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.     

胸骨后间隙在食管癌外科治疗中的作用

目的：探讨胸骨后间隙在食管癌外科治疗中的作用。方法：总结我院2003年4月至2008年4月67例食管癌切除后胃代食管经不同途径吻合的治疗预后。其中经胸骨后吻合术33例（A组）,经胸腔内吻合术34例（B组）,对比两组术后的吻合口瘘和吻合口狭窄发生率、死亡率及肿瘤复发率。结果：术后随访6—60个月。A组全部治愈出院,其中并发吻合口瘘4例（12．1％）,无死亡（0％）,吻合口狭窄2例（6％）,肿瘤复发7例（21．1％）。B组治愈出院29例（85．2％）,并发吻合口瘘6例（17．6％）,死亡5例（14．7）,吻合口狭窄3例（8．8％）,肿瘤复发8例（23．5％）。B组死亡率高于A组（P〈0．05）,而两组吻合口瘘、狭窄的发生率及肿瘤发生率无明显差异（P〉0．05）。结论：食管癌手术时,胃代食管经胸骨后间隙吻合是安全可靠的,有一定的临床应用价值。     

鼻咽癌调强放疗靶区剂量学研究及近期疗效观察

目的:分析鼻咽癌调强放疗和常规放疗中靶区和周围组织器官的剂量分布,观察鼻咽癌调强放疗的效果和副作用.方法:对63例初治鼻咽癌采用CT模拟定位,为每例患者制定2套放疗计划,即调强放疗计划和半开准直器常规放疗计划.63例患者非随机分为2组,调强组28例进行调强放射治疗,常规组35例进行常规放射治疗.结果:在IMRT和常规计划中,对肿瘤区(GTV)的靶区覆盖率(V95)分别为99.55%和98.41%,差异无显著性(P>0.05);对于临床靶区(CTV1)的靶区覆盖率(V95)分别为98.51%和87.26%,差异有显著性(P<0.05);颈淋巴结靶区的靶区(CTV2)覆盖率(V95)分别为98.71%和77.63%,差异有显著性(P<0.05),临床靶区(CTV1)和颈淋巴结靶区(CTV2)IMRT的V95优于常规放疗.对串联器官IMRT计划和常规计划均能比较好的保护脊髓、脑干和视交叉,对并联器官IMRT计划中腮腺和下颌骨受照剂量显著低于常规计划.调强组与常规组近期有效率分别为96.4%和97.1%,差异无显著性(P>0.05),放疗6个月后调强组口干症状明显轻于常规组.结论:调强放疗可以使各个靶区得到足够、均匀的剂量分布,周围正常组织得到较好的保护.     

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。     

体外冲击波疗法结合同种异体骨钉治疗成人股骨头缺血性坏死

目的探讨体外冲击波疗法（ESWT）结合同种异体骨钉治疗成人股骨头缺血性坏死的疗效。方法2003年7月～2007年1月,采用体外冲击波或结合同种异体皮质骨钉植入术治疗54例（84髋）股骨头缺血性坏死患者并随访观察。男41例,女13例;年龄20～61岁,平均30岁。按Ficat分期,Ⅱ期55髋,Ⅲ期29髋。其中40髋（Ⅱ期27髋,Ⅲ期13髋）,采用ESWT结合同种异体骨钉治疗,治疗后6、12、24个月复查双髋X线、MRI及髋关节Harris评分（HHS）。44髋（Ⅱ期28髋,Ⅲ期16髋）患者采用单纯ESWT治疗。对两组治疗结果进行统计学分析。结果随访24～29个月,平均25．7个月。二者治疗后Harris评分分别为83．71±18．76和57．20±12．82,二者比较差异有统计学意义妒〈0．01）：影像学X光片评估：ESWT结合同种异体骨钉术后随访股骨头塌陷12髋,塌陷率为30％,单纯ESWT治疗随访股骨头塌陷25髋,塌陷率为56．8％。结论体外冲击波疗法结合同种异体骨钉是治疗中期ONFH的方法之一,它不但具有冲击波疗法促进骨愈合作用,而且复合骨钉移植可起到骨传导及骨支撑作用,近期可以减少股骨头塌陷发生。     

一种新的放射治疗计划优化方法

在采用多射线束的放射治疗中,治疗计划优化是一个重要的步骤.本文描述了一种新的治疗计划优化方法.它是基于治疗医师对治疗过程中各因素的综合考虑,弥补了传统方法的不足,具有较高的准确性.     

恶性肿瘤调强适形放射治疗质量保证的研究

目的：探讨调强适形放射治疗的质量保证方法。方法：用CMS放射治疗计划系统设计调强适形放射治疗计划。采用CT模拟的方法验证射野等中心位置，比较各照射野实际胶片调强图与治疗计划系统得到的相应照射野的测强图的一致性，采用多通道剂量仪验证多点绝对剂量。结果：射野等中心位置误差在3mm以内。各射束垂直方向测得的调强图与计划系统计算的调强图一致。等中心点实测剂量与计划剂量的误差在3％以内，其余偏离点的实测剂量与计划剂最误差在5％以内。近期疗效为完全缓解（CR）58．8％（10／17），部分缓解（PR）17．6％（3／17），无变化（NR）23．5％（4／17），总有效率（CR＋PR）为76．5％（13／17），所有17例患者均能耐受放射治疗，按计划完成调强透形放射治疗。结论：上述质量保证措施切实可行。调强适形放射治疗对恶性肿瘤有较好的近期疗效。     

Pleomorphic Lymphoepithelioma-like Carcinoma of the Urinary Bladder

Lymphoepithelioma-like carcinoma (LELC) of the urinary bladder is often mixed with conventional transitional cell carcinoma and/or other histotypes. The pathologist’s determination of the morphologic purity of a given LELC at the biopsy stage is a clinically relevant endeavour, because there is some anecdotal evidence suggesting that pure or predominant LELC may be comparatively chemosensitive and have a favorable prognostic profile, which may potentially offer the possibility of effective therapy without bladder resection. The precise degree of cellular pleomorphism that is allowed in a pure LELC is unclear. We describe herein an otherwise conventional and pure LELC that showed, in a localized area that constituted approximately 25% of the overall tumor volume, a two to six fold variation in nuclear size, including multinucleated tumor cells. These pleomorphic areas were set in the same lymphoplasmacytic infiltrate as their conventional counterparts, and similarly displayed cellular syncytia. We performed a detailed immunophenotypic comparison between the conventional areas and the pleomorphic areas. No significant differences were found between the 2 areas in overall lymphoplasmacytic or histiocytic density, lymphocytic CD4/CD8 ratio, and lymphoplasmacytic kappa/lambda ratio. Similarly, both displayed similar qualitative and quantitative staining indices for p53, Ki67, cytokeratin AE1/AE3 and p16^INKa. Scattered cells were cytoplasmically beta-catenin positive exclusively in the pleomorphic areas; however these cells were not notably larger than the cells in the conventional areas. Both components were immunohistochemically negative for HMB-45, CD1a, the estrogen receptor, Epstein-Barr virus, CD117, D2-40, CD56, cytokeratin 20 and chromogranin. Clinicopathologic analysis of a series of cases is required to establish if there is any significance to nuclear pleomorphism in LELC. However, the phenotypic similarity between the 2 areas in this case, the intimate admixture of the pleomorphic cells with the lymphoplasmacytic infiltrate, and their syncytial pattern of growth, all suggest that pure LELC may display marked nuclear pleomorphism, and that this finding may not, in of itself, be a valid basis for removing a case from the “pure” group.     

Role of Laser Energy Density for Photodynamic Therapy of Radiation Injuries of the Skin

The role of different laser energy densities used in photodynamic therapy in the reparation of radiation ulcers caused by X-ray exposure in a dose of 80 Gy was studied. Tissue reparation manifested differently at different laser energy densities. After photodynamic therapy at energy density of 0.1 J/cm² the rate of healing was notably higher during early periods. After exposure at 5 and 40 J/cm² acceleration of ulcer healing was observed 14 and more days after the treatment, indicating the emergence of another mechanism of photodynamic therapy effect. Laser energy density of 5 J/cm² was the most effective for maximally complete healing of radiation ulcers. __________ Translated from Byulleten' Eksperimental'noi Biologii i Meditsiny, Vol. 140, No. 11, pp. 570–573, November, 2005     

Image Display for Collision Avoidance of Radiation Therapy: Treatment Planning

Patient treatment in a medical linear accelerator is characterized by many angular and translational movements of the gantry and couch. The direction and orientation of each treatment beam is specified by a set of gantry, turntable, and collimator angles. It is possible that some selected treatment field configurations will result in gantry/couch or gantry/patient collisions that remain undetected during the treatment planning process. In this work, a digital camera has been used to record all the workable gantry/ patient set-up images, and a Windows programming language is used to edit and display these images on a personal computer for the treatment planner to screen the treatment plans. These graphical displays enable the planner to be aware of any potential collision hazards by an actual visualization of each selected gantry/turntable or gantry/patient angle configuration.     

鼻咽癌调强放疗中目标剂量覆盖率的研究

目的：探索鼻咽癌调强放疗计划中目标剂量是否最大限度覆盖靶区，是否同时满足靶区和重要器官的处方剂量和目标耐受量要求。方法：随机选取70例鼻咽癌病人的PTV70、PTV65、PTV60和PTV504作为研究对象。用剂量体积直方图有关参数进行分析，来评价靶区剂量覆盖率、适形度和不均匀性指数等，并分析正常组织耐受量的余量问题。结果：在四个靶区中,大于85％以上的等剂量面覆盖PTV70和PTV60为100％。其中满足大于93％处方剂量的覆盖率分别为80％和84％；PTV60和PTV504覆盖率不理想,大于85％以上的等剂量面覆盖率为75％和50％。其中满足大于93％处方剂量的覆盖率只有44％和39％，所有靶区的最大剂量均小于110％的处方剂量。正常组织中脊髓、脑干、视交叉、视神经1％体积所受最大剂量均值为39Gy、51Gy、45Gy和42Gy。和目标耐受量相比还有22％、15％、25％和30％的余量；晶体、眼球余部体积所受平均剂量均值为2Gy和7Gy，和目标耐受量相比，还有50％和80％的余量。腮腺受量只有16％的病人健侧50％体积所受剂量小于26Gy以下,其余余部体积的平均剂量均值为36Gy。无加量余地。结论：本研究显示各正常器官除腮腺外还有15％-30％的余量，如果按鼻咽癌的剂量响应梯度19％即再增加靶区19％的处方剂量（GTV总量达83Gy），是可以用正常组织的耐受余量来完成的，那么将鼻咽癌的局部控制率再提高20％应是可行的。在同期整合椎量照射（simuhaneous integrated boost,SIB）技术中，PTV70和PTV66能得到确定的剂量。但是要注意PTV60和PTV504的低剂量区.     

鼻咽癌调强放疗中摆位误差对物理剂量学的影响

目的：测量头颈部肿瘤在放射治疗中的摆位误差，分析鼻咽癌（NPC）调强放射治疗（IMRT）中误差对靶区和危及器官物理剂量学的影响。方法：随机抽取76名头颈部肿瘤患者，通过比较数字重建图像（DRR）和射野图像，测量其摆位误差；从其他住院患者中随机抽取另外10名作调强治疗的鼻咽癌患者，在计划系统中模拟患者治疗时体位的三维误差，重新计算剂量分布，分析一系列相关的靶区和危及器官的剂量参数，明确摆位误差对物理剂量的影响。结果：头颈部肿瘤在左右、头脚、腹背方向的摆位误差分别是（-0．62±1．46）mm，（-0．41±1．54）mm，（-0．31±1．67）mm；鼻咽癌调强放疗中超过3mm的摆位误差对GTV的最小剂量和CTV个别剂量参数的影响有统计学意义，腹背方向的误差对脊髓和脑干受照剂量的影响有统计学意义。结论：对于鼻咽癌调强治疗的患者，摆位误差需要控制在3mm之内：在日常工作中用EPID做质量保证和质量控制工作很有必要。     

The Role of Emotion in Psychological Therapy

This Special Issue of Clinical Psychology: Science and Practice provides a series of articles detailing efforts to consider the concepts of emotion and emotion regulation in relation to clinical assessment and psychopathology intervention efforts across the lifespan. In our commentary, we review some common themes and challenges presented in these articles to move forward the discussion of emotion's role in psychological therapy. We discuss efforts to conceptualize the role of context in defining emotion concepts and maximizing the relevancy of such concepts to treatment. We review the importance of imbuing efforts to develop emotion-focused treatments with emphases on positive, as well as negative, emotions and flexibility in the expression of these emotions. We also highlight the relevance of a lifespan developmental approach to the accurate use of emotion and emotion regulation concepts within treatment. Finally, we discuss the application of these issues to our own treatment development and evaluation efforts regarding a unified approach to the treatment of emotional disorders in adults and adolescents.     

The Place of Radiation Diagnostics in the Treatment Process

This article reviews characteristics of human vision from the perspective of the origin and development of life and the role of images in perception of reality. It shows that the human ability to create images led to significant acceleration of evolution. One of the most complex of images is the medical image in X-ray diagnostics. Various physical fields used in X-ray diagnostics allow imaging specific properties of physical objects, hence many times empowering perception of reality.