左侧乳腺癌调强放疗中心跳对左心室肌及左前降支剂量评估的影响

目的 研究左侧乳腺癌调强放射治疗（IMRT）中,心跳对左心室肌（mLV）及左前降支（LAD）剂量评估的影响。方法 选取15例女性患者平静吸气屏气下的心电门控（ECG-gated）4D-CT图像,参照心动周期以5%间隔进行图像重建,重建0~95%共20个时相的图像。分别勾画mLV及LAD。基于0%时相的图像进行左侧乳腺癌IMRT计划设计。统计各时相mLV的体积并计算相似性指数（dice similarity coefficient,DSC）;计算LAD及mLV剂量-体积指标的变化范围。结果 mLV的DSC变化率最大可达472.07%,其平均变化率约为体积变化率的8倍。mLV的体积与DSC在最大、最小值之间差异均具有统计学意义（t=-6.585、-28.870,P<0.05）。mLV的平均剂量（D_mean）变化率最高可达41.95%。mLV的D_mean、V₁₀、V₂₀、V₃₀、V₄₀在最大、最小值之间差异均有统计学意义（t=-5.260、-4.084、-3.592、-3.273、-2.566,P<0.05）。LAD的D_mean平均变化率最高可达130.14%。LAD的D_mean、V₁₀、V₂₀、V₃₀、V₄₀在最大、最小值之间差异均有统计学意义（t=-9.758、-8.810、-8.682、-7.853、-6.205,P<0.05）。结论 左侧乳腺癌放疗中,心跳对mLV和LAD的剂量评估影响不容忽视。     

乳腺癌根治术后双弧VMAT与IMRT计划的剂量学比较

目的 比较乳腺癌根治术后双弧的容积旋转调强放射治疗(VMAT)与5野的静态调强放射治疗(IMRT)2种计划之间的剂量学差异,评估VMAT技术在乳腺癌根治术后的剂量学特点与应用能力.方法 选取28例乳腺癌根治术后患者(左侧10例,右侧18例),分别制定双90度弧段的VMAT与5野的IMRT 2种计划,主要的计划评估参数为靶区的肿瘤控制概率(TCP)、适形指数(CI)、均匀指数(HI)以及接受相应处方剂量水平照射体积百分比V₉₅、V₁₁₀,危及器官(OAR)评估包括患侧肺的正常组织并发症概率(NTCP)、D_mean、V₅、V₂₀、V₃₀,心脏的NTCP值、D_mean、V₂₅,健侧乳腺的D_mean、机器跳数(MU)以及治疗时间.结果 VMAT计划与IMRT计划的TCP值分别为(96±2)%、(90±2)%(t=-6.28,P<0.01);HI值分别为0.15±0.04,0.22±0.02(t=13.29,P<0.05);肿瘤位于左侧时,心脏NTCP值在VMAT计划与IMRT计划中分别为(1.0±0.12)%,(1.7±0.13)%(t=2.14,P<0.05);肿瘤位于右侧时,2种计划心脏的NTCP差异无统计学意义,平均剂量分别为(3.27±0.26)、(6.0±0.47)Gy(t=9.21, P<0.01);VMAT计划在MU少于IMRT计划(t=9.58,P<0.01),治疗时间短于IMRT计划(t=8.40,P<0.05).结论 乳腺癌根治术后,VMAT计划具有更强的临床应用能力,且表现出更优的剂量学特点.     

早期乳腺癌保乳术后仰卧及俯卧位调强放疗的剂量学比较

目的 比较早期乳腺癌保乳术后仰卧位与俯卧位调强治疗计划靶区和危及器官的剂量学差异.方法 选取15例接受保乳术后放疗的大乳腺及乳腺下垂的左侧乳腺癌患者,分别进行仰卧位及俯卧位CT定位扫描,利用相同优化条件分别进行切线2野调强治疗计划设计.比较2种不同体位计划的靶区剂量分布、心脏、左肺及右侧乳腺受照剂量和体积,以及机器跳数的差异.结果 俯卧位调强计划适形度指数(CI)优于仰卧位计划(0.79±0.05 vs. 0.72±0.04,W=138,P<0.01),均匀性指数(HI)也优于仰卧位计划(1.09±0.01 vs. 1.12±0.02,t=-4.7,P<0.01).俯卧位计划靶区接受95%处方剂量照射的百分体积(V_95%)、最小剂量(D_min)大于仰卧位计划(t=7.1、6.4,P<0.01),平均剂量(D_mean)大于仰卧位计划(W=153,P<0.01),最大剂量(D_max)小于仰卧位计划(t=-3.6,P<0.01).仰卧位计划的右乳接受5 Gy照射的百分体积(V₅)小于俯卧位计划(W=160,P<0.01),心脏接受30 Gy照射的百分体积(V₃₀)大于俯卧位计划(t=5.4,P<0.01),心脏平均剂量(D_mean)、左肺接受20和5 Gy照射的百分体积(V₂₀、V₅)明显大于俯卧位计划(W=133、120、120,P<0.01).机器跳数间差异无统计学意义.结论 对于大乳腺及乳腺下垂乳腺癌患者,保乳术后俯卧位调强计划与仰卧位调强计划相比,靶区剂量分布更均匀,心、肺受照射剂量和体积明显减少.     

切向双弧容积弧形调强技术对保乳术后包括内乳淋巴结区照射的心脏剂量学评价

目的 通过对左侧乳腺癌保乳术后患者内乳淋巴结局部放疗,探讨一种新的切向50°双弧容积弧形调强放射治疗（tangential volumetric modulated arc therapy,T-VMAT）技术的剂量学特点,评价T-VMAT对心脏的潜在保护作用。方法 15例左侧乳腺癌保乳术后患者,每例患者分别设计常规加楔形板切线野（W-TF）、6野调强适形放射治疗（6F-IMRT）和T-VMAT计划,靶区处方剂量50 Gy/25次,计算并比较靶区和危及器官（OAR）的剂量体积参数和适形指标。结果 与W-TF相比,T-VMAT技术不仅可降低心脏和冠状动脉前降支（LAD）最大剂量D_max、平均剂量D_mean和≥ 10 Gy剂量区体积（P<0.05）,而且有降低5 Gy剂量区体积V_{5 Gy}趋势,但差异无统计学意义（P>0.05）;与6F-IMRT相比,T-VMAT技术可明显降低心脏的D_mean、V_{5 Gy}、V_{10 Gy}和V_{20 Gy},以及LAD的D_mean、V_{5 Gy}和V_{10 Gy}（P<0.05）。与W-TF相比,T-VMAT计划中同侧肺V_{20 Gy}和健侧乳腺V_{5 Gy}均未增加,差异无统计学意义（P>0.05）,且靶区剂量覆盖和适形度均明显优于W-TF,热点体积V₁₁₀明显低于W-TF（P<0.05）。结论 在不增加同侧肺和健侧乳腺受照体积的同时,T-VMAT不仅可以降低心脏和LAD高剂量区受照体积,而且有降低心脏和LAD低剂量区受照体积的趋势。     

乳腺癌保乳术后部分乳腺三种放疗计划的剂量学比较

目的 比较容积弧形调强（VMAT）、固定野动态调强（IMRT）及三维适形放疗（3D-CRT）技术对乳腺癌保乳术后采用部分乳腺放疗的剂量学差异。方法 选取20例临床分期为T_1-2N₀M₀的早期乳腺癌保乳术后患者进行VMAT,并同时设计IMRT及3D-CRT,比较3种计划的剂量学参数,包括剂量-体积直方图（DVH）、靶区剂量适形度、靶区及危及器官的剂量、机器跳数及治疗时间。结果 IMRT及VMAT计划靶区剂量分布优于3D-CRT计划,其中最大剂量,平均剂量及适形指数（CI）组间比较差异具有统计学意义（F=14.86、8.57、18.23,P<0.05）。正常组织受量：VMAT计划在患侧乳腺V₅上优于IMRT及3D-CRT计划（F=5.83,P<0.05）;IMRT在患侧肺V₂₀、V₅及D₅上有优势（F=16.39、3.62、4.81,P<0.05）;在对侧肺的统计中,IMRT计划在最大剂量及D₅上可以得到比VMAT和3D-CRT更低的剂量（F=3.99、3.43,P<0.05）;VMAT、3D-CRT和IMRT计划所需机器跳数值分别为621.0±111.9、707.3±130.9、1161.4±315.6,计划间的差异有统计学意义（F=31.30,P<0.05）。VMAT、3D-CRT和IMRT计划所需治疗时间分别为（1.5±0.2）、（7.0±1.6）、（11.5±1.9）min。结论 IMRT和VMAT计划靶区剂量分布优于3D-CRT计划,而不提高患侧肺剂量。对于部分乳腺癌的放疗,容积弧形调强放疗在降低机器跳数和减少治疗时间方面具有明显优势。     

水平射野对肺癌调强计划结果的影响研究

目的 探讨水平方向射野对肺癌调强计划结果的影响.方法 收集肺癌患者18例,其中左肺癌患者10例,右肺癌患者8例,设计普通调强(IMRT计划)和在普通调强基础上添加一个水平方向射野(H-IMRT计划)的计划,比较机器跳数、子野数及靶区和危及器官(OARs)的剂量分布.结果 两种计划PTV的D_max、D_min及D_mean,患侧肺的V₃₀和D_mean,健侧肺的V₂₀ 和V₃₀,全肺的V₃₀差异均无统计学意义.与IMRT计划相比,添加水平射野后,PTV的均匀性(HI)及适形度(CI)都有显著提高(t=-9.33、10.88,P<0.05);肺的其他剂量指标均变差(t=-1.55~-7.58,P<0.05);心脏的保护更优(t=1.84~3.99,P<0.05);MUs及子野数量降低(t=12.57、3.19,P<0.05).结论 在肺癌的IMRT治疗中,添加水平射野可以改善靶区的剂量分布,但会使肺的低剂量照射体积增加,无益于肺的保护.     

乳腺癌根治术后调强放疗的一体化射野设计

目的 比较一种一体化调强射野设计方式与常规射野设计方法在乳腺癌根治术后调强放疗中的剂量学差异。方法 选取41例左侧乳腺癌根治术后患者的CT图像,进行胸壁、部分腋窝、锁骨上、内乳等靶区及危及器官（OAR）勾画。对每一套CT图像分别制作一体化射野设计的调强计划和常规调强计划。评估两种计划靶区和OAR剂量学分布。结果 两种计划靶区剂量分布和OAR受照剂量均满足临床要求,靶区剂量学参数差异无统计学意义（P>0.05）。一体化调强计划相比于常规计划：患侧肺V₅降低9.7%（t=2.407,P<0.05）、V₁₀降低11.2%（t=2.160,P<0.05）、V₂₀降低17.3%（t=2.465,P<0.05）、V₃₀降低13.4%（t=2.119,P<0.05）、D_mean降低13.8%（t=2.258,P<0.05）;心脏V₃₀下降28.4%（t=2.589,P<0.05）、D_mean下降23.2%（t=2.409,P<0.05）;其他OAR剂量学差异不具有统计学意义（P>0.05）。结论 一体化调强射野设计技术显著降低了患侧肺和心脏的受照体积与受照剂量,有望减轻乳腺癌根治术后放疗的不良反应。新型设计方案选取了较多的样本,包含不同分期的左乳癌根治术患者,对乳腺癌根治术后调强放疗临床应用具有普遍性,可以作为一种新的照射方式推广。     

基于Pinnacle3自动化计划设计模块在直肠癌调强放疗的应用研究

目的 通过比较自动化计划设计（Auto-Planning,AP）和调强放疗（IMRT）在直肠癌调强计划设计中的靶区和危及器官的剂量学差异,探讨AP在直肠癌计划设计中的优势。方法 选取10例直肠癌术后放疗病例,用Pinnacle³9.10计划系统基于同一CT图像进行IMRT和AP计划设计,比较两种不同计划的剂量体积直方图,分析靶区适形度指数（CI）、均匀性指数（HI）和危及器官受照剂量的差异。结果 AP计划中,靶区D_mean和D_min略有增加,D_maxcGy略有减小,差异有统计学意义（t=-1.36、-3.03、0.37,P<0.05）。D₂、D₉₅、D₉₈差异均无统计学意义（P>0.05）。AP计划中靶区的HI值有所降低,CI值有所提高,差异有统计学意义（t=1.24、0.10,P<0.05）。危及器官中膀胱V₄₀、V₅₀,小肠的 V₃₀、V₄₅、V₅₀,左右股骨头V₃₀、V₄₀,在AP计划与IMRT计划比较中差异有统计学意义（t=-3.21~1.02,P<0.05）。膀胱V₃₀、V₄₅,小肠V₄₀及左右股骨头V₄₅受照剂量体积均略低于IMRT计划,但差异无统计学意义（P>0.05）。结论 直肠癌AP计划能够达到比IMRT计划更好的靶区适形度,能有效降低靶区最高剂量,增加靶区最低剂量,减少热点和冷点,同时降低危及器官受照剂量,更好的保护正常组织。     

中心型肺癌快速旋转调强与固定射野动态调强放疗的剂量学比较

目的 比较快速旋转调强(RapidArc)与固定射野动态调强(dIMRT)两种调强放疗技术在中心型肺癌治疗计划中的剂量学差异。方法 利用瓦里安(Varian)计划系统(Eclipse 8.6)随机选取10例已行dIMRT治疗的中心型肺癌患者,采用容积调强(volumetric modulated arc therapy,VMAT)治疗技术设计RapidArc调强放疗计划。在满足靶区处方剂量要求(95%体积的PTV达到66 Gy)的情况下,通过剂量体积直方图DVH评价和比较两种类型治疗计划的PTV最大剂量 D_max、最小剂量 D _min和平均剂量 D_mean以及适形指数CI,危及器官的脊髓最大剂量 D _max,双肺的 V₅、V ₁₀、 V₂₀、 V₃₀,心脏 V₃₀,食管 V₅₀、V₆₀和平均剂量 D_mean,并比较两种治疗计划的总机器跳数(MU)和治疗时间。结果 在中心型肺癌治疗计划中,与dIMRT相比较,RapidArc靶区的 D _max、 D_min和 D_mean略有升高,但统计学差异无意义( P >0.05), 适形指数CI优于dIMRT,且差异具有统计学意义(t=-4.968,P=0.001)。双肺的 V₅、V₁₀有所上升, V₂₀、 V₃₀有所下降;心脏 V₃₀受照射体积也有不同程度降低,差异均具有统计学意义。RapidArc总MU减少32%,治疗时间为dIMRT的1/3。结论 两种治疗技术所设计的治疗计划剂量分布均能满足临床治疗需要。RapidArc靶区适形度更高,实际治疗时间明显缩短,同时MU的降低减少了治疗区域正常组织的不必要照射。     

左侧乳腺癌保乳术后ABC与Catalyst呼吸门控系统动态调强放疗的剂量学分析

目的 对比自主呼吸门控系统(ABC)和Catalyst呼吸门控系统在左侧乳腺癌保乳术后的剂量学差异。方法 回顾性选取深圳市人民医院放疗科2020年11月至2021年8月收治的左侧乳腺癌保乳术后女性患者48例,分成ABC和Catalyst组,设计动态调强放疗(IMRT)计划。分析2组计划的靶区和危及器官的剂量学差异。结果 2组呼吸门控IMRT计划在胸壁靶区的D_90%、D_98%、D_max、D_mean、适形指数、均匀性指数及机器跳数方面差异无统计学意义(P＞0.05)。2种呼吸门控深吸气屏气(DIBH)模式IMRT计划在患侧肺、心脏方面差异无统计学意义(P＞0.05)。ABC组和Catalyst组冠状动脉左前降支D_mean、D_max、D_2%依次为(1 047.72±1 401.84)vs.(454.48±206.26)、(1 619.28±809.05)vs.(1 068.53±419.63)、(1 405.85±798.30)vs.(1 016.54±592.00) cGy,Catalyst优于ABC呼吸门控组,差异有统计学意义(t=-2.07、-3.18、-2.07,P＜0.05)。结论 ABC和Catalyst呼吸门控系统均满足临床治疗要求,Catalyst较ABC呼吸门控可进一步降低冠状动脉左前降支受照射剂量。     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

Developmental validation of the PowerPlex(®) ESI 16 and PowerPlex(®) ESI 17 Systems: STR multiplexes for the new European standard

In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega^® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex^® ESI 16 (European Standard Investigator 16) and the PowerPlex^® ESI 17 Systems. The PowerPlex^® ESI 16 System combines the 11 loci compatible with the UK National DNA Database^®, contained within the AmpFlSTR^® SGM Plus^® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR^® SGM Plus^® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex^® ESI 17 System amplifies the same loci as the PowerPlex^® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR^® SGM Plus^® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex^® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.     

Bronchial stump fistula :treatment with covered retrievable hinged metallic stents-preliminary clinical experience

Objective To evaluate the preliminaily clinical efficacy and retrievability of a retrievable hinged covered metallic stent in the treatment of the bronchial stump fistula （BSF）. Methods Between April 2003 and March 2005, 8 patients with bronchial stump fistula after pneumonectomy or lobectomy were treated with two types （A and B） of retrievable hinged covered metallic stents. Type A stent was placed in 6 patients and type B in 2 under fluoroscopic guidance. The stent was removed with a retrieval set when BSF was healed or complications occurred. Results Stent placement in the bronchial tree was technically successful in all patients, without procedure-related complications. Immediate closure of the BSF was achieved in all patients after the procedure. Stents were removed from all patients but one. Removal of the stents was difficult in two patients due to tissue hyperplasia. Patients were followed up for 6 - 21 months. Placement of the stents remained stable in all patients except one due to severe cough. Permanent closure of BSF was achieved in 7 （87.5%） of 8 patients. Conclusion Use of a retrievable hinged covered expandable metallic stent is a simple, safe, and effective procedure for closure of the BSF. Retrieval of the stent seems to be feasible. （J Intervent Radiol, 2007, 16： 253-257）     

Prevalence and severity of hip and groin pain in sub‐elite male football: a cross‐sectional cohort study of 695 players

The purpose of this study was twofold: (a) to investigate the prevalence of hip and groin pain in sub‐elite male adult football in Denmark and (b) to explore the association between prevalence and duration of hip and groin pain in the previous season with the Copenhagen Hip and Groin Outcome Score (HAGOS) in the beginning of the new season. In total 695 respondents from 40 teams (Division 1–4) were included. Players completed in the beginning of the new season (July–Sept 2011) a self‐reported paper questionnaire on hip and/or groin pain during the previous season and HAGOS. In total 49% (95% CI: 45–52%) reported hip and/or groin pain during the previous season. Of these, 31% (95% CI: 26–36%) reported pain for >6 weeks. Players with the longest duration of pain during the previous season had the lowest HAGOS scores, when assessed at the beginning of the new season, P < 0.001. This study documents that half of sub‐elite male adult football players report pain in the hip and/or groin during a football season. The football players with the longest duration of pain in previous season displayed the lowest HAGOS scores in the beginning of the new season.