE-Ausscheidung. Bananen erhöhten die Ausscheidung von AD, NA, VMS, MN und 5-HIE. Kaffee und Ananas bewirkten eine geringe Zunahme der MN-Werte. Rauchen von 20–30 Zigaretten/Tag beeinflußte keine der vier Variablen.Wenn die beschriebenen Methoden benutzt werden, sollte lediglich auf den Verzehr von Bananen und Walnüssen vor und während der Harnsammelperioden verzichtet werden, da die oberen Normgrenzen im Harn überschritten werden könnten. Ein Verzicht auf Kaffee und Ananas in normalen Mengen ist nicht erforderlich. Es besteht kein Anlaß, weiterhin die bisherigen umfangreichen Restriktionen der übrigen Nahrungsmittel beizubehalten.