腹部肿瘤适形放疗的标记探讨

目的通过对CT-sim定位病例的分析,找出常规皮肤标记法中存在的摆位偏差,找到解决方法,提高摆位的准确性和重复性。方法在TOPSLANE定位系统下,在病人的身上做三角式三点纹身标记,选定扫描参考层,沿横断面拉CT片。与常规标记法(两点或四点)的CT片对比分析所获得的影像结果。结果20例病例中,用常规标记法,定位摆位和复位摆位两个过程之间的重复性偏差在3mm-10mm之间;而用新方法的重复性偏差≤3mm。结论使用标记方法是否得当至关重要,探讨新方法可以获得非常好的复位重复性。     

Intensity-modulated irradiation for superficial tumors by overlapping irradiation fields using intensity modulators in accelerator-based BNCT

The distribution of the thermal neutron flux has a significant impact on the treatment efficacy. We developed an irradiation method of overlapping irradiation fields using intensity modulators for the treatment of superficial tumors with the aim of expanding the indications for accelerator-based boron neutron capture therapy (BNCT). The shape of the intensity modulator was determined and Monte Carlo simulations were carried out to determine the uniformity of the resulting thermal neutron flux distribution. The intensity modulators were then fabricated and irradiation tests were conducted, which resulted in the formation of a uniform thermal neutron flux distribution. Finally, an evaluation of the tumor dose distribution showed that when two irradiation fields overlapped, the minimum tumor dose was 27.4 Gy-eq, which was higher than the tumor control dose of 20 Gy-eq. Furthermore, it was found that the uniformity of the treatment was improved 47% as compared to the treatment that uses a single irradiation field. This clearly demonstrates the effectiveness of this technique and the possibility of expanding the indications to superficially located tumors.     

辐射灭菌法对生肌膏临床疗效影响的评价

目的观察60 Co-γ辐射灭菌法对生肌膏临床疗效的影响,以提高创面修复质量。方法选择2013年3月-2014年3月医院收治的符合纳入标准患者进行随机对照研究,治疗组33例患者应用灭菌生肌膏,对照组32例患者应用普通生肌膏;两组患者分别于入组后的第0、3、6、9、12、15天观察伤口愈合情况,并对创面形态、创面肉芽、创面分泌物、创面pH值和分泌物细菌培养及创面周围肿胀程度、疼痛程度、皮肤温度等进行评分并记录,最后进行统计评价。结果在治疗第15天后两组患者总有效率均为100.0%;在伤口愈合率、肉芽生长、创面pH、水肿评分、疼痛评分、皮肤温度等疗效相当;第9天比较两组对感染的治疗与控制疗效相当,但是创面形态修复对照组比治疗组早3d发生明显改变;对照组脓液增加明显,第9天有显著增加(P=0.030),治疗组脓液变化不明显。结论采用60 Co-γ射线辐射灭菌的方法对生肌膏进行灭菌处理后,对生肌膏的总体临床疗效影响较低,而且未经过灭菌处理的生肌膏也未见有加重创面感染的现象。     

新辅助内分泌治疗绝经后乳腺癌的临床疗效观察

目的 观察和探讨新辅助内分泌治疗绝经后乳腺癌的临床疗效和应用价值.方法 对56例绝经后乳腺癌患者应用新辅助内分泌治疗,疗效达CR（完全缓解）、PR（部分缓解）或SD（稳定）则继续进行治疗,直至病情出现PD（进展）或主动提出终止内分泌治疗,再给予手术治疗.结果 所有患者中CR 6例,PR 29例,总有效率（CR＋PR）为62.5%;不同受体阳性患者中,以ER、PR双阳性疗效最好,有效率为78.38%.结论 新辅助内分泌治疗用于治疗绝经后激素受体阳性的乳腺癌患者有明显疗效,副作用小,具有在临床上推广的价值.     

评价药物联合治疗小儿腹泻的临床效果

目的评价药物联合治疗小儿腹泻的临床效果。方法采用回顾性方法分析,选取我院住院及门诊自2013年4月—2014年4月一年以来收治的118例腹泻患儿的临床资料,根据用药途径分为两组,每组各59例,对照组患儿给予蒙脱石散治疗,观察组在此基础上给予双岐三联活菌片,比较两组患儿的临床疗效及各项生理指标。结果观察组患儿的临床总有效率为91.53%（54/59）明显高于对照组患儿临床总有效率52.54%（31/59）,其差异具有统计学意义（P〈0.05）;观察组患者止泻时间（1.01±0.23）d、大便恢复时间（2.13±0.36）d均低于对照组患者（2.12±0.31）、（4.12±1.20）d,且止痛时间及退烧时间也短于对照组患儿,其差异具有统计学意义（P〈0.05）。观察组患儿的止痛时间、止泻时间、退烧时间及大便恢复时间均短于对照组患儿。结论小儿腹泻应用蒙脱石散联合双岐三联活菌片治疗可取得显著疗效,具有较高安全性,且不良反应少,临床症状消失快,值得临床推广应用。     

中医治疗乳腺囊性增生病的临床治疗效果

目的探讨和分析中医治疗乳腺囊性增生病的临证治疗效果。方法对我院近5个月接收的222例乳腺囊性增生病患者进行随机抽取,从中选取84例患者进行临床研究,对他们进行中医治疗,主要的治疗方法是采用中医的内外合治法进行治疗,观察其治疗效果。结果经过几个月的中医治疗后,84例患者中,有60例患者痊愈,20例患者好转,4例患者未愈。中医治疗的总有效率高达95.23%。而无效率仅有4.77%。而84例患者中有76例患者对中医的内外合治法比较满意,满意度为90.4%。结论在临床上,乳腺囊性增生病是一种常见疾病,严重的会影响患者的日常生活,通常情况下,对于乳腺囊性增生病患者采用中医进行治疗,不仅效果显著,还能去除病根,对患者没有更多的副作用,值得在临床上大力的推广。     

宫颈癌调强放疗骨盆受照射剂量与骨髓抑制的临床研究

目的 研究宫颈癌调强放疗时骨盆受照射剂量、体积与急性骨髓抑制的相关性,探讨放射治疗中骨盆骨髓保护的必要性,降低急性骨髓抑制发生率,提高患者的生活质量。方法 选取在徐州医科大学附属医院放射治疗科行盆腔调强放疗的80例宫颈癌患者,根据有无发生≥2级急性骨髓抑制,分为急性骨髓抑制组(试验组)40例、无骨髓抑制组(对照组)40倒。比较2组间骨盆剂量体积参数(Dmax、Dmean、V5、V10、V15、V20、V30、V40、V50)与≥2级急性骨髓抑制的相关性。结果 急性骨髓抑制组骨盆Dmax、Dmean、V5、V10、V15、V20、V30、V40高于无骨髓抑制组,2组间Dmean、V5、V10、V15、V20差异有统计学意义(t分别=2.365、2.157、2.127、2.251、4.800,P<0.05)。结论 盆体外照射时急性骨髓抑制与骨盆受照射剂量、体积有关,骨盆对放射线较敏感,应注意保护。     

第二代双源CT的Flash序列在肋骨外伤检查中的应用价值

目的：探讨第二代双源CT的Flash序列在肋骨外伤检查中的应用。方法对28例肋骨外伤患者分别使用常规螺旋序列扫描和二代双源Flash序列扫描,比较两种扫描方法的图像质量及辐射剂量。结果常规螺旋序列扫描图像的优良率明显低于Flash序列扫描图像。Flash序列扫描的管电流、CT容积剂量指数、剂量长度乘积、有效剂量、扫描时间均低于常规螺旋扫描,差异具有统计学意义（P＜0.05）。结论Flash序列扫描具有辐射剂量低、扫描时间短、图像质量高等特点,优于常规螺旋序列扫描,值得推广。     

Evaluation of imaging performance of megavoltage cone-beam CT over an extended period

A linear accelerator vendor and the AAPM TG-142 report propose that quality assurance testing for image-guided devices such megavoltage cone-beam CT (MV-CBCT) be conducted on a monthly basis. In clinical settings, however, unpredictable errors such as image artifacts can occur even when quality assurance results performed at this frequency are within tolerance limits. Here, we evaluated the imaging performance of MV-CBCT on a weekly basis for ∼ 1 year using a Siemens ONCOR machine with a 6-MV X-ray and an image-quality phantom. Image acquisition was undertaken using 15 monitor units. Geometric distortion was evaluated with beads evenly distributed in the phantom, and the results were compared with the expected position in three dimensions. Image-quality characteristics of the system were measured and assessed qualitatively and quantitatively, including image noise and uniformity, low-contrast resolution, high-contrast resolution and spatial resolution. All evaluations were performed 100 times each. For geometric distortion, deviation between the measured and expected values was within the tolerance limit of 2 mm. However, a subtle systematic error was found which meant that the phantom was rotated slightly in a clockwise manner, possibly due to geometry calibration of the MV-CBCT system. Regarding image noise and uniformity, two incidents over tolerance occurred in 100 measurements. This phenomenon disappeared after dose calibration of beam output for MV-CBCT. In contrast, all results for low-contrast resolution, high-contrast resolution and spatial resolution were within their respective tolerances.     

乳腺癌PICC化疗患者CDSMP实施效果评价

目的:评价乳腺癌经外周静脉置入中心静脉导管(PICC)化疗患者CDSMP(慢性病自我管理健康教育项目)实施后的效果。方法:采用历史性对照试验研究设计,将2010年11月～2011年10月88例乳腺癌PICC化疗患者实施CDSMP作为干预组,将2010年2～11月90例乳腺癌PICC化疗患者作为对照组,比较两组患者化疗结束后PICC拔管前疾病自我管理行为、PICC自我管理能力、自我效能、健康状况和并发症发生率等方面的变化。结果:与对照组比较,干预组在健康状况的7个方面(整体健康自评、健康担忧、精力指标、疲劳、气短、疼痛、PICC对患者生活影响)明显好于对照组(P均<0.05),干预组在自我管理行为方面、PICC导管自我管理能力方面明显提高,机械性静脉炎、导管堵塞、管腔回血、导管感染、导管脱出等并发症发生率明显低于对照组(P均<0.05)。结论:CDSMP可改善乳腺癌PICC化疗患者的健康状况、自我管理行为、PICC导管自我管理能力、自我效能,可降低机械性静脉炎等并发症的发生率。     

经导管肝动脉化疗栓塞联合立体定向放射治疗对不可切除原发性肝癌的疗效分析

目的:分析经导管肝动脉化疗栓塞(TACE)联合立体定向放射治疗(SRT)治疗不可切除原发性肝癌的疗效及不良反应.方法:选取56例不可切除肝癌患者,根据治疗方法的不同将其分为TACE联合SRT组(联合组,32例)和单纯TACE组(单纯组,24例),联合组采用TACE联合SRT方法,单纯组采用单纯TACE治疗方法.依据实体...     

A surveillance study of intensity-modulated radiation therapy for postoperative cervical cancer in Japan

Intensity-modulated radiation therapy (IMRT) was recently introduced to the field of gynecologic malignancies; however, its value is not yet validated. A clinical trial is in preparation to investigate the efficacy and feasibility of IMRT for postoperative cervical cancer. The object of this study was to perform a surveillance study of IMRT for post-operative cervical cancer. A questionnaire regarding the precise methods of conducting IMRT was sent to six institutions that had already introduced IMRT for post-operative cervical cancer, and the data were analyzed. Half of the institutions used static IMRT and the others used volumetric-modulated arc therapy (VMAT). Most institutions used body-immobilizing devices for patient fixation. Most institutions instructed patients to fill their bladder before undergoing planning CT or daily treatment. While one institution inserted metallic markers and another one used radio-contrast–soaked gauze to visualize the vaginal cuff, the other institutions used nothing for vaginal cuff visualization. Most institutions defined the clinical target volumes according to the Japan Clinical Oncology Group or the Radiation Therapy Oncology Group guidelines. Only one institution used a prescribed dose based on 95% of the PTV (D₉₅), while the rest used the mean dose (D_mean). This valuable information from six leading institutions will be utilized in a future prospective clinical trial.     

Evaluation of delayed effects of ionizing radiation: an historical perspective.

It is widely assumed that after the bombing of Hiroshima and Nagasaki there were no lasting effects of the acute injuries (which included extensive damage to blood forming tissues by the radiation) or the massively high death rate (which was caused by environmental effects of the blast as well as personal injuries). However, close inspection of the dose response curves for non-cancer deaths has shown that this could be a false impression caused by one effect of marrow aplasia being confused with leukemia (defective erythropoiesis) and a second effect being confused with early selection in favor of general fitness (defective immune responses). Possible consequences of such confusion (for cancer risk coefficients) are discussed in relation to what is known about late effects of prenatal x-rays and occupational exposures to radiation.     

一次性内镜床旁预处理盒在胃肠镜清洗过程中的应用效果评价: 一项单中心观察性研究

 目的 研究在内镜床旁预处理环节使用一次性内镜床旁预处理盒对内镜的清洗效果, 以及清洗阶段清洗槽内清洗液用量, 为提高内镜清洗质量, 降低临床成本探索可行措施。方法 选取112条使用后的胃肠镜随机分为A、B两组, 在预处理阶段, A组使用传统预处理桶, B组使用一次性内镜床旁预处理盒, 在清洗阶段每组再分为2小组, 即A1、A2、B1、B2共4组, A1、B1组清洗槽内清洗液多用一更换, A2、B2组清洗槽内清洗液一用一更换。采用三磷酸腺苷(ATP)生物荧光法和NICE CHECK残留蛋白检测法检测床旁预处理前后和清洗后内镜管腔内面相对光单位值(RLU) 和蛋白残留量, 比较各组的清洗效果。结果 预处理前ATP检测值和蛋白质残留量均值A组与B组比较, 差异均无统计学意义(均P＞0.05);预处理后B组ATP检测值低于A组(P＜0.05), 蛋白残留量B组与A组比较差异无统计学意义(P＞0.05)。清洗后, B1、B2组ATP检测值均比A1、A2组低(均P＜0.05), 而A1组与A2组、B1组与B2组ATP检测值比较, 差异均无统计学意义(均P＞0.05);四组蛋白残留量比较, 差异均无统计学意义(均P＞0.05)。结论 使用一次性内镜床旁预处理盒进行预处理, 并在手工清洗阶段采取清洗槽内清洗液多用一更换模式, 是综合临床成本及清洗效果的最优选择。     

Application of an ultraminiature thermal neutron monitor for irradiation field study of accelerator-based neutron capture therapy

Phantom experiments to evaluate thermal neutron flux distribution were performed using the Scintillator with Optical Fiber (SOF) detector, which was developed as a thermal neutron monitor during boron neutron capture therapy (BNCT) irradiation. Compared with the gold wire activation method and Monte Carlo N-particle (MCNP) calculations, it was confirmed that the SOF detector is capable of measuring thermal neutron flux as low as 10⁵ n/cm²/s with sufficient accuracy. The SOF detector will be useful for phantom experiments with BNCT neutron fields from low-current accelerator-based neutron sources.     

白芍总皂苷对大鼠子宫内膜异位症治疗作用的实验研究

目的:观察白芍总皂苷对大鼠子宫内膜异位症模型的影响,为寻找和开发治疗子宫内膜异位症的创新药物提供科学依据.方法:制备大鼠子宫内膜异位症模型,连续灌胃给药4周,于电子显微镜下观察异位子宫内膜形态,计算异位病灶体积,采用放射性免疫法测定血清中雌二醇(E2)、孕酮(P)、黄体生成素(LH)及卵泡刺激素(FSH)含量,同时做病理组织学检查.结果:白芍总皂苷能明显改善移植子宫内膜的病灶组织形态,缩小病灶体积,加速病灶组织萎缩和坏死,显著降低子宫内膜异位症大鼠血清中E2、P及LH水平.结论:白芍总皂苷对大鼠子宫内膜异位症具有明显的治疗作用,其作用机制可能与其作用于垂体-卵巢性腺轴,通过抑制垂体分泌LH及FSH进而抑制卵巢分泌E2和P,使异位病灶萎缩变小有关.     

Dosimetric effect of set-up error in accelerator-based boron neutron capture therapy for head and neck cancer

The dosimetric effect of set-up error in boron neutron capture therapy (BNCT) for head and neck cancer remains unclear. In this study, we analyzed the tendency of dose error by treatment location when simulating the set-up error of patients. We also determined the tolerance level of the set-up error in BNCT for head and neck cancer. As a method, the distal direction was shifted with an interval of 2.5 mm, from 0.0 mm to +20.0 mm and compared with the dose at the reference position. Similarly, the horizontal direction and vertical direction were shifted, with an interval of 5.0 mm, from −20.0 mm to +20.0 mm. In addition, cases with 3.0 mm and 5.0 mm simultaneous shifts in all directions were analyzed as the worst-case scenario. The dose metrics of the minimum dose of the tumor and the maximum dose of the mucosa were evaluated. From unidirectional set-up error analysis, in most cases, the set-up errors with dose errors within ±5% were Δdistal < +2.5 mm, Δhorizontal < ±5.0 mm and Δvertical < ±5.0 mm. In the simulation of 3.0 mm shifts in all directions, the errors in the minimum tumor dose and maximum mucosal dose were −3.6% ±1.4% (range, −5.4% to −0.6%) and 2% ±1.4% (range, 0.4% to 4.5%), respectively. From these results, if the set-up error was within ±3.0 mm in each direction, the dose errors of the tumor and mucosa could be suppressed within approximately ±5%, which is suggested as a tolerance level.     

前列腺癌调强放疗重复CT模拟定位的作用

目的:探讨前列腺癌调强放疗重复CT模拟定位的作用。方法:前列腺癌调强放疗首次CT模拟定位后行CT扫描,在模拟定位工作站确定靶体积中心(等中心)做体表标记。于放射治疗4周左右进行重复CT模拟定位,扫描前用激光灯核对原等中心标记,记录等中心数值后进行CT扫描。在模拟定位工作站录入记录的原等中心数值传输至治疗计划系统,与首次CT模拟定位的图像融合后进行对比分析。结果:首次CT与重复CT图像融合后测量靶区位移的平均误差左右(RL)方向为1.9mm;头脚(SI)方向为2.8mm;前后(AP)方向为3.1mm。危及器官膀胱和直肠的最大剂量分别增加0.5～3.7Gy、0.9～5.0Gy;平均剂量分别增加0.7～4.9Gy、0.6～5.4Gy;最小剂量分别增加0.3～1.3Gy、0.6～2.8Gy。结论:前列腺癌调强放疗重复CT模拟定位便于对比分析靶区和危及器官的位移和对剂量的影响,为及时调整治疗计划提供依据。