肺癌化疗患者疾病不确定感与心理社会适应能力的相关性研究

目的：探讨肺癌化疗患者疾病不确定感与心理社会适应的相关性。方法：采用一般资料调查表、肺癌患者疾病不确定感量表和疾病心理社会适应量表对175名化疗期的肺癌患者进行调查。结果：肺癌化疗患者的疾病不确定感总分为（82.84±13.47）分;心理社会适应能力总分为（43.21±8.52）分;两者总分及各维度之间呈负相关（r=-0.183～-0.932,P<0.05）。结论：肺癌化疗患者疾病不确定感与心理社会适应呈负相关,随着疾病不确定感水平的增加,其心理社会适应越低。护理人员应采取适当的干预方案加强对疾病的认知,降低患者的疾病不确定感水平,鼓励患者积极参加疾病治疗过程,帮助其适应角色转变,促进疾病的心理适应过程。     

不可手术切除的肝转移癌行50Gy/10f分割模式立体定向放疗疗效评估

目的：探讨立体定向放疗（stereotactic body radiotherapy，SBRT）对不可手术切除的肝转移癌患者的临床疗效。方法：回顾性分析2018年3月至2019年11月同济大学附属东方医院收治的28例肝转移癌患者的临床资料。予4D-CT或呼吸门控技术进行CT模拟定位，予肝转移病灶50Gy/10f的剂量分割模式。结果：所有患者均顺利完成全程放疗。半年和1年的总生存率（overall survival，OS）为95.0%和70.1%。1年的局部控制率（local control，LC）为92.2%。常见的不良反应为Ⅰ~Ⅱ级的恶心、纳差、腹痛等，无Ⅲ级以上的不良反应发生。结论：以50Gy/10f分割模式的立体定向放射治疗技术治疗肝转移癌安全有效。     

乳腺癌保乳手术加术中放疗32例临床观察

目的临床观察早期乳腺癌保乳手术加术中足量电子线放疗(intraoperative radiotherapy,IORT)的可行性和近期疗效。方法 2007年10月至2009年10月我科32例早期乳腺癌(肿瘤直径不超过2.5厘米)患者接受了保乳手术及术中9~12 MeV电子线照射,剂量为21 Gy。术后对切口愈合状况、并发症、乳房外观及肿瘤复发等进行临床观察,并随访至今。结果切口愈合天数为14~22天,平均17天,全组未出现术后切口感染或血肿。手术切口愈合后、术后半年、1年、2年对乳房外观评价,评价为优的分别为43.8%、51.7%、70%及80%;评价为良的分别为37.5%、31%、20%及20%;评价为一般的分别为18.8%、17.2%、10%及0.0%。仅出现照射区域的轻至中度纤维化,未出现其他放疗并发症。未发生局部复发,远处转移。结论对于低危的早期乳腺癌患者,采用术中电子线行部分乳腺照射是可行的。但病例选择标准、远期美容效果、局部肿瘤控制及远期生存率有待进一步探讨和观察。     

局部晚期非小细胞肺癌三维适形放疗同步序贯化疗的临床研究

目的 观察分析三维适形放疗同步化疗与序贯化疗治疗局部晚期非小细胞肺癌的疗效及不良反应.方法 将53例局部晚期非小细胞肺癌患者随机分为两组：同步组（27例）和序贯组（26例）.同步组采用三维适形放疗（3DCRT）联合吉西他滨和顺铂同步化疗,放疗后再予以吉西他滨及顺铂化疗2个周期;序贯组采用3DCRT结束后,予以吉西他滨和顺铂化疗4个周期.结果 同步和序贯两组有效率（PR＋CR）分别为70.4%和53.8%,两组比较差异无统计学意义（P〉0.05）;1年生存率分别为81.5%和61.5%,2年生存率分别为37.0%和26.9%,两组比较差异无统计学意义（P〉0.05）;中位生存期为17.0个月和 13.0个月,两组比较差异有统计学意义（P〈0.05）.不良反应以骨髓抑制、放射性食管炎为主,差异无统计学意义（P〉0.05）.结论 3DCRT联合吉西他滨同步化疗在近期疗效上优于序贯化疗,在不良反应上无差别.     

A Feasibility Study on the Role of Ultrasound Imaging of Bladder Volume as a Method to Improve Concordance of Bladder Filling Status on Treatment with Simulation

PurposeAccurate positioning of the prostate is of paramount importance to ensure optimal target coverage and normal tissue sparing in stereotactic ablative body radiation when large doses per fraction are delivered with tight margins around the prostate. Bladder and rectal filling play an important part in controlling the accuracy of a patient's setup and therefore the overall toxicities and outcomes. The aim of this study was to establish the value of characterizing patients' bladder filling kinetics at the time of simulation with ultrasound scans so that a predictive model can be used to ensure that a bladder volume at treatment would match at simulation.MethodsA prospective trial was conducted in unfavorable risk prostate cancer patients to evaluate the utility of ultrasound bladder monitoring. Thirty patients (n = 30) were enrolled in this study. Patients were required to void before simulation and then were given 500 mL of fluids to drink. Ultrasound measurements of the bladder were documented at 15-minute intervals for up to four measurements before simulation. On treatment, bladder volumes were measured at a single time point; typically, half an hour after the patient voided and consumed 500 mL of fluids. The kinetic model was then used to predict the optimal time to set up the patient for treatment such that the bladder volume at treatment would match the volume at simulation. Every patient had a cone beam computed tomography scan before each fraction to ensure accurate patient positioning before dose delivery. Bladder volumes at treatment were measured and compared with those at simulation on the cone beam computed tomography data sets using MIMVISTA software.ResultsOf 30 patients, 26 were analyzed. The comparison of the bladder contours at treatment compared to simulation yielded a DICE coefficient (similarity) of 0.76 ± 0.11. The largest variation in bladder size was seen in the anterior-posterior direction.ConclusionsThis study demonstrated that ultrasound monitoring of the bladder status was a valuable tool in ensuring reproducible bladder filling on treatment. The bladder kinetic model indicated the general time required to achieve optimal bladder filling was 60 minutes after voiding and drinking 500 mL of water.     

人工神经网络模型在肺癌与胃癌或肠癌中的鉴别分析

目的:应用人工神经网络技术,联合检测6种肿瘤标志对肺癌与胃癌或肠癌进行区分判别,建立肿瘤标志联合检测肺癌的辅助诊断模型。方法:采用放射免疫学、分光光度法、原子吸收分光光度法等方法,测定67例肺癌患者、47例胃癌患者和50例大肠癌患者血清中癌胚抗原(CEA)、胃泌素(gastrin)、神经元特异性烯醇化酶(NSE)、唾液酸(SA)、铜锌比值(Cu/Zn)、钙(Ca)等6项指标。建立基于人工神经网络的肺癌肿瘤标志智能诊断模型。结果:肺癌-胃癌的人工神经网络模型判别肺癌的灵敏度,特异度和准确度分别为100%、83.3%和93.5%;肺癌-肠癌模型判别肺癌的灵敏度、特异度和准确度分别为76.9%、100%和87.0%。结论:本研究成功建立基于人工神经网络技术的肿瘤标志物联合检测的人工智能诊断模型,对肺癌-胃癌、肺癌-肠癌中肺癌的鉴别诊断有助于提高肺癌的诊断率。     

Higher serum nitrate levels are associated with poor survival in lung cancer patients

OBJECTIVES: Angiogenic factors induce tumour growth and angiogenesis which leads to tumour metastasis and a poor survival rate. This study aimed to assess the possible roles of nitric oxide (NO) and vascular endothelial growth factor-A (VEGF-A) in the overall survival of patients with late stage lung cancer. DESIGN AND METHODS: The study was carried out with primary lung carcinoma patients (n=31) and healthy controls (n=15). Pre- and post-cisplatin-based chemotherapy serum nitrite/nitrate levels were measured as nitrite after enzymatic conversion followed by Griess reaction and serum VEGF-A analysis was performed using ELISA. After patient follow-up, survival rates were calculated by using the Kaplan-Meier method [Dudek et al. Cancer Invest 2005; 23(3):193-200]. RESULTS: The serum nitrite/nitrate and VEGF-A levels of lung cancer patients and the control group were 93.7+/-48.9 and 63.7+/-32.2 microM (p=0.018), and 620+/-491 and 255+/-157 pg/mL (p=0.001), respectively. High nitrite/nitrate (>67.2 microM) concentration had statistically significant effects on overall survival (Cox analysis, p=0.026). The overall survival of the lung cancer patients with higher serum nitrate concentrations was significantly less than the ones with lower serum nitrite/nitrate (Kaplan-Meier survival functions test, log rank significance=0.0007). CONCLUSION: Our results suggest that having a high serum nitrite/nitrate concentration is a strong indicator of poor survival for late stage lung cancer patients. However, this conclusion deserves to be elucidated further by using a larger sample size.     

MMC与DDP交替腔内化疗治疗肺癌并心包积液

目的:观察总结丝裂霉素(MMC)与顺铂(DDP)交替化疗治疗肺癌并心包积液的疗效及毒性反应。方法:37例肺癌并心包积液患者均在B超或彩超引导下心包腔置入中心静脉导管引流,每日少量引流并MMC与DDP交替腔内化疗(其中MMC 2mg/d、DDP 20~30 mg/d至MMC总量8~10 mg、DDP 90~100 mg)。结果:CR 25例,PR 10例,NR 2例,总有效率94.6%。治疗后发热4例,其中高热1例;胃肠道反应12例,主要为Ⅰ~Ⅱ度;骨髓抑制14例,主要为Ⅰ度。结论:心包腔闭式引流加MMC与DDP小剂量交替化疗是控制肺癌并心包积液的有效方法。     

Study of automated breast tumor extraction and diagnosis using three-dimensional ultrasonic imaging: Multivariate logistic regression analysis with multiple parameters

We are developing a new method of breast cancer screening that we call Automated Breast Cancer Diagnosis (ABCD). This system uses computerized three-dimensional (3D) imaging techniques and statistical analysis to base diagnosis on data obtained from ultrasound images. Here we use this system to investigate ten parameters and their effectiveness in determining the malignancy of tumors. Twenty-nine benign tumors and 32 malignant tumors were studied. The benign tumors comprised 8 cysts and 21 fibroadenomas; the malignant tumors were 23 ductal carcinomas, 2 special carcinomas, 1 malignant lymphoma, and 6 other types of lesions. The procedure requires the simultaneous acquisition of both the ultrasonic image data and the position and orientation of the probe for each slice. This data is transferred to a computer, where the tumor surface is determined using fuzzy reasoning and relaxation techniques. The extracted tumor image is then rendered in 3D, allowing interactive manipulation and observation. A significant distinction between benign (0.57±0.25, 2.08±0.12, 0.76±0.25) and malignant tumors (0.78±0.33, 2.22±0.16, 0.58±0.29) was obtained for all three parameters (Sz/Sxy, M-D, and Vei/V). A malignancy probability expression is calculated using multivariate logistic regression analysis in combination with the five parameters (Sz/Sxy, M-D, Vei/V, 3D-D/W, and S/Vindex). Satisfactiorily results were obtained when this method was applied to newly prepared external data that consist of three benign and two malignant tumors additional tumors.