三维适形放射治疗中晚期宫颈癌临床分析

目的 评价三维适形放疗在治疗中晚期宫颈癌中的临床疗效.方法 治疗组40例中晚期宫颈癌接受三维适形放疗,对照组40例接受腔内后装放射治疗.所有患者前5周均接受全盆腔外照射剂量5 000 cGy及同步化疗.结果 治疗组CR 77.5%,PR 10.0%,有效率87.5%;对照组CR 32.5%,PR 40.0%,有效率72.5%,治疗组明显高于对照组(P＜0.05).结论 全盆腔外照射后三维适形放疗,能提高中晚期宫颈癌的局部控制率,对直肠、膀胱受照量的降低也具有优势,可提高肿瘤区域的剂量,提高肿瘤控制率而不会增加正常组织的毒性反应.     

肿瘤的放射治疗

所谓放射治疗是利用放射源对肿瘤组织进行照射治疗,俗称“照光”。临床上常用的有:钴~(60)、加速器、后装、同位素等。许多肿瘤除了外照射以外,还需要内照射的补充治疗,一般来说,单一的放射治疗效果均不够理想。钴~(60)治疗机其放射源为人工放射性同位素钴~(60),射线性质为γ线,平均能量为1.2Mev,具有穿透力强,皮肤剂量小,并和软组织有     

瓦里安Acuity模拟定位机故障维修二例

<正>模拟定位机最早于20世纪60年代末被应用于放射治疗。近年来,随着计算机技术和医学影像技术的快速发展,三维适形放射治疗、调强放射治疗(intensity modulated radiotherapy,IMRT)已经成为肿瘤放射治疗的主流^[1-2],由于IMRT治疗计划的剂量分布特点是靶区内高剂量分布均匀,而靶区边缘的剂量梯度差衰减更快^[3],这就对放射治疗摆位的位置精确性提出了更高的要求。而模拟定位机的作用是把X线诊断部件和具有外照射治疗机相关运动功能的机械部件组合在一起,以确保模拟定位体位与治疗体位的一致性^[4],     

专题论坛一-数字影像技术和精确放射治疗：调强放射治疗的临床应用

适形调强放射治疗(Intensity Modulated Radiation Therapy，IMRT)是近十年在三维适形放射治疗的基础上发展起来的一种崭新的放射技术，IMRT的设计主要致力于受常规放疗的限制部分、同时又要对肿瘤组织的照射不能限制，理论上讲、如果肿瘤能作放射治疗、那么IMRT将对许多肿瘤的治疗都会产生深远的影响，它可以根据肿瘤的形状给予致死剂量的照射，而对肿瘤邻近的正常组织器官接受较低的剂量照射。     

碘-125籽源组织间照射患者和周围人员受照剂量的测量和估算

目的 测量碘-125籽源植入人体模型后患者和周围人员的受照剂量。方法 模拟前列腺癌治疗,用FD3101γ剂量仪测量体表、离体表30 cm和100 cm处的外照射剂量率,用LiF TLD探测器测量体模内各主要器官的剂量当量。结果 患者体表剂量与各主要器官剂量当量都较低。结论 碘-125籽源组织间放射治疗对患者和周围人员都是一种较安全的肿瘤治疗方法。     

调强放射治疗的临床应用

适形调强放射治疗(Intensity Modulated RadiationTherapy,IMRT)是近十年在三维适形放射治疗的基础上发展起来的一种崭新的放射技术,IMRT的设计主要致力于受常规放疗的限制部分,同时又要对肿瘤组织的照射不能限制。理论上讲,如果肿瘤能作放射治疗,那么IMRT将对许多肿瘤的治疗都会产生深远的影响,它可以根据肿瘤的形状给予致死剂量的照射,而对肿瘤邻近的正常组织器官接受较低的剂量照射。     

动态适形照射在恶性肿瘤治疗中应用的初步探讨

放射治疗是治疗恶性肿瘤三大主要方法之一。由于受正常组织耐受量的限制 ,肿瘤靶区的剂量难以提高 ,从而影响了放射治疗肿瘤的局控率和治愈率。近年来国外开展适形放疗的新技术治疗恶性肿瘤 ,提高了肿瘤靶区 (ＧＴＶ)剂量 ,减少正常组织受量 ,疗效较满意[4 ,5] ,我院自 1997年 12月～ 1998年 4月开展动态适形照射治疗 6例 ,现将初步体会介绍如下。1　资料与方法1·1　临床资料　见附表附表 6例患者有关临床资料性别 年龄(岁 ) 临床诊断 常规外照射 (ＤＴ)适形补量(ＤＴ)女 61膀胱移行细胞癌探查术后 47Ｇｙ 1 2Ｇｙ/ 4次 / 4ｄ男 50鼻咽癌外…     

头颈部肿瘤精确放疗摆位误差的研究进展

放射治疗以其准确和最大限度减少头面部器官的损伤而成为目前头颈部肿瘤主要和首选的治疗手段,为保证放射治疗疗效,其中最重要的前提是保证每次治疗的摆位重复准确,以保证靶区获得精准剂量,同期相邻周边正常组织和重要敏感器官获得恰当的保护。各种精确放疗技术在头颈部肿瘤的治疗成果愈加彰显了其治疗优势作用,如三维适形放疗(CRT)和调强放疗技术(IMRT)以及图像引导技术下与实时自动校正系统结合的放射治疗(IGRT),体位固定架装置等不断地应用于临床定位、计划设置和最终的治疗,使放射治疗向着增加肿瘤GTV剂量,提高肿瘤局控率,减少周围重要组织受累的几率的目标不断迈进。     

瓦里安Unique直线加速器治疗头旋转故障案例分析及维修三例

医用直线加速器是一种用于肿瘤精确放射治疗的大型医用设备,可通过加速高能X线对肿瘤组织进行有效治疗,达到控制病情的目的[1-2]。Unique直线加速器(美国瓦里安公司)是一款单光子加速器,可实现三维适形调强放射治疗和容积调强放射治疗等,具有锁定肿瘤准确的特点,可最大限度降低周围正常组织的照射剂量。为确保Unique直线加速器的正常运行,仪器管理人员应重视仪器的日常监测与维修。     

三维近距离放射治疗计划系统的研究

近距离放射治疗是临床综合治疗肿瘤的有效组合部分。由于历史的及其自身的复杂性等原因,它的发展滞后于外照射,国内的应用和研究都落后于国外。因此我们开展了地三维近距离治疗计划系统的研究。提出了基于图像的三维近距离治疗计划的研究和实施方案,在ＳＧＩ工作站上建立了计划系统的基本框架和窗口界面,重点研究和实现点源的插植剂量分布的计算、等剂量线的二维和三维显示、体积－剂量直方图对计划的评估等,适用于源或施源器的     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.