一种全颅全脊髓适形照射野的布野方案

目的:探讨一种简便易行、剂量准确性高的全颅全脊髓的适形照射的布野方案。方法:100多例髓母细胞瘤患者,俯卧位躺在特制的头颅固定器和真空负压袋上,进行CT模拟定位,在头颅放置3个标记点作为全颅野照射中心,进床30 cm左右作为全脊髓野的照射中心,通过多次改变全颅野的下界和脊髓野的上界来保证照射野内的剂量准确性。结果:经过上述方法设计的治疗方案,使得全颅全脊髓的放射治疗剂量分布精确,操作方便并且定位时间不长,临床疗效好。治疗时不在一个点上接野,确保脊髓的剂量无冷热点。结论:适形移动的全颅全脊髓的治疗技术操作方便,定位时间短,剂量分布准确,临床疗效好,副作用小,值得推广。     

全脑全脊髓照射技术的改进

目的:介绍全脑全脊髓放射治疗的一种新技术。方法:患者采用仰卧位,在整体定位板上做颈肩和体膜固定,行CT扫描定位,将图像传输治疗计划系统,进行三维重建。按照全脑全脊髓照射的要求勾画靶区,设计治疗计划,调整剂量分布。治疗前行CBCT扫描,进行在线的体位验证。结果:通过计划系统进行剂量计算,可以直观显示靶区的剂量分布并加以调整,计划照射野衔接处没有明显的剂量冷点和热点出现体位验证结果符合临床要求;通过CBCT在线验证,保证位置准确。结论:全脑全脊髓放射治疗采用了仰卧位热塑膜固定,较传统的俯卧位使患者更舒适,治疗过程中体位容易保持,确保治疗的准确;CT模拟定位方法,较传统的模拟机定位简单易行,且定位精确;用计划系统计算剂量分布并进行调整,使靶区剂量分布均匀,避免照射野衔接处剂量分布出现冷、热点。     

全脑全脊髓转床半野照射技术的临床应用

目的：介绍一种通过转床、半野进行全脑全脊髓照射的技术。方法：模拟定位时首先设颈胸脊髓野：机架角O°,小机头0°,床角0°,SSD=100cm,野长40cm,野宽4cm～5cm,同时在体膜上标记射野上界（B点）和下界（C点）,然后设全脑野：使用半束左右两野对穿照射,机架角90°或270°,小机头11.3°或348．7°,床角0°,SAD=100cm,Y1=0,X和Y2取包括颅骨外1cm,使射野X方向中心线在透视下与B点重合,最后设腰骶脊髓野：以C点为中心使用半束照射,机架角11.3°,小机头O°,床角90°,SSD=100cm,X2=0,Y和X1取包括腰骶直至S4。同时使用Kodak-Ec-film胶片、固体水模体以及MatriXX系统在加速器治疗机上模拟射野进行射野衔接点的几何和剂量验证,并观察12例使用该技术投照期间患者的放疗反应。结果：颈胸段脊髓野与全脑野衔接点以及颈胸段脊髓野与下位脊髓野衔接点处射野边界清晰锐利,未见射野间分离和重合现象,等剂量线基本平滑,未见明显的凹陷和凸出现象,12例患者都完成全脑全脊髓的照射计划,未见明显严重的放疗反应。结论：全脑全脊髓转床半野照射技术做到了射野间的无缝衔接,方法简便,值得临床推广应用。     

全脑全脊髓照射仰卧位CT模拟定位技术

目的：探讨全脑全脊髓照射仰卧位CT模拟定位技术。方法：7名患者分别躺在真空负压袋固定器上，进行CT模拟定位，打印正侧位数字重建射线彩像（DRR）图，放射治疗前拍摄正侧位定位验证片，测量解剖参考点和射野边界之间的距离。结果：患者左右方向及背腹方向误差在2mm以内。人体上下方向误差在4mm以内；放疗后，患者受照射的皮肤部位均出现色素沉着。结论：仰卧位全脑全脊髓照射CT模拟定位技术可用于俯卧位不合作的患者。     

颈段胸上段食管癌T形野三种照射技术的剂量学比较

目的：控讨颈段胸上段食管癌T形野照射的最佳放疗模式。方法：26例颈段胸上段食管癌T形野照射的患者采用瓦里安Eclipse三维治疗计划系统（3D—TPS）对3种照射技术即：调强放疗（IMRT）、三维适形放疗（3D—CRT）和常规放疗（Con—RT）进行放射治疗计划设计。规定处方剂量54Gy，95％等剂量线涵盖95％PTV（计划靶体积）。Con—RT利用3D．TPS模拟X线模拟机定位设计，等中心照射，前后T形野36Gy，双侧水平野18Gy，均用剂量体积直方图（DVH）分析PTV靶区各项参数和肺及脊髓受照体积和剂量。结果：（1）PTV靶区等剂量线、剂量不均匀指数（Ⅲ）和适形指数（CI）3种照射技术比较IMRT优于3D—CRT。3D—CRT优于Con-RT（P=0．000）（2）肺和脊髓受照体积和剂量3种照射技术比较IMRT优于Con—RT和3D—CRT虽然某些参数Con—RT稍优于3D—CRT，但大部分参数比较差异无统计学差异。（3）调强技术野数的参数比较．PTV、肺和脊髓的各项参数中，5野，7野和9野大部分参数优于3野．7野与9野比较差异均尢统计学意义（P=0244～0．947）。结论：IMRT技术是颈段胸上段食管癌T形野照射最佳选择，它与其他照射技术相比具有明显剂量学优势，以7野和9野IMRT较适宜。     

鼻咽癌放疗中的垂体屏蔽技术

目的：研究在鼻咽癌放射治疗中对两侧耳前野进行垂体屏蔽前后垂体的剂量分布变化，以了解该技术对保护垂体功能的意义。材料与方法：采用治疗计划系统分析计算鼻咽癌放疗中采用两侧耳前野垂体屏蔽技术后垂体的受量分布，与不采用者进行比较，并用胶片法测量结果加以验证。结果：①治疗计划系统计算结果显示采用两侧耳前野垂体屏蔽技术后垂体在鞍底及垂体中平面剂量约为不采用者的一半，且屏蔽后垂体的容积剂量较不屏蔽者减少。②胶片法测定结果显示采用屏蔽技术后垂体在鞍底部位受量约为５０％。结论：初步研究认为本文采用的垂体屏蔽技术降低了垂体受量，相同剂量水平下的垂体受照射体积亦有明显减少，它可以起到保护垂体功能的作用。     

模拟调强放疗照射离体细胞的质量保证

目的：在模拟调强放疗方式照射细胞的过程中，保证细胞按调强方式被照射，照射剂量准确。方法：在细胞培养瓶中装满细胞培养液，水平固定在标准水箱（30cm×30cm×30cm）电离室横梁上，在水箱中加水到电离室上方5cm，用CT机（philips brilliance bigbor CT）扫描获取图像，传到计划系统（ECLIPSE 7．0）中；再用一个空的培养瓶替换装满培养液的培养瓶，重新用CT机扫描，获取图像，传到计划系统中。采用先设野中野后合并野中野的设计方法，设计模拟调强照射计划，设定电离室处的吸收剂量400cGy。再把此水箱放到加速器（Varian 600-C／D）下，按设计的模拟调强照射计划进行照射，同时用电离室（NE 0．6cc）剂量仪（NE FARMER 2570）测量得到实际吸收剂量。结果：在细胞培养瓶中装满细胞培养液时模拟调强照射实测得到397cGy，与理论值相差-0．8％；在细胞培养瓶中不装细胞培养液时模拟调强照射实测得到395cGy，与理论值相差-1.3％。结论：用CT模拟定位，用计划系统通过设野中野的方法设计模拟调强照射计划是可行的，可以实现模拟调强照射离体细胞，理论剂量与实测剂量相差小于2％。     

直线加速器注入电流与照射野对称性的关系研究

目的：电子直线加速器的注入电流在使用中会发生改变。从而对剂量学参数照射野对称性产生影响。作者对注入电流的变化规律及其造成照射野对称性改变的程度进行实验研究。探讨加速器照射野质量控制的要求。方法：手动模拟加速器注入电流的改变。在照射野对称性良好的注入电流工作点附近设置正负模拟值，以胶片法测最和分析对应的照射野对称性改变。结果：注入电流的数值在加速器的枪靶方向不会影响照射野对称性的质量。在左右方向的对称性偏差值受注入电流数值的影响近似为线性关系，当注入电流偏离中值0.2A时，相应的对称性误差接近3％。作者工作部门的正常工作量下注入电流每月约下降（0．1～0．2）A。结论：检测加速器注入电流的改变可以提示照射野对称性的误差。照射野剂量特性和注入电流应纳入每周的质控检验内容。     

4—10 医用直线加速器等中心照射技术与剂量学问题

中日友好医院放疗科自开诊以来,主要开展的是等中心照射技术,本文介绍有关的几个问题。一、等中心定位技术与通常的源皮距方式不同,等中心照射要使加速器的等中心点在照射过程中始终保持在肿瘤的某一固定点中。照射野的改变只能靠大机架、机头和床的旋转实现,而不能象源皮距方式,上下左右移动治疗床。临床实践证明,大部分病人治疗时,等中心点并不在原发肿瘤中心,照射前必须在模拟机上充分定位。定位结束前还需利用三方位激光     

鼻咽癌调强放疗布野方案剂量学比较

目的：通过对鼻咽癌逆向调强放疗三种常用的7野方案进行比较，确定符合临床要求的较佳布野方案。方法：对10例初治鼻咽癌患者采用调强放射治疗方案，针对每例患者按不同方案设计3个计划，分别为方案A：7野均匀分布，方案B：前7野，方案C：后7野。每野的照射范围从颅底到锁骨上淋巴预防区。所有计划都用同样的物理目标函数和约束条件进行优化，分别比较三个计划的靶区和危及器官剂量分布、剂量体积直方图（DVH）、靶区适形度指数（CI）等指标。结果：三个计划的靶区剂量分布无明显差异，方案A、C比方案B降低了12t腔黏膜平均剂量的21．2％和31．3％，但是方案C计划增加了后颈部软组织的剂量。方案A、B比方案C分别降低了颞叶珐剂量的2．7％、3．5％和脑干珐剂量的1．7％、2.3％。A、B、C三种方案中脑干、脊髓的D1剂量无明显差别，腮腺、颞颌关节的D50剂量也无明显差别。适形度指数三种方案差别并不显著。结论：调强放疗7野计划可以满足鼻咽癌靶区的剂量要求。布野方向对剂量分布有较大影响，方案A优于方案B、C：但是若肿瘤侵犯到了鼻咽腔的顶壁、前床突、后床突等部位，方案A、C较难避开晶体，只能选择B方案。用非共面射野方式以避开晶体。     

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.