表观弥散系数在预测宫颈癌病理学特征中的应用价值

摘 要：［目的］ 应用高b值磁共振扩散加权成像（DWI）及表观弥散系数（ADC）分析宫颈癌相关病理学特征。［方法］ 49例病理证实的宫颈癌患者以及19人正常宫颈健康志愿者的常规MRI平扫、DWI、ADC图像,b值取700s/mm2,比较宫颈癌组与正常宫颈组ADC值。［结果］ b＝700s/mm2时正常宫颈黏膜层、结合带、肌层及宫颈全层ADC值分别为(1.717±0.132)×10-3mm2/s、(1.391±0.106) ×10-3mm2/s、(1.956±0.217)×10-3mm2/s、(1.613±0.145)×10-3mm2/s,差异有统计学意义（P<0.05）。宫颈癌组ADC值为 (0.912±0.140)×10-3mm2/s,显著性低于正常宫颈 (P<0.05)。鳞癌ADC值为 (0.882±0.103)×10-3mm2/s,腺癌ADC值为(1.047±0.165)×10-3mm2/s,两组差异有统计学意义（t=－3.985,P＝0.000）。角化性大细胞型组与非角化性大细胞型组ADC值差异无统计学意义。［结论］ DWI及其量化参数ADC值有助于鉴别宫颈癌与正常宫颈以及评估宫颈癌的病理类型。     

分次内锥形束CT扫描联合Fraxion放疗体位固定系统在颅内肿瘤立体定向放疗中的应用

摘 要：［目的］ 探讨分次内CT扫描联合Fraxion体位固定系统在颅内肿瘤立体定向放疗(SRT)中的应用。［方法］ 随机选取25例行SRT的颅内肿瘤放疗患者,应用Fraxion框架固定后行CT扫描,扫描图像与计划参考图像配准,得到左右（LR）、头脚（SI）、前后方向（AP）的平移误差和绕左右（Roll LR）、绕头脚（Roll SI）、绕前后方向（Roll AP）的旋转误差。用六维治疗床校正摆位误差,行SRT治疗同时行分次内CT扫描。再次配准,并记录结果逐弧配准,重复此步骤直到治疗结束。［结果］该组患者首次配准LR、SI、AP方向的平移误差和Roll LR、Roll SI、Roll AP的旋转误差分别为(0.35±0.12)cm、(0．39±0.10)cm、(0．33±0.10)cm和(1.56±0.26)°、(0.53±0.29)°、（0．48±0.28）°,平移误差均在4mm以内,旋转误差<2°,分次内CT扫描误差分别为(0．19±0．05)cm、(0.18±0．07)cm、(0.14±0.06)cm、和(O.32±0.13)°、(O.31±0.10)°、（0.31±0.14）°,平移误差减小,控制在0.2cm以内,旋转误差在0.4°以内,两两比较差异有统计学意义(P均<0.05)。［结论］ 分次内CT扫描联合Fraxion框架在颅内肿瘤SRT中是行之有效的,在治疗时间稍长的情况下保证治疗精度。建议在行SRT时,采用分次内CT扫描逐弧体位验证以减少治疗中的误差。     

老年食管癌在调强放射治疗中摆位误差的研究

摘 要：［目的］ 应用千伏级锥形束CT（KV-CBCT）探讨两种不同固定方式对老年食管癌调强放射治疗（intensity-modulated radiotherapy,IMRT）中摆位误差的影响,并分析分次间及分次内摆位误差的变化趋势。［方法］ 老年食管癌患者30 例,Ａ组15例采用热塑体膜固定,Ｂ组15例采用负压真空气垫固定。每例患者在摆位纠正前及治疗后进行KV-CBCT扫描,将获取的CBCT图像与计划CT图像相匹配,得到分次间及分次内摆位误差,分别比较和分析A、B两组的摆位误差及外放边界（MPTV）。［结果］ 通过对480张CBCT扫描图像分析,A组在X（左-右）、Y（头-脚）、Z（前-后）轴上的分次间和分次内的相对平移误差分别为(-1.31±2.21)mm、(-1.13±2.10)mm、(-0.50±2.15)mm和(-0.13±0.80)mm、(0.12±0.97)mm、(-0.10±0.93)mm,B组分别为(-1.12±1.95)mm、(1.21±2.30)mm、(-0.59±2.16)mm和(0.43±1.10)mm、(0.57±1.26)mm、(-0.45±1.08)mm。A、B两组在X、Y、Z轴上分次间的平移误差差异无统计学意义（P均>0.05）,而两组在X、Y、Z轴上分次内平移误差差异有统计学意义（P均<0.05）。A、B两组在X、Y、Z轴上分次间的外放边界分别为6.8、6.8、5.3mm和6.4、6.6、5.8mm;分次内的外放边界分别为3.1、3.5、2.7mm和4.5、4.6、3.9mm。［结论］ 在老年食管癌调强放射治疗中,采用热塑体膜固定可以有效减小X、Y、Z轴上分次内平移误差。前三次连续KV-CBCT扫描出分次间摆位误差总结的记录,能较好地降低后续位移误差。     

IntegraBiteTM口含器在颅内肿瘤中的放疗摆位误差分析

摘 要：［目的］ 探讨颅内肿瘤放疗采用热塑面膜体位固定时用IntegraBiteTM口含器增加口腔固定点的意义。［方法］ 选取2016~2017年收治的40例颅内肿瘤患者,采用常规热塑面膜体位固定20例（A组）,采用热塑面膜与IntegraBiteTM口含器联合固定法20例（B组）,应用锥形束CT（Cone-beam CT）对患者治疗前摆位进行验证,对A、B两组X（左右）、Y（头脚）、Z（前后）轴的线性误差及旋转误差进行比较。［结果］ A、B两组在X、Y和Z轴的线性误差分别为（0.94±0.78）mm与（1.07±0.74）mm（P=0.155）、（1.78±1.32）mm与（1.24±1.04）mm（P=0.000）、（1.05±1.14）mm和（0.79±0.70）mm（P=0.023）;旋转误差分别为（0.60±0.47）°与（0.51±0.49）°（P=0.126）、（0.82±0.55）°与（0.70±0.54）°（P=0.087）、（0.76±0.53）°与（0.76±0.59）°（P=0.967）;B组在Y与Z轴的线性误差小于A组,差异有统计学意义。［结论］ 相对于常规固定方式,用IntegraBiteTM口含器增加口腔固定点可以减少Y与Z轴的线性误差,患者的体位重复性更好,可提高颅内肿瘤的治疗精准度。     

机器人导航辅助CT引导下肺恶性肿瘤放射性粒子植入术的临床应用

摘 要：［目的］ 探讨机器人导航辅助CT引导下在肺恶性肿瘤放射性粒子植入术中的应用价值。［方法］对40例肺恶性肿瘤患者行粒子植入术,比较机器人导航辅助CT引导组（20例）与常规CT引导组（20例）的穿刺次数、扫描次数、精度偏差、治疗时间、DLP以及并发症发生率。［结果］ 机器人导航辅助CT引导组的平均穿刺次数(2.7±1.0 vs 4.3±1.5)、扫描次数(4.7±1.2 vs 6.0±1.4)、精度偏差(3.4±1.3mm vs 6.3±2.1mm )以及DLP值(325.2±104.1 mGy·cm vs 457.5±163.5 mGy·cm)均低于常规CT引导组,差异均具有统计学意义（P均＜0.05）;两组在治疗时间和并发症方面差异无统计学意义（P＞0.05）。［结论］ 机器人导航辅助CT引导下行肺恶性肿瘤放射性粒子植入术的操作精度高、辐射剂量少,安全性好,具有较高的临床应用价值。     

前列腺癌三维适形放疗中体位对靶区和正常组织体积及照射剂量的影响

目的对比研究仰、俯卧体位下前列腺癌三维适形放疗对靶区和周边重要器官体积改变和照射剂量变化。方法临床穿刺细胞学证实的分期为T1~T2N0M0期的前列腺癌8例,行对称六野三维适形放疗。定位前1 h排空膀胱,定位前1.0、0.5 h口服造影剂各400 ml,每例病例同一时间分别行前列腺癌仰、俯卧位CT定位扫描,定位后勾画靶区及盆腔重要器官结构,三维计划设计。分别评估CTV、PTV、直肠、膀胱、股骨头和盆腔小肠体积,CTV、PTV、直肠、膀胱、股骨头、盆腔小肠平均照射剂量,50 Gy膀胱、直肠和30 Gy股骨头受照体积及盆腔小肠最大照射剂量,对比仰、俯卧位各器官结构体积变化以及照射剂量差别。结果无论是仰卧位还是俯卧位,靶区均能得到均匀理想的剂量分布。直肠体积在不同体位下变化较大。仰、俯卧位各正常组织的平均体积分别为:膀胱(306±58)、(325±69)cm3,直肠(59±20)(、144±96)cm3,小肠(94±51)、(75±18)cm3。CTV、PTV、股骨头体积变化不明显。CTV、PTV、膀胱、股骨头、小肠平均照射剂量在不同治疗体位下差别不大。仰、俯卧位直肠平均照射剂量分别为(3364±995)(、2221±1176)cGy。DVH分析显示直肠在俯卧位保护最好,仰、俯卧位50 Gy直肠体积分别占总体积的39.5%±19.7%、19.8%±15.7%。俯、仰卧位小肠最大照射剂量分别为(234±143)(、275±220)cGy。结论前列腺癌俯卧位三维适形放疗使直肠体积明显增大,可因减少直肠照射而起一定保护作用。     

鼻咽癌适形放射治疗不同固定方法对摆位精度的影响

[目的]探讨鼻咽癌放射治疗两种不同固定方法摆位误差值的大小 ,为设计PTV提供参考数据。[方法]面膜固定组20例 ,泡沫枕尼龙带固定20例 ,按放疗处方规范摆位 ,每周在模拟机下拍片一次 ,与定位片比较误差大小。[结果]等中心点误差值面膜组为(0.94±1.47)mm,泡沫枕尼龙带固定组为(1.38±1.94)mm。[结论]①面膜组摆位误差明显低于普通组(P<0.01) ;②设计PTV时 ,不同固定方法 ,预留范围应有所区别 ,面膜组可定为3mm ,普通组为5mm。以免漏照射或造成不必要照射     

盆腔肿瘤三维适形放疗摆位重复性研究

目的研究盆腔肿瘤三维适形放疗的摆位误差大小,为盆腔肿瘤适形放疗计划设计时CTV外放PTV提供参考数据。方法接受放疗的直肠癌病例3例和前列腺癌病例2例,均为男性,行俯卧位盆腔三维适形放疗。每例病例治疗时身下垫有孔泡沫板,连续5 d摆位照射,每次摆位时在患者体表固定点粘贴定位金点,热塑成型固定膜固定,加速器机头插入与治疗中心一致的定位“+”字刻度板,照射正侧位治疗验证片各1张,共计摆位25次,照射治疗验证片50张。以第1次摆位片为标准,计算前后、头尾、左右方向摆位误差。结果5例病例25次摆位误差,人与人间以及次与次间均存在一定差别。前后方向摆位误差最大,平均值为(0．98±0．68)cm,有9次摆位误差≥1 cm,占测算次数的45%,其中2次误差≥2 cm；头尾方向摆位误差为[(0．50～0．70)±0．45]cm,正位测定误差小于侧位,分别为(0．51±0．46)、(0．70±0．45)cm,正位和侧位分别有4次和7次摆位误差≥1 cm；左右方向误差最小,为(0．37±0．28)cm,仅1次误差≥1 cm。结论在三维适形技术放疗盆腔肿瘤时．左右方向摆位误差最小,头尾方向居中,前后方向最大；CTV外放PTV应考虑左右方向0．5 cm,头尾方向1．0 cm,前后方向1．5 cm。     

IMRT联合锥形束CT技术治疗颅内危险区 肿瘤病灶

 目的采用兆伏级锥形束CT(cone-beam computed tomography, CBCT)技术图像引导调强放射治疗（intensity modulated radiotherapy, IMRT）颅内危险区肿瘤病灶,评估其摆位误差及PTV外扩范围。方法对36例颅内肿瘤患者设计IMRT放疗计划,采用西门子ONCOR直线加速器配备的MVision兆伏级CBCT进行三维方向（左右、上下、前后）容积成像并与计划CT图像相匹配获取前5次放射治疗摆位后和摆位误差调整后CBCT数据,分析摆位误差及PTV外扩范围。结果36例患者三维方向摆位误差分别为,左右(2.22±1.37) mm、上下（2.62±1.50） mm和前后（2.77±1.34） mm。摆位误差调整后较调整前摆位误差相比在三维方向均有降低, 并且差异均具有统计学意义（P<0.05）。5次CBCT分次间摆位误差在三维方向上差异均无统计学意义（P>0.05）。若不行CBCT摆位误差校准,PTV在三维方向的外扩范围,左右：2.94 mm, 上下：3.31 mm,前后：3.52 mm。若行CBCT摆位误差校准,PTV在三维方向的外扩范围,左右: 1.00 mm,上下: 1.19 mm,前后: 1.68 mm。结论各个方向的摆位误差边界小于4 mm,采用兆伏级CBCT技术对颅内肿瘤IMRT治疗分次间摆位误差的纠正和PTV边界的评估对提高颅内危险区肿瘤IMRT治疗的精度有重要意义。     

系统保留盆腔自主神经的广泛性子宫切除术对宫颈癌患者尿流动力学的影响

摘 要：［目的］ 探讨系统保留盆腔自主神经的广泛性子宫切除术对宫颈癌患者术后近期及远期尿流动力学的影响。［方法］ 92例早期宫颈癌患者随机分为两组,观察组46例行系统保留盆腔自主神经的广泛性子宫切除术,对照组46例行传统的广泛性子宫切除术,比较两组术前、术后1个月、术后12个月的尿流动力学相关指标。［结果］ 观察组和对照组术前最大尿流率（MFR）、最大逼尿肌收缩压（MPdet）、膀胱顺应性分别为27.4±4.3ml/s、44.3±9.8cm H2O、103.6±59.8ml/cm H2O和27.7±4.9ml/s、43.7±8.9cm H2O、104.9±60.9ml/cm H2O;两组术后1个月上述指标分别为20.4±3.0ml/s、29.7±5.4cm H2O、55.8±49.2ml/cm H2O和12.0±5.6ml/s、19.5±7.3cm H2O、30.1±14.7ml/cm H2O,均较术前低（P均＜0.05）;两组术后12个月上述指标分别为25.9±4.8ml/s、42.5±9.3cm H2O、96.1±56.7ml/cm H2O和19.3±3.8ml/s、30.1±7.7cm H2O、79.2±44.1ml/cm H2O,均有一定程度恢复,其中观察组恢复至术前水平（P均>0.05）,而对照组尚低于术前（P均＜0.05）。观察组和对照组术前膀胱残余尿量分别为10.2±3.8ml和8.2±4.5ml;两组术后1个月分别为86.1±10.8ml和196.9±74.2 ml,均较术前高（P均＜0.05）;两组术后12个月分别为20.2±8.6 ml和65.7±20.0 ml,均有一定程度恢复,但对照组仍高于术前（P均＜0.05）。两组术前MFR、MPdet、膀胱顺应性、膀胱残余尿量比较差异均无统计学意义（P均>0.05）。观察组术后1个月、12个月的MFR、MPdet、膀胱顺应性均高于对照组（P均＜0.05）;而膀胱残余尿量低于对照组（P均＜0.05）。［结论］ 系统保留盆腔自主神经的广泛性子宫切除术对宫颈癌患者术后尿流动力学影响相对较小,尤其是远期膀胱功能恢复方面有明显优势,可明显改善患者的生活质量。     

Ringworm in animals in a farm in Assiut

Bericht über das Auftreten von Hautmykosen bei Tieren auf der Farm der Landwirtschaftlichen Fakultät der Universität Assiut. Von 70 Kälbern waren 42 pilzkrank, davon 22 durch T. mentagrophytes, 20 durch T. verrucosum. Von 180 Kühen waren 8 pilzbefalien, sämtlich durch T. mentagrophytes. Von 2 kranken Bullen wurde T. verrucosum isoliert. Auch die 3 Pferde und 2 Maultiere der Farm waren pilzinfiziert; Erreger war in diesen Fällen T. equinum. Auch ein Kalb war von T. equinum befallen. Die gleiche Pilzart wurde ferner von 3 Tierpflegern isoliert, die Pilzherde am Hals und an den Armen aufwiesen.     

Statistical challenges in preprocessing in microarray experiments in cancer

Many clinical studies incorporate genomic experiments to investigate the potential associations between high-dimensional molecular data and clinical outcome. A critical first step in the statistical analyses of these experiments is that the molecular data are preprocessed. This article provides an overview of preprocessing methods, including summary algorithms and quality control metrics for microarrays. Some of the ramifications and effects that preprocessing methods have on the statistical results are illustrated. The discussions are centered around a microarray experiment based on lung cancer tumor samples with survival as the clinical outcome of interest. The procedures that are presented focus on the array platform used in this study. However, many of these issues are more general and are applicable to other instruments for genome-wide investigation. The discussions here will provide insight into the statistical challenges in preprocessing microarrays used in clinical studies of cancer. These challenges should not be viewed as inconsequential nuisances but rather as important issues that need to be addressed so that informed conclusions can be drawn.     

Trends in zygomycosis in children

Zygomycosis, or mucormycosis, is associated with significant morbidity and mortality in both children and adults. Studies in adults have shown an increase in the incidence of zygomycosis, particularly among haemtopoietic stem cell transplant (HSCT) recipients and patients with haematologic malignancies. There is a paucity of data on the epidemiology of zygomycosis in children. We performed a retrospective analysis to describe trends in zygomycosis between 1 January 2003 and 31 December 2010. We used the Pediatric Health Information System (PHIS) database to identify paediatric patients who were diagnosed with zygomycosis during the study period. Administrative data on diagnoses, demographics, underlying conditions and clinical experiences were collected. Summary statistics were calculated and tests for trend were conducted. We identified 156 unique patients with zygomycosis. The prevalence of zygomycosis did not significantly increase over time (P=0.284). The most common underlying condition was malignancy (58%) and over half received intensive care. Voriconazole utilisation among all hospitalised children significantly increased during the period (P=0.010). Our study demonstrates that the incidence of zygomycosis is not significantly increasing. During the time period there was a significant increase in the use of voriconazole among children.     

Dermatomycosis in Goats in India

Summary: In an extensive survey involving 2176 goats 1.56% of goats manifested clinical lesions of ringworm infection. Animals below the age of 6 months were affected most (4.20%). The incidence of infection was higher during the winter months. T. verrucosum, T. mentagrophytes and M. gypseum were isolated from the skin scrapings of 12, 4, and 2 goats respectively. It is suggested that the infected animals could be a source of disease to human population in which the zoophilic dermatophyte invasion is characterized by severe inflammatory lesions of the skin. The zoonotic importance of different dermatophytes is stressed.
Zusammenfassung: In einer ausgedehnten Untersuchung an 2176 Ziegen wurden bei 1,56% klinische Zeichen einer Hautmykose festgestellt. Tiere, die jühger als 6 Monate alt waren, zeigten mit 4,20% am häfigsten Krankheitssymptome. In den Wintermonaten war die Erkrankungshäufigkeit am gröBten. T. vermcosum, T. mentagrophytes and M. gypseum wurden jeweils von 12,4 bzw. 2 Ziegen isoliert. Die inflzierten Tiere köinnen eine Infektionsquelle für die menschliche Bevölkerung darstellen und dort Mykosen mit stark entzündlichen Veränderungen auslösen. Die Bedeutung verschiedener Dermatophyten als Erreger von Zoonosen wird hervorgehoben.     

Hemoglobin in lymphogranulomatosis in children

The peculiarities of hemoglobin content and properties in lymphogranulomatosis were studied in children by different methods. In most patients the content of fetal hemoglobin and methhemoglobin was found to increase and the rate of ferricyanide oxidation of hemoglobin also increases. Simultaneously, the rate of non-homogenicity of basic hemoglobin fractions was observed to increase on account of immunologically different components.     

Sex hormones in women in rural China and in Britain

Plasma concentrations of certain hormones linked to breast cancer risk were measured in age-pooled samples from 3,250 rural Chinese women in 65 counties, and 300 British women, all aged 35-64. In age-groups 35-44, 45-54 and 55-64 respectively, mean oestradiol concentrations were 36% (P = 0.043), 90% (P less than 0.001) and 171% (P = 0.001) higher in the British than in the Chinese women, and mean testosterone concentrations were 48% (P less than 0.001), 68% (P less than 0.001) and 53% (P = 0.001) higher in the British than in the Chinese women. The difference in testosterone concentrations between the two countries appeared to be due largely to the lower average body weight in the Chinese women. Sex hormone binding globulin did not differ significantly between the two countries in age groups 35-44 and 45-54, but was 15% (P = 0.002) lower in the British than in the Chinese women at ages 55-64. Prolactin concentrations did not differ significantly between the two countries in any age group.     

Temozolomide treatment in glioma--experiences in two university hospitals in Finland

Thirty-two patients with relapsing glioma were treated with temozolomide in two university hospitals in Finland. One patient (3%) had complete response and 9 (28%) partial response, with 8 patients (25%) showing stable disease. Median progression-free survival for these 18 patients (56%) was 7 months (range 2-11+). The remaining either had progressive disease (25%) or only clinical evaluation (19%). Karnofsky score improved in 34% of patients and decreased in 3%. Symptoms were alleviated in 44% and deteriorated in 9%. Grade 3-4 toxicity was detected in 9% of the patients. Only 4% of the days in treatment were spent in hospital. An average 1.8 neuroradiological investigations, 6.9 laboratory visits, and 5.3 visits to the oncologist were made. This study confirms that temozolomide has positive effects on the outcome of often heavily pretreated glioma patients. High drug costs are compensated by prolonged home care and even the possibility to maintain working capacity.